Disturbing the Disturbed: Breaking All the Rules

Hey again – you may remember me: Nixie, that chick who was doing a series about mental illnesses called Disturbing the Disturbed?
Well, I’ve actually gotten myself into gear to work on the post! [cue gasps of shock]

As a note, for this post I looked exclusively at medical sites and Wikipedia (and checking Wikipedia’s references >_>) rather than other blogs and such. This is because I wanted to avoid the blunt force trauma that my skull would be subject to from slamming it into the desk repeatedly. The fact that looking up “psychopath” kept leading me back to a lot of sites on narcissism also played a part... but it was mainly the blunt force trauma.

This week, we cover Antisocial Personality Disorder, Sociopathy, and Psychopathy and the differences between them. Firstly, as you can see psychopathy is its own illness – being mentally ill, insane, or disturbing is not the sole criteria to be a psychopath. Let’s get to it, shall we?

FIRST: antisocial does not mean "doesn't like socializing". That is asocial. Antisocial is what goes against society's norms. Just had to say that.

Antisocial Personality Disorder (ASPD) is defined by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) as a personality disorder characterized by "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood".

While Sociopathy and Psychopathy are subtypes of ASPD, under the DSM and ICD they are used as synonyms. The specifics will be covered later.

The symptoms of ASPD are not so clean-cut as the symptoms of other mental illnesses as there are a variety of things that could be considered symptoms. So I shall list the diagnosis under the DSM-IV and the World Health Organization’s ICD.

Under the DSM-IV

• A) There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three or more of the following:
1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;
2. deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;
3. impulsiveness or failure to plan ahead;
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults;
5. reckless disregard for safety of self or others;
6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations;
7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another;
• B) The individual is at least age 18 years.
• C) There is evidence of conduct disorder with onset before age 16 years.
• D) The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or a manic episode. 

Note the explicit exclusion under section D – this is to cater for other disorders that on occasion have aspects of ASPD. As we know from my post on Bipolar Disorder, sufferers become reckless during a manic episode and may experiment with drugs and other socially deviant behaviour. I will cover schizophrenia in a later post.

Since evidence has indicated ASPD can be developed in children due to environmental as well as genetic factors, the limit on age has been included here. However, it has been found that those diagnosed with ASPD as adults were often diagnosed with conduct disorder as children.

According to these criteria, ASPD have a prevalence of 3% in males and 1% in females.

Under ICD-10 (where it is classified under the similar Dissocial Personality Disorder)

It is characterized by at least 3 of the following:

1. Callous unconcern for the feelings of others
2. Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations.
3. Incapacity to maintain enduring relationships, though having no difficulty in establishing them
4. Very low tolerance to frustration and a low threshold for discharge of aggression, including violence.
5. Incapacity to experience guilt or to profit from experience, particularly punishment.
6. Markedly prone to blame others or to offer plausible rationalizations for the behavior that has brought the person into conflict with society

There may be persistent irritability as an associated feature.
The diagnosis includes what may be referred to as amoral, antisocial, asocial, psychopathic, and sociopathic personality (disorder).
The criteria specifically rule out conduct disorders. Dissocial personality disorder criteria differ from those for antisocial and sociopathic personality disorders.
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Now, since the World Health Organization decided to lump in ASPD with DPD but also specifically rule out some aspects of it, I’d advise that if you have need of this information (maybe for a book – since that is the only reason I’d sanction lest you’re a psychiatrist in which case you already knew this) to stick to the DSM-IV.

Millon also gives us five subtypes of ASPD:

• covetous antisocial – variant of the pure pattern where individuals feel that life has not given them their due.
• reputation-defending antisocial – including narcissistic features
• risk-taking antisocial – including histrionic features
• nomadic antisocial – including schizoid, avoidant features
• malevolent antisocial – including sadistic, paranoid features.

I will point out that the features of the “nomadic antisocial” are mostly benign – so, once again, no need to vilify.

Correlations and Causes

The fact is that a lot of other disorders are capable of coexisting with this one, and quite commonly do so: Anxiety disorders, Depressive disorder, Substance-related disorders, Somatization disorder, Borderline personality disorder, Histrionic personality disorder, and Narcissistic personality disorder. If alcohol is involved then there will be more frontal function deficits on neuropsychological tests (brain tests) that are greater than those associated with each involved condition.

Now, what’s interesting about ASPD is that there have been some correlations found with hormone levels. The roots of ASPD are said to be in genetics but are triggered by environmental factors, such as family relations. Traumatic events can lead to the disruption of the development of the central nervous system, thus changing what hormones are released when/where and changing the normal developmental patterns. A big player here is serotonin. In terms of function, serotonin is a mood moderator – tries to help against mood-swings and the like. Lower serotonin levels lead to higher levels of aggression and more instances of impulsiveness – two symptoms of ASPD.


Statistics
How common is ASPD? Well, apart from the aforemention DSM-IV related statistics, I have found a couple of contradictions on different sites in regards to prison populations. According to Wikipedia, a 2002 study found that ASPD was found in 47% of male prisoners and 21% of female prisoners. There is also a higher concentration than the norm within alcohol/drug treatment programs (Hare 1983).
However, according to Medicine.net, Wikipedia's Hare's Psychopathy Checklist page, and Internet Mental Health 50-80% of incarcerated individuals suffered from ASPD.

Either way, it is important to note that these statistics is about how many criminals have ASPD and not how many APD sufferers are criminals. After all, “disregard of lawful behaviours” is only one possible symptom of ASPD and with a minimal requirement of three of the listed symptoms it is more than likely that most ASPD sufferers do not present this symptom.
References for ASPD (I have just decided to list them in bulk because they overlap so much): the US National Library of Medicine, Medicine.net, PsychCentral, Internet Mental Health (which, despite the name and appearance, is pretty good provided you can navigate it - the search function is less than refined), and the Mayo Clinic (very good link, puts everything in layman's terms).


Now for Psychopathy... oh boy.

While Psychopathy was not used as an official term is refers to a personality disorder characterized by “an abnormal lack of empathy combine with strongly amoral conduct but masked by an ability to appear outwardly normal”. Note the use of the word “amoral” rather than “immoral” – while “immoral” means morally wrong, “amoral” is unconfined by the convention. They aren’t always doing things that are wrong or right – they just do the things that they want to do regardless of whether it’s considered one or the other.

(Think old fashioned Fair Folk – like the Seelie or Unseelie… mainly the Seelie.)

However, there is a bit of a problem - no-one has agreed on a set criteria for what a psychopath is. Silly, isn't it?


While I usually don't cover the statistics until later, it's one of the things that are agreed on so it seems fitting that I should open with them. While about 80% of incarcerated criminals were diagnosed with ASPD, only 11-20% of these were found to be psychopaths. Also, a study was recently conducted that found that 1 in 25 of today's business leaders could fit the criteria for psychopathy.

(Side note: psychopathy used to be the term used for any mental illness and was derived from the Greek words “psyche” (mind) and “pathos” (suffering) – suffering mind.)

The first fact is that psychopathy is a personality disorder characterized by a pervasive pattern of disregard/violation of the rights of others. Also included are a total lack of empathy and remorse, and being regarded as selfish, insensitive, dishonest, arrogant, aggressive, impulsive, irresponsible, and hedonistic.

As is expected of the subject, Wikipedia’s entry has a “check for neutrality” tag. So I will cover what is discussed in the Hare’s Checklist as it’s backed up by the medical journals. Now, there are a number of proposed assessments for psychopathy, but here I will only cover the Hare Psychopathy Checklist as it’s the most commonly used and relates it back to ASPD. Other tests include the Psychopathic Personality Inventory (PPI), and the Cleckley Checlist (Mask of Sanity – symptoms of those he deemed psychopaths)

(It is important to note that neither the World Health Organization or the American Psychiatric Association have given this mental illness formal recognition in their International Classification of Diseases (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).)
The most commonly used “psycho-diagnostic tool” used to assess pychopathy is Robert D. Hare's Psychopathy Checklist, Revised (PCL-R). It was originally a test based on two factors:

Factor 1: Personality “Aggressive narcissism:

• Glibness/superficial charm
• Grandiose sense of self-worth
• Pathological lying
• Cunning/manipulative
• Lack of remorse or guilt
• Shallow affect (genuine emotion is short-lived and egocentric)
• Callousness; lack of empathy
• Failure to accept responsibility for own actions

Factor 2: Case History “Socially deviant lifestyle”

• Need for stimulation/proneness to boredom
• Parasitic lifestyle
• Poor behavioural control
• Lack of realistic long-term goals
• Impulsivity
• Irresponsibility
• Juvenile delinquency
• Early behavior problems
• Revocation of conditional release

The two separate factors are supposed to aim at identifying the “affective deficits” and ASPD symptoms respectively. (the first factor also correlates with Narcissistic Personality Disorder)

It makes a point of saying that promiscuous sexual behaviour, multiple short-term marital relationships, criminal versatility, and “acquired behavioural sociopathy/sociological conditioning (Item 21: a newly identified trait i.e. a person relying on sociological strategies and tricks to deceive)” are correlated with either factor.

However, further studies have been editing and making suggestions about the criteria. For instance Cooke and Michie have indicated 3 factors, where the items for factor two that strictly relate to ASPD are removed from the final model, with the remaining factors being divided into “Arrogant and Deceitful Interpersonal Style”, “Deficient Affective Experience” and “Impulsive and Irresponsible Behavioural Style”. It should be noted that this particular model has multiple problems with it statistically speaking so it’s best to ignore it in favour of the most recent edition of the PCLR-R, where Hare adds a 4^th factor, consisting of those Factor 2 items excluded from the previous model. (The factors now examine the “Interpersonal”, “Affective”, “Lifestyle”, and overt “Antisocial features” of the personality disorder.)

Factors 1a and 1b are correlated with Narcissistic and Histrionic Personality Disorders, while 2a and 2b correlate with ASPD and criminality. However, to summarize, the criteria only highlight "What is missing, in other words, are the very qualities that allow a human being to live in social harmony".

Other facts of note are the only the minority of those diagnosed as psychopaths in institutions are violent offenders, and that while psychopaths are careless towards other people, they are also careless towards themselves. Also, psychopathy can coincide with anxiety disorders so “lack of nerves” isn’t a must-have-symptom.

Causes and precursors

Childhood precursors to psychopathy include a conduct disorder of some sort, or possibly Oppositional Defiant Disorder. (while the likelihood of a child with such a disorder becoming a psychopath is higher than the general population it must be stressed that the great majority do not become psychopaths as adults – or turn out to be disordered at all)

So far the most well-known test is known as the Macdonald triad: bedwetting (after the age of 12), cruelty to animals and firestarting. However, statistical analysis has proven the bedwetting to not be a significant factor. The other two factors, however, are still considered significant (as stated in my Classified Killers post).

Genetics also plays a role in what may bring about psychopathy, with studies finding that the “callous-unemotional traits” were strongly linked to genetics and were not influenced by the environment. This is also the belief of Robert Hare (of Hare’s Checklist) as expressed in his book "Without Conscience: The Disturbing World of Psychopaths Among Us" where he also expresses concern over the fact that the children of the psychopaths will be genetically predisposed to the disorder.
There are also hormonal links: psychopathy was also associated in two studies with an increased ratio of HVA (a dopamine metabolite) to 5-HIAA (a serotonin metabolite). Studies have indicated that individuals with the traits meeting criteria for psychopathy show a greater dopamine response to potential 'rewards' such as monetary promises or taking drugs such as amphetamines. This has been theoretically linked to an increased impulsivity. I explained the effects of dopamine in Mad Love.

A 2010 British study found that high prenatal estrogen exposure, was a "positive correlate of psychopathy in females, and a positive correlate of callous affect (psychopathy sub-scale) in males". This makes sense, especially when combined with the facts in my Battle of the Sex Hormones post... which makes even more sense when combined with the theory that high levels of testosterone with low levels of cortiso contribute since testosterone is "associated with approach-related behavior, reward sensitivity, and fear reduction" and cortisol increases "the state of fear, sensitivity to punishment, and withdrawal behavior". However, while some studies support the cortisol theory, the testosterone one has not been tested yet.
I would suggest checking out the neuroscience area since that isn't a subject I am particularly adept in (or researched very much, or have people to consult with about it) so I don't want to misexplain something.


Finally, in an interesting side-note, psychopathy can be a side-effect of other diseases. For instance, Wilson’s Disease (the body’s inability to process copper) results in a mental illness – one such illness it can result in is psychopathy.

References for Psychopathy: Medicine.net, Psychopathy, Hare's checklist, two articles in Scientific American, and  significant overlap with the references for ASPD (since it is considered a subtype).



The term Sociopath tends to be used interchangeably with both ASPD and Psychopathy - it doesn't even get it's own page on most sites. It is claimed by David T. Lykken, a claim that seems to be supported by most sites, that the only difference between Psychopathy and Sociopathy is that the psychopath is born with the temperment that lead to their behaviour, while the sociopath was born with a rather normal temperment and are more a product of their environment. Basically, it comes down to nature verses nurture - the psychopath being when nature wins out over nurture and the sociopath being when nurture wins out over nature. (some places refer to Primary and Secondary Psychopathy, which fit the Psychopathy and Sociopathy I have covered respectively)
Information gathered on Sociopaths were from the same sites as ASPD and Psychopathy.




Now, while the series isn't over yet I won't be posting it consistently and will have other posts in between. This is a combination of (a) busy life, and (b) the larger amount of research to cover the disorders I plan on covering. To make for easier reading, I have added the tag "Disturbing the Disturbed" to all posts on the series.


I'd like to thank those who have been reading so far. :) Hope you've learnt something.

Disturbing the Disturbed: Reflections on Narcissism

Greetings! I will first apologize for how late this post is – things happened. But that aside, this week we talk about Narcissism in its three main forms: narcissism, narcissistic personality disorder, and malignant narcissism. I will warn you now that this post will be very, very long.

Firstly, narcissism is not Histrionic Personality Disorder. The laconic version is that Histrionics desire attention, while Narcissists desire admiration. Histrionics are characterized by excessive emotionality and attention-seeking, including a need for approval and inappropriately provocative behaviour, typically beginning in early adulthood. Other possible qualities include being easily influenced, over-dramatization of difficulties, egocentric, self-indulgent, in possession of good social skills, yet a tendency to be manipulative.

OK, before we decide that most teenagers suffer from HPD there are other symptoms that distinguish it. They tend to view their relationships as a sort of do-or-die deal, with many seeking counselling for depression when they end. They may go through multiple jobs due to becoming easily bored and having problems dealing with frustration. They are also thrill seekers and hence can end up in risky situations simply for the novelty.
The interesting thing about HPD is that its combination of symptoms actually put sufferers at greater risk of developing depression.

A useful way to remember the main traits of Histrionic Personality disorder is the mnemonic PRAISE ME. Both the Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR and The World Health Organization's ICD-10 lists reflect some combination of these symptoms.

• P - provocative (or seductive) behavior
• R - relationships, considered more intimate than they are
• A - attention, must be at center of
• I - influenced easily
• S - speech (style) - wants to impress, lacks detail
• E - emotional lability, shallowness
• M - make-up - physical appearance used to draw attention to self
• E - exaggerated emotions – theatrical

Others not covered above include, exhibitionist behaviour, constant seeking of approval/reassurance, extreme sensitivity to criticism, low tolerance for frustration or delayed gratification, rapid shifts in emotional state to the point of appearing superficial, rashness in decision making, extreme resistance to all change, and having Somatic symptoms and using these symptoms as a means of garnering attention.

HPD is more often found in women as men with similar symptoms tend to be diagnosed with narcissist personality disorder. The cause of HPD is unknown but the trigger events include things like deaths in the family, divorce, illnesses in the family which provoke constant anxiety, and perhaps genetics.

Millon also has subtypes for HPD – these are:

• Theatrical histrionic - especially dramatic, romantic and attention seeking.
• Infantile histrionic - including borderline features.
• Vivacious histrionic - synthesizes the seductiveness of the histrionic with the energy level typical of hypomania.
• Appeasing histrionic - including dependent and compulsive features.
• Tempestuous histrionic - including negativistic (passive-aggressive) features.
• Disingenuous histrionic - antisocial features.

Note that we do not see anything that features Narcissistic Personality Disorder – this is because histrionic has symptoms similar to NPD but also piles on some more while detracting from others: you’ll see that later that the inverse is not true.

Now that that’s over we can start on Narcissism. So, what is narcissism? Let me ask you a riddle: “without it you will crawl, with it you will stand tall, too much and you will fall” – what is it?
The answer is pride and this is where we meet narcissism in its “garden variety” form – a personality trait, rather than a personality disorder. And just like any other personality trait, moderation is the key.
“Healthy” narcissism is the thing that gives you self-confidence – a highly valuable trait on leaders according to management theory. “Destructive” narcissism is when that confidence goes overboard. Self confidence is good – believing others inferior is not. Enjoying power is ok – pursuing it at all costs is not.
Basically, moderation is the key difference between healthy and destructive narcissism

Now, just because a person is narcissistic, it doesn’t mean they suffer narcissistic personality disorder – people are perfectly capable of being arrogant without having to blame it on a mental disorder.

Narcissistic personality disorder

Now, pathological narcissism can be put into a spectrum based on severity. The most extreme form is NPD. While usually I don’t go into the theories of causation, mainly because they hand-wave it as genetic or something, here I will discuss a few suspected causes.

Theories:

A sufferer of NPD believes that they are flawed in a way that makes them unacceptable to others. This belief is so deep in their conscious that they don’t even know they think it. So, to protect themselves from this belief and the horrible rejection it would entail, they try to control how others view them. Hence why they rage when people criticize them, and desire people to fear/admire them. This sort of thing, coupled with an inability to tolerate setbacks, makes them hard to work within a team environment.

A 1994 study by Gabbard and Twemlow reports that histories of incest, especially mother-son incest, are associated with NPD in some male patients.

The cause for NPD is still unknown but there are a lot of theories about it. I shall list some of them as these were observed in patients by many researchers according to Groopman and Cooper.

• An oversensitive temperament at birth is the main symptomatic chronic form
• Being praised for perceived exceptional looks or abilities by adults
• Excessive admiration that is never balanced with realistic feedback
• Excessive praise for good behaviors or excessive criticism for poor behaviors in childhood
• Overindulgence and overvaluation by parents
• Severe emotional abuse in childhood
• Unpredictable or unreliable caregiving from parents
• Valued by parents as a means to regulate their own self-esteem

In this list you can see that they could fall under two categories for the most part, in a way that links to the theories of psychiatrist Glen Babbard. He believes that NPD can be broken down into two subtypes: “Oblivious” and “hypervigilant”.
The “oblivious” are grandious, arrogant, and thick-skinned –which could be the result of overindulging parents– and wish to be admired and envied in order to protect the weaker internalized self. The “hypervigilant” is very sensitive to criticism, easily hurt, and ashamed and consequentially views devaluation as unjust – a possible consequence of overcritical or neglectful parents.

This is further backed by the psychological concept of “splitting”. This is the idea that NPD sufferers use splitting as a defence mechanism. To quote the psychoanalyst Kernberg:

“the normal tension between actual self on the one hand, and ideal self and ideal object on the other, is eliminated by the building up of an inflated self concept within which the actual self and the ideal self and ideal object are confused. At the same time, the remnants of the unacceptable images are repressed and projected onto external objects, which are devalued.”

Basically NPD sufferers merge the idea of their inflated self and their actual self, and other people are either an extension of the sufferer’s self (the givers of admiration) or are worthless (those who disagree with the NPD sufferer’s inflated view).

But enough of the theory, let’s see the symptoms!

Symptoms

The main thing about a narcissist is that they are preoccupied with issues of personal adequacy, power, prestige, and vanity. So, their symptoms tend to include the following:

• Reacts to criticism with anger, shame, or humiliation
• May take advantage of others to reach his or her own goal
• Tends to exaggerate their own importance, achievements, and talents
•  Imagines unrealistic fantasies of success, beauty, power, intelligence, or romance
• Requires constant attention and positive reinforcement from others
• Easily becomes jealous
• Lacks empathy and disregards the feelings of others
• Obsessed with oneself
• Mainly pursues selfish goals
• Trouble keeping healthy relationships
• Is easily hurt and rejected
• Sets unreal goals
• Wants "the best" of everything
• Appears as tough-minded or unemotional

It can be easily seen how these symptoms can be similar to the traits of people who have a high-self esteem, confident or even arrogant, but the fact is that the underlying psychological structures of why they react this way is considered pathological.
While a narcissist believes that they “are all that” they are very susceptible to criticism and actually have a fragile self-esteem and will lash out by belittling in order to back up their own self-worth. In layman’s terms, the expression “Blowing out another’s candle won’t make yours glow any brighter” has little bearing here. This is the defining trait of sufferers of NPD – the need to back up their own idea of their self-worth with reasons why others aren’t as worthy.

(Author’s note: So basically, the minds of NPD sufferers are so broken that they don’t even know or aren’t capable of accepting the idea that they’re broken.)

While usually I reference the World Health Organization’s ICD-10 lists for clarification of the symptoms, they only have NPD listed under “other specific personality disorders”. So, this time I will reference symptoms from the Diagnostic and Statistical Manual of Mental Disorders. Note that it has to satisfy this criteria as well as the list of general personality disorder criteria (which has been retroactively added to my original Disturbing the Disturbed post).
Firstly, the individual must have a pattern of grandiosity (in fantasy or behaviour) everywhere, a need for admiration, and a lack of empathy. These symptoms begin in early adulthood and are present in a variety of areas. They must also have five or more of the following symptoms:

1. A grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
2. Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
4. Requires excessive admiration
5. Sense of entitlement, i.e., unreasonable expectations of especially favourable treatment or automatic compliance with their expectations
6. Interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
7. Lacks empathy: is unwilling/unable to recognize or identify with the feelings and needs of others
8. Often envious of others or believes others are envious of him or her
9. Arrogant, haughty behaviors or attitudes

Millon also has subtypes for NPD, these being:
• Unprincipled narcissist – including antisocial features. Iis a fraudulent, exploitative, deceptive and unscrupulous.
• Amorous narcissist – including histrionic features. Is erotic, exhibitionist, acts like a Casanova.
• Compensatory narcissist – including negativistic (passive-aggressive), avoidant features.
• Elitist narcissist – variant of pure pattern.
• Fanatic narcissist – including paranoid features. Self-esteem was severely arrested during childhood, usually displays major paranoid tendencies, and holds on to an illusion of omnipotence. They are fighting delusions of insignificance and lost value, and trying to re-establish their self-esteem through grandiose fantasies and self-reinforcement. When unable to gain recognition or support from others, they take on the role of a heroic or worshipped person with a grandiose mission.
There are actually lots of theories as to subtypes of narcissist. Alexander Lowen has some too, but I like to stick to Millon as they show how the disorders can relate to each other. As you can see the histrionic adds a more sexual side to the narcissist’s pride.

NPD occurs in less than 1% of the general population and is seen more frequently in males than females. Narcissistic traits are very common in adolescents, however, most adolescents grow out of this behaviour – those who don’t, if the behaviour intensifies, become diagnosed with NPD. It’s common for successful people to become narcissistic but this doesn’t mean they suffer from NPD: only when the behaviour is “distressing or disabling” does it become grounds for seeking a diagnosis.

Malignant narcissism

As for this section, there are a few problems. The first problem is that most psychologists have not actually recognized this as a term. The second problem is those who do recognize it can’t seem to decide whether it’s psychopathy, another name for NPD, or a disorder all on its own. As a friend noticed, the term “malignant narcissist” is rather emotionally loaded, so I’m inclined to believe that someone decided to get fancy with their dislike of NPD by using a word that sounds really nasty that they can fall back on the secondary meaning of “likely to spread” when they get accused of bias.
Therefore, I am forced to skip this disorder at least until somebody gives me an official health site that has it. This annoys me on many levels and I apologize for being unable to find more information on it.

Author's Notes:

Now for miscellaneous information I found while searching the net. Or, more appropriately, misinformation. I won’t go into specifics but some sites have claimed things like the “common expressions of a narcissist”, which is logically flawed. Things like “I had them eating out of my hands” were taken as a subconscious expression of their belief that manipulating people is the best way to get things. For starters, you don’t have to be a narcissist to be good at or enjoy manipulating others. Secondly, if we’re going to take that expression as such a serious thing then a lot of kids should start calling the cops when their parents say “I brought you into this world, I can take you out of it” because clearly they wish to murder them.
I will admit that turns of phrase can help reveal what a person is actually thinking, basing an entire diagnosis on whether someone calls you a control freak is beyond ridiculous. Also it kind of strikes me as a cop out for those who are actually control freaks (or other insult) to just say that the person who says them is a narcissist.
Think about it, when you insult someone are you insulting them to prop yourself up, because the insult actually applies, or because you’re angry and words are just flying? Are you so willing to assume the first, even though so many of us are just doing the second two options?

For the sake of full disclosure, I have not included every piece of information I have read. Mainly because they either disagreed with the medical documents, were stand-alone (or crackpot) theories, or were written as though they were describing a supervillain. The last one especially... just because someone is an abuser it doesn’t make them mentally ill, and just because someone is mentally ill it doesn’t mean they are an abuser. A lot of sites tend to be dedicated to supporting the victims of “bad” NPD’s and spend a lot of words vilifying the NPD. I’m not blaming the victim, but I don’t think the solution is to create a concentrated ball of hate against the entire demographic that the abuser just happens to fall under. Also, there tends to be the implication that all abusers can be classified as psychopaths, sociopaths, or narcissists – I will dedicated a later post to statistics proving this implication wrong. Statistics are fun like that.
After all, we know from last week’s post that “sane” people are just as capable of being indifferent to suffering.

Now, obviously I can’t stop you from reading this and then deciding that “OMG I know an undiagnosed narcissist!” but hey I’m going to try. Are you a psychiatrist/psychologist? If you answered yes then you already knew all this. However, if you answered no then you do not have the technical know-how to do this.
So if you think that someone is up themselves then just stop there – that’s all they have to be. Don’t go off and decide that clearly they need to be insane too.

 

I will not be doing a Disturbing the Disturbed post (at least not one of the usual structure) next week as I have a major assignment to get done as well a cosplay costume to sew. Depending on the assignment I may not be able to post until the week after that. However, rest assured we will be continuing with (Spoilers sweetie!) Antisocial Personality Disorder and Psychopathy.

See you in a week or two!

Disturbing the Disturbed: Swing A Little More!

Now for the second instalment of Disturbing the Disturbed... a title I am now less than thrilled with. Ah, well what’s done is done. I will mention that in these posts I will dwell on symptoms, percentages, demographics, definitions, and occasionally causation rather than treatments and that sort of thing – I’m more interested in clarifying things.

A scene that is all too common in fiction, and real life I’ve noticed, is when some character’s mood changes multiple times in a short period. Either and argument will ensue or the mood-swinger will leave the room, but either way the aftermath will contain a line like “What are they? Bipolar?”
This is incorrect. The first disorder we shall discuss today is Bipolar disorder which, rather surprisingly I must admit, has very many aspects to it. After that we will discuss the true identity of this mysterious mood-swinging illness which has so maligned BD.

Bipolar (Affective) Disorder
This disorder is formally known as manic-depressive disorder which, in my opinion, gives a better indication as to what is actually going on.

Firstly bipolar is a mood disorder that is defined by the present of one or more episodes of mania (elated energy/cognition/mood) with/without one of more depressive episodes. Just so you know what I’m going on about, I will list the definitions of those the different episodes.

Depressive Episode: Persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems concentrating; loneliness, self-loathing, apathy or indifference; depersonalization; loss of interest in sexual activity; shyness or social anxiety; irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal ideation.
In the more severe cases, psychosis may occur with the sufferer experiencing unpleasant delusions and (less commonly) hallucinations. The episode will persist for at least 2 weeks and may exceed 6 months if untreated.

Manic Episode: This is the “signature characteristic” of BD and it’s severity dictates how the disorder is classified. Generally, mania is a distinct period of elevated mood, sometimes euphoria. Other symptoms include increased energy, decreased need for sleep (as little as 3 or 4 hours a night or even a few days without sleeping), pressured speech (talking fast and frenzied), racing thoughts (random thoughts and memories moving quickly), low attention span, and being easily distracted. In this state the sufferer’s judgement may be impaired such that they may indulge in behaviour that is abnormal for them (e.g. spending sprees) and some may go as far as substance abuse particularly alcohol (depressants), cocaine (stimulants), and sleeping pills. Behaviour can get aggressive, intolerant, or intrusive and the sufferer may feel out of control, unstoppable or like they are on a special mission or some such grandiose delusion. In related news they may experience an increased sex drive. Manic episodes can vary from person to person and where some may experience severe anxiety and irritability to the point of rage, others are grandiose and euphoric.
In the case of Bipolar I (discussed soon) the sufferer may experience psychosis or a break from reality – basically where their thinking is affected along with their mood.

For such things to be called mania they must last for at least one week, unless hospitalization is required. There are various scales used to measure the severity of a manic episode, including the self-reported Altman Self-Rating Mania Scale and clinician-based Young Mania Rating Scale.


Hypomanic Episode: Basically a mild/moderate version of mania, mainly characterized by optimism, pressured speech and activity, and decreased need for sleep. Unlike those inflicted by typical mania, many of those inflicted by hypomania will actually be more productive since they get all the energy associated with mania but none of the shortened attention span. Of course, they can also suffer some of the other symptoms such as increased creativity, poor judgement, irritability, and hypersexuality. However, they will not get the delusions or hallucinations.
While this actually sounds rather neat (I mean the more energy and inspiration deal – not the bipolar disorder that’s attached) hypomania is harder to diagnose since it just looks like happiness despite carrying the same risks as mania (the impaired judgement and possible substance abuse). Often those who experience hypomania will deny it since it actually feels good – if they can remember what they did as sometimes one cannot remember what happens while in hypomania.
It is stressed that hypomania is not a bad thing on its own – in fact, when it’s not irritable, it’s typically called hyperthymia or happiness. It’s when it’s accompanied by depressive episodes or when the mood changes are uncontrollable and mercurial (also known as volatile but mercurial is such a pretty word) that the problem.

“Indeed, the most elementary definition of bipolar disorder is an often "violent" or "jarring" state of essentially uncontrollable oscillation between hyperthymia and dysthymia.”

Hypomania can last from a few days to a few years – more commonly in the weeks to months category though.

Mixed Affective Episode: This is where symptoms of both mania and clinical depression occur at the same time – so, exactly what it says on the tin. This state presents itself as a combination of the two symptoms – like tearfulness during a manic episode, or racing thoughts during a depressive one. This can frustrate the sufferer as in this state they can feel like crap but have a “flight of ideas” (basically ideas going through your head so fast that you can’t keep track).
This is a very dangerous state as complications such as substance abuse, panic disorder and suicide attempts increase greatly.

Now, usually when a person meets the criteria for BD it is because they experience a number of episodes, averaging 0.4 to 0/7 a year (lasting 3 to six months). However, there is rapid cycling which is defined as having 4 or more episodes a year and is found in a significant portion of BD sufferers. Ultra-rapid (days) and ultra-ultra rapid or ultradian (within a day) cycling have also been described. Rapid cycling can happen in any of the Bipolar subtypes, which I will now discuss.

There are quite a few types of BD (not as many as schizophrenia but we’ll get to that at a later date). The DSM-IV-TR and ICD-10, conceptualize bipolar disorder as a spectrum of disorders occurring on a continuum. Here are the main ones.
Bipolar I disorder
One or more manic episodes. Subcategories specify whether there has been more than one episode, and the type of the most recent episode. A depressive or hypomanic episode is not required for diagnosis, but it frequently occurs.
Bipolar II disorder
No manic episodes, but one or more hypomanic episodes and one or more major depressive episode. A bipolar II diagnosis is not a guarantee that they will not mania in the future. As discussed in the hypomania section, it is difficult to identify hypomania and this bipolar II is also difficult to diagnose for those reasons as well as it being reported less frequently than a “distressing, crippling depression”.
Cyclothymia
A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes. The “low-grade” cycling of mood can be confused for a personality trait and interferes with functioning.
Bipolar Disorder NOS (Not Otherwise Specified)
This is a catchall category, diagnosed when the disorder does not fall within a specific subtype.

Causation:
Okay, BD has been theorized to have genetic, physiological, and environmental causes – though most studies seem to agree that with that there is some sort of trigger event in the former cases.

Now, in BD sufferers we have rather high suicide rates – 1 in 3 will attempt, or complete, suicide and the annual average suicide rate is 0.4% - 10 to 20 times that of the general population. However, in terms of symptoms that can signal the oncoming BD, as children the sufferers can have suffered mood abnormalities, full major depressive episodes, and ADHD. The onset of BD is accompanied by changes in cognitive processes/abilities including reduced attention, executive capabilities, and impaired memory.

4% of the population will suffer “broadly defined” BD in their life. The lifetime prevalence of BD type 1 is estimated at 2% and is equally prevalent in men and women and across society.

Late adolescence and early adulthood are the peak years for the onset of the disorder but, interestingly, in 10% of bipolar cases the onset of mania happened after the age of 50.

In terms of the age of the sufferer, BD can affect all ages though in the case of the elderly while it is supposed that it becomes less prevalent, it is difficult to tell if they are suffering from BD as they may also be suffering from dementia or side-effects of medications for other conditions.
(Bipolar disorder in children)As for children, mania episodes are rare before puberty and due to the discovery of conditions like ADHD it is hard to differentiate the two in children as instead of euphoric mania they get outbursts of anger, irritability, and psychosis. Also, the stereotypical view of BD appears in children – that is the fast mood swings.

The main treatment for Bipolar Disorder is lithium – the lightest metal known. Side-effects of this include significant weight gain, possible birth defects in new born babies if the sufferer is pregnant (as it’s a teratogen), and dehydration.
Fun fact: the dehydration is caused because lithium competes with the receptors for the antidiuretic hormone in the kidney, causing more water output in the urine – this is called nephrogenic diabetes insipidus (mentioned in the clinic case of a House episode). Now, while lithium is usually cleared from the kidneys with the help of medication it can lead to more depression than before as well as suicidal thoughts/actions and will reduce activity of thyroid hormone (hypothyroidism). So while lithium is the only drug known to reduce suicide in Bipolar sufferers, some of the drugs required to get it out of the your system will increase suicidal impulses… great.
(… actually, the thyroid condition that results from the medication may be the cause of the misconception that bipolar means moodswings – I am very closely acquainted with someone who suffers hypothyroidism and they do get severe mood-swings from that condition. Huh, that’s fridge brilliance for you…)

I mention these side effects as I’ve actually heard of people taking Lithium recreationally and I just find that idiotic (just look to the Wikipedia page on what happens when you overdose – it’s not pretty). That above piece of inspiration was not planned – but now we suspect know! And knowing is half the battle.

Aaaaand back on track! –looks up at the page- Ok... I think that’s quite enough on Bipolar Disorder.

Now, Bipolar is often mistaken Unipolar depression as while Bipolar has both stages of mania and depression it is inconsistent as to the which mood is prominent in sufferers. Also, the younger the age of onset, the more likely the first episodes are to be depressive ones. Because it may take a while for sufferers to have their first manic episode (10% of sufferers don’t get their first manic episode till they’re 50) many are misdiagnosed as having major depression. Actually, Bipolar is so difficult to diagnose it can be mistaken for schizophrenia, schizoaffective disorder, drug intoxication, brief drug-induced psychosis, schizophreniform disorder and borderline personality disorder.

However, in fiction the thing that is mistaken for BD is… Borderline Personality Disorder. Why? Mood swings of course!

However, in the case of BD moodswings refer to the previously discussed episodes, which can last for weeks or months and disrupt appetites and sleeping patterns.

In BPD, the moodswings are the actually marked lability (uncontrolled displays on emotion such as laughing or crying) and reactivity of mood (poorly modulated emotional response that does not fall within the conventionally accepted range of emotive response) to external stressors. These have negligible affects on sleep and appetite. These mood swings can last for a matter of seconds through to a matter of days and everything in between.

Now, while BD is a mood disorder, BPD is actually a personality disorder like OCPD from last week - though some may argue that BP is some sort of threshold condition between the two.

Borderline Personality Disorder
BPD is a personality disorder (duh) which is characterized by variability of moods.

Symptoms include:

Inability to relate to other people and the world around them: Self explanatory.

Changing views of others: Sufferers can rapidly change between idolizing a demonizing a person depending on fear and disappointment.

Deep feelings of insecurity: This includes fear of abandonment and loss and will be exhibited in continually seeking reassurance even for small things; inappopropriate displays of anger towards those the sufferers deem responsible for their feelings are; fragile sense of self and their place in the world. These feelings of insecurity make their relationships with other difficult and the sufferer will often do anything to get their partner to stay.
This also means that criticism will hit them hard.

Persistent impulsiveness: Abusing alcohol and other drugs; spending excessively; gambling; stealing; driving recklessly, or having unsafe sex.

Confused, contradictory feelings: Frequent questioning and changing of emotions or attitudes towards others, and towards aspects of life such as goals, career, living arrangements or sexual orientation.

Self-harm: While this includes cutting, burning, and drug overdoses (both prescription and illegal) it also includes more "subtle" methods such as binge eating or starving, abusing alcohol/drugs, and repeatedly putting oneself in dangerous situations or attempting suicide. (Note that self-harm is considered a separate symptom to "trying to get people to stay")

Mood swings: The aforementioned "mood swings". These emotional outburst are often unsuitable and poorly regulated - think of the expression "crying over spilt milk" in the literal sense.

Manipulative: In their ways of using attention.


As with most disorders it's possible that sufferers to suffer from other disorders alongside BPD, or symptoms traditionally associated with other disorders. For instance those associated with anxiety or mood disorders such as excessive worrying and having panic attacks, obsessive behaviour, hoarding or having unwanted thoughts, feeling persistently sad, moving or talking slowly, losing sexual interest or having difficulty concentrating on simple tasks.
They may even experience psychotic symptoms such as delusions or false beliefs such as excessive paranoia.

And on that note we look to Millon's subtypes:
Discouraged borderline — including avoidant, depressive or dependent features
Impulsive borderline — including histrionic or antisocial features: this would easily fit in with those who seek attention in order to avoid abandonment
Petulant borderline — including negativistic (passive-aggressive) features
Self-destructive borderline — including depressive or masochistic features

As you can see, not every disorder allows for certain other disorders to feature in smaller capacities - for instance narcissism does not feature here. The "featured" disorder has to, well, I guess "get along" with the main one and it's overall theme - if you get what I mean. Like how they either reinforce the impulsiveness or the inner turmoil.

Much like many disorders a stigma comes attached to BPD - mostly that sufferers are manipulative attention-whores. It ought to be remembered that the reason for their actions is rooted in their disorder which causes them to feel lonely, desperate, and hopeless - they want the attention so they aren't lonely anymore but they can't help that. Obviously medication is a help but hardly a cure-all.

Also, just because of the sheer ridiculousness of it I will post that some feminists have a problem with the diagnosis of BPD as it fits with the "stereotypical hysterical woman". -facepalm-

Between 2% and 5% of the population will be effect by BPD in their lives.

Symptoms will typically first appear in mid-late teens or early adulthood. Women are 3 times more likely than men to be diagnosed.

Fun fact: The reason this was called "borderline" personality disorder was because it was originally used when the clinician was unsure of the correct diagnosis because the client manifested a mixture of neurotic and psychotic symptoms. Many clinicians thought of these clients as being on the border between neurotic and psychotic, and thus the term “borderline” came into use.

Those are the main features of BDP. So...
Even more elegant and finely crafted links which basically restate what I already said and the things I said I wouldn't cover!

We once more end on the International Classification of Disease by the World Health Organization ICD-10 who call it emotionally unstable disorder and have symptoms under two types:

F60.30 Impulsive type
At least three of the following must be present, one of which must be (2):

marked tendency to act unexpectedly and without consideration of the consequences;
marked tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or criticized;
liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions;
difficulty in maintaining any course of action that offers no immediate reward;
unstable and capricious mood.
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

F60.31 Borderline type
At least three of the symptoms mentioned in F60.30 Impulsive type must be present [see above], with at least two of the following in addition:

disturbances in and uncertainty about self-image, aims, and internal preferences (including sexual);
liability to become involved in intense and unstable relationships, often leading to emotional crisis;
excessive efforts to avoid abandonment;
recurrent threats or acts of self-harm;
chronic feelings of emptiness.
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Reiterating the end of my last post - if you have any symptoms see professional healthcare people. Do not take weird internet quizzes.

I have realized that regular updating will become more difficult once studies start up again given how much reading some of these disorders take. However, I will do my best as usual but it may become fortnightly for a little while.

Til next week! (Hopefully!)

Disturbing the Disturbed: Obsessing over Perfection

This week, I shall discuss the difference between Obsessive Compulsive Disorder (OCD) and Obsessive Compulsive Personality Disorder (OCDP).

Now, most of us are familiar with (unresearched) fiction's depiction of an OC sufferer - they're that person who is meticulously measuring every grain in making coffee and almost have a stroke whenever they see a pile of magazines that aren't perfectly in line.

Actually, the perfect example here would be Death The Kid from Soul Eater.

Death is obsessed with symmetry – his house is completely symmetric: posters are directly opposite each other on walls, etc. If his enemy is symmetric he will refuse to fight it (even letting himself get beaten half to death), but if it’s asymmetric he will destroy it. If anyone pointed out the asymmetric stripes in his hair he would have a tantrum and he fainted when he had to write out his name because the “k” could never be symmetric.
The point is – he is a typical example of non-researched fictional OCD (I’ll mention that they justify his madness later but he serves as a great example). However, fact varies greatly from fiction.

Obsessive Compulsive Disorder
This falls under what is known as an “anxiety disorder”. It is characterized by recurring intrusive/unwanted thoughts (a.k.a. obsessions) and repetitive behavioural/mental rituals (a.k.a. compulsions). Sufferers usually know that this is all rather irrational but they have a great deal of trouble controlling their obsessions and it’s hard to resist the compulsion.
The main idea is that the obsessions cause worry on the part of the sufferer and, obsessions being what they are, they have trouble trying to think of something else. This is where the compulsion comes in – it’s the sufferer trying to distract themselves from the obsession or lessen the effect of the obsession. If they don’t carry out their particular compulsion, anxiety will be experienced in the form of the obsession.

Common obsessions:
• thoughts of contamination
• repeated doubts
• need for orderliness – this one is the most common in fiction
• aggressive impulses
• sexual imagery – this one is actually rather common
• religion

Common compulsions:
• Checking
• Washing
• Ordering – also very common in fiction
• Requesting or demanding reassurance from other people ( e.g. 'Did I lock the door?')
• Praying
• Counting
• Repeating words silently

An interesting fact is that about 20% of OCD sufferers have a tic (sudden, repetitive, stereotyped, nonrhythmic movements [motor tics] and utterances [phonic tics] that involve discrete muscle groups), thus it could be related to Tourette Syndrome but this is yet to be confirmed. Also, about 3 out of 100 people will get OCD in their lives.

“Tics are movements or sounds "that occur intermittently and unpredictably out of a background of normal motor activity", having the appearance of "normal behaviors gone wrong". The tics associated with Tourette's change in number, frequency, severity and anatomical location. Waxing and waning—the ongoing increase and decrease in severity and frequency of tics—occurs differently in each individual. Tics also occur in "bouts of bouts", which vary for each person.”

A quick note on Tourette Syndrome is that while the most publicized symptom is Coprolalia (spontaneous swearing and other bad words/phrases), it actually occurs in only about 10% of patients. Echolalia (repeating the words of others) and palilalia (repeating one's own words) occur in a minority of cases. The most common motor tic is blinking, while the most common vocal tic is throat clearing.


Obsessive Compulsive Personality Disorder

To put it simply, OCPD sufferers are perfectionists and believe that no-one else can be trusted to complete a task properly. Sufferers of this anxious personality disorder are preoccupied (read: obsessed) with orderliness, perfectionism, and control. At first you may be thinking “Hey! What’s the difference between OCPD and OCD where the obsession is order?” however, while OCD sufferers know that their thoughts are intrusive/unwanted/wrong, OCPD sufferers believe that their thoughts are correct and hence do not try to suppress them or distract themselves from them. This can be a problem as they spend their early life ignoring/avoiding the symptoms – if they ever end up acknowledging the symptoms.

Some, but not all, OCPD sufferers show an obsession with cleanliness – not to be confused with domestic efficiency as paying too much attention to details can actually make daily activities difficult to accomplish.

Symptoms tend to start in early adulthood and may interfere with one’s ability to complete tasks due to their standards being too rigid – for instance, wanting something redone exactly to the instructions given and ignoring anything better/more efficient route. An example can be derived from Harry Potter: The Half-Blood Prince. If Harry was to work in a group assignment with someone with OCPD in Potions class and tried to use the Prince’s annotated text book, the OCPD sufferer would probably make Harry do the potion over again following the normal instructions, no matter how much better the other potion would have been – even if they saw the results to be better.

Other symptoms of OCPD that aren’t similar to those of OCD are:
• Excess devotion to work
• Inability to throw things away, even when the objects have no value
• Lack of flexibility
• Lack of generosity
• Not wanting to allow other people to do things
• Not willing to show affection
• The aforementioned reoccupation with details, rules, and lists
Another striking feature is that they tend to polarize their beliefs and actions and those of others – that is to say, set them on extreme scales such as “right” and “wrong” with very little in between. This sort of perception strains interpersonal relationships and the frustration can even result in violence (known as disinhibition). This probably contributes to why sufferers of OCPD tend towards pessimism, depression, and in extreme cases, suicide.


Actually, a rather good example of possible OCPD on TV is Monica from Friends – she’s an extreme perfectionist who seems to panic rather than get mad (most of the time), has an obsession with cleanliness and order, and even hoards a lot of stuff. She is not very flexible and I can recall her saying something like “Rules are good - they help contain the fun.” (I don’t recall the exact phrase) and has always shown strict adherence to the rules. Also, a recurring theme is that when she is performing a task she is reluctant to delegate or accept assistance because she thinks other people will do it wrong – unless she is bossing them around every step of the way. A dominant character trait is that she actually enjoys cleaning up.

Now, a fellow who will show up again in my blog is Theodore Millon – he developed a series of subtypes of different disorders. These subtypes are basically “dominant disorder with features of another disorder” – e.g. for the personality disorder of Narcissism there is the subtype of “unprincipled narcissism” which has features of Antisocial Personality Disorder, and for Antisocial Personality Disorder there is the subtype of “reputation-defending antisocial” which has features of Narcissism. (both of these disorders will be covered more extensively later)

Anyway, Millon’s subtypes for OCPD are
• conscientious compulsive—including dependent features.
• puritanical compulsive—including paranoid features.
• bureaucratic compulsive—including narcissistic features.
• parsimonious compulsive—including schizoid features. Resembles Fromm's hoarding orientation[20]
• bedeviled compulsive—including negativistic (passive-aggressive) features.
A quick summary, for the times being, is that
• Paranoid - Constant distrust and suspicion of others.
• Shizoid - Asocial. No concern for what others think of you. Little to no desire to form personal relationships of any sort.
• Narcissistic - Self-centered and thinks they are the Greatest Person Ever. Constantly need affirmation that they are, indeed, awesome.
• Dependent - the constant need to rely and depend on others. Find it difficult to make even very simple choices on their own.


Why do these two get mistaken for each other a lot? Apart from the similar names, of course. Well, as you can see, their symptoms follow the same basic pattern – compulsions caused their obsession – except in OCD the compulsion is to deal with the obsession tend to get very distressed with their actions while in OCPD it is to assist the obsession (perfection) and usually enjoy the task. I will mention that the two conditions can be suffered by the same person.
Sufferers of these disorders tend to be high achievers and feel “a sense of urgency about their actions”. They will have rigid routines and feel upset if someone interferes with them. One thing I didn’t know before researching this was that they may have trouble expressing their anger, thus choosing more appropriate emotions such as anxiety. This is why OCD is known as an anxiety disorder and OCPD as an anxious personality disorder.

However, as seen above, it’s when you look at the additional symptoms of OCDP that you really see the differences between the two disorders – this is where most fiction falls short.


Now, to end this post I will direct you to the World Health Organization's ICD-10. As is the case with most organizations, they like to use completely difference names to what everyone else learns. Here, OCDP is (F60.5) Anankastic personality disorder.

It is characterized by at least three of the following:
1. feelings of excessive doubt and caution;
2. preoccupation with details, rules, lists, order, organization or schedule;
3. perfectionism that interferes with task completion;
4. excessive conscientiousness, scrupulousness, and undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships;
5. excessive pedantry and adherence to social conventions;
6. rigidity and stubbornness;
7. unreasonable insistence by the individual that others submit exactly to his or her way of doing things, or unreasonable reluctance to allow others to do things;
8. intrusion of insistent and unwelcome thoughts or impulses.
Includes:
• compulsive and obsessional personality (disorder)
• obsessive-compulsive personality disorder
Excludes:
• obsessive-compulsive disorder
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

For some reason, whenever I read a page on mental/physical health it urges me to see a psychiatrist/doctor if I display symptoms so I guess I will say that too – if you think you may match the symptoms as listed by the World Health Organization I’d suggest getting a formal diagnosis before treating yourself. Internet quizzes are unreliable and can only give an indication – even then, if you were in an odd mood when taking the quiz your results can get really messed up.

An example is that when I take these quizzes I pretty much always rank highly on either Bipolar or Cyclothymia for the depressive illnesses, and for the personality disorder ones I typically score highly in Paranoid, Schizoid, and Schizotypal. However depending on my mood I have also gotten high results in Narcissism, Avoidant, Dependent, and Antisocial... on the same test.
So, I’m going to say that while the internet is a great place to find information you really need a qualified mental health specialist to make a diagnosis.

On a less serious note – my next post will take place over the next day or two as I am still writing it and we are experiencing a heat wave where I live and I’d rather not accidentally overheat my laptop if I don’t have to.