Histrionic, Somatic Personality Disorders - Excerpts Part 4 - Narcissists as Friends

Written by Sam Vaknin

All PDs are interrelated, in my view, at least phenomenologically. True, there is no Grand Unifying Theory of Psychopathology. No one knows whether there are - and what are - the mechanisms underlying mental disorders. At best, mental health professionals register symptoms (as reported by the patient) and signs (as observed by them in a therapeutic setting). Then, they group them into syndromes and, more specifically, into disorders. This is descriptive, not explanatory science. Sure, there are a few theories around (psychoanalysis, to mention the most famous) but they all failed miserably at providing a coherent, consistent theoretical framework with predictive powers.

Still, observations are a powerful tool, if properly used. People suffering from personality disorders have many things in common:

1. Most of them are insistent (except those suffering from the schizoid or the avoidant personality disorders). They demand treatment on a preferential and privileged basis. They complain about numerous symptoms. They never obey the physician or his treatment recommendations and instructions.

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2. They regard themselves as unique, display a streak of grandiosity and a diminished capacity for empathy (the ability to appreciate and respect the needs and wishes of other people). They regard the physician as inferior to them, alienate him using umpteen techniques and bore him with their never-ending self-preoccupation.
3. They are manipulative and exploitative because they trust no one and usually cannot love or share. They are socially maladaptive and emotionally unstable.
4. Most personality disorders start out as problems in personal development which peak during adolescence and then become personality disorders. They stay on as enduring qualities of the individual. Personality disorders are stable and all-pervasive - not episodic. They affect most of the areas of functioning of the patient: his career, his interpersonal relationships, his social functioning.
5. The person suffering a PD is not happy, to use an understatement. He is depressed, suffers from auxiliary mood and anxiety disorders. He does not like himself, his character, his (deficient) functioning, or his (crippling) influence on others. But his defences are so strong, that he is aware only of the distress - and not of the reasons to it.
6. The patient with a personality disorder is vulnerable to and prone to suffer from a host of other psychiatric disturbances. It is as though his psychological immunological system has been disabled by the personality disorder and he is left prey to other variants of mental sickness. So much energy is consumed by the disorder and by its corollaries (example: by obsessions-compulsions), that the patient is rendered defenceless.
7. Patients with personality disorders are alloplastic in their defences. In other words: they would tend to blame the external world for their mishaps. In stressful situations, they will try to preempt a (real or imaginary) threat, change the rules of the game, introduce new variables, or otherwise influence the external world to conform to their needs. This is as opposed to autoplastic defences exhibited, for instance, by neurotics (who change their internal psychological processes in stressful situations).
8. The character problems, behavioural deficits and emotional deficiencies and instability encountered by the patient with personality disorders are, mostly, ego-syntonic. This means that the patient does not find his personality traits or behaviour objectionable, unacceptable, disagreeable, or alien to his self. As opposed to that, neurotics are ego-dystonic: they do not like what they are and how they behave on a constant basis.
9. The personality-disordered are not psychotic. They have no hallucinations, delusions or thought disorders (except those who suffer from a Borderline Personality Disorder and who experience brief psychotic "microepisodes", mostly during treatment).

They are also fully oriented, with clear senses (sensorium), good memory and general fund of knowledge and in all-important respects "normal".

The bible of the psychiatric profession is the Diagnostics and Statistics Manual (DSM) - IV-TR (2000). It defines "personality" as:

"...enduring patterns of perceiving, relating to, and thinking about the environment and oneself... exhibited in a wide range of important social and personal contexts."

Click here to read its definition of personality disorders

next: Excerpts from the Archives of the Narcissism List Part 5