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.

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Filed under Describing narcissism, diagnosing NPD, Examples of narcissistic behaviour, Understanding narcissism

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