ASPD, Definitions, and Inflicted Insight

I know I did a post on Anti-Social Personality Disorder but I just wanted to clear up a couple of things. I recently heard a "statistic" that "1 in 25 people are sociopaths". Now, let's remember that sociopathy is considered a subdivision of ASPD and 3% of men and 1% of women are diagnosed with the disorder. The world is roughly 50/50, so the total probability is actually 2% (1.5% + 0.5%). That makes it 1 in 50.

But moving on from that, there is a reason I brough this up - these same "statistic" was mentioned in the context where the author was saying that 1 in 25 people are completely without empathy. Not only that, they credit the World Health Organization (ICD) for this. But wait! Let's take another look at the diagnosis criteria...

(quoted from my prior post, which contains the links)

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. 

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

Why am I bringing this up again? Because for each person who references the World Health Organization to say that sociopaths (sufferers of antisocial personality disorder) lack empathy, they seem to forget the simple phrases "at least 3" and "three or more". Only one symptom in the DSMV and two in the ICD-10 roughly correspond to lack of empathy. This means that it's possible for the not to have lack of empathy has a symptom. Now, of course I don't know the probability and relationships between each symptom but the point is that it is possible! But hey, congratulations world - you're just stereotyped another group of people based one aspect that subdivision of them have.


Furthermore, I would like to draw attention to some symptoms these being:

1. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another;
2. Markedly prone to blame others or to offer plausible rationalizations for the behavior that has brought the person into conflict with society

 While if you take many of the symptoms aside they can appear to be somewhat normal behaviour, I wanted to draw special attention to this. Now, very few people will try to hurt a person for the sake of hurting a person - most will rationalize it with things like "they deserved it", "it wasn't that bad", or "it was for the better". How many times is this actually true and not just people trying to feel less guilty. Again, look at the wording - specifically in point one: "lack of remorse or ..."

A sufferer of ASPD can feel remorse, but just rationalize a misdeed - like "sane" people do. So... is this behaviour sane? Even blaming others - "If my boss hadn't fired me...", if this, if that. These are possible symptoms of what people like to call sociopathy.

But the ones that reach the media are dramatic and extremely negative - portraying the worst of a group of people who, quite frankly, are mostly normal. However, as a friend pointed out, there may be another reason why the least glamorous symptoms are the ones that are emphasized, and next to no attention towards the more commonplace ones.

Nobody wants to draw attention to their own potentially sociopathic behaviour. This is an especially good point when combined with the idea of "inflicted insight" - the idea of exposing the less savoury or comfortable facets of a person's own psyche and forcing them to confront them. I've mentioned the Milgram Experiment before, where participants pretty much blindly followed orders to electrocute another person - many of those same participants (84%) thanked the people running the experiment for showing them that side of them and helping them realize that they needed to question their own actions more, and 15% were neutral.

And yet inflicted insight is veiwed as a bad thing. Could this be why people ignore the more mundane symptoms? Because people don't want to know that they aren't so different from the sociopaths they so revile?

In order to solve a problem, it actually needs to be acknowledged first.

Classified Killers

I'd like to point out three things before I get started.
Point the first: This post is really me to getting really pedantic about terms that crime shows misuse. Well... just one term that really gets on my nerves.
Point the second: I did mention that due to my assignments I wouldn't be doing a proper Disturbing the Disturbed post this week, however I did find some really neat studies while researching this so they will go in a different post.
Point the third: Half of this blog is me giving my thoughts some sort of structure. So this is a bit of an organizing process.

Firstly the "one phone call" rule means one phone call to your lawyer - not to the helpful old lady who will find the real killer for you. Just wanted to clear that up.

Now, the ones that actually sparked my desire to explain terminology: mass murderer, spree killer, and serial killer. Now, most of you have probably heard of the first and last ones from crime shows. The fact is that most of the “serial killers” on television are, in fact, spree killers – if there is a serial killer on a show, it will likely be the “big bad” for the season and their crimes will be a overarching plot between different shows, in which the individual crime will play second fiddle to the murder-of-the-week until the big confrontation episode. An example of a TV serial killer is the Dollhouse Killer of from the CSI franchise.

However, what is the actual difference?

Let’s start with mass murder.

First thing about mass murder is that all the killings take place in one place over a continuous period of time. This time span ranges from a few minutes to a day. They have to have killed at least 3 (or 4) people. Most high school shootings fit under Mass Murder, as well as crimes that involve the killing of multiple family members at a time.
The mentality to do with a mass killing is different to serials and sprees. For starters, while the demographic of serial killers and spree killers are typically white males from the ages of 20 to 30, the mass murderer, while also a white male, is typically between the ages of 25 and 40. Their “plan” tends to be disorganized and the motive is usually revenge or rejection.
Cases of rape are rare, and sadism is not usually a factor. The greatest difference would be that the attitude towards being caught is uncaring, or even suicidal. Typically the mass murderer is a frustrated individual, has lots of weapons, likes violence, have no partner, and lives alone or with a parent.


Next is the spree killer.

The spree killer will have killed two or more victims in multiple locations in a short period of time. The common time frame is from a few days to a week but the formal definition is that “there is no cooling-off period”. Timing is the key difference between the three categories with mass murderers having no distinctive time period between kills and with the crimes of serial killers being definitely separate events – a spree killer’s kills, though in different locations, are considered a single event.

Spree killers tend to be disorganized, and also tend to be fueled by revenge/rejection. Sadism is not a factor in their kills but rape may factor in. Spree killers usually don’t plan on being caught but there are exceptions to this.

Both mass murderers and spree killers fall under “rampage killers” and their victim demographic is usually spread between men and women (though more women do tend to die in mass murders). However, spree killers and serial killers are more likely to have partners than mass murderers.


Finally we come to serial killers.

The serial killer commits 3 or more murders over a period of more than a month with a “cooling off period” between, and has a motive based on psychological gratification. Usually the victims have something in common, such as race or sex, but in some cases such as that of the Zodiac killer there is no pattern. Due to the large time difference between kills it can be months, years, or even decades before a serial killer is caught, if they are caught at all.

While spree killers and mass killers tend to use guns, a serial killer will commonly use a knife or employ some means of strangulation to kill their victim. Both rape and sadism can play a part in their crimes and serial killers do not intend on being caught.

In terms of personal characteristics, there have been many studies done on this.

• A sample of 174 serial killers revealed a mean IQ of 93, with only bombers having IQs significantly greater than average.
• Often abandoned by their fathers and were raised by domineering mothers.
• Their families often have criminal/psychiatric/alcoholic histories.
• They were emotionally/physically/sexually abused by a family member.
• May have a large history of suicide attempts.
• Frequently bullied as children
• Interested in voyeurism, fetishism, and sadomasochism from an early age.
• A disproportionate number exhibit one, two, or three of the MacDonald Triad (predictors of psychopathy):
• Pyromania
• Sadistic tendencies (especially in children who have not yet reached sexual maturity – usually takes the form of torturing animals)
• Bed wetting beyond the age of 12.
• More than 60% did this but there have been debates on the statitistical significance of this figure.

There are exceptions to this, such as Harold Shipman, Dennis Nilsen>/a>, Vlado Taneski, and Russell Williams. These are only guidelines.

Some serial killers exhibit various degrees of psychopathy, a condition that will be covered in a later post but is mainly defined by having traits of both narcissism and antisocial personality disorder (also covered later). 50-80% of criminals exhibit ASPD but only 15-30% score as primary psychopaths on the PCL-R test. There is no data to identify the prevalence of psychopathy amongst serial killers.
However, serial killers who exhibit ASPD are often aware of how to hide the characteristics in order to blend in – an infamous case is that of Ed Kemper who tricked psychiatrists into thinking he was cured.

While there are female serial killers they are very rare and primarily kill for money, are emotionally close to the victims, and generally have a relationship with them (wife/mother/nurse). Once again, there are exceptions such as Aileen Wuornos.

A common theory as to why serial killers keep killing is that they are trying to live out a fantasy and since reality never meets up to fantasy, they are compelled to keep trying.

Serial Killers can be both organized, disorganized, and mixed (a three to four ratio on the first two). What this means is that
Disorganized:

•  More impulsive, often use whatever weapon is available at the time, don’t usually try to hide the body
• They usually have a history of mental illness, below average intelligence (the mean IQ of disorganized killers is 92.5), may be unemployed or a loner, and their crimes can be very violent.

Organized:

• Plan methodically, usually have above average intelligence (mean IQ of organized killers is 113), usually abduct victims, have different kill and dump sites, and may lure out victims by playing on sympathy (e.g. Ted Bundy) or target prostitutes due to their being more likely to walk off with strangers.
• Occasionally they have forensic knowledge to help them control the crime scene and cover their tracks.
• They are socially adequate, has friends/lovers, and even a family. These are the ones who would be described as “they wouldn’t hurt a fly”.

Serial Killers obviously have a motive of some sort – recognized motives are:

• Visionary: having suffered a psychotic break from reality, they sometimes believe that they are another person or are being compelled to murder by another entity.
• Mission-oriented: justify their actions in that they are “ridding the world” of a type of person whom they deem undesirable on the basis of sexual preference, occupation, ethnicity, religion, etc. It is important to note that these kinds are generally not psychotic.
• Hedonistic: thrill seeker and see people as expendable in order to get said thrills.
• Lust: sex is the primary motive here regardless of whether the victim is alive or dead. The fantasy plays a large part in their killings and the will use close contact weapons like knives or hands. As the killings continue the time between victims will decrease and/or the stimulation required increases.
• Thrill: primary motive is to inspire pain/terror in victims and thus excitement for themselves. They murder only for the kill – the attack is not prolonged and there is no sexual aspect. The victims are typically strangers but prolonged stalking may proceed the attack. They can abstain from killing for a long period of time and tend to refine their techniques as they go on – they aim for the perfect murder.
• Comfort (profit): material gain is the main purpose, thus the victims are usually family members or close acquaintances. Long periods of time between victims in order to avoid suspicion. Poison is the most popular weapon – especially arsenic.
• Power/control: main objective is to exert power over the victim. These killers were usually abused as children and they are trying to make up for their lingering feelings of powerlessness and inadequacy. In these cases rape is not about sex but domination.

[looks at the page]
Well… that’s enough of serial killers for me. >_>

A great graph that mostly summarizes most of this can be found here. And I like this site but failed to include – just read.

DISCLAIMER: In regards to the demographics of the killer (white/male/age) one must keep in mind that these are derived from figures taken from the USA. When these statistics are compared with those of other countries, it is found that Caucasians are no more likely to be a serial killer than any other race. This can be attributed to the media’s tendency to focus on crimes where the victims are “pretty white females”. However, of America, South Africa, and Australia, the latter has a much lower incidence of serial murders.

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: Empathy, Where Art Thou?

Unfortunately, the post I wish to make is not fully researched yet... this can be blamed on three things:
The first thing, is my uni work.
The second thing is that I have over 40 links to go through.
The third thing is that of those 40 links I have to extract the useful information from the piles of "mean narcissists" pages. I have found no less than 3 blogs that explicitly state their contempt for narcissists.

To clarify, I am not a narcissist. While I am fairly vain and rather proud, I have other characteristics that definitely don't fit the criteria as well as missing key parts.
In my posts I try to be objective - which is why I stick to medical journals and Wikipedia... more so towards the former. I'm not going "if someone has this, stay clear", I'm trying to be informative as to what these terms actually mean - hence why I try to include both the good, the bad, and the difficulties faced by sufferers (also a few statistics never hurt).

However, after reading "X" number of pages with titles like "Narcissists Suck" (which I am only enduring to see if they have anything the journals don't) one begins to see a very large "them versus us" mentality. I found a similar thing when I researched Borderline Personality Disorder.
(Not to mention the number of pages where the author declares they will use "narcissist" and "psychopath" interchangeably which, to borrow a phrase from my sibling, makes me want to rip their heads off.)

This is a sample bias - people don't tend to talk about something if they're happy with it. My very first statistics unit taught me this, which is why voluntary participation is a nuisance. The people who know "normal" people with mental disorders won't speak up because they're content, only the ones with bad experiences will.

Psychologists are still trying to figure out narcissism and are not sure what causes it yet. People who suffer from personality disorders and other mental illnesses are not to blame for their disorder - just because someone has a disorder it doesn't mean they'll play up to the the "evil insane person" image that is so prominant.

Take sociopaths for instance: one of their symptoms is a lack of empathy. They're not all going to use this to hurt people! Most of them will "just" have a hard time getting on in society - it hurts the sufferer, not the "sane people". There's a reason why I call them sufferers and not beneficiaries!
Admittedly some of the mentally ill channel their tendencies into less than socially beneficial activities, but then so do "sane" people!

Anyone else noticed the irony that while narcissists and sociopaths are reviled for not having empathy a lot of the "normal sane people" who have empathy don't even want to try and sympathize with them? And television's no help: any character who isn't the main one who sympathizes with the "villain" is guaranteed to be dead within half an hour - we're being told that it isn't acceptable to try to understand. It's a big reason why I don't watch crime dramas with my mum - eventually some mentally ill person will be cast as the criminal and it'll lead to an argument. (I'm not saying I defend every mentally ill criminal, but some of them are just heartbreaking.)
My sibling is on board with this - we actually had a nice long conversation on the matter after a TV cop sneered "typical narcissist" - as though the guy woke up one day and said "Hey, you know what would be really fun? Being a narcissist." The cop's statement was especially jarring because the main murder in the episode was committed by a "sane" woman in complete cold blood - she wasn't even sad that she murdered the wrong person: "They looked the same from behind" was her justification.

Hell there are people with "empathy" who don't care to know about people's problems when it doesn't directly involve them - even a few who don't want to know when it does involve them.
Actually, here's a blog post that mentions the Milgram experiment. 65% of the participants would electrocute someone with 450V because they were told to, and the 35% that didn't still did some electrocuting and never checked on the "slow-learner". Wait! It gets better. They did variations on the study and tested how compliance went depending on the subject's proximity to the experimenter and found that compliance decreased to 30% when the subject had to physically move the person's hand onto the shockplate. My sentiments? That's right - 30% of people are willing to do that. Fun fact: 30% of the population are not sociopaths, so those were "sane" people.

(Before someone brings up my sampling bias again I will mention that subjects were not told that they would be playing Zeus when they signed up - just that they would be particpating in a learning thing. So, no we didn't just get sadists sign up.)

Tell me, where's this empathy thing again? Because I'm failing to see it.

How are they better than a sociopath who cannot feel empathy even if they wanted to? Doesn't that strike you as sad - a barrier that they just aren't able to cross?

Whatever happened to compassion? You can be compassionate without being stupid, it's not hard.

... and now I'm ranting when I should be researching. Well... maybe this was informative. Maybe... to the readers who are not the one who already knows this rant... and who made a post strikingly similar to this now that I think about it. However since I held this belief prior to meeting them it... [appropriate end of sentence which I am too tired to think of right now].
Ah, well, this is my rant done in my way (read: more sarcasm, sneering, and fist-shaking most likely) at 1:30am. Next week I shall have a proper post.

All I can say is that if this is how badly people are reacting to narcissists I am not looking forward to researching for the sociopath and psychopath post...

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!)

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.

Disturbing the Disturbed

As I have hinted at, I have an interest in mental disorders above that of most people I know (i.e. more than no interest) and one thing I have discovered while researching these disorders is how many times fiction, and real people, get it wrong.

 

Over the next few weeks I will put up a post explaining some of the common misconceptions that appear in fiction. I anticipate that the series will last about 6 weeks, provided I don't have some sort of pressing rant I'd like to get off my chest. In that case I may post twice in a week to keep to schedule depending on how enthusiastic I'm feeling.

 

The first post of this series will be on Wednesday and it's sequals will also be posted on Wednesdays. After the series ends I shall return to posting on Mondays for the most part.
(Any Monday posts before the end will likely be an aforementioned "pressing rant".)

 

Anyway, so that is all for now.

 

ADDENDUM:

 

When I discuss any "personality disorders" (it will be stated in their name) they must first satisfy the following criteria before a specific disorder can be assigned:

 

Under the DSM-IV:

• An enduring pattern of psychological experience and behavior that differs prominently from cultural expectations, as shown in two or more of: cognition (i.e. perceiving and interpreting the self, other people or events); affect (ie. the range, intensity, lability, and appropriateness of emotional response); interpersonal functioning; or impulse control.
• The pattern must appear inflexible and pervasive across a wide range of situations, and lead to clinically significant distress or impairment in important areas of functioning.
• The pattern must be stable and long-lasting, have started as early as at least adolescence or early adulthood.
• The pattern must not be better accounted for as a manifestation of another mental disorder, or to the direct physiological effects of a substance (e.g. drug or medication) or a general medical condition (e.g. head trauma).

 

Under the ICD-10:

• markedly disharmonious attitudes and behaviour, involving usually several areas of functioning, e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;
• the abnormal behaviour pattern is enduring, of long standing, and not limited to episodes of mental illness;
• the abnormal behaviour pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
• the above manifestations always appear during childhood or adolescence and continue into adulthood;
• the disorder leads to considerable personal distress but this may only become apparent late in its course;
• the disorder is usually, but not invariably, associated with significant problems in occupational and social performance.

The ICD also adds that 'For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations.'

 

Blood Calls For Blood

Well, not really. But kinda. Allow me to explain.

Okay, for some reason my posts have been sort of turning into me dumping all my thoughts on a particular matter together, even if it is a collection of links and explanations. I guess it's because it helps me clarify things in my own mind. Nevertheless, we continue.

Now, anyone who has read a "trashy romance novel", watched a soap opera, the odd crime drama, or picked up a mythology book knows that siblings or other relatives "hooking up" is no rare thing in fiction. However, none of these things tend to go into the psychology of it - or at least explaining that there is psychology behind it. I'm going to spend this post explaining that there are in fact theories behind this behaviour and siting examples to prove my point. I've actually found works of fiction that work this into the story in an interesting way because the author actually understands the psychology behind it.

The first effect is called Genetic Sexual Attraction, which is exactly what it says on the tin - attraction to those one is genetically related to... who they first meet as adults. Often this happens as the result of adoption, infidelity, etc - basically circumstances that stop the siblings/relatives from meeting before adulthood or, in many cases, even knowing of their relationship.

There are a couple of theories behind why this happens. Surveys find that people commonly find that faces similar to their own are more attractive - usally such things are hereditary. In 2004 Bereczkei argued that children "imprint" on the opposite sex parent and hence go after people with similar interests and personality traits. However there is a great deal of debate over this as we don't know if such traits are inheritable and to what extent. Anyway, if inheritable they will likely stick to close relatives.
Truth be told, I'm very divided on that particular issue (whether or not personalities/interests are inheritable) and am likely to go into detail in another post.

Now, you're probably wondering what I meant by "imprinting" and if you've read/watched Twilight you will recognize it from Breaking Dawn (whether or not you are smiling or cringing at the reference is subjective), however the term "describe[s] situations in which an animal or person learns the characteristics of some stimulus". The most common version is filial imprinting where the child!animal takes on the characteristics/behaviours of the parent!animal. Such situations include those were an animal of one species spends it's "childhood" with animals of another so it grows to act like them - for instance I owned a cat which thought it was a dog. Next type is sexual imprinting, which is where child!animals learn to be attracted to traits that the animals that raised them possess - a contributor to Bereczkei's theory.

Finally we take on the other side of this argument - the Westermarck Effect. This is reverse sexual imprinting, and why children don't normally feel sexual attraction to siblings, parents, and other close relatives. It works on the basis that where two people who live in close proximinity during the first few years of life they will become sexually desensitized to each other. This has been observed in many situations, such as the Israeli kibbutzim, such that basically where children are raised in groups there is a very small number of marriages between members of that group in the long run. In the mentioned example, of nearly 3,000 marriages only 14 happened in the same group, and none of them were raised together during the first 6 years of life. Therefore children who are raised together in the first 6 years of life are unlikely to become sexually attracted to each other at a later point.

What I like about these theories combined is that they debunk other theories... like Freud's (dude, not everything comes down to sex). While Freud argued that all children lust after family members based on his having an "erotic reaction" on seeing his mother dress, Westermarck pointed out that Freud was raised by a wetnurse and thus never desensitized to her.

Anyway, many historical accounts of this can be seen. In ancient Egypt, in order to preserve the royal blood (which was carried through the women) royalty used to raise boys and girls separately before marrying the next Pharoah to his (half)sister - since they never met in the first 6 years, the Westermarck effect was avoided. However in Europe at some point they attemped the same thing only to have the King and Queen refuse to breed because they saw each other as brother and sister due to being raised together.
This is also why marriages between cousins were so much more popular as a combined affect of both effects - not being raised together during the critical phase and being genetically similar enough to cause GSA.

For the sake of fairness I will mention that the genetic side-effects of inbreeding between cousins have been mostly exaggerated the likelihood of birth defects is only 4% compared to the usual 2%. However, as you can see in the British royal family Haemophilia has been concentrated due to a long history of inbreeding.

Actually, Fridge Brilliance in that the Greek Pantheon's notorious inbreeding actually makes sense since none of them were raised together, since of the first six gods Hestia, Demeter, Hera, Hades, Poseidon, and Zeus all but the youngest were devoured by Chronos and Zeus was raised by nympths on Crete. Therefore none of them were technically raised together so it would be natural for Zeus to be attracted to his sisters (having married Hera, having Persephone with Demeter, and Hestia was apparently so desired that she pledged herself to chastity). Depending on the "being eaten by Daddy" situation, Poseidon's attraction to Demeter may or may not be justified, but Hades's attraction to Persephone would certainly fall under here due to this effect since nobody ever visited him (as well as the fact that he lived a dull existence and she was just the perfect ray of sunshine).

What, ironically, makes less sense is the Egyptian Pantheon unless their gods were raised the same way as their royalty - I haven't read anything to specify so.

Anyway, hopefully this has proved enlightening in some way or at least gave you something weird to think about... which, let's face it, is clearly my main intention.

Self Fulfilling Prophecy

When one hears the phrase "self fulfilling prophecy" most mythology buffs will immediately think of the story of Oedipus - the boy who heard that he will kill is father and marry his mother, prompting him to leave town to spare his parents who were actually his adoptive parents and thus actually end up killing his biological father and marrying his biological mother. There is also the fact that the whole reason he was left on that hillside was because his father heard a prophecy that he would be killed by his son.

Actually come to think of it an awful lot of kings get that prophecy thrown at them.

Another example is Paris of Troy - Paris was a shephard after his parents abandoned him to the wilderness because the queen dreamt that she gave birth to a firebrand who would bring Troy to ashes. Zeus chose Paris to judge the the beauty contest that the goddesses were having because he was a humble shepherd. If not for that prophecy Troy wouldn't have burned. (Actually, the Trojan war can be traced back to a curse many generations prior on another household but suffice it to say that that the stars were not aligned favourably. :P)

One final example is actually from Norse mytholgy - Odin was told that Loki and his children would bring about the end of the world. So what did he do? Lock up all of Loki's kids and have everyone shun the guy. Gee, I wonder why the god of Mischief slowly got evil and at least three of his kids grow to hate Odin. (Fun fact: Loki was actually benevolent - one myth I stumbled across actually had a poor couple ask Tyr and Odin for help in saving their sons from giants only to have those two give up after failing once. When they prayed to Loki, he actually fixed the problem permanently.)

Anyway, you are probably wondering why I related these tales to you. It's because these "prophecies" aren't just restricted to mythology or fantasy - they are very much applicable to real life.
If you look at each of the above examples the prophecies aren't predicting happy dreams of fluffy bunnies and spiders - they're all about destruction, death, and general negativity. They're about fear. We may as well call them "self fulfilling fears", which is actually what I wish to talk about.

Now, a lot of us have a fear of some sort: I, myself, have a fear of falling. (No, not a fear of heights - that would be irrational...) However, the fears I wish to discuss are the psychological ones (yes, I know all fears are psychological but I mean the ones that aren't a fear of a physical thing... or lack of thing). For instance a fear of heights falling is hardly self fulfilling.

This is hardly a new concept - it's all over the place in sociology (and time travel). I'm just putting it in one place and chatting about it. (It is also in economics but I will cover that subject in more depth in a later post.)

Since most people are familiar with the Pygmalion effect (treat someone one way, or expect someone to do something and they will meet your expectations - e.g. Loki) we won't dwell on it, mainly because it's the Reflexivity Theory that is most relevant here. It's where you believe something will happen, so you react in accordance to that belief thus bringing about that belief (also present in the Loki myth). (Economics example is that if you believe prices will fall you will sell - this causes supply to increase and demand to either decrease or remain unchanged, either way the prices will fall.)

I will use three examples of fear to explain:

Fear 1: Abandonment.
Now someone thinks that their friends or family members will eventually leave them - perhaps this belief is founded, perhaps not but that's not the point. Depending on the individual there would be two more common reactions - clinginess (must hold onto them while I can) or distance (mustn't get attached because they'll go away). Blah blah clinginess makes people want to have their space blah blah - discussed to death. In the case of distance this makes the people around that person wonder what is wrong but the fact that they keep getting stonewalled will make them think that they are not wanted and so the will eventually leave. There we go, "abandonment".

Fear 2: Not Good Enough
This is one I saw recently. Now, keep in mind that the idea of "good enough" is subjective. The person believes that they "ruin good people" or "don't deserve good people" - good being their own definition. So, they settle for what they believe are "bad people" because it's what they think they deserve and further indulge in "bad behaviour" - rending thing unworthy (in their minds) of said "good people". Eventually they may actually become unappealing to the "good people" if these behaviours are that opposite those of the "good people" (not saying the "good people will look down on them but just that they don't want to date them - there's a difference). Self-fulfilling.
(The main thing in this one is that they really believe this and that nothing they can do will ever make them worthy - that is their fear.)

Fear 3: Crushing Rejection (pun!)
Suppose you have a crush on a friend, maybe a new friend. Now, obviously you really like them and you don't want to scare them off by declaring it. You want to be sure first. So you wait a while and guess what? You really do like them. But you also like them as a friend and, just like before, you don't want to ruin the friendship. At the same time you don't want to be stuck in the "friend zone" for eternity but the "ruin the friendship" fear is greater. So you don't say anything and the crush gets worse as you get more and more attached and hence more and more afraid to confess. This one isn't so much self fulfilling as it is self stagnanting. A vicious cycle where the fear feeds itself.

I'm not saying that you shouldn't be wary of these things, but being afraid of them results in more harm than good... such as the fear itself or stagnation. A wariness would be much better served - so that the first prson doesn't push people away, so that the second seeks to correct what they see as "bad behaviour" rather than fall into it, and so that the third isn't so paralyzed.

The last thing I said about Fear 3 was that the fear feeds itself - the same goes for them all. Fear 1 gets more rejection, and Fear 2 becomes more "unworthy". They all dig themselves into a deeper pit from which it becomes very difficult to emerge from.

Fear... it's pointless. Wariness isn't - you should be cautious. Fear for your life is ok - that's instinct. But these other fears feed themselves and grow. Even "fear of failure" results in a crash and burn scenario from overwork, or failure at something they neglected (usually a personal life). But yeah - fear is self fulfilling, so don't give it the satisfaction. As you can see with the above examples, it's very difficult to get out once you're in.

(P.S. It's Monday here so... I'm still adhering to my schedule.)

Addendum: Fear 3 is not a bad thing so long as it's weariness and not fear. Not confessing because you're scared is silly; not confessing for other reasons is not. For instance, if you know your friend doesn't feel the same way (duh), if you're not sure how they feel (this is not a "scared" thing - the fact is that they may feel pressured into reciprocating those feelings or it could get awkward for them. It should be more about how your news will effect them.), or, and this is a nice one, you are happy being "just" friends with them and value that over the possibility of a romantic relationship. There is nothing wrong with friendship after all.

I just felt I had to clarify that.