george nisyrios | Narcissistic, Obsessive Compulsive and Borderline personalities
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Oct 19 2015

Narcissistic, Obsessive Compulsive and Borderline personalities

When trying to understand a person’s behaviour, it often helps me slot their behaviour into category.

There are a number of ways of defining aspects to personality and a number of different theories.

Personality disorders are different in that a range of criteria, behaviours and traits must be present in a person to fit a definition of a disorder.

I thought I might reflect on a few that I seem to come across most often.

Narcissistic

When I meet a person with aspects of this traits, sometimes it’s hard to pick whether they are simply reflecting on some truths in their life or whether all that they are saying is quite disproportionate to reality.  It might even be interesting to hear this person talk about themselves, but soon the lack of balanced conversation and empathy starts to surface.

Listed in DSM-5 as part of the disorder definition

1. Impairments in self functioning (a or b):

a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.

b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.

AND

2. Impairments in interpersonal functioning (a or b):

a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.

b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others’ experiences and predominance of a need for personal gain

Antagonism, characterized by:

a. Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others.

b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.

Obsessive Compulsive

We all come across this type of person often enough and there is certainly a scale of severity.  In day to day life I find this type of person quite hard to feel comfortable with if there is a lot of anxiety and dysfunctional thoughts and behaviour associated with their obsessiveness.

Listed in DSM-5 as part of the disorder definition

An extensive pattern of preoccupation with perfectionism, orderliness, and interpersonal and mental control, at the cost of efficiency, flexibility and openness. Symptoms must appear by early adulthood and in multiple contexts. At least four of the following should be present:

  • Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
  • Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
  • Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
  • Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
  • Is unable to discard worn-out or worthless objects even when they have no sentimental value.
  • Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
  • Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
  • Shows rigidity and stubbornness.

Borderline

I think people with aspects of this type are very common along a scale of severity.  I find these people very difficult in that they can harbour a lot of anger and victim feelings and often seem tangential and deluded in their thoughts and subsequent behavioural responses.

Listed in DSM-5 as part of the disorder definition

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning in early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  • Frantic efforts to avoid real or imagined abandonment.
  • A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
  • Identity disturbance: markedly and persistently unstable self-image or sense of self
  • Impulsivity in at least two areas that are potentially self-damaging (e.g., substance abuse, binge eating, and reckless driving).
  • Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
  • Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
  • Transient, stress-related paranoid ideation or severe dissociative symptoms
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