Been making note of the various (armchair) diagnoses of Trump with Narcissistic, been wanting to ask this for awhile. Yes, I am well aware that the professional consensus is that full recovery/transcendence/(semantics) from such things is rather rare, often because individuals don’t want to seek out treatment because they usually are not motivated to seek it out or at least try to heal on their own.
I am also aware that if we have any mental health professionals here that patient/therapist confidentiality rules would keep you from talking about a given patient.
Still, I remain curious if you know anyone who has done it.
Please be more specific about what you are calling a “disorder”. People do overcome extreme shyness, physical cowardice, being completely self centered etc. as they mature or are put into must perform challenging situations such as military training or action or job requirements.
My son went from being very disconnected and non-motivated in his early 20’s to a hard charging, “get it done” retail food manager at 25 who is all about helping other people develop their skills and competency.
Where do bad habits and attitudes end and mental dysfunctions begin?
astro, “personality disorder” is a very specific diagnosis.
Many “normal” people can have traits of various PDs but the diagnosis criterion is very specific (I am not 100% acquainted with DSM-V changes except that they were substantial). PDs are considered so pervasive that they are much more resistant to treatment than mood, anxiety, etc. disorders. PDs are a core part of the person’s personality.
Some PDs may “mellow” with age, but don’t (usually) go away completely.
I was diagnosed with schizoid PD about eight years ago. I still meet many of the criteria for the disorder. But I don’t think I am as disordered as I once was.
For one thing, after my diagnosis, I later learned that there is a neurological underpinning behind my social aloofness. Realizing this helped me to pinpoint my particular challenges. Socializing isn’t a chore for me not because I hate people. Socializing is a chore because I have a difficult time expressing myself verbally. I don’t speak fluently, so I don’t enjoy recreational talking. I can tolerate it, but it’s generally not fun because speech doesn’t come spontaneously for me. But I also don’t like being the listener all the time. So I’d just as well not socialize if I don’t have to.
Related to the above, I also have a hard expressing and recognizing my emotions. It was initially assumed my alexithymia was purely psychological–perhaps the result of childhood abuse. But once I was evaluated by a neuropsychiatrist, I began to see how this particular challenge may be a neurological one, at least in my case. And to complicate things, it may be a combination of “nature” and “nurture”. Like, as a kid I was teased rather heavily because of my physically awkwardness–which is definitely the manifestation of atypical neurology. I possibly learned to cope with this by numbing my emotional nerve endings. No one can know what the deal is for certain. But realizing that there is a biological cause (proximate or ultimate) for my interpersonal detachment makes me more comfortable reaching out to people. I used to think I was an evil robot who doesn’t deserve any kindness or love. Now I understand that this isn’t true. I do feel things. I just may not be aware of the feelings all the time.
I am happier than I was when I was first diagnosed. My life has objectively improved since then. I still meet the cardinal symptoms, but I don’t think I’m a prototype case.
I think I was fortunate to have a therapist who was willing to work with me in a supportive manner, rather than keeping me to a “to do” list of arbitrary goals.
I think it would be rather interesting were Trump to do the odd mushroom or acid trip and experience Ego Death. But I think I would wish that on any extreme narcissist.
Got my own bag o’ demons, most have gotten better, some occasionally go walkabout.
A room mate I had while I was in college was diagnosed with Borderline Personality. The difference between her and most people with BP is that she accepted and owned the diagnosis and decided to do something about.
She’s still an atypical person, but much closer to normal and capable of normal social interactions. She just finds them more effort than most of us do. She likes having a lot of alone time.
My Mom has Borderline Personality Disorder and she finally got the proper treatment (Dialectical Behavioral Therapy) and she found a way to be happy. She lives a lifestyle that is unusual (living off disability with her new husband, taking off at a moment’s notice to ride motorcycles cross country and not seeming to understand why everyone can’t just live like that, with no planning or foresight) but her happiness requires her to completely forget about anything bad she did in the past, which in practical terms means we ended our relationship permanently because my pain was an inconvenience to her new, happy life. Sucks for me, but by every reasonable measure she is much better off than she was before, and has managed to form some relationships that are probably healthy and is MUCH better at regulating her emotions than she used to be. I think she is happy for the first time in her life. By all accounts me ending our relationship has barely been a blip on her happiness radar. I am just sorry/bitter I’m not a part of it, especially because I’m the one who worked so hard to get her the help she needed.
In case it’s not clear from my above post, therapy helped her significantly but I wouldn’t call her anywhere close to normal functioning. It has put an end to her violent behavior as far as I can tell, with very rare exceptions, but she still struggles to empathize with others and process human interaction in a normal, healthy way, particularly as it relates to our family. I think she has just created this mentality in her head of ‘‘my family is bad for me’’ which is generally true but was never the case for me, at least it shouldn’t have been, because I was never anything but supportive, but she associates me with everyone else and of course the fact that my childhood permanently traumatized me fucks with her internal narrative that she has always been the victim and never the perpatrator, and therefore I get kicked to the curb. But she has found a way to be happy after a lifetime of misery, and that’s gotta count for something… and frankly that’s all I ever wished for her so I should probably be grateful for that much and move on.
This post makes me feel so sad. I so much wish that you had the mother that you deserve and one who appreciated the woman you have become despite her shortcomings. I know you have heard it a million times, but you are really amazing and nothing your mom does or dosen’t do can change that. You have taken a bunch of crap that life has thrown at you and persevered. It is impressive, lovely lady.
Sure. Myself. I have Aspergers. I’ve learned how it affects my socialization, and need to be mindful of how other people might regard my presence. No therapy, just self-awareness and internal examination. I guess I used to make people feel uncomfortable. I’ve learned how to redirect myself to reduce the incidence of that.
Anyone can overcome, at least partly, a “personality disorder” just by recognizing the disorder, and giving due consideration to how it affects other people around you.
Thank you for your lovely comment. I’m apparently in full-blown grieving mode right now but it’s just a process to get through like any other kind of loss.
I appreciate all the work you’ve done to address the issues you face, but Aspergers is not a personality disorder as recognized by the DSM. The OP is referring to things like Borderline Personality Disorder, Narcissistic Personality Disorder, Obsessive Compulsive Personality Disorder, etc (with the caveat that I don’t know much about the DSM-V or how its classifications have changed.) Personality disorders are characterized by a dysfunction in relationships to other people.
These disorders are particularly resistant to treatment because people who have them tend to view the problem as everyone else’s, not their own. It’s rare for someone to seek help for a personality disorder or even attempt to change. Most people who enter the mental health system with a personality disorder do so for some other issue – depression or anxiety – and not the disorder itself. It’s a credit to my mother that she eventually was willing to accept her mental illness; it’s an indicator of how fucking intractable these disorders can be that the changes she made were insufficient to salvage our relationship.
Which isn’t to say people can’t get treatment or make positive changes in their lives - they absolutely can. People can and do overcome these disorders despite overwhelming challenges including the stigma attached to having such a diagnosis. The renowned psychologist Marsha Linehan suffers from Borderline Personality Disorder, and she’s also credited with creating the first evidence-based treatment for BPD, a treatment whose underpinning theory is grounded in compassion rather than stigma. But it isn’t an issue of willpower, it’s an issue of relearning how you relate to people on every single conceivable level. Essentially, healing from a personality disorder requires you to acknowledge that you have engaged in a host of shitty, destructive behaviors, and to become a different person. That’s a tall order for anyone much less someone struggling with a severe mental illness.
My mother in law is manic-depressive and it is very well managed by drugs. I’m not sure that meets the OPs criteria, but then you wouldn’t expect someone with a physical illness to ‘overcome’ it without pharmaceutical assistance either.
Bipolar isn’t a personality disorder, but it is a biologically based mental illness. It’s one of the few psychological disorders for which I’d argue recovery is impossible without medication. Treating bipolar without medication would be like treating diabetes without insulin.
That’s just my opinion but it’s pretty well in line with the consensus in the psych community.
But seriously, read some of these proposed descriptions for these disorders and see how stigmatizing they are:
Notice the emphasis isn’t on the individual’s well-being but on this pervasive judgment of what is normal. And that’s coming from the folks who are supposed to treat them. How can we expect people to have a shot in hell if their diagnosis essentially means, ‘‘You are a bad person’’??
I know two people who have borderline personality disorder and have gotten treatment to deal with it or start getting their life back on track. I also had a former partner who I’m confident had it, but never had a formal diagnosis and would deny it. My experience is that if someone is willing to acknowledge their problem, take ownership of their actions, and work on their condition, then it’s quite possible to overcome the disorder. But if someone isn’t willing to acknowledge their condition, and thinks that it’s perfectly normal to fly into a white-hot rage over a sandwich or shout at their partner for hours because they’re in a bad mood, they aren’t ever going to get better.
The clinical literature all bears this out, one of the reasons that personality disorders are so difficult to treat is that one of the symptoms of many of them is an extremely strong belief that they don’t have a problem - people with Antisocial Personality Disorder just don’t care, pw Narcissistic PD think they are awesome and deserve everything, pw Borderline PD have such strong emotions (including guilt) that feelings create facts for them. There really isn’t anything that talk therapy can do to help someone who doesn’t acknowledge that they need help, and the conditions are pervasive personality patterns that generally don’t respond to psych drugs.
Accurately describing someone’s awful behavior towards people close to them is not ‘stigmatizing’ them, it’s accurately describing what they do. I have absolutely no problem with ‘stigmatizing’ people who engage in emotional and/or physical abuse of their partners, or with saying that it is NOT normal or acceptable.
If a person with a personality disorder holds this attitude, RUN don’t walk away from them. If someone says ‘I have a habit of doing bad things, I need to work on how not to do that’ they might recover. But if someone says ‘You talking about the things I’ve done to you means you are saying I’m a bad person, that’s so mean, why are you being mean to me, do you hate me?’ they’re not going to get better, and probably are going to make your life hell if you stay close to them.
I’m a pragmatic person, interested in treatment that works. It’s been well-established that women are disproportionately diagnosed with BPD more than men with the same symptoms, and they are more likely to be treated badly by psychotherapists than people exhibiting similar symptoms who do not have that diagnosis.
Having a personality disorder does not mean, necessarily, that you are abusive. Assuming anyone with such a disorder has all of these negative traits is stigmatizing and inaccurate.
Marsha Linehan’s research on Borderline Personality Disorder found that the key driver of Borderline Personality Disorder is enduring a pervasive pattern of severe trauma in an invalidating environment. My mother was traumatized and whenever she had issues as a result she was scapegoated as crazy by our family in order to marginalize her viewpoint and shut her down. It doesn’t excuse the things she did to me but it goes a long way in explaining why she is the way she is, and most importantly, it presents a framework for effective treatment. Nobody ever attempted to do this before with people who have BPD, it was a catch-all, stigmatizing diagnosis for difficult people and people with BPD were regarded as lost causes. It turns out what people with this disorder needed most in their lives was someone to take their problems seriously, and Marsha Linehan did that because she herself suffered from it. It was rumored, but she finally came out about it in 2011, long after she had established herself as a celebrity within the psychological community.
Being raised with pervasive trauma in an invalidating environment was a key driver of my own issues. But I wasn’t diagnosed with Borderline Personality Disorder, because even though I had some of the symptoms in my early 20s, such as emotional lability (rapid mood swings), they weren’t the sort of symptoms that caused problems for other people. Instead, I was diagnosed with Complex Post Traumatic Stress Disorder, and one of the major proponents of CPTSD, trauma psychologist Judith Herman, argued that it was essentially the same complex of problems encountered by people with BPD, just more compassionately viewed. Both disorders are viewed as pervasively affecting the personality, though CPTSD isn’t even recognized in the DSM at present.
I suspect that being diagnosed with CPTSD vs. Borderline Personality Disorder made all the difference in how I was treated therapeutically and my diagnosis gave me a better shot at fair treatment and therapists who actively believed in my ability to overcome the trauma of my past. If I’d have been slapped with that stigmatizing label as a confused, deeply traumatized kid fresh into college it would have haunted me the rest of my life.
And here you are, using the same phrasing argue against accurate diagnosis of the condition.
rolleyes I’m sure it has nothing at all to do with the very strong and common habit of people with BPD to deny that their condition exists or that any of their behaviors are unreasonable, or their tendency to manipulate people around them, including therapists, into taking blame for their actions or excusing their behaviors. When I was first learning about the condition, one of the most eye-opening things was seeing stuff written by people with uncontrolled BPD, because there was so much active hatred against accurate diagnosis or books helping the victims of abusive people with BPD. No one ever seems to explain what’s actually wrong with the diagnosis, it’s just ‘mean’ or ‘stigmatizing’ or ‘worrying’.
I didn’t say either of those things, nor did the description you quoted and claimed was ‘stigmatizing’. But pretending that I made the claim, and arguing that accurate description of someone’s symptoms is ‘stigmatizing’ as a way to deflect from actually discussing the issue is exactly the sort of deflection that people with severe unmanaged personality disorders and other mental illnesses use to avoid addressing their issues. “Oh, you listed some symptoms? And talked about abuse at all? Well, that’s stigmatizing, you’re just trying to persecute people.”
I am 100% confident in saying the stigma against BPD likely reinforces the cognitive and behavioral mechanisms that perpetuate the disorder. This has been well-established in the psychological literature. I’m not talking about self-help books, I’m talking about the underlying theoretical framework of Dialectical Behavioral Therapy that has been reinforced by countless randomized controlled trials in a strictly controlled clinical research setting.
Acknowledging that stigma is a significant barrier to treatment is 100% different than excusing abusive behavior, and it’s completely out of line for you to suggest that is what I’m doing.
I find it interesting that a lot of people who are diagnosed with autism as adults often have a previous diagnosis of a personality disorder, particular borderline PD. It would be wonderful to find out how often people are mislabeled as having a PD when really they are neurological atypical. Also, how many people develop PDs due to being a neurological misfit? Someone should do a study to find out.
And I think as we understand the brain better, we’ll find measurable biological indicators in PD patients. We already see such signs in borderline PD and schizotypal PD. For the latter, medication has been shown to ease some of the symptoms. I think the lines are probably more blurry than how we’ve conceived them.
Personally, I don’t think we know enough about personality to divorce it from “biology”. I know that my personality changes depending on my energy levels, blood sugar, and the amount of physical pain I’m in. These are biologically-based factors. So when I meet someone who has a rather imperfect personality, it seems logical for me to assume that there is something biologically “off” about them. If abuse can affect the brain, then perhaps people with PD should be treated with the same biologically-based therapies we’d prescribe for anyone with brain damage.
I also don’t think people with PD’s are really THAT much different from people with other mental disorders, as far as self-awareness goes. I almost never think I’m depressed even when I’m killing myself over and over in my fantasies. People can suffer from anxiety disorders and be completely in denial about how irrational their fears are (see hoarders). People can be addicted to drugs, food, and gambling and not realize their “habit” is a serious problem. I wouldn’t be surprised me if anosognosia is more common with PDs if only because behaviors you’ve had your whole life easily seem “normal” to you. But lack of self-awareness is pretty common with disorders like autism, schizophrenia, bipolar mania, and OCD.
All excellent points, monstro. The wiki on Personality Disorders I referred to also discusses psychotropic meds influence on various disorders and IRC Borderline Personality Disorder does respond well to mood stabilizers, which makes perfect sense since rapid mood fluctuations are a common symptom.
I had no idea so many people with autism were diagnosed first with PD.
I don’t think I could ever argue against biology as a potential factor for every existing mental health disorder. I think some are probably more environmentally driven, like maybe you have a pre-existing disposition genetically to developing certain maladaptive behavior patterns, but a traumatic experience would enable those patterns to become more fully realized. Nobody in my family is what I would describe as ‘‘neurotypical.’’ My Mom’s brother was schizoaffective, several women in my family have PMDD (severe hormonally driven psychological problems) in addition to their other diagnoses, unipolar major depressive disorder is very common in my family as is bipolar type I. At a certain point the lines become blurry, is this issue an environmentally driven one, or genetic, or both? I think it’s probably both in many cases, and I would favor approaches that take both factors into consideration in the course of treatment.
