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发帖数: 29846 | 1 A Fate That Narcissists Will Hate: Being Ignored
By CHARLES ZANOR
Narcissists, much to the surprise of many experts, are in the process of
becoming an endangered species.
Not that they face imminent extinction — it’s a fate much worse than that.
They will still be around, but they will be ignored.
The fifth edition of the Diagnostic and Statistical Manual of Mental
Disorders (due out in 2013, and known as DSM-5) has eliminated five of the
10 personality disorders that are listed in the current edition.
Narcissistic personality disorder is the most well-known of the five, and
its absence has caused the most stir in professional circles.
Most nonprofessionals have a pretty good sense of what narcissism means, but
the formal definition is more precise than the dictionary meaning of the
term.
Our everyday picture of a narcissist is that of someone who is very self-
involved — the conversation is always about them. While this
characterization does apply to people with narcissistic personality disorder
, it is too broad. There are many people who are completely self-absorbed
who would not qualify for a diagnosis of N.P.D.
The central requirement for N.P.D. is a special kind of self-absorption: a
grandiose sense of self, a serious miscalculation of one’s abilities and
potential that is often accompanied by fantasies of greatness. It is the
difference between two high school baseball players of moderate ability: one
is absolutely convinced he’ll be a major-league player, the other is
hoping for a college scholarship.
Of course, it would be premature to call the major-league hopeful a
narcissist at such an early age, but imagine that same kind of unstoppable,
unrealistic attitude 10 or 20 years later.
The second requirement for N.P.D.: since the narcissist is so convinced of
his high station (most are men), he automatically expects that others will
recognize his superior qualities and will tell him so. This is often
referred to as “mirroring.” It’s not enough that he knows he’s great.
Others must confirm it as well, and they must do so in the spirit of “vote
early, and vote often.”
Finally, the narcissist, who longs for the approval and admiration of others
, is often clueless about how things look from someone else’s perspective.
Narcissists are very sensitive to being overlooked or slighted in the
smallest fashion, but they often fail to recognize when they are doing it to
others.
Most of us would agree that this is an easily recognizable profile, and it
is a puzzle why the manual’s committee on personality disorders has decided
to throw N.P.D. off the bus. Many experts in the field are not happy about
it.
Actually, they aren’t happy about the elimination of the other four
disorders either, and they’re not shy about saying so.
One of the sharpest critics of the DSM committee on personality disorders is
a Harvard psychiatrist, Dr. John Gunderson, an old lion in the field of
personality disorders and the person who led the personality disorders
committee for the current manual.
Asked what he thought about the elimination of narcissistic personality
disorder, he said it showed how “unenlightened” the personality disorders
committee is.
“They have little appreciation for the damage they could be doing.” He
said the diagnosis is important in terms of organizing and planning
treatment.
“It’s draconian,” he said of the decision, “and the first of its kind, I
think, that half of a group of disorders are eliminated by committee.”
He also blamed a so-called dimensional approach, which is a method of
diagnosing personality disorders that is new to the DSM. It consists of
making an overall, general diagnosis of personality disorder for a given
patient, and then selecting particular traits from a long list in order to
best describe that specific patient.
This is in contrast to the prototype approach that has been used for the
past 30 years: the narcissistic syndrome is defined by a cluster of related
traits, and the clinician matches patients to that profile.
The dimensional approach has the appeal of ordering à la carte — you get
what you want, no more and no less. But it is precisely because of this
narrow focus that it has never gained much traction with clinicians.
It is one thing to call someone a neat and careful dresser. It is another to
call that person a dandy, or a clotheshorse, or a boulevardier. Each of
these terms has slightly different meanings and conjures up a type.
And clinicians like types. The idea of replacing the prototypic diagnosis of
narcissistic personality disorder with a dimensional diagnosis like “
personality disorder with narcissistic and manipulative traits” just doesn
’t cut it.
Jonathan Shedler, a psychologist at the University of Colorado Medical
School, said: “Clinicians are accustomed to thinking in terms of syndromes,
not deconstructed trait ratings. Researchers think in terms of variables,
and there’s just a huge schism.” He said the committee was stacked “with
a lot of academic researchers who really don’t do a lot of clinical work.
We’re seeing yet another manifestation of what’s called in psychology the
science-practice schism.”
Schism is probably not an overstatement. For 30 years the DSM has been the
undisputed standard that clinicians consult when diagnosing mental disorders
. When a new diagnosis is introduced, or an established diagnosis is
substantially modified or deleted, it is not a small deal. As Dr. Gunderson
said, it will affect the way professionals think about and treat patients.
Given the stakes, the blow-back from experts in personality disorders should
come as no surprise.
Dr. Gunderson has written a letter co-signed by other clinical and research
leaders to the trustees of the American Psychiatric Association and the task
force that governs DSM-5. And Dr. Shedler and seven colleagues published an
editorial in the September issue of The American Journal of Psychiatry. In
the relatively small world of mental health diagnostics, this is most
certainly a battle worth watching.
Right now, this much seems clear: It is way too early for the narcissists to
give up their seat on the bus.
Charles Zanor is a psychologist in West Springfield, Mass. |
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