: not a blog

08 feb 07

do you have any personality disorders? NPD?

i have many.

when you take this test, bear in mind that 1. this is the internet, 2. self-report fouls everything up (it's obvious what the questions are getting at), and 3. "personality disorders" aren't all that clinical or clear-cut to begin with.

mental illness and its diagnosis is particularly susceptible to grey area, and is a good example to use (along with "race" in humans) if your intent is to demonstrate that all categories are invalid.

but seriously, who's to say who has an anxiety disorder, who's manic depressive, and who's autistic? a patient might obviously be more one than another, but often patients will exhibit signs and symptoms of many "disorders" ("collections of symptoms" is maybe better), and it's just a matter of narrowing it down to put something on the insurance form, and decide on a good treatment (prozac, "how do you feel about your mother?", or "here's what you should think to yourself the next time deepak pisses you off at work").

to elaborate more on the use of "random drug x", psychopharmacologists sometimes prescribe psychoactive drugs to treat conditions not considered by the drug maker. moreover, these unintended uses are often just as legitimate (ie, produce just as good results) as what's indicated on the bottle. for instance, i believe prozac is used to treat patients with certain eating disorders, even though the drug was originally developed an antidepressant.

no-one knows exactly what's going on with these drug-brain-mind interactions, electrochemically, and so if a new use for a psychoactive drug is discovered (benifical effects are observed), everyone is that much happier. or, that much less anxious, less prone to stuff their face, less prone to run naked through the streets, etc.

i'm ultimately forced to the conclusion that the whole process of psychiatry can be reduced to: "i don't feel well in the head". "here, take this". "what is it?" "it doesn't matter." most of the time the patient will feel better.

that's a silly exaggeration, but it holds truth. this is not to consider diagnoses as murky as "personality disorders", which might just be "personality traits that we don't like", or that our culture doesn't like. behavior that has been determined to be wrong or bad is easily made into an illness, or "disorder". it's been done for centuries. homosexuality was removed from the DSM-IV ("diagnostic and statistical manual #4", a list of mental illnesses that men in white coats use as legal grounds to put you away) only about 30 years ago.

i probably have some features of narcissistic, avoidant, histrionic, dependent, and antisocial personality disorders (i took that test). in fact, the only disorders i didn't score significantly on were obsessive-compulsive and paranoid. so, one or both of the following is true: 1) i am sicker than your average monkey. 2) there's some bullshit going on here.

both, probably.

The DSM adopts a categorical approach, assuming that personality disorders are "qualitatively distinct clinical syndromes" (p. 689). This is doubted by many. The polythetic form of the DSM's Diagnostic Criteria—only a subset of the criteria is adequate grounds for a diagnosis—generates diagnostic heterogeneity. In other words, people diagnosed with the same personality disorder may share only one criterion or none. -- someone

interestingly, this isn't engineered to be technically possible according to the DSM-IV diagnostic criteria. for example, in NPD (narcissistic personality disorder), we need the presence of at least five to make a diagnosis. and, there are only nine possible symptoms. it almost seems as though it were set up this way to avoid categorical ambiguity -- if you have a five-symptom requirement and only nine symptoms, then it's not possible for two diagnosed patients not to share at least one, and exactly one, symptom.

here are what the DSM-IV's diagnostic criteria for NPD:

Diagnostic Criteria

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 interpersonally 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

does that sound like me to you?

it might, because you can define and interpret the terms any way you like. upon closer examination, these symptoms or criteria reveal themselves to be literary and imprecise; cetainly unscientific. take number eight: "shows arrogant, haughty behaviors or attitudes". do we really need this one in there? it seems like an umbrella symptom for the others. and certainly all of them are open to interpretation: what does it mean, for instance, to "be preoccupied with"? how many seconds of a given day? what's a "fantasy", anyway? a dream? an occasional thought of "that'd be cool"?

i'm not trying to totally shut down all psychology here, but only to point out that it's an inexact, art-centered discipline, and furthermore that personality disorders are even more inexact and art-centered than other diagnoses, particular axis-I diagnoses.

in the DSM-IV, "axis I" disorders are more serious, organic, clear-cut, debilitating condtions, like depression and schizophrenia. "axis II" disorders are less so, and happen to include just the personality disorders and mild mental retardation (don't ask me). at any rate, they're placed on a different "axis" to demonstrate that they're not as dangeorus or as treatable as those on "axis I".

the DSM-IV is sort of scary -- it amounts to a work of literature that's used to impose social control.

here are all of the recognized "personality disorders", and a general idea of what sort of behavior constitutes them:

1. antisocial: hannibal lechter. formerly "sociopath", and formerly still "psychopath". overlap with schizoid (people are inconsequential), and narcissistic (i am all-important).
2. avoidant: hates and fears social contact -- afraid he can't do it right, so avoids it. "social phobia", bacially. lots of overlap with schizoid PD.
3. dependent: self-explanatory (fear of independence, in constant need of "help"). smacks of "avoidant PD".
4. schizotypal: borderline dellusional -- the type of person who thinks aliens walk among us. lots of overlap with paranoid PD, although paranoid PD doesn't have to feature mild dellusions.
5. narcissistic: thinking you're wonderful, even if you're not, and thinking that others should think you're wonderful, too. and, apparently, me.
6. borderline: even more bullshit than the other PD's. just basically a crazy person; sort of a cross between narcissistic, hystrionic, and schizotypal. a lot of times it's narrowed to 1) emotional disregulation, and 2) black-or-white thinking.
7. hystrionic: think of your typical pretty girl. no, haha, that's mean and racist (?). well...yeah: someone who needs to be the center of attention, gains this with her appearance and affect, sexualizes every situation, and tends to spazz out and cry "me! me! me!" when she's not content (ie, not the center of attention). this is why i don't like pretty girls. i mean, until i find one to marry me, at which point she will become the only exception (this is what i will tell her). overlap with narcissitic.
8. obsessive compulsive: counting the cracks in the sidewalk, needing to turn every door-knob back and forth before opening a door; that sort of thing. overlap with schizotypal (magical thinking).
9. schizoid: similar to an autistic. like the attendant says in the movie "rainman", about raymond the rainman: "people aren't exactly his first priority". somewhat like avoidant PD, but more serious. in the case of the schizoid PD sufferer, he isn't scared of or worried about having relationships with others -- he simply doesn't care. my idol.

Common Axis I disorders include depression, anxiety disorders, bipolar disorder, ADHD, and schizophrenia.

Common Axis II disorders include borderline personality disorder, schizotypal personality disorder, antisocial personality disorder, narcissistic personality disorder, and mild mental retardation.

i have everything on this list except for schizophrenia, schizotypal PD, and mild mental retardation (though i've never had an IQ test, and i do lose my wallet a lot). futhermore, i was diagnosed by the MMPI (Minnesota Multiphasic Personality Inventory) as "schizophrenic prey". ie, i'm someone who, at the time of taking the test (1993), answered questions as did people who developed schizophrenia later in life: specifically, early adulthood. i'd be concerned, but the six-eyed transluscent floating fish that keeps kissing me tells me it's nothing to worry about.

i have a couple of friends who are convinced that i'm autistic. some other people think i'm narcissistic (ahem). i, on the other hand, think the best way to describe me is solipsistic -- i don't love myself unduly (far from it), and i'm not unable to read and be affected by the emotions of others (far from it). however, i am self-centered, although not in the sense of ordering people around to get me fruit plates while i file my nails -- just in the sense that i'm sort of burried in my own mind, and i find the rest of the universe to be a bit oddly unreal. or maybe a better way to put it would be that i divide reality into two categories: self and other.

but, whatever. like i said, not only are these things completely murky and unreliably signaled, but personality disorders aren't really treatable. treating a PD would be like treating someone for being an asshole, which is a category that i might like to add to the DSM-IV, if i ever get on the right committee. i know a lot of people i would diagnose.

ok, so my answer is "no, personality disorders are bullshit". but i am self-absorbed (although not necessarily selfish and bratty) -- in some ways, i just don't understand other people as entities in any way like myself. maybe it's as simple as i just don't like many people.

although this one retired guy -- a 65 year old taiwanese former structural engineer in my computer animation class -- is nice. i can relate to him. but most of the other people in that class are just boneheaded and silly; teenagers sporting their various headgear, like this one kid with a ski-jump nose, a tiny little head and blue hair, who's about 6'3" and probably weighs 150 pounds. he was yelling the other day about how he didn't want to see "an inconvenient truth" because al gore was so stupid as to have claimed to have invented the internet.

During my service in the United States Congress, I took the initiative in creating the Internet. -- al gore

he passed a bill that funded network development, at a time when network use was largely unavailable to most people outisde of universities and the military. he misspoke a little bit, but he didn't claim to have invented the internet. "i helped develop greater public awareness and use of the internet" would have been a better thing for him to say, but you know what they say about "would have", "could have", and "should have".

i read that walking is one of the most fundamental, and also one of the most difficult, animation skills to master. i think i did pretty well here, even if it's a little choppy, and even if he keeps walking right by the parthenon without giving it so much as a glance. what a nekulturní.

solipsism is "the position that the self is the only thing that can be understood or verified". maybe it'd be good to substitute "narcissistic personality disorder" with "solipsistic personality disorder" in the DSM-IV; i'd be more willing to diagnose myself with that. but the fact is, i don't attribute enough value to myself and my "achievements" to be a proper narcissist, let alone a pathological one. of course, that's what all narcissists say.