L8: Antisocial, narcissistic PD and psychopathy Flashcards
DSM symptoms of narcissism
Grandiose sense of self
Need for admiration
Arrogant
Entitled
Fantasies of succes, power etc.
Envious of others
Feels “special”
Lack of empathy
Exploitative
prevalence of narcissism
- community: 0-6.2%
- forensic studies: higher prevalence (27%)
- more men than women (50-75% is men)
2 types of narcissism
- grandiose: dominance, self-assurance, immodesty, exhibitionism (putting yourself in the center of attention), aggression
- vulnerable: introversion, negative emotions, interpersonal coldness, hostility, need for recognition, entitlement, egocentricity
(both are narcissism, but very different presentations of them)
wat is er met vulnerable narcissism en de dsm
vulnerable narcissism lijkt meer op BPD
vulnerable narcissism meer details
voelen zich ook beter dan anderen, maar dan meer op een hostile, introverte manier. dus dan draait het nog steeds wel alles naar hunzelf, klagen veel over hoe bepaalde dingen hen beïnvloeden.
“poor little me”
“pity me”
dimensional: factoren
identity
self-direction
empathy
intimacy
identity of a narcissist
- uses others for self-definition and self-esteem (hinges on what other people think about them)
- exaggerated self-appraisal
- emotion regulation fluctuates with self-esteem
self-direction of a narcissist
- goal setting is based on gaining approval
- high/low personal standards
- unaware of own motivations (dus geen introspectie)
empathy of a narcisist
- impaired ability to recognise/identify
- excessively attentive to reactions of others
- over- or underestimating own effects on others
intimacy of narcisist
- superficial relationships
- restrained mutuality (little genuine interest)
- demand a lot from partner, wont give much back
2 pathways for boosting ego
- admiration: trying to get positive attention through self-promotion, being charming, strive for uniqueness, posting on social media, etc.
-> social potency (does lead you to have admirers in the real world) - rivarly: more negative, pushing other people down, try to devaluate others, make a lot of downward comparacies, strive for supremacy
welke pathways gebruiken narcissists meer
grandiose: prefers the admiration pathway, however, if they perceive a threat against their ego they are likely to use that second pathway
vulnerable: more likely to use the rivarly pathway (but maybe less aggressive way)
ASPD characteristics DSM
- disregard for and violation of the rights of others, starting since age 15 (dan nog niet gediagnosticeerd, maar het gedrag moet er dan wel al zijn!)
- not conforming to social norms (can lead to repeated unlawful behaviour)
- deceitfulness (lying, conning)
- impulsivity
- irritability and aggressiveness
- reckless disregard for the safety of self and others
- consistent irresponsibility
- lack of remorse
prevalence of ASPD
- community: 0.2-3.3%
- forensic: 30%
- more men than women
wat zie je in de praktijk veel bij ASPD
- lachen terwijl dingen helemaal niet grappig zijn
- lack of remorse
- they just dont care
- soms heel rationeel, geen emoties bij verhaal
- weinig oogcontact
psychopathy kenmerken opgeschreven in 1950s
- Superficial charm and good “intelligence”
- Absence of delusions and other signs of irrational thinking
- Unreliability
- Untruthfulness and insincerity
- Lack of remorse or shame
- Inadequately motivated antisocial behavior
- Poor judgement and failure to learn by experience
- Pathological egocentricity and incapacity for love
- General poverty in major affective reactions
- Specific loss of insight
- Unresponsiveness in general interpersonal relations
- Fantastic and uninviting behavior with drink and sometimes without
psychopathy nu
Factor 1: affective/interpersonal
* Affective: lack of guilt/remorse, emotionally shallow, callous (lack of empathy), failure to accept responsibility for actions
* Interpersonal: glibness/superficial charm, grandiose, pathological lying, conning/manipulative
Factor 2: antisocial/lifestyle
* Antisocial: poor behavioral control, early behavioral problems, juvenile delinquency, revocation of conditional release, criminal versatility
* Lifestyle: need for stimulation, lack of realistic long term goals, parasitic lifestyle, impulsivity, irresponsibility
Other
* Promiscuous sexual behavior
* Many short-term relationships (but very serious: moving in very fast etc)
diagnosis
- need secondary source of information (unreliable, lying)
- file information
- info from clinical/criminal records
- infor from family or other sources - psychopathy checklist (20 items, scored from 0-2, more than > 26 or >30 = psychopathy. need for training.
waarom vaak alleen een diagnose als je een misdaad hebt gepleegd
omdat je dus die extra info nodig hebt om de diagnose te kunnen stellen
identity of ASPD
- egocentrism
- self-esteem derived from personal gain, power, or pleasure (dominance)
self-direction ASPD
- based on personal gratification (regardless of the costs of others, goals are set)
- absence of prosocial internal standarrds, normative ethical behaviours
empathy in ASPD
- lack of concern for others
- lack of remorse after hurting or mistreating another
intimacy in ASPD
- incapacity for mutually intimate relationships
- exploitation is used to relate to others
- use of dominance or intimidation
when will you see these people?
- Usually not voluntarily
- In forensic settings
- Because family wants
them to go - When voluntary: coming for a different problem
it is not always obvious…
- charming/manipulative
- “normal”
- externalising blame
- NPD: subtle egocentric, emphasizing own suffering, gaslighting
be careful diagnosing:
- Narcissism is a spectrum
- Sometimes narcissism is used as a mask (for anxiety, insecurity)
- ASPD/psychopathy diagnoses may be damaging
- Situational vs. Personality traits?
- There are cultural differences: e.g., macho culture, individualistic vs. collectivistic cultures
- There are generational differences: e.g., the “selfie” generation
- There are gender x culture differences: e.g., men might be expected/allowed to be more narcissistic
consequences of these PDs
- Involvement in criminal justice system
- Poor interpersonal relations
- Negative consequences for others: In close relationships, in work settings
- Poor personal outcomes (low quality of life)
treatment for these PDs
- Tailored to the needs of the person
- Treatments for BPD are often used
- Good signs: Taking responsibility, Varied emotional responses/high emotionality
- Otherwise: Focussed on harm reduction (especially for psychopathy)
countertransferance: NPD
Client:
* Might try to use admiration/rivalry
* Does not listen, only talks
You
* Might get bored
* Might get competitive, frustrated
countertrasnferance: vulnerable narcissism
Client:
* Seems anxious, but constantly looks for
confirmation
* Is sentitive to what therapist says
You
* Might become overly invested/empathetic
* Might become irritated
countertransferance of ASPD
Client: Depends on level of emotionality
You:
* Hopeless
* Irritated/frustrated
countertransferance bij psychopathy
Client:
*Manipulative/conning
You
* Might think there is less of a problem
* Frustration when therapy does not seem to improve
* Overly invested
