Passive-Aggressive Behaviour

NPD MIL has big anger issues. She is constantly simmering below the surface angry. My mother describes her as the most angry person she has ever met yet MIL has never raised her voice in my company. So how do I know she is angry?

You don’t have to shout to show anger. No fist needs to be banged on a table, no finger jabbed in your face, the teeth don’t have to show in a snarling mouth nor do insulting words need to be shot out with force. Anger can be a cold, crippling state of being that blackens your soul. My MIL’s soul is of the deepest black.

She hates her ex-husband, my lovely FIL. She hates him because he survives very well without her. She left him. He just wouldn’t rise to her bait and retreated into his work, slept downstairs in his office and became a non-person to her after their children grew and left home. She decided he was mentally defective and left him, as she tells it, for his own sake. This was after she tried to get a doctor to diagnose him with a rare form of early onset dementia.

So how does she show her vicious hatred? She redirects junk mail that occasionally gets sent to her (once their) house to his new partner with intimidating messages scrawled on the front. She found FIL’s partner’s address on the internet. Nice huh?

She now refuses to attend any event where her ex-husband may be present. Christenings, birthdays, graduations are all disrupted by her weeks of haggling over who will be there, when and with whom. If she is put on the defensive regarding her intractable demands about not meeting her ex she threatens to go to the police with a trumped up accusation of assault. I know it is trumped up as the actual story of the assault keeps changing, and more importantly it is supposed to have occurred in front of her children, in their late teens at the time, who noticed nothing at the time. Oh and it only ever gets brought out when she is backed up against a wall.

But what is interesting about her methods is their indirect nature. She never comes out and says “do this my way or I’ll go to the police”, that would be too obvious. She says things like “I can’t be in the same room as FIL. Maybe I should have been more insistent with the police, you know, with being assaulted. It still upsets me a lot…” the threat is left hanging, but the message is clear.

MIL is a master of passive-aggressive behaviour.

Responding to conflict

There is a range of interpersonal responses available to someone in a difficult situation. A completely passive response is like the dog rolling onto its back and showing its tummy.  You say nothing to express your own thoughts and meekly, willingly comply with the other person.

An aggressive response is picking a fight, getting your haunches up and snarling back.

Passive-aggressive behaviour is feeling one thing while displaying the other. Looking passive or at least not overtly confrontational but still having the rage of an aggressive person locked down inside. The anger doesn’t disappear. Anger never does, it’s a bit like there should be a conservation of anger law to match the conservation of energy law.

The anger comes out in indirect ways, that is what passive-aggression is about, indirect displays of anger. Here are some examples of  PA behaviours taken from this article http://www.counselling-directory.org.uk/counsellor-articles/what-is-passive-aggressive-behaviour

Non-Communication when there is clearly something problematic to discuss

Avoiding/Ignoring when you are so angry that you feel you cannot speak calmly

Evading problems and issues, burying an angry head in the sand

Procrastinating intentionally putting off important tasks for less important ones

Obstructing deliberately stalling or preventing an event or process of change

Fear of Competition Avoiding situations where one party will be seen as better at something

Ambiguity Being cryptic, unclear, not fully engaging in conversations

Sulking Being silent, morose, sullen and resentful in order to get attention or sympathy.

Chronic Lateness A way to put you in control over others and their expectations

Chronic Forgetting Shows a blatant disrespect and disregard for others to punish in some way

Fear of Intimacy Often there can be trust issues with passive aggressive people and guarding against becoming too intimately involved or attached will be a way for them to feel in control of the relationship

Making Excuses Always coming up with reasons for not doing things

Victimisation Unable to look at their own part in a situation will turn the tables to become the victim and will behave like one

Self-Pity the poor me scenario

Blaming others for situations rather than being able to take responsibility for your own actions or being able to take an objective view of the situation as a whole.

Withholding usual behaviours or roles for example sex, cooking and cleaning or making cups of tea, running a bath etc. all to reinforce an already unclear message to the other party

Learned Helplessness where a person continually acts like they can’t help themselves – deliberately doing a poor job of something for which they are often explicitly responsible.

My husband once broached the subject with his mother, suggesting in a very roundabout way that perhaps the family had a PA way of communicating. MIL said she had no idea what that meant and she actually found and referred to the article I linked above. MIL said perhaps only one example sounded remotely true to her. My husband and I have specific examples, numerous examples to back every single point except the one about chronic lateness (MIL is actually early on purpose to throw people off). It would be funny if it weren’t so tragic.

When your mother has NPD

My poor husband. I hear about his childhood, his recollections are like this…

I remember building model planes with my dad and then taking them into the garden. We got air rifles and shot them all up, it was great fun.

I remember my dad sitting with me watching Open University programmes early in the morning at the weekend, I’m sure this developed my interest in maths.

One year my dad said he’d buy me a new computer game if I could write a short computer program. I made up this simple drawing program. He was really impressed! 

After I got terrible sunburn on the beach my dad took me to the shower and stood me under it for ages to soothe the blisters.

When we went to France on the ferry my dad and I would stand on the deck spotting all the navy boats at Portsmouth.

He wasn’t raised by his single parent father, he has a mother. These are the things he “fondly” remembers about his mother…

My sister and I were a bit naughty one day and she shouted at us then sat in front of the drinks cabinet and drank G+Ts until our father came home.

One time she kept turning the hose on me over and over, even after I said no she still did it and thought it was funny. In the end I ran off down the street and stayed there.

Mum had her way of organising the cupboards in the kitchen. They were crammed full of things in rows. The herbs and spices were organised alphabetically. I hated the cupboards being like that. If you didn’t put things back just the way she had them she would go nuts.

We would go and visit her mother. We were scared to touch anything and the atmosphere was always really tense. Mum would cry in the car all the way home.

I met my maternal grandfather once, in the service station of a motorway. I don’t know what his name is. I don’t know why she wouldn’t speak to him.

Mum would choose my clothes, right up until I was 17 years old.

When I told her I was going on holiday with my girlfriend and her family she didn’t speak to me for two weeks.

I’m not selectively editing this, these are the things he reports to me and a whole load of other things too like being forced to eat pureed food left over from the previous meal. Every nice memory he ever relates is of his father and every memory of his mother is of her controlling him, controlling others or being in an unpredictable emotional state. I don’t think he is aware of this. He thinks he is remembering good and bad from both parents in equal amounts.

He has a few other memories of her shouting and ranting at him for doing things wrong (telling his grandmother he had passed 11 exams when he “should” have only said 10, not counting the AS in maths taken early) even though he recalls more occurrences of his father coming and reassuring him afterwards and checking he was OK than he does of the ranting itself.

He has abuse amnesia. I wouldn’t believe such a thing existed if I hadn’t seen it myself. When our eldest child was born MIL refused to hold the baby. I overheard some of the conversation that took place at the foot of our stairs while I was in the bedroom. My husband was very hurt by this, he came and spoke to me about it right away, I was resting in bed after the birth. He talked about it for weeks. Three years later we started to seriously address his mother’s treatment of us and her behaviour around us. I mentioned the baby-holding incident and he had no memory of it. Only after describing everything I could about what he had said had happened, after repeating what his words to me had been on the various occasions he had discussed did he say he had a vague memory of it but couldn’t recall the details. I was, in fact I still am, gobsmacked by this. It’s not the only thing he can’t remember.

Getting memories of his mother’s behaviour to stick in his head is like taking a weak magnet and trying to stick it to a fridge door. It stays for a short time then slides inexorably down until slipping under the bottom edge of the fridge. Under the fridge is my husband’s subconscious; dark, rarely inspected and home to nasty bits of forgotten debris. Even recent conversations with her are erased. He struggled to recount the specifics of a conversation with her to his dad just a few weeks after it occurred even though he could remember feeling upset by it he couldn’t accurately explain what had been said.

A great deal has been written about the Adult Child of…. phenomena. It started out as adult children of alcoholics but as many therapists found similar behavioural patterns in other non-alcohol soaked families the Adult Child descriptors have been extended to cover the grown up children of different groups of dysfunctional parents. You can apply the adult child coping mechanisms to drug/alcohol/personality disordered families.

Children learn rapidly and very early how to best relate to their disordered parent. If the parent is mum and you need her to feed you, keep you warm and safe then you do what she wants, her way. You. suck. it. up.

My husband does this by people-pleasing and rescuing. He takes on responsibility for the happiness of others in a way that is out of proportion to any actual responsibility he has for it. He won’t buy sandwiches for a picnic when hand making the bread would make it nicer (in his opinion). He will twist himself in knots anticipating what another person would like rather than just ask them outright. He apologises for things which are not his fault. He jokes to lighten the atmosphere, he hovers over his NPD mum to provide her with what she may want before she asks. He is a compulsive over-achiever.

His sister is more reserved. As a child he tells how she would go off in her room and read for hours. She retreated from the nastiness of her mother’s behaviour. Now she is absorbed in her work which takes her all over the world. She is away a lot and recently moved abroad, the ultimate in getting away from mum. My husband tried over and over to do it right for his mum. He still does this. He thinks that one day he will get it right and she will be warm, appreciative and loving in response. Ha. Yeah right.

What’s that old joke? Denial is not a river in Africa.

What do the diagnostic criteria actually mean?

What do all the dry academic words that attempt to pin down the defining features of NPD actually mean in real life? Here I’m going to attempt to illustrate each one with some examples from life with NPD MIL.

A. An enduring pattern of inner experience and behavior the deviates  markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:
1. Cognition (i.e., ways of perceiving and interpreting self, other people and events)

This one is a corker, I mean what is disordered cognition exactly? Thinking you are God or that fairies live in your garden is not what this criteria is referring to. The criterion refers to ways of perceiving and interpreting. So what a disordered person sees in a given situation is very different from what you or I would see and what they then conclude about that event also markedly deviates from what we would conclude.

So how does that work out in a real situation? PD person is sitting outside a cafe and see someone they know walk by, no eye contact is made and they make no attempt to call out to them. The PD person perceives a deliberate snub. MIL actually did this to me but under much more extreme circumstances than this. I was pushing my then very ill child through a hospital corridor to a meeting with the consultant when I walked past MIL sat in the hospital coffee shop. She made no attempt to attract my attention, I had no expectation she would even be in the hospital at that time and I didn’t see  her, I obviously had other things on my mind, like would my child need a vital organ removed or would the doctors be able to save it. MIL brought this up as an example of my treating her rudely.

PD person is told someone can’t make it to their planned event so they cancel the whole thing. This is all or nothing thinking, they didn’t consider going ahead anyway or moving the event to another day. There is no middle ground and no flexibility in their approach.

Bizarre attributions of magical, unusual and unlikely properties to ordinary objects is also a type of cognitive distortion. MIL thinks her mobile phone if left on overnight will wake her “30 or more” times. She doesn’t just switch off her mobile, she unplugs the landline too.

Suspicious or determinedly negative assumptions about people are another example. MIL won’t use Skype to communicate as she thinks unnamed people will be able to hack into her computer through it and spy on her.

The resource “Personality Disorders” at the South West Alabama Behavioural Health care Systems is very helpful on understanding the diagnosis criteria for a personality disorder, it gives lots of examples of disordered thinking patterns.

2. Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response)

This is a frequently misunderstood criteria. Many people who write about personality disorders are talking about Borderline Personality Disorder which is characterised by extreme swings of emotion and volatility. But the criteria for diagnosing a personality disorder do not specify extreme ranges of emotion with, high intensity or great lability. The opposite is also true. A very limited range of displayed or felt emotions, those emotions having little intensity and  rarely leading to crying or laughter would also be characteristic of a personality disorder because they are behaviours that markedly deviate from the norm for our culture. The emotions in this case are too limited.

MIL has a very limited range of emotions, I have only ever seen neutral, panic, smug, envy and angry. I have never seen joy, happiness, fear, curiosity, anxiety, frustration, pride, sorrow, compassion, friendliness, I could go on but you get the idea.  Even when she gets exactly what she wants she isn’t actually happy, she is placated until the next demand surfaces.

Occasions when she has completely failed to show an appropriate emotional response have included my husband and my wedding (total absence of any reaction before, during or after the wedding), on the announcement of my pregnancies (expressed an unwillingness to be pleased incase something went wrong with the pregnancy and as a result she ended up disappointed), the birth of our children (refused to hold our first child and didn’t smile in either of the photos we have of her holding her newborn grandchildren), dealing with her mother’s dementia and death (no matter what happened she only ever expressed slight frustration with her mother and demonstrated little or no grief at her death or funeral).

Even during the course of a normal conversation her facial expressions and tone of voice hardly varies. She can be bloody-mindedly argumentative with you while a smile plays across her face and she speaks with a slight haughty laugh to her voice. In fact appearing unruffled or even slightly amused by everything is all you usually see.

3. Interpersonal functioning

MIL is narcissistic so she has a strong need for control and power in her relationships. She also is very self absorbed. The opinions of others only matters to her with respect to herself, she has to have the good opinion of others even on really insignificant little things. She has little empathy for others’ feelings, why would she? Life is all about her and her feelings which she struggles to regulate, just like a small child.

So when she interacts with other people she does things which try to control them. She went to the supermarket to buy a greetings card marking the arrival of our second child and bought two. One was from her and she expected my mother to take the other card that she had chosen and send that to my and husband and me. My mother politely declined, saying she  would rather choose her own card to mark her grandchild’s birth.  MIL tries to control people ALL the time.

MIL exhibits conversational narcissism in the extreme. Every comment you make is brought round to her somehow, this makes conversation very one sided and alienates people. It is why she has no friends. For example I made our youngest child a dress, my husband drew attention to this as the baby was wearing it and MIL looked, said nothing at all about the dress then remarked “I have stopped making clothes as the patterns cost too much”.

Interactions are more than just conversationally one sided, she only gets in touch when she wants something. Her phone calls or emails are topped or tailed with perfunctory phrases like “hope you and the children are well” or some other sweetener then she gets down to it “I am having a problem with the car…”, she never rings up or gets in touch just to chat. This is what makes her relationships so exploitive, you are only in her thoughts if she can get something out of you.

In order to get you to do what she needs she will manipulate and persist. She will keep pushing and pushing, changing her arguments as to why you should do what she wants, lying and distorting facts, using tiny details and points of logic to unpick your counter arguments, then she tries emotionally to manipulate with sulking, oh poor me victim-martyr behaviour, aggressive silent treatment, outright rage, bad mouthing you to others and then waits until it dies down a bit and tries again. She persisted for more than six months to get us to accept that she would buy a basic provision for our children. We said no as she was using a power play to encroach on our parental responsibilities (we can provide necessities for our kids, this was all about putting my husband in a dependent role and her in the parental role) she is still going on about it. Gifts are never just gifts when a personality disorder is involved, they enmesh you in a web of dependence, indebtedness and obligation.

This inability to accept “No” as an answer is a hall mark of all manipulative behaviour. In Gavin de Becker’s book “The Gift of Fear” he talks about the pre-incident indicators, warning signs that someone is manipulating you into a potentially dangerous situation, and not taking no for an answer is one of them. Persistence in the face of clear a rebuffle is a characteristic of stalking.

4. Impulse control

As with criteria 2 above, impulse control in this context refers to both extremes; little impulse control (as with anti-social personality disorder) and also excessive control (as with avoidant or obsessive-compulsive personality disorder). Rigid and persistent over-control of impulses can show itself as emotional inhibition, a reluctance to do anything that involves any type of uncertainty or risk, a reluctance to start new things or try new activities, and over-conscientiousness or scrupulousness.

This is hard to fathom with respect to my MIL. She seems to flip between the two. Most of the time I would say she is massively over controlled. She is extremely emotionally inhibited seeing obvious display of emotion as a despised weakness even in other people. She never ever wants to be seen to make a mistake or do something incorrectly as that would undermine her belief that she is better than others and expose her to criticism. So she plans things minutely. She also gives up or doesn’t try things for fear of not being able to do it well. Everything in her life is controlled and contained even her diet. We are only ever served one or two dishes in her house (chicken or stew with a bought cake or home made fruit crumble). She won’t try new foods. But when MIL is stressed and panicking (because she fears she may be shown as inferior in some way) or raging (because her own way has been thwarted) she can be stupidly impulsive.

B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

This is straight forward, MIL’s behaviour is like this all the time, in her house, our house, out for the day, on happy occasions, sad occasions, you name it she will be difficult.

C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Well it led to the breakdown of her marriage, the alienation of her siblings, the damage to her relationship with her son, her daughter moving abroad to get away from her, she has no friends at all and no social activities.

D. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.

Oh yes, MIL’s teenage antics included getting a car and driving it all over her school playing field to churn up the grass just for a laugh, vandalising hospital equipment while awaiting an operation, taking chemicals from the school labs to make stink bombs etc. She was a right pain in the arse by her own account. She boasts about these activities, there is nothing she likes more than being seen to get one over on anyone in authority, who she inevitably regards as inferior to herself.

E. The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder.

No depression or other signs of mental illness, on the contrary she despises mental illness in others seeing it as a character flaw and considers herself to be unusually self aware and psychologically strong.

F. The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug abuse, a medication) or a general medical condition (e.g., head trauma)

Her behaviour is not due to alcohol or drugs (which could decrease impulse control and increase emotional expression).

After that long analysis I hope you can see how some of these criteria actually play out in day to day life. Everyone of us at sometime acts in these ways. What makes a personality disorder is the inability of the person to act any other way and the extent of the behaviour. Personality disorders are behaviours taken to an extreme and behaviour that are stuck and inflexible.

In further posts I am going to go through each of the criteria specific to narcissistic personality disorder.

Diagnosing NPD – what the manuals say

How does someone get a diagnosis of narcissistic personality disorder? Well there are two main sources of diagnostic criteria for mental health conditions. One is the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association, the other is the ICD-10 Classification of Mental and Behavioural Disorders published by the World Health Authority. If the person meets the criteria for diagnosis as listed in these academic publications then their clinician (a GP, psychiatrist or psychoanalyst) would be able to diagnose narcissistic personality disorder. Only its not as simple as that.

First off the DSM has changed the criteria for diagnosing personality disorders. The previous edition DSM IV had one version and the present version DSM V has a rather different version. The ICD-10 doesn’t list Narcissistic Personality Disorder at all in the main body of the classification, it could be diagnosed as an other personality disorder not fitting the listed disorders. They include a comment on NPD in the appendix where the DSM IV criteria and listed and it is suggested this is a topic for further discussion and research.

So why all the contradiction and disagreement? The DSM IV criteria have been criticised from within the psychiatric medical community on several points.

Firstly the emphasis in the diagnostic criteria in DSM IV is placed on  the way NPD appears to outside observers in the actions and behaviours of the PD person. Not a lot of emphasis is put on the internal state of mind and thought processes occurring in the PD person which then lead to the behaviours. The result of this is twofold. The clinician has little to go on when trying identify NPD in a therapeutic situation. Imagine a person has all sorts of problems with their relationships and gets depressed, sees a doctor and starts talking about their feelings and thoughts. The DMS IV describes behaviours in a social-interpersonal setting which the clinician never sees. The clinician needs more information about the internal landscape of someone with NPD to identify it in a person in therapy.

The other problem is that the behaviours of someone with NPD overlap with behaviours shown by other personality disorders. This blurring of the boundaries of personality disorders is unhelpful if you believe (as I think many psychiatrists do) that each disorder is caused by a particular and specific developmental disruption in the person’s early life. The nature of the damage done and the age it occurred at will uniquely determine the manifestation of the disorder. Well I’m not sure I would be confident in supporting that discrete definition in its entirity but that seems to be the underlying assumption in wanting less overlap between the disorders.

If the definition of the disorder is heavily behaviourally based there will always be a tendency for cross-diagnosis between disorders as two people can behave in a similar way for entirely different reasons. Ideally one needs to identify the key features of the disorder as they appear externally to others and internally as the person experiences it themselves. The marked thing about NPD is that the external presentation of behaviours almost completely contradicts the internal experience of the sufferer. They act extremely self assured and superior, they feel utterly ashamed and inferior. The external behaviour is enacted as a way of suppressing the internal feelings which the NPD sufferer has, in the main, stuffed into their subconscious.

This criticism of the DSM IV criteria and general debate on the subject in the clinical literature means there has been no agreement between DSM and ICD-10. There is no argument that such a set of behaviours for the surmised reasons exists. NPD is seen in many clinical settings. ICD-10 wants a clear set of symptoms before it will include NPD as a specific named personality disorder, DSM updates itself periodically to try and keep abreast of developments. The WHO manual is more conservative, the American manual is criticised for medicalising all manner of behaviours and being in hock to large pharmaceutical companies (who for a price will sell you a drug to treat the disorders in the DSM).

Below is a straight copy and paste from the relevant tomes.

DSM IV Criteria for diagnosing a personality disorder

A. An enduring pattern of inner experience and behavior the deviates  markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:
1. Cognition (i.e., ways of perceiving and interpreting self, other people and events)
2. Affectivity (i.e., the range, intensity, liability, and appropriateness of emotional response)
3. Interpersonal functioning
4. Impulse control
B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.
E. The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder.
F. The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug abuse, a medication) or a general medical condition (e.g., head trauma).

DSM IV criteria for NPD

A. 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 highstatus 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.

DSM V criteria for diagnosing a personality disorder

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose a personality disorder, the following criteria must be met:

A. Significant impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning.

B. One or more pathological personality trait domains or trait facets.

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 sociocultural 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) or a general medical condition (e.g., severe head trauma).

DSM V criteria for NPD

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) or a general medical condition (e.g., severe head trauma).

ICD-10 Criteria for diagnosing a personality disorder

Conditions not directly attributable to gross brain damage or disease, or to
another psychiatric disorder, meeting the following criteria:
(a)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;
(b)the abnormal behaviour pattern is enduring, of long standing, and not limited to episodes of mental illness;
(c)the abnormal behaviour pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
(d)the above manifestations always appear during childhood or adolescence and continue into adulthood;
(e)the disorder leads to considerable personal distress but this may only become apparent late in its course;
(f)the disorder is usually, but not invariably, associated with significant problems in occupational and social performance.