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)."
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 ...