Tourniquet

I tried to kill my pain
But only brought more
So much more
I lay dying
And I'm pouring crimson regret and betrayal
I'm dying, praying, bleeding and screaming
Am I too lost to be saved
Am I too lost?

Recently I’ve been thinking of suicide – not thinking of suicide as in “suicidal thoughts” but just thinking about the concept of suicide and its implications. Specifically religious implications. Probably because I've been listening to Tourniquet a lot lately - hence the title.

Okay, while not all religions were against suicide – for instance in ancient Japan it was believed to be more honourable kill oneself than to surrender and some mythologies were similar – those descended from Judaism were vehement on the matter: it was forbidden.

In the original versions of the Seven Deadly Sins that Despair was originally a mortal sin because it symbolized a loss of faith and hope – no longer trusting in God. Suicide is taking God’s most precious gift and getting rid of it. Those who take their own life cannot enter the Kingdom of Heaven.

This is where my musing actually starts – what about drugs? So many medications out there, especially anti-depressants, include suicidal thoughts as a side-effect.

Also, take into account mental illness - it's estimated that 87%-98% of suicides had a mental disorder. The obvious ones are Depression and Bipolar Disorder, but there are others. Of suicides, mood disorders are present in 30%, substance abuse in 18%, schizophrenia in 14%, and personality disorders in 13% of suicides. These are all chemical imbalances - either caused by the illness, causes the illness, or by the medication for the illness. (In Swing a Little More I mention that while Lithium is the most effective medication in regards to suppressing suicidal impulses/thoughts, the medication to stop the kidney damage from lithium increases such thoughts.)

Even without looking to specific mental disorders, it's been found that those who attempt suicide have low seratonin levels (mood modulator and neurotransmitter), and those who complete it have the lowest levels.

Is a chemical imbalance someone willingly throwing their life away? Or would it be considered differently? Are there exceptions, a rule, a second chance?

My next question is this: what about those who willingly endanger their lives?
Just to clarify – I am not saying that my following examples should be considered the same as suicide-by-free-will. My thoughts are... odd on this matter so I’m trying to properly categorize them. How is saying “Hey, I don’t care if I die” different to saying “I don’t want to live”?
If those who are chemically imbalanced towards hurting themselves in a fatal way get penalized (forgive the word), what happens to those who are mentally healthy but through themselves off cliffs attached to a chord, or diving into the rift, or other “thrill seeking” activities. I mean, I know we all take risks with our lives just by leaving the house but we don’t run in front of the cars! These guys sign contracts that explicitly state that if they die then it’s not the company’s problem!

Ok, I know that may be irrational but I don’t see why if someone who is supposedly in full possession of their faculties could care so little about their lives that they may as well throw them away...
I know that they probably don’t think that it’s possible that they may die – at least it’s not in the forefront of their mind. Like for surfers – they don’t have to sign a contract to go in the ocean.

Not on the “thrill seeker” side of things there are soldiers – men who willingly risk their lives for what they perceive is a worthy cause. They know full well that they could die. I know they aren’t happy with the idea and they aren’t seeking to die but they know it’s a risk.

I guess it’s that a suicide intends to die, while the soldier accepts that it’s a possibility but doesn’t want to, and the thrill seeker doesn’t really consider it. It is intention.

I’m not saying that stupidity or honour is on par with actually taking one’s life – what I am saying is that since suicide could be the result of mental illnesses and drug side-effects can they really be considered to be taking their life of their own volition? I mean real free-will? I know some can resist these impulses – but what if the imbalance is that bad or the illness that far progressed?

I’ve never read an exclusion clause. I’d like to think that there’s something to help but I don’t believe in reincarnation or past-lives despite the romanticism behind them – mainly because I don’t like the idea that my personality as it is has nothing to do with my soul and I could have just as easily been a male born in 1955. However, I know that Judaism has explicit mention of past-lives, and that Christianity isn't mutually exclusive with the idea. Hell, a younger me thought that it was a good explanation as to why Heaven wouldn't be overcrowded.

Actually, I’d be likely to believe such a theory if said second chance took the form of them being reborn without said illness or imbalance thus giving them a chance to relive their life over... however that would be unfair to those who don't get a second chance unless everything except said imbalance/illness was the same but that would go against the concept of free-will which is something I believe in thus I couldn't believe that theory anyway...
Not to mention that it would seem to imply that I either I monumentally frakked up my past life attempts and am on my nth chance with God, or that I haven't frakked up but am still supposed to live all this out again and risk on of my future lives frakking up the afterlife for all of "me". On top of that I have no small amount of distaste for the idea that if I could have married multiple people already at that once I die whatever vows I made/make ultimately mean nothing. But that's getting into my personal weirdness.

And then we look to those who were dying and then committed suicide. For instance, a person dying of a particularly painful disease. They have days, weeks, maybe months to live but all in complete agony. Is it so bad that maybe they don't want to wither away like that? By that same token, would a person refusing further medical help be considered suicide if said treatment could extend their life? Personally, I don't know - I'd imagine my thoughts may change if a relative/friend chose such a route.
I so love chasing myself in a circle... not.
This post doesn’t involve me coming to some sort of brilliant conclusion, a minor epiphany, or even some weird little decision. It’s just me wondering what is going on here.

My wounds cry for the grave:
My soul cries for deliverance.
Will I be denied?
Christ!
Tourniquet!
My suicide...

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: The Dark Triad

Hello! It's still Wednesday!

No “witty” title here – this week we discuss the Dark Triad. Okay, the next three weeks (including this one) will be done somewhat oddly as I am actually building up to the concept of a psychopath – a definition that gets pretty much butchered... at least as far as I’ve noticed. However, it comes in this nice little package with two other personality traits that I am fond of so I wanted to discuss them first as one of them is also very relevant to a future post.
But I’m getting ahead of myself...

The Dark Triad is a group that consists of three personality traits: Narcissism, Machiavellianism, and psychopathy. Now, the reason these guys are part of this dark little club is that while each is distinct in theory, they often overlap in life.

An argument to try and separate the three in terms of an example is that while the narcissist will attack when threatened, the psychopath will attack when threatened; also in a academic view, the Machiavellian will plagiarize an essay to cheat, the psychopath will try to copy another’s exam answers without forethought.
However, those examples are rather negative... and kind of sound like a David Attenborough documentary.

So instead I will give each disorder its own post... mainly because my Narcissism section was long enough to warrant a post of its own. I’m sure it’s very happy that it no longer has to share with Machiavellianism as originally intended.

Okay, I will first tackle Machiavellianism.

I assume we’ve all heard the expression “the ends justify the means”? Well, this is a misappropriation to Niccolò Machiavelli, an Italian diplomat and political writer. Much like the “It is better to be feared than loved” quote it’s been taken out of context and shortened. The correct versions are as follows:

"look to the consequences before you act"

And

Whether it be better to be loved than feared or feared than loved? It may be answered that one should wish to be both, but, because it is difficult to unite them in one person, is much safer to be feared than loved, when, of the two, either must be dispensed with...
Nevertheless a prince ought to inspire fear in such a way that, if he does not win love, he avoids hatred; because he can endure very well being feared whilst he is not hated.
— Niccolo Machiavelli, The Prince, Chapter 17

However, it is this popular understanding that gives us the general gist of this personality trait.

Commonly, Machiavellians use deception and manipulation to trick others for their personal gain. An entity’s capacity for Machiavellianism is called Machiavellian Intelligence. This behaviour may be demonstrated through:
• Blaming and forgiveness;
• Lying and truth-telling;
• Making and breaking alliances
• Making and breaking promises
• Making and breaking rules;
• Misleading and misdirection.

Yes, I think this list is rather, well, silly. I mean, forgiveness? I presume that it is talking about using the above to manipulate others/events – this fits with the fact that Machiavellians feel little remorse or empathy when their actions harm others.

One method Machiavellians may use is known as "gaming the system - "[using] the rules and procedures meant to protect a system in order, instead, to manipulate the system for [a] desired outcome".
If you’re a gaming fan then “gaming the system” is the same as rules-lawyering (also known as “ignoring rule 0: the Game Master is always right”).

The Machiavellianism trait also strongly correlated with the belief that it is fine to lie for the greater good to be achieved – a sentiment which makes sense to me. NOTE: One of the “defining” traits of Machiavellianism is supposed to be cynicism towards morality, however the acknowledgement of a “greater good” contradicts that idea and yet these people still have enough traits to be classified as Machiavellian. Therefore, just because someone is Machiavellian, it doesn’t make them a “bad” person.
(Actually, most descriptions vary between “cynical towards morality” and “cynical towards people” – you could actually link the latter to basic economic theory in that if everyone acts in their own self-interest then you get a better result overall. Economic interests. -_-)

Ok, in essence Machiavellianism is " the employment of cunning and duplicity in statecraft or in general conduct ” which sounds less judgemental.

A great villainous example of Machiavellianism is Edmund from King Lear – not only does he deceive his father into thinking his half-brother was plotting to kill him, he manages to trick Goneril and Regan into thinking he’s in love with them. Through these deceptions he gets himself an estate, and almost a kingdom – you know, if Edgar hadn’t come and stabbed him.

As you may have noticed by now, this trait is common amongst fictional villains – the ones usually termed “psychopaths”. When we get around to discussing psychopaths you’ll see it to be rather different. However, as I stated earlier, the Dark Triad do occur together fairly often so it may be were the misconception is rooted.

This trait is not a bad one per say – no mental condition or personality trait is inherently bad. It’s all to do with how it’s applied. Machiavellianism has so far stayed through to its roots in politics - politicians with this trait fare much better than those without it. This is partially because Machiavellianism is highly correlated with charisma – whether this is as a result of their manipulation skills or as assistance to it, I’ll leave to you... though I reckon it could go either way since I know many charismatic people who aren’t manipulative but I also know a lot who are (but then out of those few are maliciously manipulative, if you understand what I mean).

Now, the charm is especially prevalent in short-term social interactions – I would consider this the difference between genuine charisma and good acting.

There were some studies that correlated High Mach with Type A personalities, but since the Type A/Type B personality thing has since been discredited I won’t talk of it.

I think I’ll close on this quote, which in my opinion summarizes Machiavellianism... which could be paraphrased from the Evil Overlord list as “I will not be a damned fool".

Any man who tries to be good all the time is bound to come to ruin among the great number who are not good. Hence a prince who wants to keep his authority must learn now not to be good, and use that knowledge, or refrain from using it, as a necessity requires. - Niccolo Machiavelli, 1469-1527

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!)