# Narcissism-no longer part of the DSM, why? **URL:** \ **Category:** Factual Questions\ **Created:** [June 27, 2011, 7:02pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052 "2011-06-27T19:02:49Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [June 27, 2011, 7:02pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/1 "2011-06-27T19:02:49Z")
Diagnostic and Statistical Manual of Mental Disorders (DSM IV) The next scheduled updated publication of the DSM, the DSM-V (diagnostic and statistical manual of mental disorders, the holy grail for mental health workers) will NOT include narcissism as a mental disorder. Now, I am appealing here to any possible psychiatrists or psychologists or anyone who may be privy to this information: why was this done? I know the move sparked intense controversy from within the mental health field itself. It is a technical move, more based on changing dianostic criteria or is it a more radical move; one based on a cultural shift more and more towards self-involvement (social media, online behavior, etc) and self-importance? ---
**Author:** ![Captain\_Amazing](https://avatars.discourse-cdn.com/v4/letter/c/6de8d8/32.png) [@Captain\_Amazing](https://boards.straightdope.com/u/Captain_Amazing)\ **Post date:** [June 27, 2011, 7:21pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/2 "2011-06-27T19:21:32Z")
They’re tired of people just buying the DSM to see if they’re mentioned in there? No, seriously, as I understand it, they’re getting rid of Narcissistic, Paranoid, Schizoid, Histrionic and Dependent Personality Disorders, and replacing them with a more general personality impairment, because there’s a lot of overlap in the diagnosis of those personality disorders. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [June 27, 2011, 7:23pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/3 "2011-06-27T19:23:49Z")
Because narcissists hate to be ignored. 😉 No, seriously, it’s nothing personal against narcissists. It’s part of a huge revamp of the DSM and diagnostic processes, moving away from lists of traits and towards more “clinically relevant” impairment diagnosis. In other words, you can be a narcissist and be not a bit impaired by it, or you can be a narcissist and completely dysfunctional under the DSM-IV diagnosis. Giving those two people the same diagnosis when effective treatment, if any, would be entirely different, is what the new system is supposed to eliminate. It’s not that no one is narcissistic, just that it’s not a meaningful term for treatment. They’re trying to move the focus to impairment and severity of impairment, rather than a list of personality traits. It’s also supposed to help clinicians diagnose and treat people who don’t fit a neat checklist of traits. In the past, you’d have to have X number of traits off the list to be diagnosed with a specific personality disorder. In real life, people don’t base their behavior on the checklist. You can have a person who has some narcissistic traits and some paranoid traits and some histrionic traits - maybe not enough of each to be diagnosed with a single personality disorder, but still a severely impaired person. The old system made it impossible to get insurance reimbursement without a diagnosis, so you end up with patients with a huge list of diagnoses, but they don’t really quite fit any of them. The new system is supposed to cut down on that, too. It’s not just Narcissistic Personality Disorder that’s being eliminated or seriously revamped. Also under consideration are Paranoid, Schizoid, Schizotypal (which are not the same as Schizophrenic), Antisocial/Dyssocial, Borderline, Histrionic, Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders. > **[DSM](https://www.psychiatry.org/dsm5)** > > Learn about DSM-5-TR, the standard classification of mental disorders used by mental health professionals in the U.S. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [June 27, 2011, 7:24pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/4 "2011-06-27T19:24:29Z")
As someone who really isn’t qualified to talk about it, couldn’t Borderline Personality Disorder include narcissism, even if it took just a little tweaking. ---
**Author:** ![Ferret\_Herder](https://avatars.discourse-cdn.com/v4/letter/f/e47774/32.png) [@Ferret\_Herder](https://boards.straightdope.com/u/Ferret_Herder)\ **Post date:** [June 27, 2011, 7:24pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/5 "2011-06-27T19:24:40Z")
What the previous posters said. Specifically, narcissism is being reclassified as a type of [antagonistic personality disorder](http://en.wikipedia.org/wiki/DSM-5#Personality_disorders). ---
**Author:** ![Cat\_Whisperer](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cat_whisperer/32/4839_2.png) [@Cat\_Whisperer](https://boards.straightdope.com/u/Cat_Whisperer)\ **Post date:** [June 27, 2011, 7:55pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/6 "2011-06-27T19:55:13Z")
I was going to say, because it isn’t a disorder if you raise an entire generation to be like that. 🙂 ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [June 27, 2011, 8:05pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/7 "2011-06-27T20:05:05Z")
> [@Cat\_Whisperer](#): > > I was going to say, because it isn’t a disorder if you raise an entire generation to be like that. 🙂 Took the words outta my mouth. ha! ---
**Author:** ![TruCelt](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/trucelt/32/523_2.png) [@TruCelt](https://boards.straightdope.com/u/TruCelt)\ **Post date:** [June 27, 2011, 8:29pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/8 "2011-06-27T20:29:58Z")
> [@Cat\_Whisperer](#): > > I was going to say, because it isn’t a disorder if you raise an entire generation to be like that. 🙂 It is if the entire generation is unable to function. :eek: ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [June 27, 2011, 8:42pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/9 "2011-06-27T20:42:53Z")
> [@TruCelt](#): > > It is if the entire generation is unable to function. :eek: Well… ---
**Author:** ![elfkin477](https://avatars.discourse-cdn.com/v4/letter/e/a9a28c/32.png) [@elfkin477](https://boards.straightdope.com/u/elfkin477)\ **Post date:** [June 28, 2011, 1:01am UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/10 "2011-06-28T01:01:10Z")
> [@Cat\_Whisperer](#): > > I was going to say, because it isn’t a disorder if you raise an entire generation to be like that. 🙂 Just to be clear, which generation do you mean? Boomers? Gen-X? Millennials? The thus far nameless turn of the century generation? ---
**Author:** ![Leo\_Bloom](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/leo_bloom/32/10377_2.png) [@Leo\_Bloom](https://boards.straightdope.com/u/Leo_Bloom)\ **Post date:** [June 28, 2011, 2:27am UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/11 "2011-06-28T02:27:22Z")
> [@Joey\_P](#): > > As someone who really isn’t qualified to talk about it, couldn’t Borderline Personality Disorder include narcissism, even if it took just a little tweaking. Something’s going to change with BPD, right? It’s being put in, or taken out, or something? Anyone know? ---
**Author:** ![Rigamarole](https://avatars.discourse-cdn.com/v4/letter/r/77aa72/32.png) [@Rigamarole](https://boards.straightdope.com/u/Rigamarole)\ **Post date:** [June 28, 2011, 3:38am UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/12 "2011-06-28T03:38:40Z")
> [@WhyNot](#): > > It’s part of a huge revamp of the DSM and diagnostic processes, moving away from lists of traits and towards more “clinically relevant” impairment diagnosis. > > In other words, you can be a narcissist and be not a bit impaired by it, or you can be a narcissist and completely dysfunctional under the DSM-IV diagnosis. Giving those two people the same diagnosis when effective treatment, if any, would be entirely different, is what the new system is supposed to eliminate. _It’s not that no one is narcissistic, just that it’s not a meaningful term for treatment_. (emphasis mine) In other words, there’s no money in it for Big Pharma. My WAG: it’s not really about science (yes, scientific theories have been revised over the years but nothing like the dramatic overhauls and 180s we’ve seen in the field of psychology in a very short timespan), it’s about keeping up with the latest Mental Health Disorders du Jour so they can keep their cash cows fat and healthy (bipolar and ADHD, for example, ain’t going _nowhere_. Those are big $$$). I mean we’re talking **huge, colossal, earth-shattering $$$**. here. Sure they make every effort to keep up the appearances of legitimate, dispassionate scientific discipline and rigor, but when that kind of money is involved we all know deals go down under the table. It’s just human nature. ---
**Author:** ![BigT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bigt/32/12044_2.png) [@BigT](https://boards.straightdope.com/u/BigT)\ **Post date:** [June 28, 2011, 4:04am UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/13 "2011-06-28T04:04:40Z")
Uh, very few of the disorders in the DSM have medicines for them. None of the personality disorders do–seeing as they aren’t even thought of as a problem with brain chemistry. It’s just a paradigm shift into functional disorders. If your life is not being impaired, you don’t have a disorder. If this wasn’t the case, half the Dope would have OCD, and the other half depression. ---
**Author:** ![Rachellelogram](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rachellelogram/32/8689_2.png) [@Rachellelogram](https://boards.straightdope.com/u/Rachellelogram)\ **Post date:** [June 28, 2011, 4:46pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/14 "2011-06-28T16:46:21Z")
> [@BigT](#): > > It’s just a paradigm shift into functional disorders. If your life is not being impaired, you don’t have a disorder. If this wasn’t the case, half the Dope would have OCD, and the other half depression. Isn’t this a bit simplistic? I mean, isn’t one of the primary hallmarks of (for example) a narcissist that they aren’t aware they are one? Their disorder doesn’t impair their own life, but the lives of those around them. ---
**Author:** ![Cat\_Whisperer](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cat_whisperer/32/4839_2.png) [@Cat\_Whisperer](https://boards.straightdope.com/u/Cat_Whisperer)\ **Post date:** [June 28, 2011, 9:10pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/15 "2011-06-28T21:10:30Z")
> [@elfkin477](#): > > Just to be clear, which generation do you mean? Boomers? Gen-X? Millennials? The thus far nameless turn of the century generation? Kids today, of course. 🙂 ---
**Author:** ![TriPolar](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tripolar/32/3008_2.png) [@TriPolar](https://boards.straightdope.com/u/TriPolar)\ **Post date:** [June 28, 2011, 10:06pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/16 "2011-06-28T22:06:59Z")
**Narcissism-no longer part of the DSM, why?** Because of me. ---
**Author:** ![salinqmind](https://avatars.discourse-cdn.com/v4/letter/s/3ec8ea/32.png) [@salinqmind](https://boards.straightdope.com/u/salinqmind)\ **Post date:** [June 28, 2011, 10:24pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/17 "2011-06-28T22:24:36Z")
My cousin took a community college course in story writing and said the personality disorders listed in the DSM were helpful to her in fleshing out her characters. (Which seemed like a kind of short cut to me, and besides, no real person has ALL of the traits in any disorder.) She said Scarlett O’Hara was, according to a psychiatric article she found somewhere, a classic case of Narcissistic and/or Histrionic disordered, and that was good enough for my cuz. ---
**Author:** ![purplehorseshoe](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/purplehorseshoe/32/2996_2.png) [@purplehorseshoe](https://boards.straightdope.com/u/purplehorseshoe)\ **Post date:** [June 28, 2011, 10:56pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/18 "2011-06-28T22:56:55Z")
[QUOTE=WhyNot] It’s part of a huge revamp of the DSM and diagnostic processes, moving away from lists of traits and towards more “clinically relevant” impairment diagnosis. In other words, you can be a narcissist and be not a bit impaired by it, or you can be a narcissist and completely dysfunctional under the DSM-IV diagnosis. Giving those two people the same diagnosis when effective treatment, if any, would be entirely different, is what the new system is supposed to eliminate. _It’s not that no one is narcissistic, just that it’s not a meaningful term for treatment._ [/QUOTE] > [@Rigamarole](#): > > (emphasis mine) > > In other words, there’s no money in it for Big Pharma. My WAG: it’s not really about science (yes, scientific theories have been revised over the years but nothing like the dramatic overhauls and 180s we’ve seen in the field of psychology in a very short timespan), it’s about keeping up with the latest Mental Health Disorders du Jour so they can keep their cash cows fat and healthy (bipolar and ADHD, for example, ain’t going _nowhere_. Those are big $$$). I mean we’re talking **huge, colossal, earth-shattering $$$**. here. Sure they make every effort to keep up the appearances of legitimate, dispassionate scientific discipline and rigor, but when that kind of money is involved we all know deals go down under the table. It’s just human nature. **Rigamarole** , why do you think treatment = pharmaceuticals? There are non-Rx approaches to many aspects of mental health care. Why immediately jump to hysterical hand-waving about Big Pharma and cash cows and huge, colossal, earth-shattering $$$? Do you think people with mental health problems should do without “treatment” entirely? ---
**Author:** ![Rigamarole](https://avatars.discourse-cdn.com/v4/letter/r/77aa72/32.png) [@Rigamarole](https://boards.straightdope.com/u/Rigamarole)\ **Post date:** [June 28, 2011, 11:25pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/19 "2011-06-28T23:25:28Z")
> [@purplehorseshoe](#): > > **Rigamarole** , why do you think treatment = pharmaceuticals? There are non-Rx approaches to many aspects of mental health care. Why immediately jump to hysterical hand-waving about Big Pharma and cash cows and huge, colossal, earth-shattering $$$? I never said that (therapists make pretty good bank too). Pharmaceuticals are a large part of it though. > [@](#): > > Do you think people with mental health problems should do without “treatment” entirely? Nope. The fact that money influences diagnoses and diagnostic criteria doesn’t preclude the possibility that medicine can genuinely help people. I just think it’s important to note that there are different interests here which may occasionally align, and other times not so much. ---
**Author:** ![code\_grey](https://avatars.discourse-cdn.com/v4/letter/c/f4b2a3/32.png) [@code\_grey](https://boards.straightdope.com/u/code_grey)\ **Post date:** [June 28, 2011, 11:26pm UTC](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052/20 "2011-06-28T23:26:41Z")
> [@purplehorseshoe](#): > > **Rigamarole** , why do you think treatment = pharmaceuticals? There are non-Rx approaches to many aspects of mental health care. Why immediately jump to hysterical hand-waving about Big Pharma and cash cows and huge, colossal, earth-shattering $$$? > > Do you think people with mental health problems should do without “treatment” entirely? [False dilemma - Wikipedia](http://en.wikipedia.org/wiki/False_dichotomy) is a logical fallacy. [Reductio ad absurdum - Wikipedia](http://en.wikipedia.org/wiki/Reductio_ad_absurdum) is also not a good way to get your point across in conversation with intelligent people. [Next page](https://boards.straightdope.com/t/narcissism-no-longer-part-of-the-dsm-why/587052.md?page=2)