FamilyMan75 - I have wondered about the diagnosis (or lack thereof) for my WH as well. He scores high (very) on the narcissist scale, but there are certain characteristics that go along with NPD that he does not have. There are times when I have hoped (as f-ed up as that is) that he got a full blown NPD diagnosis because it would have made it easier for me to just say "your problem is beyond repair" and walk away. But I eventually had to ask myself, do I need an NPD diagnosis to say the problem is beyond repair where HE doesn't want to do the work to try to fix himself? The answer that I came to is "No" precisely because if he doesn't want to fix it/work on fixing it to a more normal level, then it is beyond repair.
To use NPD as an example, the DSM is changing the characteristic from DSM IV to V therefore potentially diagnosing individuals with NPD who would have not been diagnosed before (and excluding others, but not many). Basically, the diagnosis is changing
NPD for example is classified using DSM IV as follows:
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
2. Is 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. Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations.
6. Is inter-personally exploitative, i.e., takes advantage of others to achieve his or her own ends.
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviors or attitudes.
My WH meets 4 of the 9 (missing 1, 3 (he doesn't care about associating with people of "high" status or what they think of him) and 5 and 8-9 but scoring exceedingly high on 4-7 and high on 2). Therefore under the DSM IV he is not NPD but has severely high narcissistic traits.
DSM V changed the diagnosis to the following:
The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of
pathological personality traits. To diagnose narcissistic personality disorder, the following criteria must be met:
A. Significant impairments in personality functioning manifest by:
1. Impairments in self functioning (a or b):
a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.
b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.
AND
2. Impairments in interpersonal functioning (a or b):
a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.
b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others‟ experiences and predominance of a need for personal gain
B. Pathological personality traits in the following domain:
1. Antagonism, characterized by:
a. Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others.
b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.
C. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.
D. The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural
environment.
E. The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication
My WH may meet the new standards as he is borderline A.1.b., meets A.2.a. and b. (severe lack of empathy and relationships to fill personal needs), does not meet B, meets D & E (not normal for his age/sociological standard, and not a result of substance abuse), C is unclear (does not seem to be stable/standard across time).
A few other things weighing against NPD - he is willing to seek treatment/recognizes there is "something wrong" with him. He wants to "blame" a lot of his problems on his depression that he cannot take meds for, and I think he hopes that the meds (when he can take them) will "fix everything" as he's said as much. He feels like he lives in a cloud where nothing matters and he seeks out things that will distract him from his life - aka "fantasy land" and "cheap thrills" to avoid whatever is going on in his head. But all that being said, he is keenly aware that there is something "not right" with him - that is a big checkmark against NPD as that type of awareness and acceptance is generally absent.
Basically, my WH does not seem to have full blown NPD, and if he did, it would be on the lesser scale. Does that really matter? He lies, cheats, devalues, has control issues, is easily angered and upset by minor things but is "afraid" to address his issues (I think because he fears there is something MAJORLY wrong with him that would end up causing him to lose his job and have people look at him in a negative/weird way). He is so filled with fear and low self esteem that he just can't see a way to dig himself out, and no one can help him but him. Yet, in his own words "What is the key? What would change look like? I am afraid."
My WH's therapist basically said the same thing your WS's therapist said (just substitute "him" for the word "her" and you're there:
That pretty much her issues likely stem from depression, low self-esteem, and emotional immaturity.
When you add in the fact that my WH was beaten and largely ignored as a child, and that major depression runs in his family (both parents are on meds and his brother is an untreated mess as well), and that no one ever talks/talked about any of it, and you have a perfect storm of fucked-up. The diagnosis really doesn't matter much - it really is their behavior. My WH doesn't want to change, or maybe he does and he's too afraid to do anything/admit how screwed up he really is. For me (and for you) that really is the bottom line.
[This message edited by ThisIsSoLonely at 10:20 AM, August 12th (Monday)]
