Clueless experts lump personality disorders together

The BBC recently wrote that people need to be more aware of personality disorders, including antisocial personality disorder so far, so good. Then the article stated that most people with personality disorders do not commit offenses, and says:

Experts are now trying to train those who are most likely to come into contact with a personality disorder how to recognise the condition to make the situation easier to manage.

This is crucial because the way in which staff interact with someone who has a personality disorder can affect the patient’s condition.

Sigh. This education process is going to be long and hard.

Read Personality disorders are ‘widespread,’ say experts, on BBC.co.uk.

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10 Comments on "Clueless experts lump personality disorders together"

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Yea, Donna, you are right, this educational process is going to be long and hard, but IT IS A START!

The part where the good doctor said it might be a “cure” didn’t bode well for either the reporting, or his ideas that PDs can be “cured” but I do think that training people to RECOGNIZE them and possibly tone down a SITUATION might help.

As well…..as if police, lawyers and judges are educated as well, maybe it would make some differences in how the ones who are criminal are handled, or family law cases and custody.

Sigh…yes, it isn’t much, but MAYBE IT IS A START.

Another article actually defending the kinds of personality disorders which lead to distress and violence. Now if we knew what kind of personality disorder it was which lead to most violence and offences we would have more chance to avoid this and more hope to push for intervention. Who’s betting the narcisists and other drama queens take the prize for most mayhem?

What shocks me is that there could be 13% of the population with a personality disorder. It’s slim pickings out there, I’m way better alone.

The fact that the article implies that there is a cure or way of dealing with these people that isn’t detrimental to our psyche, is pure rot. How can you deal with people who don’t think anything is wrong with them and don’t want to change? Who is going to remedy that?

I think personality disorders are so ingrained, there is no changing them. We can deal with them differently by not getting involved with them, with family- limiting our relationships and having very good boundaries.

Some bi-polar disorders and schizophrenia can have their symptoms managed with therapy and medication, but they still have the disorder!

I read a book on narcissism that talked about dealing with a narcissist effectively and still having a relationship with them. In my opinion, they may have narcisstic traits but not the full blown disorder. Just my thoughts. I would like to know what doctor out there has cured narcissism or sociopathy? Any case studies? Didn’t think so.

Dear Hope4,

Good to see you kiddo!! Yep, no case studies on that one, however, in looking at the current thought, support and literature on families being supportive of people on parole….encouraging people to hang in there with their family criminal who is in the pen, it isn’t for the good of the FAMILY it is for the good of the SYSTEM. Give Junior a place to go when he gets out of prison, give him food, a place to flop, transportation and so on,, so the SYSTEM is not burdened with trying to get these things for him or turn him out on the street homeless with $20 in his pocket.

As it is only 40% of the prisoners released on parole complete parole without commiting another felony. But when 25% of them are scoring 30 on the PCL-R as full fledged psychopaths, and the rest of them have an AVERAGE score of 22 (less than 5 is “normal”) WHAT DO YOU EXPECT almost every prisoner has a HIGH SCORE on the PCLR, though there are probably a FEW with lower scores, but the majority of people who end up in prison go back and go back and go back. Even if they don’t go back, they sure are NOT GOOD CANDIDATES FOR A “RELATIONSHIP.” Yet, over and over people are told to “hang in there” and be supportive of these people high in psychopathic traits, but it is not for the benefit of the families, but for the system’s benefit.

Sure, there are a few who make it, who were not psychopaths to begin with and one of the prison ministries that I know about has only a 10% recidivism rate….and the reason I got interested in this group is that my P-son got into it (as a way to get supply, don’t you know! LOL) but I’m not so sure that it is because they do so much good turning people around, as that they probably select out the “cream of the crop” as far as the non-psychopathic inmates, rather than changing anyone who is a psychopath. 15 years of hearing their sermons weekly didn’t keep my P son from trying to kill me. LOL

Oy, what a troubling article. Very ambiguous, which sets my red flag detector going. On the one hand it sets up an “us vs. ‘them'” tone. On the other, as HopeforJoy points out, it de-emphases the horrible damage the most severely personality damaged can do.

What I find most disturbing is the overly-generic linguistic ‘sleight-of-hand’ that lumps in pretty much anyone the reader may not like into that ‘other’ group. Forget the terms psychopathic, sociopathic, narcissistic – now the reader can freely discriminate against the following Personality Disordered “Types”:

“Personality Disorder types and the associated symptoms
Odd/Eccentric: people can be paranoid; indifferent to social relationships; unable to relate to people; have an unusual appearance
Dramatic: people can be histrionic; narcissistic; have unstable moods; fear being abandoned and self-harm.
Anxious: people can be preoccupied with orderliness and perfectionism. They may fear negative evaluation; feel inadequate in social situations; are dependent and submissive.”

You’ll notice that exploitation wasn’t anywhere in the above list. One could argue that many (if not most) victims coming out of a spath relationship would temporarily fit some of the above criteria.

Reading between the lines, it almost sounds like this is an ideal setup to use to define victims as being equally disordered as exploitative personalities. An old acquaintance of mine used to say that society doesn’t much care if you’re a perpetrator or a victim – to the non-victimized ‘both’ are equally “trouble – best to stay away from”.

“For example, a belief that people with personality disorders often have is, ‘people cannot be trusted – they will always let you down.'”

The above quote could just as easily be attributed to every LF reader when they first join this site. What’s missing from that equation is the purpose and benefit of this site, which is to teach victims and non-victims alike: 1) that not everyone can be trusted, and 2) WHAT TO LOOK FOR so that you LEARN who to trust, and who not to trust, and WHY.

I would imagine there are a number of spaths quite happy to read this article’s disinformation.

Edit: Oxy – great point about the parole criteria being there for the good of ‘the system’, not the good of the family (or society for that matter). I think that would be a good topic for a future article.

Dear Annie,

Actually I was thinking seriously about doing a BOOK on that very thing….then decided to save my energy and focus more on helping myself than doing the “John The Baptist” stick—crying and preaching in the wilderness to people who didn’t want to hear me in the first place! LOL And, frankly, I’m NOT a expert on that subject by a long shot—I know my own personal observations is about it….of course that didn’t keep me from writing other articles about thing ain’t no expert on anyway! LOL Seriously, though, there are some people here actually who ARE much closer to being experts and have some professional experience working in prisons (which I don’t) who I think SHOULD write articles and books about this subject and with a lot more credibility that anything I would write would have.

I actually collected about two dozen books written for family members to tell them how to survive while their “loved one” is in prison, and how to keep their love alive why their lover is in prison….but not one book did I find that said “Protect yourself from your loved one—s/he is a psychopath” although clearly at least 25% of the time THAT IS A TRUE STATEMENT.

If you take into cosideration that the AVERAGE score on the PCL-R for ALL inmates is 22 (it only takes a 30 to qualify as a P!) and normal scores are 4-5, then you can see that ALMOST NO INMATES are worth much in the way of RISKS for being a good intimate partner if you look at it statistically…..and yes, I do know that a FEW (percentage wise) do come out of prison and turn their lives around—-but what are the ODDS? Let’s see, they have an AVERAGE PCL-R of 22, 60% of them don’t complete their parole before committing another crime….(rolling eyes up and to the left here) DUH, welllllll…..I guess we can eliminate As a lover anyone who has a felony criminal record, huh? Let’s see, there are about 2 MILLION in CUSTODY TODAY, about 5-8 million on parole/probation now and how many ex cons in this country? A BUNCH!!!! And how many “half way houses” are there to take them if their family won’t? Yep, I’d say the system has a BIG vested interest in promoting the “family” to stay in touch with Bubba and take him in when he gets out of prison.

I think the real problem with this article is the notorious hordes of leftists who have been infesting the BBC for decades. As an article, it would have been valuable enough in two respects: first, by bringing attention to the prevalence of personality disorders, and second, by highlighting the fact that people with these conditions can need careful handling. Much of the article is about special training for an array of workers, including prison officers, who are likely to come into contact with personality disordered people. (It doesn’t state whether this “training” includes firearms and other self defense tactics!)

But the flaw is not JUST that it lumps the relatively “harmless” disorders (like “dependent personality disorder”) together with those that can be downright dangerous. Even when personality disordered people do commit serious crimes, the writer seems to be speaking of them as “poor victims” of their own mental condition. It’s very euphemistic in discussing these people’s misdeeds. Nowhere does it speak bluntly of abuse, fraud, assault, robbery, rape, mayhem or murder. At worst these people can be “unco-operative,” or (on a really bad day) “threatening” or “aggressive.” The writer seems to be worrying most about how this “causes distress to THEMSELVES” (with “others” added only as an afterthought), how it “gets THEM into trouble,” “gets them involved in the criminal justice system” so that they “end up in prison.” There’s virtually nothing about what they DID to get there, or the lives they destroy in doing so.

In other words, this much is nothing but typical “bleeding heart liberal” soft-on-crime garbage that used to be so common in the latter part of the last century. The BBC is still full of dinosaurs who are about forty years out of date. And if they do believe all these disorders can be cured by present methods, that’s just one more manifestation of the stock leftist belief in the supposed “Perfectibility of Man.”

Anyway, it is annoying when people WILL go lumping personality disorders together as if they were all the same. But what can we expect, when some of the so-called “experts” responsible for DEFINING personality disorders are doing exactly that, willy-nilly?

It’s been well said that a CAMEL is “a horse designed by a committee.” It’s typical of the misshapen things some committees come up with, and look at what they’re doing now!

The DSM-IV was already bad enough with its loose treatment of quasi-“psychopathic” conditions. The committee responsible for this had all the tools they needed in the form of the well established and widely recognized PCL-R to define “psychopathy” as a disorder. Instead, the DSM-IV committee rejected that obvious and sensible solution, supposedly due to a belief that there was “too much subjectivity” involved in the diagnostic approach. As if there wasn’t “subjectivity” involved in ALL diagnoses of mental disorders! I think what they were really saying was that it was too much trouble to get an accurate diagnosis!

So instead of accepting “psychopathy” as a well defined condition, they substituted a far broader notion of their own that they dubbed “antisocial personality disorder.” The trouble with “ASPD” is that it’s based far too heavily on purely behavioral criteria. That’s just because “behavior” is easier to assess—as opposed to the deeper psychological factors at the root of the behavior. In other words, a diagnosis of ASPD may tell us WHAT some people are prone to do, but NOT necessarily what a diagnostician NEEDS to know: WHY they’re doing it! It doesn’t always tell us what precisely is wrong in their minds that makes them behave that way.

The result of this sloppiness was obvious when it was put to the test. For one thing, although so many psychopaths and those labeled with “ASPD” are convicted of crimes, the DSM-IV definitions were never tried on prison populations, a group to whom they are extremely relevant. Other studies have found that while about 20 percent of prison populations (depending on the estimate) can be identified as true psychopaths, as many as EIGHTY or even NINETY percent meet the much looser criteria for so-called “antisocial personality disorder”!

Now there is an argument that some people could be “moderately psychopathic” without scoring high enough to be “full blown psychopaths.” However, a proportion as great as eighty or ninety percent is way out of the box. People commit crimes that get them sent to prison for all kinds of reasons, not just because they’re psychopaths. Some of these are treatable. Substance abuse is just one major factor that comes to mind. Drugs for instance are behind a lot of criminal behavior in people who are not necessarily psychopathic. Many steal to finance their habit. Some end up in prison for drug possession alone. In some areas, social factors play a strong part. Young people fall in with gangs and end up in prison for their ill-advised criminal activities. Other offenders again will be suffering from different mental conditions, not even “personality” disorders necessarily. It’s almost absurd to imagine that only TEN percent (or even twenty percent) of incarcerated offenders are not psychopaths. In reality, a “diagnosis” of something called “ASPD” must be catching a lot of people who are not psychopaths at all, though many will be affected by some quite different condition.

Plainly a “condition” as broad and vague as ASPD is not too far from being meaningless. Some critics have claimed that ASPD is “virtually synonymous with criminality.” As a “diagnosis,” it tells us very little that we don’t know already, beyond the fact that somebody has been committing crimes. A diagnosis of psychopathy is much more useful, not least because it’s been found to be a good predictor of persistent violent criminality, which “ASPD” is not. I must also wonder if the definition of “ASPD” would FAIL to catch many genuine psychopaths who have just been too cunning to get caught doing anything criminal. All this makes ASPD look like the kind of “camel” a committee WOULD design.

Yet now that the APA is revising their DSM once again, instead of correcting and tightening up their definition of the so-called “antisocial personality,” the new DSM-V committee is going further in the wrong direction. They’re making the definition looser still by lumping it together with “narcissistic personality disorder.” A great many experts are NOT happy about this change, and rightly so. One critic said it was happening because the DSM-V committee was overloaded with research theoreticians, at the expense of clinicians with sound practical experience. Here’s the article again:

NPD to be eliminated in diagnostic manual

So now they’re adding ANOTHER hump to their existing “camel” by grafting “narcissistic” characteristics onto it as well, making it into a kind of “Bactrian personality disorder” with two humps instead of one. The result of this conflating of two distinct conditions can already be seen in Susan Strudwick’s essay at explaining why the camel she’s calling a “sociopath” does commit suicide. True enough, some of them do, but she seems to be adverting largely (and unnecessarily) to specifically “narcissistic” traits in order to explain this, rather than traits that are essentially psychopathic—or for that matter, human universals.

And that’s not all, because the DSM-V committee is proposing to eliminate fully HALF of the ten recognized personality disorders and lump them in with other conditions. This is a loss of clarity and precision. The way things are going, pretty soon we’ll end up with ONE monstrous multi-humped camel called “Defective Personality Disorder,” though with zillions of variants.

For the ordinary person, the only saving grace in all this ia from a purely practical viewpoint. That is, that clinical conditions alone cannot and never could really tell us whether or not a person is a threat, or what kind of threat. Not, at any rate, without knowing the seriousness of their condition.

Most psychopaths are not serial killers, for instance. For that matter, some serial killers are not psychopaths either. Some have been paranoid schizophrenics, like Sutcliffe, Kaczynski, and Berkowitz. Some bipolar people are habitually abusive; many are not. Some people with borderline personality disorder will injure or kill you; many are not so bad. Then what about the recent spree killer in the UK, Derrick Bird? There’s nothing to suggest he was a psychopath, narcissistic, or psychotic for that matter. He just seems to have “blown up” when the pressure got too great. Nobody predicted it, though he undoubtedly had hidden flaws in his personality. The only signs I can see are the insecurities he was undoubtedly hiding, plus strong evidence of paranoid thinking on his part.

But there is not and never will be such a thing as “Abusive Personality Disorder” (APD), “Controlling Personality Disorder” (CPD), “Predatory Personality Disorder” (PPD), or “Homicidal Personality Disorder” (HPD). People who do these things, even habitually, can be driven by a variety of different conditions. The best an ordinary person can hope to do is to recognize, first, that these conditions EXIST, that some people CAN be dangerous, and second, to recognize SOME of the major warning signs. And above all, to TAKE CARE of oneSELF, and NOT let others take advantage of you.

By the way, I sincerely HOPE the APA is not eliminating personality disorders for crass financial reasons. However, I did see this speculation (for whatever it’s worth) from someone named “Danielle” on the New York Times blog:

More disturbing than these diagnoses being eliminated or submerged into other other domains, is the issue of why it is that the APA is making these changes to begin with. My guess would be that there is an industry influence, and more specificially that the pharmaceutical companies have some involvement. I wonder what kind of kick backs physicians are receiving for eliminating these diagnoses.

Personality disorders are notorious for being pervasive in nature, and patients typically do not respond well to medication therapies. Perhaps if those who would typically fall into Axis II criteria for a personality disorder are now only meeting diagnostic eligibility for Axis I, they would be more likely to receive insurance coverage for medicating these patients over longer periods of time. To illustrate this idea, patients diagnosed with Borderline Personality Disorder have long since been known to not respond to medication, but benefit tremendously from dialectical behavioral therapy ideally in a residential treatment setting. However, the vast majority of these individuals cannot afford to pay for this kind of therapy. So, if they are now diagnosed with an axis I diagnosis (borderline personality disorder is supposedly going to be moved to axis I along with the other mood/psychotic disorders like depression and schizophrenia) they can simply be prescribed an antidepressant/mood stabilizer that a psychiatrist, internist, PCP or whoever will quickly and easily be reimbursed for. Much more cost-effective for both insurance companies, providers and Big Pharma”less effective for the patient.

Just a thought but certainly one worth considering.
— Danielle

Dear Redwald,

“the camel is a horse designed by a committee” was my late husband’s favorite saying, and is one of mine. It describes so much how the DSM is written—everyone gets their hump on the diagnosis in so many instances, especially the personality disorders, I think.

Trying to decide scientific things based on a political consensus is almost impossible I think.

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