21 Responses to “Narcissistic Personality Disorder and Histrionic Personality Disorder To Be Eliminated in the DSM-V: Starbuck’s Diagnostics 101”


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  1. Well, we can look on the bright side. If it’s not classified as a “disorder” then maybe evil, abusive women can stop using the crutch of “I can’t help how I treat you. I have a disorder.” Maybe they can start taking responsibility for their behaviors, even if it’s forced. Yeah, right. I know I am dreaming about them stepping up to the plate and saying “I treat people poorly because I have learned that by being a manipulative bully who holds people emotionally hostage I can get what I want.” However, if it’s not a “diagnosis”, then maybe others around them will stop enabling them and excusing their bad habits of abuse.

    • Verbal

      Also, disordered women will no longer be able to use the dismissive, “I don’t have a personality disorder. You’re the one with a personality disorder.”

  2. Anonimos_Non

    Pardon my rambling, but it here goes:

    It is our ability to name things that allows us to make distinctions and gain power over our environment and circumstances — science requires that we have precise ways of communicating. Further, clinicians and legal authorities either should adhere to, be guided by, and insist upon evidence-based practices and standards. To me, consolidation of Personality Disorders in the DSM V is tantamount to Psychiatric “Newspeak” http://en.wikipedia.org/wiki/Newspeak . I agree with you completely that consolidation of Personality Disorders in the DSM V mean that “it will be even more difficult for the average Joe or Jane to figure out what is going on with their loved one/tormenter.”

    My intuition tells me that the “Starbucks” approach to such diagnoses will likely backfire and be detrimental to men caught up in the legal system — especially cases where such men are up against those with High Conflict Personalities. IMHO, rather than consolidate such PD diagnoses, it would be better to document and codify the relationships and potential co-morbidities between apparently separate medical conditions and/or personality disorders. For example, as Dr. Randy Sansone has mentioned in his article, “Fibromyalgia and Borderline Personality: Theoretical Perspectives” In: Focus on Fibromyalgia Research ISBN: 1-60021-266-2 Editor: Albert P. Rockne, pp. 127-141 © 2007 Nova Science Publishers, Inc. :


    If future empirical studies confirm, among a minority of fibromyalgia patients, a
    relationship with BPD (Borderline Personality Disorder), what might the explicit relationship between the two be? To address this question, we might consider several theoretical models.

    Independent Co-Occurrence Model

    This model proposes that fibromyalgia and BPD actually have no genuine relationship to one another. Their association, or comorbid occurrence, in an individual is simply one of random chance. In other words, they independently co-occur.

    Common Causality Model

    This model proposes that both fibromyalgia and BPD share a common etiology (i.e. they are caused by the same phenomena), but have slightly different presentations and disease processes in the same individual. In other words, both originate from the same cause, but develop into somewhat different diseases.

    Spectrum Model

    This model proposes that fibromyalgia and BPD share similar etiologies as well as
    similar courses. Indeed, the two are not really distinct from one another, but are actually versions of the same disease phenomenon—i.e., they both exist as closely related spectrum disorders.

    Predisposition Model

    In this model, one syndrome precedes the other. In doing so, the first heightens the risk of developing the second. In this case, one would suspect that BPD is the forerunner disorder, which then subsequently heightens the risk of developing fibromyalgia.

    Whether any of these relationship models accurately describes the comorbidity of
    fibromyalgia and BPD is unknown. However, the spectrum model is appealing. Regardless, these models provide an interesting panorama of possibilities for future research.”

    We humans begin creating (and destroying) everything around us through our words. I concur with Dr. Gunderson’s assessment that a “careful dresser” can all-too-easily become a “dandy” or “clotheshorse” at the caprice of a clinician, psychiatrist, psychologist or others with an agenda. In their efforts to be precise and accurate, they may end up being more arbitrary and prejudiced. In any case, the changes apparent in the DSM V scare me precisely because of the politics involved, the infighting amongst DSM committee members, the profit motives on the part of insurance and pharmaceutical companies, and the potential for abuse by legal systems that are increasingly biased against men.

  3. Cousin Dave

    I’m inclined to go with Dr. Shedler’s statement: this makes a sort of sense from a research standpoint, where you want to be able to precisely quantify characteristics. But from a clinical standpoint, I can see where it will cause great difficulty in making or understanding a diagnosis. One possible fallout from this is that it will make it much harder to get insurance to pay for treatment for a (formerly) Cluster B personality disorder, since the disorder can’t be tied to a specific syndrome name in the DSM. The ironic consequence is that, for the few NPDs who actually seek treatment for their condition, it will make treatment much harder to get.

  4. dietrich

    Interesting, but it’s important to remember that these ideas and formulations are still in embryo.

    Personally, I think compacting the PD category is a good thing. Certain PDs are rarely, if ever, diagnosed. In 13 years of working in clinical settings, I’ve never seen someone diagnosed as ‘schizotypal’. Dependent, avoidant, and schizoid PDs are also very, very rare.

    It makes sense to cluster them together, as there is significant overlap, but I agree that rating multiple traits is tedious and trivializes the process of diagnosis.

    • moundbuilder

      I believe ‘schizoid’ has been thought to possibly be the same thing as Asperger’s, which is on the autism spectrum. If the two are one in the same that possibly it does make sense to drop that from the list of personality disorders. Since autism spectrum issues are developmental, as I understand it, then it doesn’t seem to consider that a matter of personality disorder, if ‘schizoid’ and Asperger’s are one in the same.

  5. Jazok

    I’ve been thinking about this and am leaning toward it being a good thing. The old categories seemed to insist on placing someone in a bucket. Disorders aren’t a continuum, only aspects of them are.

    I believe EVERYONE has traits which could be classified individually as a disorder. The question is how they add up, overall.

    In the quest to figure out what to do about my marriage, it’s become clear that my wife has several strong straits in the current borderline personality disorder “bucket”, but has no indication in others outside of normal human behavior. One thing that you have to be very careful about is not assuming that because a person shows traits A, C and F, therefore she must have B, D and E and begin seeing what you want to see.

    • Ming_on_Mongo

      Some of the newer research in neuroscience is actually providing evidence of more of a “continuum” approach, due to the phenomenon of common affected areas of the brain. For example, it’s become well-known that all the former “cluster B” disorders share a common absence of empathy. But it’s also been discovered that this capacity for empathy is located in a specific portion of the brain, the pre-frontal cortex. What’s more, the frontal brains of Psychopaths, the most serious of the cluster B’s, have been found to match those of people suffering frontal brain damage. “Continuum” indeed!

      But if we’re going to reduce the number of “buckets” for adding “characteristics” to, then it would seem that at least one basic and essential bucket should be Narcissism, which is already well recognized, and is often used as a starting point for so many other “co-morbidities” (BPD, ADD, OCD, Depression, etc.).

      Although how “convenient” at a time of increasing encroachment by “science”, that this new psychiatric paradigm, will now more than ever require an individualized, “private” opinion, albeit one more resistant to “outsiders” second-guessing the DSM!

  6. Dave M.

    I dated a single mom in 2000. She had a difficult situation with her ex and had to take a psychological evaluation. 2 weeks later she called and said “they said I have a Narcissistic Personality Disorder.” She went on to say that, it says I have this trait and that trait naming off 4-5 different traits. It was like a light going off over my head, as she was all those things. My daughter’s mom is a Borderline Personality Disorder and I know 2 Histrionic Personality Disorders. To eliminate these is an injustice to people who gain insight and knowledge of people we run across and are involved with in our everyday lives.
    They are making a big mistake in the DSM-V as far as I’m concerned.

  7. TheGirlInside

    I tend to think it’s a good thing.

    From this site and other reading (not to mention personal experience), I see the dirorders as ‘degrees of psychosis.’

    Meaning, Histrionic may be the mildest, moving on to
    Borderline, then even worse / more destructive
    Narcissistic Personality Disorder*
    then the most dangerous: Antisocial / sociopath

    Like different articles of clothing, sewn using varying patterns, yet all cut from the same cloth.

    Also, I think it’s good that they will be able to ‘make a salad’ of different tendencies…from my limited education of psychology, I understand people are often diagnosed with Mental Illness X with Y and Z tendencies.

    On a personal note, I believe most of the above mentioned personalities are simply different ‘recipes’ of a**hole. Just as there’s about a billion different ways to make equally delicious chocolate chip cookies…there’s about that many different ways of being an A #1 A-hole.

    *One thing that bugs me about the ‘official’ symptoms / diagnostic critera for NPD, is that they define how a narcissistic thinks (per the DSM-IV):

    1. a grandiose sense of self-importance
    2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
    3. believes that he or she is “special” and can only be understood by, or should associate with, other special or high-status people (or institutions)
    4. requires excessive admiration
    5. has a sense of entitlement, ie unreasonable expectations of especially favourable treatment or automatic compliance with his or her expectations
    6. is interpersonally exploitative, ie takes advantage of others to achieve his or her own ends
    7. lacks empathy and is unwilling to recognize or identify with the feelings and needs of others
    8. is often envious of others or believes that others are envious of him or her
    9. shows arrogant, haughty behaviours or attitudes

    in order to truly diagnose a narcissist by those criteria, you have to know what they are truly thinking…and there’s no way for anyone else to know that. Annoying.
    Dr. Tara, thankfully, cuts through the psychology-speak to give us real-life applicable defining characteristics.

    • Ming_on_Mongo

      Having been married to an NPD/BPD (clinically diagnosed), seems to me that all those symptomatic ways of “thinking” do manifest as pretty specific (and not so pleasant) “behaviors”! And as I’m sure anyone who’s had any significant experience with them can attest, after awhile you acquire pretty good “antennae” for picking up on all the “cues”.

      Among the ones I find easiest to notice is the “entitlement”, where they very quickly indicate some way in which the typical “rules” or common courtesies don’t apply to them somehow, due to some special “circumstance” or “condition”. Also the well-known absence of empathy, and I think also a lack of humor, are others, although you have to be able to have a little more experience around them to detect that.

      But if you suspect it, one easy way I’ve found is to simply bring up the general subject of narcissism (social, clinical or otherwise) and observe what happens. An “N’s” strong need for “control” will soon surface, along with their hyper-sensitivity to any perceived criticism (because it’s always all about ‘Me”… even when it isn’t)! So they’ll often be the folks who seem curiously “uncomfortable” or “annoyed” with the whole subject, which they’ll quickly try to control via “re-framing” the discussion, usually thru some haughty and dismissive explanation, or else with what’s basically just a solipsistic argument (“it must be so, because I think it is)! ;-p

  8. Jdog

    If you have been a victim of a narcissist or psychopath (or borderline), you probably will react differently to this decision than someone who has an academic interest.

    Unfortunately, the word “evil” tends to spring to mind with NPD, ASPD, and BPD.

    The distinction I’ve always thought helpful is those narcissists/psychopaths who go to prison and those who don’t (the socialized vs non-socialized) – now they are all being lumped together more closely. The “white-collar” types are far more dangerous; we meet them in the office and marry them and they do so much to destroy others.

    It is extremely frustrating to see “narcissism” popularized in a non-clinical way and see in the popular press how we live in a narcissist culture, when someone with a true disorder does untold damage in their relationships and communities. For that reason alone, a single “narcissistic personality disorder” is extremely useful. The better we can distinguish behaviors, they better they can be recognized and dealt with. Collapsing them seems to be a way of running from the clinical realities of these disorders.

  9. Tom

    How Psychiatry Went Crazy
    The “bible” of psychiatric diagnosis shapes—and deforms—both treatment and policy.
    May 17, 2013 3:27 p.m. ET

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