Tuesday, December 14, 2010

Let's Play Spot the Personality Disorder

In a recent blog post, I discussed narcissism in the context of its proposed downsizing from the DSM-5 as a stand-alone “categorical” diagnosis to one of many “core impairments” in a dimensional schema of “personality functioning.” Personality is complex, and clinicians have a hell of a time trying to sort out what is going on. To give you an idea, I have prepared a little quiz:

Following are symptoms taken from the four DSM-IV “Cluster B” personality disorders: Antisocial, Borderline, Histrionic, Narcissistic.  See if you can match the symptom to the disorder. Answers and commentary further down:

1 "Is uncomfortable in situations in which he or she is not the center of attention."

2 "Requires excessive admiration."

3 "Impulsivity or failure to plan ahead."

4 "Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)."

5 "A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation."

6 "Considers relationships to be more intimate than they actually are."

7 "Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another."

8 "Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others."

9 "Displays rapidly shifting and shallow expression of emotions."

10 "Identity disturbance: markedly and persistently unstable self image or sense of self."

11 "Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations."

12 "Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations."

13 "Shows arrogant, haughty behaviors or attitudes."

14 "Irritability and aggressiveness, as indicated by repeated physical fights or assaults."

15 "Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)."


1 Histrionic

2 Narcissistic

3 Antisocial

4 Borderline

5 Borderline

6 Histrionic

7 Antisocial

8 Narcissistic

9 Histrionic

10 Borderline

11 Narcissistic

12 Antisocial

13 Narcissistic

14 Antisocial

15 Borderline


I think you get the point. Namely, we have a preponderance of overlapping symptoms that defy easy categorization. Yes, we all sort of know what a narcissist is, for instance, but some of the features are strikingly close to histrionic and borderline, which in turn appears to be the female twin of the more male antisocial, which yet in turn can be difficult to distinguish in certain respects from narcissism. Enough, already!

I’d be interested in how well or how badly you fared, and other sundry opinions. Please give me feedback in the comments below. Confession: In the course of assembling this quiz, I couldn’t keep track of the correct answers, myself. I was obliged to keep rechecking and rechecking again ... and again.

Obviously, we need a lot more clarity in the next DSM. But will the new dimensional system only result in far more confusion?

Much more to come ...


Keith Anselm said...

This quiz was incredibly difficult. My score was marginally better than chance.

Anonymous said...

As someone who had a close relationship with a narcissistic person, I thought all of the traits related to narcissism! (I say "narcissistic person" because he was never diagnosed. He behaved narcissistically, as his behavior was judged by most who knew him.) I am choosing anonymity for this post to protect his privacy, by the way.

Althea Hayton said...

I agree that the whole idea of "personality disorders" is highly suspect if not totaly absurd. For example (according to my research) womb twin survivors exhibit most of not all of the so-called "symptoms" of borderline personality disorder. They are often misdiagnosed as such, and labelled for life as a bit crazy when in fact they are perfectly normal womb twin survivors. They "recover" remarkably quickly once they understand that their problems arise out of the fact that their co-twin died before they were born.


"Doc Adler" said...

I got about two-thirds of the questions correct, but couldn't help but notice how much overlap there was between histrionic and narcissistic personality disorders on the one hand and between antisocial and borderline on the other.

Charles Sakai

Tony the cretin said...

I see the shades of gray in them. I got 7 correct outright, another 5 where the correct answer was among two choices, and 3 completely wrong. Those 5 were real toss ups. If I had to choose among them, I would probably get less than half right. Tough quiz. Definitely makes a point.

mercurialmind said...

I received 13/15. I can see that there is a lot of overlap between the various personality disorders.I think when it comes to narcissism that we all have it to a degree however it is hard to say when it interferes with an individual's functioning.

Anonymous said...

i can say all of this about absolutely everyone i have met.

why point the bigger finger at those reporting depression and anxiety?

John McManamy said...

Many thanks, people. You validate my hunches. I see your point, Anonymous, in everything looking like narcissism to you. Likewise, all the symptoms could have looked like antisocial or borderline to someone else.

Mercurialmind, absolutely about we all have narcissism to a degree. I would content we also have a bunch of other personality disorders to a degree, and that's where the new dimensional system would come in - it would take into account that more than one thing is going on and look at how severe each one is. A little bit of narcissism could be healthy. But maybe not mixed with a lot of something else.

RM said...

10/15. I think you are on it Doc Adler. Perhaps interestingly only 1 of my errors a Hist instead of Narc, the other 4 swapping Bord & Anti. 3 Bs instead of As & 1 A instead of B. Maybe reflects that I had an oblivious Narc father, have a severely Hist mother which might explain why I am a Borderline Anti with Narc traits & Hist tendencies.
I see them clearer than I see myself?