The Diagnostic and Statistical Manual of Mental Disorders (DSM), remains a work in progress. The current version, DSM-5 was published in 2013 after over 12 years of debate and careful considerations.
The diagnoses of Personality Disorders (PDs) have always been controversial. In the current DSM-5, no significant changes were made to the PDs, as more research is (and will be for some time) in-progress. To accommodate and validate the research done so far, which has identified shortcomings to the current approach to PDs, the DSM-5 includes an alternative model to PDs in Section III, also known as “the hybrid methodology.”
Personality Disorders are no longer diagnosed on a separate Axis, as was the case in DSM-IV-TR (2000). Apart from that, two major proposed changes are of interest:
- The alternative approach uses a dimensional perspective based on the level of impairment that merges from maladaptive functioning into normalcy (DSM-5, 2013). In order to meet the criteria for a PD, moderate to greater impairment in functioning in two or more areas need to be present. The four areas are identity, self-direction, empathy and intimacy.
- Rather than the 10 different PDs, the alternative approach identifies 6 “distinct” PDs, but it is recognized that the “typical” person meeting the criteria for one PD, often also meets the criteria for at least one other PD. The six PDs are Antisocial PD, Avoidant PD, Borderline PD, Narcissistic PD, Obsessive-Compulsive PD and Schizotypal PD. Pathological traits are found within the following domains: Negative Affectivity (vs. Emotional Stability), Detachment (vs. Extraversion), Antagonism (vs. Agreeableness), Disinhibition (vs. Conscientiousness) and Psychoticism (vs. Lucidity).
PDs are pervasive across personal and social situations. PDs are stable over time and have an onset in adolescence or early adulthood. Impairment in personal functioning (identity, self-direction, empathy and intimacy) is moderate or greater. If it was mild…we could perceive it as “within the normal range”.
I will briefly list three of the six PDs, as these three are IMHO potentially causing the community the most harm.
- Identity: Egocentrism
- Self-direction: Goal setting is based on personal gratification
- Empathy: Lack of concern for the feelings and needs of others, lack of remorse
- Intimacy: Incapacity for mutually intimate relationships
- Manipulativeness: Controlling others with the use of seduction and charm
- Callousness: Lack of concern for other, lack of guilt feelings and remorse
- Deceitfulness: Dishonesty and fraudulence
- Hostility: Angry feelings, vengeful behavior
- Risk taking: Engaging in potentially self-damaging activities
- Irresponsibility: disregard for obligations and commitments (to meet the diagnostic criteria 6 or more of the above traits need to be present)
- Identity: unstable Self-image
- Self-direction: Instability in goals
- Empathy: Compromised
- Intimacy: Intense and unstable
- Emotional Lability
- Separation insecurity
- Risk taking
- Hostility (to meet the diagnostic criteria, 4 or more traits need to be present)
- Identity: Excessive reference to others for self-definition and self-esteem regulation
- Self-direction: Goal setting is based on gaining approval from others
- Empathy: Impaired
- Intimacy: Largely superficial
- Grandiosity: Feelings of entitlement, self-centeredness, feelings of superiority and condescension toward others
- Attention seeking: Seeking Admiration and wanting to be the focus of attention (both pathological personality traits need to be present)
There is some confusion in regard to one statement in the DSM-5. The statement suggests that all those who meet the criteria for NPD have a “vulnerable self-esteem”. This puzzled me as based on the many stories of victims and ex-partners, rather than a vulnerable self-esteem, many seem to have an inflated self-esteem. Some researchers therefore, make a distinction between Vulnerable NP and Grandiose NP. The first cover up their fear for rejection and their anxiety, but they have vulnerabilities and they do not feel so sure about themselves in all situations. They avoid those (and people) where they feel more vulnerable. The other type, grandiose NP, do not suffer from a vulnerable self-esteem at all. To teach these people tools to help them increase their self-esteem is to teach criminals tricks to become better in their profession.
NARCISSM AND INFIDELITY
When the behavior (the affair) is out of character and a one-off, the cheater did not show the traits of someone meeting the criteria for Narcissistic PD (NPD) BEFORE the affair. The cheater does show these traits DURING the affair as affairs thrive on deception, and justification of despicable behavior. A person who does not have NPD and who wants to work on the marriage shows accountability, remorse and emphasizes with their spouse. Those who had a good marriage and know that they ruined it, know also that they have to do the work and they will put in the effort. Just be careful: Although the person who betrayed may not meet the criteria for any PD, a person who betrays is EXTREMELY SELF-CENTERED or SELF-ABSORBED and this needs a lot of work if they really want to have a good marriage.
In cases where the Narcissistic Personality Traits were there BEFORE the affair, the likelihood of recovery and healing is a lot smaller and the chance is there that the cheater will not be faithful in the future. The reason is that those with NPD lack accountability, the ability to feel deep remorse and to emphasize with those they have hurt.
Many, if not all of us use lies (mostly “just” white lies). But not all who use lying have one or more of the three personality disorders listed above. Those who meet those personality disorders, however, all use deception. It is better to be forewarned. When those with many of the traits of the personality disorders listed above, are placed in a position of authority, harm will be done to the community, unless clear boundaries are placed to curb the level of authority. Many companies learn the hard way that they have been deceived.