Did you know that the powers that be were considering not putting NPD as a diagnosis into the new DSM-5? It came out recently, however, that "they," whoever they are, ultimately did decide to keep NPD in the book. To clarify, the DSM-5 is the book used by doctors and insurance companies for diagnosis and treatment.
There can be many different types of NPDs
Passive aggressive or malignant narcissists, cerebral narcissists or covert narcissists, not to mention the inverted narcissists or the standard narcissists. But what about the term sociopath? What's a sociopath? It sounds like a narcissist when I read about that, so are sociopaths listed in the DSM-5?
And when we read about NPD as a personality disorder, it begs to ask is everyone a narcissist? Is there a thing such as healthy narcissism? Are teens naturally narcissists? Being stuck in Early Childhood narcissism? Healthy self-love versus narcissism? Is everyone on a narcissistic scale? Is there a high end and low end of the narcissistic scale? Where did the scale come from? Are we a narcissistic society? I heard that the show Seinfeld is all based on Narcissism, and what about other television shows like Two and a half men? If we enjoy Facebook, does that make us narcissists? With the advent of Facebook and the selfie culture, are we becoming a narcissistic society?
I have argued with others here that there is no scale, and if there is, where did a scale come from? It is a personality disorder plain and simple. Is it untreatable! Not my fault! If you make it a "scale", then what does that mean to me or you and our healing from the effect of a narcissist on us? As I researched further, it turns out, instead of PTSD (post-traumatic stress disorder) I have Narcissistic Survivor Syndrome. It describes the symptoms that those who just got out of a long-term relationship with a narcissist suffer from. We used to be grouped in with those coming home from war or surviving a tragic event, but now we get our own little section of diagnosis and treatment in the new DSM-5.
I. So first off, why would "they" want to remove NPD from the book, DSM-5?
Under the topic of Personality Disorders is a list of 10 types of Personality Disorders. This list is commonly referred to as Cluster A, Cluster B and Cluster C.
- Cluster A (the "odd, eccentric" cluster): Paranoid, Schizoid, and Schizotypal Personality Disorders.
- Cluster B (the "dramatic, emotional, erratic" cluster): Borderline Personality Disorder, Narcissistic Personality Disorder, Histrionic Personality Disorder, and Antisocial Personality Disorder.
- Cluster C (the "anxious, fearful" cluster): Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders.
Some men are bipolar and it can often be hard to distinguish between the two. This is a huge problem, because you can be bipolar and present narcissistic symptoms without being a narcissist. If the narcissism only exists during a manic, then they are not a narcissist. If the narcissism vanishes with the manic episode, they are only bipolar. I found a layman's definition to the question. "Is your ex a dick when manic only, or is he a dick all the time?" Answer: he is a dick all the time, and doubly "dickish" when manic. Then, he is both a narcissist and bipolar. It’s very unscientific and unprofessional, but there it is.
Scientific Quote: " This particular co-occurrence is difficult to diagnose because symptoms of a personality disorder are sometimes overshadowed by bipolar episodes. One study found that symptoms of Cluster B personality disorders may be evident in as many as 1/3 of bipolar patients."
The key word is Co-occurrence. It took a lot of reading. I found that bipolar patients are usually narcissistic during manic episodes only. If the patient is narcissistic when not manic, then maybe they have more than one issue, so maybe they are a narcissist too. It is common for patients to be "co-occurring" within a Cluster. So, if one is diagnosed with something in cluster B they may actually get two Cluster B diagnoses. The symptoms and issues commonly overlap within Clusters. Here's the thing with Narcissism. ALL 10 Personality Disorders show narcissistic tendency. If all the Clusters A B and C show narcissism, then why have a separate diagnosis for NPD? Every diagnosis above is co-occurrence with NPD.
II. Is narcissism untreatable?
The whole purpose of the DSM-5 is to Diagnose and provide Treatment. It has been a rule that NPD is untreatable. If the Cluster A B and C personality disorders are given NPD as a co-occurring diagnosis then "they" just declared the patient untreatable. This is where the scale argument came from.
Doctors wanted to attempt treatment. Doctors were having some success with patients that were not as high in their presentation of symptoms. But were they "high" or were they "low" in their presentation of symptoms? If "they" could treat an Obsessive-Compulsive Personality Disorder with co-occurrence NPD, was the NPD untreatable? Again why have the diagnosis of NPD in the book in the first place? If one of the goals in the book was to provide treatment methods and there was so many blurred lines between NPD and all the clusters and there was some success in treatment of the lower end of the scale of NPD? Then why have it as a separate diagnosis within the book? Why not just assume that every Cluster diagnosis has NPD within its treatment issues?
III. "They" had a convention or conference and argued for days.
Some of the younger and new hip thinkers wanted a scale. Having a scale had solved the issue for Autism. Autism had different types and categories. You wouldn't treat someone with Asperger's Syndrome the same way you would someone with a more traditional Autism. They took Asperger's out of the book and all of the other types and created a scale from low to high presentation of symptoms. One would get a diagnosis of Autism plain and simple, but the scale presented treatment so much easier. Asperger's is no longer a diagnosis in the DSM-5. But any parent with a child with Asperger's will tell you that their child has Asperger's. They will read everything they can on Asperger's. Just because it is not in the book doesn't mean that everyone stops talking about it as if it didn't exists. The categorizing or naming of Asperger's is helpful to the parents and the non-professional. It is how we as people converse and research and understand and deal with it.
So, just because the words "covert Narcissist" or other categories of Narcissism is not in the book - just because "they" didn't put it in the DSM-5, it doesn't mean that when you use that term that I don't know what your talking about. It doesn't mean that you can't expedite your healing because you prefer to see NPD as a personality disorder not as a scale OR because you prefer to see NPD as a scale and not as a personality disorder. Even the experts don't agree. The scale idea is not in the DSM-5 under NPD. They decided to keep it as a personality disorder diagnosis as it was in the DSM-IV. It is still understood as untreatable.
Opinion: I wouldn't be surprised if they do move to a scale in the future because the emphasis for the doctors is on treatment. But to you and me, "his" diagnosis is important to us because we need to understand what happened to us by him so we can heal. If you have divorced a narcissist, you are probably trying to find yourself again and heal. If you have had a high conflict divorce, you probably are beyond caring if he gets treatment or not. You might be praying for Karma and not so much sending him a "get well soon" card with a box of candy and balloons. Maybe. Maybe it's just me. At this point in time, I am more interested in my recovery and treatment than his. I practice No Contact.
IV. “They" compassionately add Narcissistic Survivor Syndrome.
The older and more established "they" wanted to leave the diagnosis of NPD in the book out of compassion for it's survivors. There was this whole other group that needed the diagnosis to be in there in order to receive treatment. The winning question at the conference was "what would happen to the survivors and how would you address their needs for treatment?" I was angry when I had heard that NPD might not be in the new DSM-5. I was angry every time someone said that everyone is a narcissist. I apologized. The scale concept made me angry. Now I know the history of the scale and it revolves around the hope of treatment. Maybe there will be hope for someone in the future.
But I was obviously angry, why? It is THE QUESTION: "What would happen to the survivors and how would you address their needs for treatment if there was no NPD diagnosis?" If there were no NPD I felt then all of what the Narcs say would be true. If he were not ill then every lie and accusation would be true? I wouldn't be suffering PTSD; I would be in fact crazy. He never loved me because it was "me" after all and not "him." If you move it to a scale I had the same problem: He never loved me because parts of it was "me" and maybe not so much "him." Don't get me wrong, I don't think I am perfect, but I am not the monster that he says I am. As a matter of fact, he is the monster that he says I am. There were things that I can do better but the bigger questions are did I deserve what he did to me, did I cause what he did to me, will it happen to me again because of some flaw within me that deserves what he did to me?
My point in all of this is, I am grateful to the "they" that left it in the book; that they gave us a special gift, the gift of recognition and treatment. Yes, all of this did happen or is happening to you. You are not crazy. You are suffering from Narcissistic Survivor Syndrome. And yes, you will heal and grow and be happy again. There is treatment for you. It's not your fault. The narc is ill. You didn't deserve what you were dealt. Happy healing and (((hugs))). Even the DSM-5 validates you.
(This article was written by a member of our community. Join First Wives World today to share your story and help yourself, as well as others, move into a place of healing.)