What does Personality Disorder Not Otherwise Specified (NOS) really mean? Find out.

It is a sign of the inadequacy of our current knowledge of personality disorders that both the American Diagnostic and Statistical Manual (DSM) and its international counterpart, the ICD, maintain a "Personality Disorders Not Otherwise Specified (NOS)" diagnostic category. It is a catch-all, meaningless, "diagnosis", a testament to the diagnostician's helplessness and ignorance in the face of human complexity which often defies neat classification.

Even the rudiments of this diagnostic category are in dispute. There is no agreement as to what traits and behaviors it applies to. The ICD, for instance, includes the Narcissistic Personality Disorder in the NOS category, insisting that it is not a full-fledged personality disorder.

The NOS diagnosis is a laundry list of all personality-related dysfunctions, signs, symptoms, and complaints that do not fit a specific personality disorder. Some people satisfy one or more diagnostic criteria of a few personality disorders ("mixed personality"), but do not run the full gamut of any of them. The only requirement is that the personality be somehow impaired and cause distress and dysfunctions in one or more important areas of life: social, occupational, sexual, interpersonal, and so on.

Personality disorders not yet recognized by the DSM Committee - e.g., depressive, negativistic, or passive-aggressive - are also NOS.

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next: Sadistic Personality Disorder

Description of Obsessive-Compulsive Personality Disorder (OCPD)  and the perfectionists and workaholics who suffer from it.

Obsessions and compulsions are about control of self (mental) and others (interpersonal). People with the Obsessive-Compulsive Personality Disorder (OCPD) are concerned (worried and anxious) about maintaining control and about being seen to be maintaining it. In other words, they are also preoccupied with the symbolic aspects and representations (with the symbols) of control.

Inevitably, OCPDs are perfectionists and rigidly orderly or organized. They lack flexibility, openness and efficiency. They tend to see the world and others as at best whimsical and arbitrary and at worst menacing and hostile. They are constantly worried that something is or may go wrong. In this respect, they share some traits with the paranoid and the schizotypal.

It is easy to spot an Obsessive-Compulsive. They are constantly drawing up and dreaming up lists, rules, orders, rituals, and organizational schemes. They demand from themselves and from others perfection and an inordinate attention to minutia. Actually, they place greater value on compiling and following rigid schedules and checklists than on the activity itself or its goals. Simply put, Obsessive-Compulsives are unable to see the  forest for the trees.

This insistence on in-depth scrutiny of every detail frequently results in paralysis.

OCPDs are workaholics, but not because they like to work. Ostensibly, they sacrifice family life, leisure, and friendships on the altar of productivity and output. Really, they are convinced that only they can get

the job done in the right manner. Yet, they are not very efficacious or productive.

Socially, OCPDs are sometimes resented and rejected. This is because some OCPDs are self-righteous to the point of bigotry.

I described it in an article I wrote for the Open Site Encyclopedia:

"They are so excessively conscientious and scrupulous and so unempathically and inflexibly tyrannical that it is difficult to maintain a long-term relationship with them. They regard their impossibly high moral, work, and ethical standards as universal and binding. Hence their inability to delegate tasks to others, unless they can micromanage the situation and control it minutely to fit their expectations. Consequently, they trust no one and are difficult to deal with and stubborn.

OCPDs are so terrified of change that they rarely discard acquired but now useless objects, change the outlay of furniture at home, relocate, deviate from the familiar route to work, tweak an itinerary, or embark on anything spontaneous. They also find it difficult to spend money even on essentials. This tallies with their view of the world as hostile, unpredictable, and "bad".

Read about the Compulsive Acts of the Narcissist - click HERE!

Read Notes from the therapy of an Obsessive-Compulsive Patient

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next: Not Otherwise Specified (NOS) Personality Disorder

When it comes to diagnosing personality disorders, is the mental health profession sexist?

Ever since Freud, more women than men sought therapy. Consequently, terms like "hysteria' are intimately connected to female physiology and alleged female psychology. The DSM (Diagnostic and Statistical Manual, the bible of the psychiatric profession) expressly professes gender bias: personality disorders such as Borderline and Histrionic are supposed to be more common among women. But the DSM is rather even-handed: other personality disorders (e.g., the Narcissistic and Antisocial as well as the Schizotypal, Obsessive-Compulsive, Schizoid, and Paranoid) are more prevalent among men.

Why this gender disparity? There are a few possible answers:

Maybe personality disorders are not objective clinical entities, but culture-bound syndromes. In other words, perhaps they reflect biases and value judgments. Some patriarchal societies are also narcissistic. They emphasize qualities such as individualism and ambition, often identified with virility. Hence the preponderance of pathological narcissism among men. Women, on the other hand, are widely believed to be emotionally labile and clinging. This is why most Borderlines and Dependents are females.

Upbringing and environment, the process of socialization and cultural mores all play an important role in the pathogenesis of personality disorders. These views are not fringe: serious scholars (e.g., Kaplan and Pantony, 1991) claim that the mental health profession is inherently sexist.

Then again, genetics may be is at work. Men and women do differ genetically. This may account for the variability of the occurrence of specific personality disorders in men and women.

Some of the diagnostic criteria are ambiguous or even considered "normal" by the majority of the population. Histrionics "consistently use physical appearance to draw attention to self." Well, who doesn't in Western society? Why when a woman clings to a man it is labeled "codependence", but when a man relies on a woman to maintain his home, take care of his children, choose his attire, and prop his ego, it is "companionship" (Walker, 1994)?

The less structured the interview and the more fuzzy the diagnostic criteria, the more the diagnostician relies on stereotypes (Widiger, 1998).

Quotes from the Literature

"Specifically, past research suggests that exploitive tendencies and open displays of feelings of entitlement will be less integral to narcissism for females than for males. For females such displays may carry a greater possibility of negative social sanctions because they would violate stereotypical gender-role expectancies for women, who are expected to engage in such positive social behavior as being tender, compassionate, warm, sympathetic, sensitive, and understanding.

In females, Exploitiveness/Entitlement is less well-integrated with the other components of narcissism as measured by the Narcissistic Personality Inventory (NPI) - Leadership/Authority, Self-absorption/Self-admiration, and Superiority/Arrogance- than in males - though 'male and female narcissists in general showed striking similarities in the manner in which most of the facets of narcissism were integrated with each other'."

Gender differences in the structure of narcissism: a multi-sample analysis of the narcissistic personality inventory - Brian T. Tschanz, Carolyn C. Morf, Charles W. Turner - Sex Roles: A Journal of Research - Issue: May, 1998

"Women leaders are evaluated negatively if they exercise their authority and are perceived as autocratic."

Eagly, A. H., Makhijani, M. G., & Klonsky, B. G. (1992). Gender and the evaluation of leaders: A meta-analysis. Psychological Bulletin, 111, 3-22, and ...

Butler, D., & Gels, F. L. (1990). Nonverbal affect responses to male and female leaders: Implications for leadership evaluations. Journal of Personality and Social Psychology, 58, 48-59.

"Competent women must also appear to be sociable and likable in order to influence men - men must only appear to be competent to achieve the same results with both genders."

Carli, L. L., Lafleur, S. J., & Loeber, C. C. (1995). Nonverbal behavior, gender, and influence. Journal of Personality and Social Psychology, 68, 1030-1041.

Ever wonder how mental health professionals developed the criteria for a healthy personality vs. personality disorders?

The Five Factor Model deals with the healthy, normal personality. Not so other factor models. In 1990, Clark and a group of researchers constructed an instrument with 21 dimensions, based on the criteria of personality disorders in the DSM-III, on various scholarly texts in the field, and even on some Axis I elements.

They proposed the following as descriptive axes: proneness to suicide, self derogation, anhedonia (inability to experience pleasure), instability, hypersensitivity, anger or aggression, pessimism, negative affect, suspiciousness, self-centered exploitation, passive-aggressiveness, dramatic exhibitionism, grandiose egocentrism, social isolation, emotional coldness, dependency, conventionality-rigidity, impulsivity, high energy, antisocial behavior, schizotypal thought.

A far more detailed work was concluded in 1989 by Livesley and others. They studied a vast trove of professional literature as well as the DSM-III-TR and came up with a whopping 79 trait dimensions required to represent all 11 personality disorders. Subsequent refinements increased the number of questionnaire items to 100. These were grouped into 18 constructs of factors:

Compulsivity, conduct problems, diffidence, identity problems, insecure attachment, intimacy problems, narcissism, suspiciousness, affective lability, passive oppositionality, perceptual cognitive distortion, rejection, self-harming behaviors, restricted expression, social avoidance, stimulus seeking, interpersonal disesteem, and anxiousness.

The Livesley model dispenses with openness to experience as an evaluative dimension. The authors regard it of limited use in describing and diagnosing personality disorders.

Similarly, years later (in 1994), Harkness and McNulty also criticized the Five Factor Model. They proposed their own five dimensions: aggressiveness, psychoticism, constraint, negative emotionality r neuroticism, and positive emotionality or extroversion.

One of the earliest factor models, based on an analysis of words in an English-language dictionary that pertained to personality traits was suggested by Allport and Odbert in 1936. They excluded words and phrases that were evaluative or judgmental (such as "good", "bad", "excessive", or "excellent"). Their Lexical Big Five Model proffered these personality dimensions: Surgency or extroversion, agreeableness, conscientiousness, emotional stability vs. neuroticism, and intellect or culture.

Tellegen and Walter (1987) harshly criticized the methodology of the Big Five Model. They factor analyzed the 1985 edition of the American Heritage Dictionary and countered with a Big Seven Model with these traits: positive valence, negative valence, positive emotionality, negative emotionality, conscientiousness, agreeableness, and conventionality. Together with Almagor they demonstrated, in 1995, that the Model applies to Israel, a culture much different to the United States.

More about personality assessment tests - click HERE!

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next: Genetics and Personality Disorders

Description of the Five Factor Personalty Model aka "Big Five" factors of personality containing all known personality traits.

The Five Factor Model was suggested by two researchers, Costa and McCrae, in 1989. The designers of previous factor models sifted through bulky dictionaries and came up with thousands of words to describe human nature in all its variability. Not so the inventors of the Five Factor Model. It is based on and derived from various personality inventories. Surprisingly, it was proven to be as powerful as its vocabulary-based predecessors: it was able to predict subjects' behavior as accurately.

The Model consists of five high level dimensions. These are comprised of lower level facet traits. The dimensions allow the diagnostician to categorize the patient's overall propensities but do not provide for accurate predictions and prognoses regarding characteristics and likely behavior patterns. The facet traits make it possible to narrow down the range of behaviors and qualities consistent with the dimension.

An example:

A subject can be neurotic (emotionally unstable). This is the first dimension. If she is neurotic, she can be impulsive, or depressive, or anxious, or hostile, or self-conscious, or angry, or vulnerable, or any combination of these facet traits.

The second dimension is extroversion. Extroverts tend to be warm, affectionate, and friendly. They are gregarious (sociable, seek social stimulation), assertive, active, excitement seeking, and with a positive outlook on life coupled with positive emotions (such as joy, happiness, love, and optimism).

The third dimension is openness to experience. Such people resort to fantasy and use imagination and creativity to augment and enrich their lives. They react strongly to beauty and to beautiful things, such as art and poetry (they are aesthetically-sensitive and inclined). They fully experience their emotions and inner life and value intimacy. They are novelty-seekers and early adopters of gadgets, trends, fads, and unconventional ideas and they are very curious. This makes them question established values, norms, and rules: they are daring and iconoclastic.

The fourth factor is agreeableness. People typical of this dimension are trusting and willing to give others the benefit of the doubt. They are honest, well-intentioned, sincere, and frank.

The fifth dimension is conscientiousness. These subjects place a high value on competence and efficacy, innate capabilities and the acquisition of skills. They are orderly, clean, organized, and neat. They are trustworthy and reliable, morally upright and principled, ambitious and self-disciplined but also deliberative and not rash.

More about personality assessment tests - click HERE!

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next: Factor Models of Personality

What causes the development of a personality disorder? A look at the role genetics and environmental factors play in causing personality disorders.

Are personality disorders the outcomes of inherited traits? Are they brought on by abusive and traumatizing upbringing? Or, maybe they are the sad results of the confluence of both?

To identify the role of heredity, researchers have resorted to a few tactics: they studied the occurrence of similar psychopathologies in identical twins separated at birth, in twins and siblings who grew up in the same environment, and in relatives of patients (usually across a few generations of an extended family).

Tellingly, twins - both those raised apart and together - show the same correlation of personality traits, 0.5 (Bouchard, Lykken, McGue, Segal, and Tellegan, 1990). Even attitudes, values, and interests have been shown to be highly affected by genetic factors (Waller, Kojetin, Bouchard, Lykken, et al., 1990).

A review of the literature demonstrates that the genetic component in certain personality disorders (mainly the Antisocial and Schizotypal) is strong (Thapar and McGuffin, 1993). Nigg and Goldsmith found a connection in 1993 between the Schizoid and Paranoid personality disorders and schizophrenia.

The three authors of the Dimensional Assessment of Personality Pathology (Livesley, Jackson, and Schroeder) joined forces with Jang in 1993 to study whether 18 of the personality dimensions were heritable. They found that 40 to 60% of the recurrence of certain personality traits across generations can be explained by heredity: anxiousness, callousness, cognitive distortion, compulsivity, identity problems, oppositionality, rejection, restricted expression, social avoidance, stimulus seeking, and suspiciousness. Each and every one of these qualities is associated with a personality disorder. In a roundabout way, therefore, this study supports the hypothesis that personality disorders are hereditary.

This would go a long way towards explaining why in the same family, with the same set of parents and an identical emotional environment, some siblings grow to have personality disorders, while others are perfectly "normal". Surely, this indicates a genetic predisposition of some people to developing personality disorders.

Still, this oft-touted distinction between nature and nurture may be merely a question of semantics.

As I wrote in my book, "Malignant Self Love - Narcissism Revisited":

"When we are born, we are not much more than the sum of our genes and their manifestations. Our brain - a physical object - is the residence of mental health and its disorders. Mental illness cannot be explained without resorting to the body and, especially, to the brain. And our brain cannot be contemplated without considering our genes. Thus, any explanation of our mental life that leaves out our hereditary makeup and our neurophysiology is lacking. Such lacking theories are nothing but literary narratives. Psychoanalysis, for instance, is often accused of being divorced from corporeal reality.

Our genetic baggage makes us resemble a personal computer. We are an all-purpose, universal, machine. Subject to the right programming (conditioning, socialization, education, upbringing) - we can turn out to be anything and everything. A computer can imitate any other kind of discrete machine, given the right software. It can play music, screen movies, calculate, print, paint. Compare this to a television set - it is constructed and expected to do one, and only one, thing. It has a single purpose and a unitary function. We, humans, are more like computers than like television sets.

True, single genes rarely account for any behavior or trait. An array of coordinated genes is required to explain even the minutest human phenomenon. "Discoveries" of a "gambling gene" here and an "aggression gene" there are derided by the more serious and less publicity-prone scholars. Yet, it would seem that even complex behaviors such as risk taking, reckless driving, and compulsive shopping have genetic underpinnings."

Read More

Liveslye, W.J., Jank, K.L., Jackson, B.N., Vernon, P.A.. 1993. Genetic and environmental contributions to dimensions of personality disorders. Am. J. Psychiatry. 150(O12):1826-31.

On Dis-ease - click HERE!

The Interrupted Self - click HERE!

The Genetic Roots of Narcissism - Click HERE!

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next: Gender Bias in Diagnosing Personality Disorders

What's it like living with Paranoid Personality Disorder (PPD)? Take a look at these therapy session notes for insight into PPD.

Notes of first therapy session with Dale G., male, 46, diagnosed with Paranoid Personality Disorder (PPD)

Dale's first enquiry is whether I am in any way associated either with the government or with his former employer. He doesn't seem reassured by my negative response. He eyes me skeptically and insists that I inform him if things change and I do become entangled with his persecutors. Why do I treat him pro bono? He suspects some ulterior motives behind my altruism and inexplicable generosity. I explain to him that I donate 25 hours a month to the community. "It's good for your image, gives you access to local bigwigs, I bet." - he retorts, accusingly. He refuses to allow me to tape record our conversation.

I set some boundaries by reminding him that the therapy session is about him, not me. He nods sagely: it's all part of an intricate scheme to "subdue" him and place him "under firm control". Why would "they" want to do that? Because he knows too much, having exposed fraud, lies, and deceit in the highest places. He has done all this from his position as a sanitary worker at the municipality? - I inquire. He is visibly offended: "There are more secrets in people's trash than in the CIA!" - he exclaims - "You think that your academic degree makes you more clever than I am or somehow superior to me?"

I remind him that therapy was more or less forced on him by his long-suffering wife. Is she one of "them"? He snickers. Well? "Yes," - he rages - "they got to her, too. She used to be on my side." His phones are tapped, his mail intercepted and inspected, there was a mysterious fire in his apartment only days after he complained against a senior law enforcement officer. Wasn't it the antiquated television set that burst into flames? "If you care to believe such nonsense." - he eyes me with pity.

When was the last time he went out with friends? He has to think hard to come up with an answer: "Four years ago." Why so long? Is he a recluse by nature? Not at all, he is actually gregarious. So, why the social isolation? Part of his defense. You never know when something you have said in company will be used against you. His so-called friends have been asking him too many intrusive questions lately. They insisted on meeting in new venues at odd times and he got suspicious.

So, what is he doing all alone at home? He laughs bitterly: "Won't they love to know my next moves!" He isn't going to give them the pleasure of evincing his strategy. All he is willing to say is that "they" will pay dearly for having underestimated him and for having turned his life "into a long nightmare in hell". Who are "they"? His superiors at the sanitary department. They reassigned him to a dangerous part of town, working night shifts, effectively demoting him from team foreman to "common janitor". He will never forgive them. But wasn't this a temporary arrangement owing to manpower shortages? "That's what they said at the time"- he admits reluctantly.

At the end of the session he insists on inspecting my phone jacks and the under-surfaces of my desk. "You can never be too careful." - he half apologizes.

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next: The Psychopathic Patient ~ back to: Case Studies: Table of Contents

Therapy session notes provide insight into living with Antisocial Personality Disorder (AsPD) - psychopaths and sociopaths.

• Watch the video on A Psychotherapist and the Psychopath 

Notes of first therapy session with Ani Korban, male, 46, diagnosed with Antisocial Personality Disorder (AsPD), or Psychopathy and Sociopathy

Ani was referred to therapy by the court, as part of a rehabilitation program. He is serving time in prison, having been convicted of grand fraud. The scam perpetrated by him involved hundreds of retired men and women in a dozen states over a period of three years. All his victims lost their life savings and suffered grievous and life-threatening stress symptoms.

He seems rather peeved at having to attend the sessions but tries to hide his displeasure by claiming to be eager to "heal, reform himself and get reintegrated into normative society". When I ask him how does he feel about the fact that three of his victims died of heart attacks as a direct result of his misdeeds, he barely suppresses an urge to laugh out loud and then denies any responsibility: his "clients" were adults who knew what they were doing and had the deal he was working on gone well, they would all have become "filthy rich." He then goes on the attack: aren't psychiatrists supposed to be impartial? He complains that I sound exactly like the "vicious and self-promoting low-brow" prosecutor at his trial.

He looks completely puzzled and disdainful when I ask him why he did what he did. "For the money, of course" - he blurts out impatiently and then recomposes himself: "Had this panned out, these guys would have had a great retirement, far better than their meager and laughable pensions could provide." Can he describe his typical "customer"? Of course he can - he is nothing if not thorough. He provides me with a litany of detailed demographics. No, I say - I am interested to know about their wishes, hopes, needs, fears, backgrounds, families, emotions. He is stumped for a moment: "Why would I want to know these data? It's not like I was their bloody grandson, or something!"

Ani is contemptuous towards the "meek and weak". Life is hostile, one long cruel battle, no holds barred. Only the fittest survive. Is he one of the fittest? He shows signs of unease and contrition but soon I find out that he merely regrets having been caught. It depresses him to face incontrovertible proof that he is not as intellectually superior to others as he had always believed himself to be.

Is he a man of his word? Yes, but sometimes circumstances conspire to prevent one from fulfilling one's obligations. Is he referring to moral or to contractual obligations? Contracts he believes in because they represent a confluence of the self-interests of the contracting parties. Morality is another thing altogether: it was invented by the strong to emasculate and enslave the masses. So, is he immoral by choice? Not immoral, he grins, just amoral.

How does he choose his business partners? They have to be alert, super-intelligent, willing to take risks, inventive, and well-connected. "Under different circumstance, you and I would have been a great team" - he promises me as I, his psychiatrist, am definitely "one of the most astute and erudite persons he has ever met." I thank him and he immediately asks for a favor: could I recommend to the prison authorities to allow him to have free access to the public pay phone? He can't run his businesses with a single daily time-limited call and this is "adversely affecting the lives and investments of many poor people." When I decline to do his bidding, he sulks, clearly consumed by barely suppressed rage.

How is he adapting to being incarcerated? He is not because there is no need to. He is going to win his appeal. The case against him was flimsy, tainted, and dubious. What if he fails? He doesn't believe in "premature planning". "One day at a time is my motto." - he says smugly - "The world is so unpredictable that it is by far better to improvise."

He seems disappointed with our first session. When I ask him what his expectations were, he shrugs: "Frankly, doctor, talking about scams, I don't believe in this psycho-babble of yours. But I was hoping to be able finally communicate my needs and wishes to someone who would appreciate them and lend me a hand here." His greatest need, I suggest, is to accept and admit that he erred and to feel remorse. This strikes him as very funny and the encounter ends as it had begun: with him deriding his victims.

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next: The Narcissistic Patient ~ back to: Case Studies: Table of Contents

Comparison of  symptoms of narcissism and  other personality disorders and Asperger's Disorder symptoms. Could similarities lead to a misdiagnosis?

Personality disorders cannot be safely diagnosed prior to early adolescence. Still, though frequently found between the ages of 3 and 6, Asperger's Disorder is often misdiagnosed as a cluster B personality disorder, most often as the Narcissistic Personality Disorder (NPD).

The Asperger's Disorder Patient

The Asperger's Disorder patient is self-centered and engrossed in a narrow range of interests and activities. Social and occupational interactions are severely hampered and conversational skills (the give and take of verbal intercourse) are primitive. The Asperger's patient's body language - eye to eye gaze, body posture, facial expressions - is constricted and artificial, akin to patients with the Schizoid, Schizotypal, and Narcissistic Personality Disorders. Nonverbal cues are virtually absent and their interpretation in others lacking.

Yet, Asperger's and personality pathologies have little in common.

Narcissistic Personality Disorder and Asperger's Disorder

Consider pathological narcissism.

From my book "Malignant Self Love - Narcissism Revisited" :

The narcissist switches between social agility and social impairment voluntarily. His social dysfunctioning is the outcome of conscious haughtiness and the reluctance to invest scarce mental energy in cultivating relationships with inferior and unworthy others. When confronted with potential Sources of Narcissistic Supply, however, the narcissist easily regains his social skills, his charm, and his gregariousness.

Many narcissists reach the highest rungs of their community, church, firm, or voluntary organization. Most of the time, they function flawlessly - though the inevitable blowups and the grating extortion of Narcissistic Supply usually put an end to the narcissist's career and social liaisons.

The Asperger's patient often wants to be accepted socially, to have friends, to marry, to be sexually active, and to sire offspring. He just doesn't have a clue how to go about it. His affect is limited. His initiative - for instance, to share his experiences with nearest and dearest or to engage in foreplay - is thwarted. His ability to divulge his emotions stilted. He is incapable or reciprocating and is largely unaware of the wishes, needs, and feelings of his interlocutors or counterparties.

Inevitably, Asperger's patients are perceived by others to be cold, eccentric, insensitive, indifferent, repulsive, exploitative or emotionally-absent. To avoid the pain of rejection, they confine themselves to solitary activities - but, unlike the schizoid, not by choice. They limit their world to a single topic, hobby, or person and dive in with the greatest, all-consuming intensity, excluding all other matters and everyone else. It is a form of hurt-control and pain regulation.

Thus, while the narcissist avoids pain by excluding, devaluing, and discarding others - the Asperger's patient achieves the same result by withdrawing and by passionately incorporating in his universe only one or two people and one or two subjects of interest. Both narcissists and Asperger's patients are prone to react with depression to perceived slights and injuries - but Asperger's patients are far more at risk of self-harm and suicide.

The use of language

Patients with most personality disorders are skilled communicators and manipulators of language. In some personality disorders (Antisocial, Narcissistic, Histrionic, Paranoid) the patients' linguistic skills far surpass the average. The narcissist, for instance, hones language as an instrument and uses it to obtain Narcissistic Supply or as a weapon to obliterate his "enemies" and discarded sources with. Cerebral narcissists actually derive Narcissistic Supply from the consummate use they make of their innate loquaciousness.

In contrast, the Asperger's patient, though verbose at times (and taciturn on other occasions) has a far more limited range of tediously repetitive topics. People with Asperger's fail to observe conversational rules and etiquette (for instance, let others speak in turn). The Asperger's patient is unaware and, therefore, unable to decipher body language and external social and nonverbal cues and gestures. He is incapable of monitoring his own misbehavior. Psychopaths, narcissists, borderlines, schizotypals, histrionics, paranoids, and schizoids are similarly inconsiderate - but they control their behavior and are fully cognizant of reactions by others. They simply choose to ignore these data.

More about Autism Spectrum Disorders:

Comorbidity in Personality Disorders

McDowell, Maxson J. (2002) The Image of the Mother's Eye: Autism and Early Narcissistic Injury , Behavioral and Brain Sciences (Submitted)

Benis, Anthony - "Toward Self & Sanity: On the Genetic Origins of the Human Character" - Narcissistic-Perfectionist Personality Type (NP) with special reference to infantile autism

Stringer, Kathi (2003) An Object Relations Approach to Understanding Unusual Behaviors and Disturbances

James Robert Brasic, MD, MPH (2003) Pervasive Developmental Disorder: Asperger Syndrome

next: Misdiagnosing Personality Disorders as Anxiety Disorders

Definition of narcissism, characteristics of a narcissist and Narcissistic Personality Disorder explained.

What is Narcissism?

The term narcissism actually comes from the Greek story about narcissus, a young man who fell in love with his own image reflected from the water he was looking at. Nowadays, narcissism refers to those who have intense emotions and an abnormal love of themselves, and a difficulty in empathizing with or caring about the needs of others. In fact, people with exaggerated narcissism have difficulty understanding the reality that others may have needs as well, and unless the needs of others can help him, they do not seem to care.

Narcissism: An Inflated Sense of Self

Narcissists tend to exaggerate their own talents and attributes (such as appearance, talents, IQ level) and they believe they are entitled to special treatment and notice. They are very self-centered and they seek constant input, admiration and attention from others. They often will take advantage of others in order to fulfill their own needs.

Narcissism is a lifelong pattern of this type of thought and behavior and is unyielding. It is one's personality and doesn't represent a change from the way someone was previously (as might be the case with a depression or anxiety disorder).

Narcissistic Personality Disorder Defined

In DSM-V, characteristics of Narcissistic Personality Disorder (NPD) involve:

• a pervasive pattern of grandiosity in fantasy or behavior
• a need for admiration
• a lack of empathy
• a sense of entitlement
• exploiting others
• lacking in empathy (an inability to recognize or identify with the feelings and needs of others)

In addition, the narcissist often seems envious of others or believes that others are envious of them.

People with Narcissistic Personality Disorder are very difficult to get close to because their needs always come above the needs of others in the relationship. They appear as selfish and self-assured to a fault.

While on the outside appearing to be overly confident, on the inside people with NPD may, in fact, have great needs and concerns about their own selves. They depend on input from others about how wonderful, how smart, how attractive they are in order to feel better about themselves.

Treating Narcissistic Personality Disorder

It is very difficult, if not impossible, to change the characteristics of one's personality. Treatment of Narcissistic Personality Disorder is extremely difficult and involves long-term psychotherapy. In addition, people with Narcissistic Personality Disorder may have other coexisting emotional problems (anxiety disorders, substance abuse, depression) that may be helped by psychotherapy or medications.

Watch HealthyPlace TV Show on Narcissism and Narcissistic Personality Disorder (NPD)

On Tuesday's (October 6, 2009) HealthyPlace TV show on narcissism, we will talk to a man (a PhD) who has written a book on Narcissistic Personality Disorder and understands the condition "from the inside out" since he, himself, suffers from NPD. Tune in for what I believe will be a fascinating show.

You can watch it live (7:30p CT, 8:30 ET) and on-demand on our website.

Dr. Harry Croft is a Board-Certified Psychiatrist and Medical Director of HealthyPlace.com. Dr. Croft is also the co-host of the HealthyPlace TV Show.

next: Does Sexual Addiction Really Exist?
~ other mental health articles by Dr. Croft