NPD: American Hype or Clinical Entity? (DSM 5-TR vs. ICD-11)

NPD: American Hype or Clinical Entity? (DSM 5-TR vs. ICD-11) (University of Applied Sciences)

Summary

The contrast between DSM and ICD highlights a broader debate in mental health: Should diagnosis be rigid and categorical or flexible and dimensional? The ICD’s nuanced, clinically informed, and culturally sensitive approach better aligns with the realities of Cluster B personality disorders and human psychology. Clinicians, researchers, and patients benefit from diagnostic systems that reflect the complexity, fluidity, and cultural embeddedness of personality disorders. Moving toward ICD-like models promises improved understanding, treatment, and outcomes for those affected by these challenging conditions. NPD: American Hype or Clinical Entity? (DSM 5-TR vs. ICD-11) (University of Applied Sciences)

Abuse, narcissism, narcissist, Personality, Psychology, Reality, Sam Vaknin, Trauma, Vaknin, Vaknin Summaries

December 28, 2025

Tip: click a paragraph to jump to the exact moment in the video. NPD: American Hype or Clinical Entity? (DSM 5-TR vs. ICD-11) (University of Applied Sciences)

00:20 Good afternoon. >> Afternoon. Uh welcome second day of of our of your lectures. So interesting for for all of us. Uh we have a lot of new people on the audience. Uh so I would like to say some uh some sentences about you, some information if you let me. >> Yes, of course I would like to. There’s nothing I can do. >> Okay. Okay. Uh so professor Baklin Saklin is professor of psychology and he is the pioneer of the field of narcissus in 1980s and 1990s and with his book Marina first love and Good afternoon. >> Afternoon. Uh welcome second day of of our of your lectures. So interesting for for all of us. Uh we have a lot of new people on the audience. Uh so I would like to say some uh some sentences about you, some information if you let me. >> Yes, of course I would like to. There’s nothing I can do. >> Okay. Okay. Uh so professor Baklin Saklin is professor of psychology and he is the pioneer of the field of narcissus in 1980s and 1990s and with his book Marina first love and
01:08 narcissist he pioneer of this field he’s also the author of many many books on plastic disorders and naristic abuse and this topic is so important now nowadays so today we have the second chance to listen to professor Sam welcome professor once again >> thank you Agata my contract obliges me to mention that I’m a professor of psychology in the commonwealth institute in Cambridge United Kingdom okay >> excuse me I have forgotten >> well it’s okay sometimes I forget Okay, I see in the audience um a few narcissist he pioneer of this field he’s also the author of many many books on plastic disorders and naristic abuse and this topic is so important now nowadays so today we have the second chance to listen to professor Sam welcome professor once again >> thank you Agata my contract obliges me to mention that I’m a professor of psychology in the commonwealth institute in Cambridge United Kingdom okay >> excuse me I have forgotten >> well it’s okay sometimes I forget Okay, I see in the audience um a few
01:53 mazukis who returned to listen to the second lecture. Don’t worry, it’s a treatable condition and u I would like exactly like yesterday I would like to thank Agatanovska, Dr. Joanna Novak, I hope I’m pronouncing all this correctly uh for their efforts in organizing this event and of course I am thankful to the University of Applied Sciences for having me at all. This uh lecture like many other free lectures and seminars throughout the world is sponsored by the Vaknin Vangelovska Foundation which I mazukis who returned to listen to the second lecture. Don’t worry, it’s a treatable condition and u I would like exactly like yesterday I would like to thank Agatanovska, Dr. Joanna Novak, I hope I’m pronouncing all this correctly uh for their efforts in organizing this event and of course I am thankful to the University of Applied Sciences for having me at all. This uh lecture like many other free lectures and seminars throughout the world is sponsored by the Vaknin Vangelovska Foundation which I
02:35 established together with my wife and so it is free and available to anyone who wishes to organize similar lectures or a seminar in their home cities. We are we are available. I do not charge speaker fees or anything. So this is the thanks part and I would also like on this occasion to thank the technical team here with me and that is Marian and Yakov his son who are taking care to record all this and appropo recording these lectures are video recorded and I’m going to upload them to my YouTube channels. Now on my established together with my wife and so it is free and available to anyone who wishes to organize similar lectures or a seminar in their home cities. We are we are available. I do not charge speaker fees or anything. So this is the thanks part and I would also like on this occasion to thank the technical team here with me and that is Marian and Yakov his son who are taking care to record all this and appropo recording these lectures are video recorded and I’m going to upload them to my YouTube channels. Now on my
03:15 YouTube channels I have half a million subscribers. So you all are going to become instant YouTube celebrities. Those of you who don’t feel comfortable with becoming a celebrity, it’s a mental issue in itself in today’s world. Those of you who don’t feel comfortable becoming a celebrity, I’m afraid would have to leave the lecture hall because we have no way to edit you out. you’re going to be included in the video and it’s going to be available initially to half a million people probably many YouTube channels I have half a million subscribers. So you all are going to become instant YouTube celebrities. Those of you who don’t feel comfortable with becoming a celebrity, it’s a mental issue in itself in today’s world. Those of you who don’t feel comfortable becoming a celebrity, I’m afraid would have to leave the lecture hall because we have no way to edit you out. you’re going to be included in the video and it’s going to be available initially to half a million people probably many
03:52 more later. So this is your chance if you feel strongly about your privacy and you do not want to be included in such a video then I’m afraid you would you would have to listen to this lecture on YouTube a bit later. One, two, three. You all want to become YouTube celebrities. That is a narcissistic feature. Okay, you will get used to my sense of humor, I hope. On the website, there is a link to an article that I wrote and was peer-reviewed and published in an academic journal. Um when you go to the website of the more later. So this is your chance if you feel strongly about your privacy and you do not want to be included in such a video then I’m afraid you would you would have to listen to this lecture on YouTube a bit later. One, two, three. You all want to become YouTube celebrities. That is a narcissistic feature. Okay, you will get used to my sense of humor, I hope. On the website, there is a link to an article that I wrote and was peer-reviewed and published in an academic journal. Um when you go to the website of the
04:38 university there’s a page and on the page there’s a link to this article you can download the article it’s u a PDF uh file and the article is a summary of what you are about to hear today not only summary but a lot more extended so those of you who want to go deeper into the issue there’s your chance with this article today we’re going to discuss the differences between the diagnostic and statistical manual DSM and the international classification of diseases the ICD with regards to cluster B personality university there’s a page and on the page there’s a link to this article you can download the article it’s u a PDF uh file and the article is a summary of what you are about to hear today not only summary but a lot more extended so those of you who want to go deeper into the issue there’s your chance with this article today we’re going to discuss the differences between the diagnostic and statistical manual DSM and the international classification of diseases the ICD with regards to cluster B personality
05:17 disorders. But the conversation is going to be a lot more philosophical and a lot more comprehensive because the attitudes and mentality and philosophy that are apparent in cluster B personality disorder diagnosis also characterize the total manual the total work that went into the specific manual. Now just to be clear, the Diagnostic and Statistical Manual, the DSM, is currently in its fifth edition text revision which was published in 2022. It is very famous. Everyone knows what is the DSM almost. disorders. But the conversation is going to be a lot more philosophical and a lot more comprehensive because the attitudes and mentality and philosophy that are apparent in cluster B personality disorder diagnosis also characterize the total manual the total work that went into the specific manual. Now just to be clear, the Diagnostic and Statistical Manual, the DSM, is currently in its fifth edition text revision which was published in 2022. It is very famous. Everyone knows what is the DSM almost.
06:02 And the reason it’s very famous is because it’s American. It’s published in the United States. And Americans are very good at self-promotion. They control the media and the global media and consequently the DSM is much more wellknown than the ICD. The ICD is in its 11th edition also incidentally or accidentally published in 2022. But the fact is that the ICD is much more widely used than the DSM. For example, in Russia, they use the ICD, not the DSM. The CCMD, which is a diagnostic manual And the reason it’s very famous is because it’s American. It’s published in the United States. And Americans are very good at self-promotion. They control the media and the global media and consequently the DSM is much more wellknown than the ICD. The ICD is in its 11th edition also incidentally or accidentally published in 2022. But the fact is that the ICD is much more widely used than the DSM. For example, in Russia, they use the ICD, not the DSM. The CCMD, which is a diagnostic manual
06:47 of China, was revised recently and relies mostly on the ICD. So, we could generalize and say that something like 60 to 80% of humanity use the international classification of diseases, not the DSM. The DSM is used mostly in North America, United States, to some extent Canada, and to some extent the United Kingdom, Anglo-Saxon countries, and maybe a bit in Australia. But that’s it. It’s not the dominant manual. The dominant manual is the ICD. That’s very important to mention. When we hear about the battle between of China, was revised recently and relies mostly on the ICD. So, we could generalize and say that something like 60 to 80% of humanity use the international classification of diseases, not the DSM. The DSM is used mostly in North America, United States, to some extent Canada, and to some extent the United Kingdom, Anglo-Saxon countries, and maybe a bit in Australia. But that’s it. It’s not the dominant manual. The dominant manual is the ICD. That’s very important to mention. When we hear about the battle between
07:29 the DSM and the ICD, we should bear in mind that the DSM reflects a very narrow social and cultural approach to mental illness. Whereas the ICD is much more representative of humanity at large. Now few months ago there was a meeting of the American Psychological Association and its president at current president who at the time was a chairman of a committee her name is Maria Okuendo. Dr. Okuendo gave an interview and Ukuendo was later appointed as the chairman of the committee that is charged with writing the next version of the DSM and the ICD, we should bear in mind that the DSM reflects a very narrow social and cultural approach to mental illness. Whereas the ICD is much more representative of humanity at large. Now few months ago there was a meeting of the American Psychological Association and its president at current president who at the time was a chairman of a committee her name is Maria Okuendo. Dr. Okuendo gave an interview and Ukuendo was later appointed as the chairman of the committee that is charged with writing the next version of
08:14 the diagnostic manual. Maybe it will be called DSM6. We are not quite sure, but she is in charge of the committee. So she gave an interview. She’s from the University of Pennsylvania. She gave an interview and she said something which I personally found shocking. You can go online, you can read the interview for yourself. Make sure that I’m quoting her correctly. She said that clinical considerations, clinical knowledge, clinical features are secondary to the demands of the insurance industry. the diagnostic manual. Maybe it will be called DSM6. We are not quite sure, but she is in charge of the committee. So she gave an interview. She’s from the University of Pennsylvania. She gave an interview and she said something which I personally found shocking. You can go online, you can read the interview for yourself. Make sure that I’m quoting her correctly. She said that clinical considerations, clinical knowledge, clinical features are secondary to the demands of the insurance industry.
08:52 I am not kidding you. the head of the American Psychological Association and the woman in charge of writing essentially the next edition of the DSM confessed admitted in public that it is the insurance industry that dictates largely what would be and what would not be in the DSM. I personally find it shocking. Another thing that I find shocking and you are beginning to realize I believe that I’m not a big fan of the DSM which will become evident by the end of the lecture. But another thing that I find shocking I am not kidding you. the head of the American Psychological Association and the woman in charge of writing essentially the next edition of the DSM confessed admitted in public that it is the insurance industry that dictates largely what would be and what would not be in the DSM. I personally find it shocking. Another thing that I find shocking and you are beginning to realize I believe that I’m not a big fan of the DSM which will become evident by the end of the lecture. But another thing that I find shocking
09:33 is that not one chairman of any committee in the American Psychiatric Association, not one of them is a psychologist. They are all medical doctors. Some of them are psychiatrists. Some of them are pure medical doctors with no degree in psychiatry or psychology. And there isn’t even a single clinician, a single psychologist, single therapist in as a chairman of any of the committees that together are writing the next edition of the DSM. I again find it shocking because the DS DSM presumably is a psychological is that not one chairman of any committee in the American Psychiatric Association, not one of them is a psychologist. They are all medical doctors. Some of them are psychiatrists. Some of them are pure medical doctors with no degree in psychiatry or psychology. And there isn’t even a single clinician, a single psychologist, single therapist in as a chairman of any of the committees that together are writing the next edition of the DSM. I again find it shocking because the DS DSM presumably is a psychological
10:20 manual. It’s a manual of mental health, mental disorders. One would think that psychologists, practicing clinicians like therapists would have a major contribution or should have a major contribution and yet they are absolutely excluded. Consequently, in the text of the DSM, there is very very little clinical practice. There’s a lot of theory, a lot of speculation and very little practice because these people, the clinicians are excluded. The tendency now, the new trend is to medicalize manual. It’s a manual of mental health, mental disorders. One would think that psychologists, practicing clinicians like therapists would have a major contribution or should have a major contribution and yet they are absolutely excluded. Consequently, in the text of the DSM, there is very very little clinical practice. There’s a lot of theory, a lot of speculation and very little practice because these people, the clinicians are excluded. The tendency now, the new trend is to medicalize
11:06 psychology, to render psychology, especially clinical psychology, a branch of medicine. Clinical psychologist when they grow up, they dream about becoming medical doctors. They imagine themselves in white robes, in laboratories, and hospital departments. they think of themselves as some kind of neuroscientists and so on so forth. There’s the attitude of scientifying psychology, making it a science, a hard science and medicalizing psychology. It’s not a new, of course, it’s not a new development. It’s not a new trend. psychology, to render psychology, especially clinical psychology, a branch of medicine. Clinical psychologist when they grow up, they dream about becoming medical doctors. They imagine themselves in white robes, in laboratories, and hospital departments. they think of themselves as some kind of neuroscientists and so on so forth. There’s the attitude of scientifying psychology, making it a science, a hard science and medicalizing psychology. It’s not a new, of course, it’s not a new development. It’s not a new trend.
11:49 If you go back to the history of psychology, Ziggman Freud was a neurologist. Shallo and Jean Jane in France they were medical doctors. So this is not something new. It was Jung for those of you who are interested in the history of psychology. It was Jung actually who was a psychiatrist. Ironically it was Jung who introduced into psychology non-medical topics and a non-medical way of thinking. But up until young the field of psychology has been largely medicalized with laboratories in Germany, Vunt, William James, Ziggman If you go back to the history of psychology, Ziggman Freud was a neurologist. Shallo and Jean Jane in France they were medical doctors. So this is not something new. It was Jung for those of you who are interested in the history of psychology. It was Jung actually who was a psychiatrist. Ironically it was Jung who introduced into psychology non-medical topics and a non-medical way of thinking. But up until young the field of psychology has been largely medicalized with laboratories in Germany, Vunt, William James, Ziggman
12:31 Freud, they were all aspiring or actual medical doctors. So we are going back to the 19th century. We are reverting to the 19th century. We are pushing psychology to become again a branch of neur neuroscience, a branch of neurology, a branch of medicine. The only problem with this is that neuroscience is very immature. It’s an adolescent science. It is not ready to inform psychology. It’s not ready to become the foundation of psychology. There is a very weak correlation between the findings of neuroscience Freud, they were all aspiring or actual medical doctors. So we are going back to the 19th century. We are reverting to the 19th century. We are pushing psychology to become again a branch of neur neuroscience, a branch of neurology, a branch of medicine. The only problem with this is that neuroscience is very immature. It’s an adolescent science. It is not ready to inform psychology. It’s not ready to become the foundation of psychology. There is a very weak correlation between the findings of neuroscience
13:17 and psychology, especially clinical psychology. The correlation is weak. There are all kinds of speculations by neuroscientists who want their 15 minutes of fame on television or the internet. So they go out with bombastic announcements about identifying this pathway in the brain, identifying this region in the brain, this multiple unit activity, this and that and linking it to known psychological syndromes or diagnosis. This is not serious. This is not serious work. And so neuroscience at this stage and psychology, especially clinical psychology. The correlation is weak. There are all kinds of speculations by neuroscientists who want their 15 minutes of fame on television or the internet. So they go out with bombastic announcements about identifying this pathway in the brain, identifying this region in the brain, this multiple unit activity, this and that and linking it to known psychological syndromes or diagnosis. This is not serious. This is not serious work. And so neuroscience at this stage
13:53 cannot be of help to psychology and definitely cannot be the foundation of psychology. It’s way too early. There’s a lot we don’t know about the brain and we are discovering new things, new major things about the brain literally every decade. Another problem with this attitude of medicalizing psychology which is pervasive in the new committees of the DSM. Another problem with this attitude is that many many studies cannot be replicated. Now most of you have heard of what we call the replication crisis. cannot be of help to psychology and definitely cannot be the foundation of psychology. It’s way too early. There’s a lot we don’t know about the brain and we are discovering new things, new major things about the brain literally every decade. Another problem with this attitude of medicalizing psychology which is pervasive in the new committees of the DSM. Another problem with this attitude is that many many studies cannot be replicated. Now most of you have heard of what we call the replication crisis.
14:33 The fact that 60 to 80% of studies cannot be replicated. When there is a discipline with such a major replication crisis, it’s very difficult to call it science. It’s very reminiscent of art or literature or pseudocience. But science it is not. The whole scientific attitude to psychology, the injection of statistics as a way to prove that it is a science, the medicalization of psychology is leading us nowhere, leading us further and further away from making sense of the human mind. We are The fact that 60 to 80% of studies cannot be replicated. When there is a discipline with such a major replication crisis, it’s very difficult to call it science. It’s very reminiscent of art or literature or pseudocience. But science it is not. The whole scientific attitude to psychology, the injection of statistics as a way to prove that it is a science, the medicalization of psychology is leading us nowhere, leading us further and further away from making sense of the human mind. We are
15:22 not getting wiser. On the very contrary in my view and where you find most of it happening is in the DSM and the committees that are writing the DSM. The idea is to create new diagnosis which would somehow conform to the ICD. The idea is called convergence. the ICD and the DSM would converge somehow and the ICD would introduce social determinants, quality of life attributes, functional biomarkers and a bit more structure into the diagnosis and the emphasis is on clinical entities similar to medicine not getting wiser. On the very contrary in my view and where you find most of it happening is in the DSM and the committees that are writing the DSM. The idea is to create new diagnosis which would somehow conform to the ICD. The idea is called convergence. the ICD and the DSM would converge somehow and the ICD would introduce social determinants, quality of life attributes, functional biomarkers and a bit more structure into the diagnosis and the emphasis is on clinical entities similar to medicine
16:09 like tuberculosis or cancer is a clinical entity. So the emphasis is to try to create clinical entities which would be invariant could be diagnosed anywhere at any period of history in any culture in any society in any geography. So invariant clinical entities and medication so there’s a new emphasis on psychopharmarmacology in the DSM. The DSM is controversial has always been controversial. The ICD is consensual, has always been consensual. The DSM is informed mostly by psychiatrists. The ICD is informed mostly by like tuberculosis or cancer is a clinical entity. So the emphasis is to try to create clinical entities which would be invariant could be diagnosed anywhere at any period of history in any culture in any society in any geography. So invariant clinical entities and medication so there’s a new emphasis on psychopharmarmacology in the DSM. The DSM is controversial has always been controversial. The ICD is consensual, has always been consensual. The DSM is informed mostly by psychiatrists. The ICD is informed mostly by
16:55 clinicians. These are two absolutely incompatible philosophies as to how to diagnose and describe mental illness and mental disorders. Let’s look at a fact. I like facts because sometimes they’re funny. In 1952, the first edition of the Diagnostic and Statistical Manual contained 101 pages. That was the first edition of the DSM. Fast forward to 2022, fifth edition, text revision. The difference between the two 70 years 70 years. Now instead of 101 pages there is 1,1 pages. The DSM multiplied 10fold. clinicians. These are two absolutely incompatible philosophies as to how to diagnose and describe mental illness and mental disorders. Let’s look at a fact. I like facts because sometimes they’re funny. In 1952, the first edition of the Diagnostic and Statistical Manual contained 101 pages. That was the first edition of the DSM. Fast forward to 2022, fifth edition, text revision. The difference between the two 70 years 70 years. Now instead of 101 pages there is 1,1 pages. The DSM multiplied 10fold.
17:58 The DSM increased by 1,000%. Are we 1,000% more mentally ill? Have we been oblivious to 90% of all mental illnesses or are we over pathologizing, over diagnosing, which I suspect is the case? The attitude of the DSM is the attitude of a snapshot, not a video. It’s a static manual, not a dynamic manual. the client or the patient presents. By the way, the very use of the word patient is because psychology wants to become a branch of medicine. In medicine, in hospitals, we have patience. That’s why to this very day, many The DSM increased by 1,000%. Are we 1,000% more mentally ill? Have we been oblivious to 90% of all mental illnesses or are we over pathologizing, over diagnosing, which I suspect is the case? The attitude of the DSM is the attitude of a snapshot, not a video. It’s a static manual, not a dynamic manual. the client or the patient presents. By the way, the very use of the word patient is because psychology wants to become a branch of medicine. In medicine, in hospitals, we have patience. That’s why to this very day, many
18:54 psychologists and psychiatrists and so on use the word patient. So the patient or the client presents himself or herself in a clinical setting. There is presentation and then the DSM says that you have to take a snapshot, a photograph of the patient. You have to make a map of static attributes, static characteristics, static clinical features, uh features, static behavioral descriptors and based on that you can diagnose the patient or the client and prescribe treatment modalities. That’s the attitude of the DSM static. psychologists and psychiatrists and so on use the word patient. So the patient or the client presents himself or herself in a clinical setting. There is presentation and then the DSM says that you have to take a snapshot, a photograph of the patient. You have to make a map of static attributes, static characteristics, static clinical features, uh features, static behavioral descriptors and based on that you can diagnose the patient or the client and prescribe treatment modalities. That’s the attitude of the DSM static.
19:40 Whereas the ICD is dynamic. We’ll come to it a bit later. Because the the DSM is static, it is based on categories. It is categorical. Many of you will say, well, that’s not the case anymore. The DSM5 is not categorical. Wrong. It is categorical. There was big hope in the 10 years, the last 10 years, 15 years, there was big hope that the DSM5 would become dimensional. But that did not happen probably because of pressure from the insurance industry and the pharmaceutical industry big farmer. It did not happen. The DSM5 text Whereas the ICD is dynamic. We’ll come to it a bit later. Because the the DSM is static, it is based on categories. It is categorical. Many of you will say, well, that’s not the case anymore. The DSM5 is not categorical. Wrong. It is categorical. There was big hope in the 10 years, the last 10 years, 15 years, there was big hope that the DSM5 would become dimensional. But that did not happen probably because of pressure from the insurance industry and the pharmaceutical industry big farmer. It did not happen. The DSM5 text
20:27 revision is copy paste. It copy pasted the DSM4 text revision. So it is still categorical and categories are defined this way in the DSM. qualitatively distinctive clinical syndrome. As if if you categorize something, if you make a bullet list of diagnostic criteria, you succeeded to capture some clinical entity without any dynamics in the absence of psychoynamics. This is crazy. This is like trying to describe cancer by listing symptoms, ignoring completely the dynamics of the disease. And this is exactly the attitude of the revision is copy paste. It copy pasted the DSM4 text revision. So it is still categorical and categories are defined this way in the DSM. qualitatively distinctive clinical syndrome. As if if you categorize something, if you make a bullet list of diagnostic criteria, you succeeded to capture some clinical entity without any dynamics in the absence of psychoynamics. This is crazy. This is like trying to describe cancer by listing symptoms, ignoring completely the dynamics of the disease. And this is exactly the attitude of the
21:16 DSM to this very day. And I will discuss a bit later the alternative models. I’m aware of them. So let’s go to cluster B personality disorders which as I told you I believe that cluster B personality disorders in the DSM are a microcosm of everything that’s wrong with the DSM to start with cluster B personality disorders are categorical what you have to this very day for each disorder for each disorder personality disorder in cluster narcissistic, borderline, antisocial, and histrionic. This is the family of DSM to this very day. And I will discuss a bit later the alternative models. I’m aware of them. So let’s go to cluster B personality disorders which as I told you I believe that cluster B personality disorders in the DSM are a microcosm of everything that’s wrong with the DSM to start with cluster B personality disorders are categorical what you have to this very day for each disorder for each disorder personality disorder in cluster narcissistic, borderline, antisocial, and histrionic. This is the family of
21:59 cluster B. For each one of them, you have a list, a bullet list of nine diagnostic criteria. If you satisfy five of these criteria, you can be diagnosed with a personality disorder, with a corresponding personality disorder. So, it’s categorical. The approach is categorical. But there are other serious problems with cluster B personality disorders in the DSM. Not the least of which is that the disorders reflect cultural biases and gender biases. There is a big debate among scholars and theoreticians and whether for example cluster B. For each one of them, you have a list, a bullet list of nine diagnostic criteria. If you satisfy five of these criteria, you can be diagnosed with a personality disorder, with a corresponding personality disorder. So, it’s categorical. The approach is categorical. But there are other serious problems with cluster B personality disorders in the DSM. Not the least of which is that the disorders reflect cultural biases and gender biases. There is a big debate among scholars and theoreticians and whether for example
22:50 antisocial personality disorder and narcissistic personality disorders disorder are clinical entities. The psychopath is someone who rejects social authority, rejects rules, someone who rejects authority. Is this a mental illness or is this a personality style? The problem with some of the personality disorders, it’s that these personality disorders are defined within a highly specific culture with specific cultural mores, cultural norms and cultural expectations. And moreover, these disorders are antisocial personality disorder and narcissistic personality disorders disorder are clinical entities. The psychopath is someone who rejects social authority, rejects rules, someone who rejects authority. Is this a mental illness or is this a personality style? The problem with some of the personality disorders, it’s that these personality disorders are defined within a highly specific culture with specific cultural mores, cultural norms and cultural expectations. And moreover, these disorders are
23:38 relational. They are defined in relation to other people. So for example, one of the diagnostic criteria of narcissistic personality disorder is that the narcissist is exploitative, exploits other people. Another diagnostic criteria is that the narcissist lacks empathy. Another diagnostic criteria, the narcissist envies other people. In other words, the diagnosis of narcissistic personality disorder in the DSM depends on the existence of other people, depends on the interaction with other people. relational. They are defined in relation to other people. So for example, one of the diagnostic criteria of narcissistic personality disorder is that the narcissist is exploitative, exploits other people. Another diagnostic criteria is that the narcissist lacks empathy. Another diagnostic criteria, the narcissist envies other people. In other words, the diagnosis of narcissistic personality disorder in the DSM depends on the existence of other people, depends on the interaction with other people.
24:21 This is not a clinical entity. A clinical entity cannot be relational. For example, in medicine, we cannot say that tuberculosis or cancer is dependent on the existence of other people. The fact that these diagnostic categories are relational, the fact that they cannot be diagnosed except when we observe interactions with other people in context, the fact that they are contextual. This fact is very problematic because it means that the diagnosis are culture bound. They’re specifically specific to spe to some cultures and it This is not a clinical entity. A clinical entity cannot be relational. For example, in medicine, we cannot say that tuberculosis or cancer is dependent on the existence of other people. The fact that these diagnostic categories are relational, the fact that they cannot be diagnosed except when we observe interactions with other people in context, the fact that they are contextual. This fact is very problematic because it means that the diagnosis are culture bound. They’re specifically specific to spe to some cultures and it
25:06 means that they cannot be diagnosed in isolation. You need to observe the patient or the client in his social millure in his interpersonal interactions in his family in his workplace and so on and so forth. Otherwise you cannot render the diagnosis. It was Theodoro Milan as you know who suggested that narcissistic personality disorder is an American problem. He said there’s no such thing as NPD. Narcissistic personality disorder is simply an artifact of American life. He said it’s it’s an means that they cannot be diagnosed in isolation. You need to observe the patient or the client in his social millure in his interpersonal interactions in his family in his workplace and so on and so forth. Otherwise you cannot render the diagnosis. It was Theodoro Milan as you know who suggested that narcissistic personality disorder is an American problem. He said there’s no such thing as NPD. Narcissistic personality disorder is simply an artifact of American life. He said it’s it’s an
25:46 American disease. He identified he one of the major authorities in the field. He himself admitted that these so-called clinical entities, these so-called diagnosis and categories are highly susceptible to change in in social context, cultural context, historical context and so on. There is also gender bias. To this very day, the diagnos diagnostic and statistical manual suggests that maybe 75% of all people diagnosed with narcissistic personality disorder are men and 75% of all people diagnosed with borderline American disease. He identified he one of the major authorities in the field. He himself admitted that these so-called clinical entities, these so-called diagnosis and categories are highly susceptible to change in in social context, cultural context, historical context and so on. There is also gender bias. To this very day, the diagnos diagnostic and statistical manual suggests that maybe 75% of all people diagnosed with narcissistic personality disorder are men and 75% of all people diagnosed with borderline
26:27 personality disorder are women. That’s in the DSM. There were so many studies to the contrary that the DSM was forced to amend the language. And today the DSM says 75% to 50% of people with narcissistic personality disorder may be men. So there’s an attempt to counter the gender bias, but the gender bias is still there. When I tell you when I use the phrase borderline nar personality disorder, most of you think of a woman and when I use the phrase psychopath or narcissist, most of you would think of a personality disorder are women. That’s in the DSM. There were so many studies to the contrary that the DSM was forced to amend the language. And today the DSM says 75% to 50% of people with narcissistic personality disorder may be men. So there’s an attempt to counter the gender bias, but the gender bias is still there. When I tell you when I use the phrase borderline nar personality disorder, most of you think of a woman and when I use the phrase psychopath or narcissist, most of you would think of a
27:11 man. The gender bias is still very much entrenched and ingrained. The diagnostic and statistical manual started off as an offshoot of psychoanalysis. The first editions, first, second and third edition were highly informed by psychoanalysis, object relation schools, psychonamic schools and so on. And then around the 1980s the the there was this new trend of medicalization and everything we have learned in psychology prior to 1985 was deleted. Everything was deleted. So you cannot find a trace of any man. The gender bias is still very much entrenched and ingrained. The diagnostic and statistical manual started off as an offshoot of psychoanalysis. The first editions, first, second and third edition were highly informed by psychoanalysis, object relation schools, psychonamic schools and so on. And then around the 1980s the the there was this new trend of medicalization and everything we have learned in psychology prior to 1985 was deleted. Everything was deleted. So you cannot find a trace of any
28:04 psychoanalytic insight, any psychonamic insight, anything object relations schools have to say nothing. Nada deleted, erased. It’s as if psychology started in 1985 with Bandura with cognitive social cognitive theory as if there was nothing before which is a major lack major lacuna in the DSM. It’s a major problem because for example the DSM does not recognize the existence of psychological defense mechanisms which is pretty shocking. There’s no hint in the DSM to the unconscious. None of it. All the insights of psychoanalytic insight, any psychonamic insight, anything object relations schools have to say nothing. Nada deleted, erased. It’s as if psychology started in 1985 with Bandura with cognitive social cognitive theory as if there was nothing before which is a major lack major lacuna in the DSM. It’s a major problem because for example the DSM does not recognize the existence of psychological defense mechanisms which is pretty shocking. There’s no hint in the DSM to the unconscious. None of it. All the insights of
28:50 behaviorism, reinforcement and so on, they were deleted, reducted, eradicated from the DSM. You will not find them in the DSM. Attachment attachment studies bowelby Aworth no mention in the DSM. no hint in the DSM. It’s like the DSM got rid of 90% of psychology and what was left was medications, neuroscience, a hint at you know modeling and similar models. That’s it. The DSM is a very impoverished book. Consequently, the diagnostic thresholds in the DSM, the differential diagnosis in the DSM are very badly demarcated, behaviorism, reinforcement and so on, they were deleted, reducted, eradicated from the DSM. You will not find them in the DSM. Attachment attachment studies bowelby Aworth no mention in the DSM. no hint in the DSM. It’s like the DSM got rid of 90% of psychology and what was left was medications, neuroscience, a hint at you know modeling and similar models. That’s it. The DSM is a very impoverished book. Consequently, the diagnostic thresholds in the DSM, the differential diagnosis in the DSM are very badly demarcated,
29:48 very fuzzy, very murky. It’s a serious problem and it gives rise to coorbidities, co-occurrence. The the current term is co-occurrence. We don’t say coorbidity anymore. It’s politically incorrect. So, we say co-occurrence in the diet. If you are using the DSM as a clinician to diagnose your patients or clients, you will end up with co-orbidity. You will end up with co-occurrence. You will be forced to diagnose four, five, six, seven, eight co-occurring mental conditions in the in the patient. Typically two or three very fuzzy, very murky. It’s a serious problem and it gives rise to coorbidities, co-occurrence. The the current term is co-occurrence. We don’t say coorbidity anymore. It’s politically incorrect. So, we say co-occurrence in the diet. If you are using the DSM as a clinician to diagnose your patients or clients, you will end up with co-orbidity. You will end up with co-occurrence. You will be forced to diagnose four, five, six, seven, eight co-occurring mental conditions in the in the patient. Typically two or three
30:26 personality disorders, a mood disorder, substance use disorder and so on and so forth. So the issue of coorbidity with the in the DSM is a huge problem and this is especially true in cluster B personality disorders. Someone diagnosed with narcissistic personality disorder is 40% likely to be diagnosed with borderline person co-diagnosed with borderline personality disorders disorder or antisocial personality disorder. 40%. That means that we don’t have a pure type. When you look at studies, personality disorders, a mood disorder, substance use disorder and so on and so forth. So the issue of coorbidity with the in the DSM is a huge problem and this is especially true in cluster B personality disorders. Someone diagnosed with narcissistic personality disorder is 40% likely to be diagnosed with borderline person co-diagnosed with borderline personality disorders disorder or antisocial personality disorder. 40%. That means that we don’t have a pure type. When you look at studies,
31:09 current studies, recent studies by the biggest names like Ronstam, you know, big names. When you look at these studies, TW, you know, you look at these studies and what you see is that the subjects of the study, they have multiple diagnosis. So there is a study that says NPD can be cured. That’s a study was published last year. by the biggest names. Campbell um Ron Stum study NPD can be cured, can be healed. Wonderful news. The only problem is that everyone who participated in this study was not only with NPD. current studies, recent studies by the biggest names like Ronstam, you know, big names. When you look at these studies, TW, you know, you look at these studies and what you see is that the subjects of the study, they have multiple diagnosis. So there is a study that says NPD can be cured. That’s a study was published last year. by the biggest names. Campbell um Ron Stum study NPD can be cured, can be healed. Wonderful news. The only problem is that everyone who participated in this study was not only with NPD.
31:59 The participants in the study, the subjects of the study also had borderline personality disorder. All of them, no exception, also had mood disorders, also had substance use disorders. So if you’re using the DSM, you will never get a pure type. You will never be able to study any specific mental health disorder because everyone would be diagnosed with multiple disorders. The diagnostic and statistical manual has huge problems. Take for example cluster B diagnosis. As I mentioned, we have four personality The participants in the study, the subjects of the study also had borderline personality disorder. All of them, no exception, also had mood disorders, also had substance use disorders. So if you’re using the DSM, you will never get a pure type. You will never be able to study any specific mental health disorder because everyone would be diagnosed with multiple disorders. The diagnostic and statistical manual has huge problems. Take for example cluster B diagnosis. As I mentioned, we have four personality
32:43 disorders. Each one of them pro there’s a list of nine diagnostic criteria. And if a patient or a client satisfies five of these conditions, five of these diagnostic criteria, they can be diagnosed. And this gives rise to a serious problem. It is known as the polythetic problem. Imagine that you have two patients or two clients. They come to you and you diagnose both of them with narcissistic personality disorder or borderline personality disorder or antisocial personality disorder or um histrionic personality disorder. It disorders. Each one of them pro there’s a list of nine diagnostic criteria. And if a patient or a client satisfies five of these conditions, five of these diagnostic criteria, they can be diagnosed. And this gives rise to a serious problem. It is known as the polythetic problem. Imagine that you have two patients or two clients. They come to you and you diagnose both of them with narcissistic personality disorder or borderline personality disorder or antisocial personality disorder or um histrionic personality disorder. It
33:26 doesn’t matter. Imagine that you diagnose both of them with the same personality disorder. The first client or the first patient met or satisfied diagnostic criteria one, two, three, four, and five. Five out of nine. The second patient satisfied or met diagnostic criteria five, 6, 7, 8, and nine. Again, five criteria. So you have two patients. They both satisfied five out of nine criteria yet they have almost nothing in common. The only criterion common to patient one and patient two is criterion number doesn’t matter. Imagine that you diagnose both of them with the same personality disorder. The first client or the first patient met or satisfied diagnostic criteria one, two, three, four, and five. Five out of nine. The second patient satisfied or met diagnostic criteria five, 6, 7, 8, and nine. Again, five criteria. So you have two patients. They both satisfied five out of nine criteria yet they have almost nothing in common. The only criterion common to patient one and patient two is criterion number
34:15 five. Otherwise all the other criteria are completely different. And yet these two clients these two patients are diagnosed with the same di diagnosis. Now imagine again we compare it to medicine. Imagine that you have two patients and you diagnose both of them with tuberculosis and yet 90% of their symptoms are not the same. Absolutely not the same. Dramatically not the same. Totally idiosyncratic. They have only one thing in common. Let’s say they’re coughing. That’s that’s a ridiculous situation. It’s a five. Otherwise all the other criteria are completely different. And yet these two clients these two patients are diagnosed with the same di diagnosis. Now imagine again we compare it to medicine. Imagine that you have two patients and you diagnose both of them with tuberculosis and yet 90% of their symptoms are not the same. Absolutely not the same. Dramatically not the same. Totally idiosyncratic. They have only one thing in common. Let’s say they’re coughing. That’s that’s a ridiculous situation. It’s a
35:00 highly problematic situation and it’s known as the polythetic problem. When you look at the at the cluster B diagnosis in the diagnostic and statistical manual, you begin to understand that they’re very narrow. They are not representative and they omit or exclude very crucial issues. For example, axis 2 problems. Now you know that in in the new version of the diagnostic and statistical manual, there are no axis. They have removed axis one, axis 2, there’s axis a gun, but I’m using it as shorthand. Yeah. Axis 2 highly problematic situation and it’s known as the polythetic problem. When you look at the at the cluster B diagnosis in the diagnostic and statistical manual, you begin to understand that they’re very narrow. They are not representative and they omit or exclude very crucial issues. For example, axis 2 problems. Now you know that in in the new version of the diagnostic and statistical manual, there are no axis. They have removed axis one, axis 2, there’s axis a gun, but I’m using it as shorthand. Yeah. Axis 2
35:44 problems. Mood mood disorders, substance use disorders. None of these are mentioned in conjunction with a cluster B personality disorders. Why is this important? Because everyone who has a cluster B personality disorder also has an axis to disorder, a mood disorder, substance use disorder, anxiety disorder. No exception. Everyone, every narcissist, every borderline, every psychopath, every histrionic, they all usually present with some coorbidity, some dual diagnosis and so on. To ignore this in the diagnostic text problems. Mood mood disorders, substance use disorders. None of these are mentioned in conjunction with a cluster B personality disorders. Why is this important? Because everyone who has a cluster B personality disorder also has an axis to disorder, a mood disorder, substance use disorder, anxiety disorder. No exception. Everyone, every narcissist, every borderline, every psychopath, every histrionic, they all usually present with some coorbidity, some dual diagnosis and so on. To ignore this in the diagnostic text
36:28 is not a minor omission. It’s a major omission because many of these co-diagnosis, many of these co-occurring diagnosis also feed into the dynamic of the personality disorder. They also synquinon. They’re also crucial elements in the personality disorder itself. For example, you cannot conceive of borderline personality disorder without depression. There’s no way to conceive of it without a mood disorder. In borderline personality disorder, of course, we have mood liability as a clinical feature. And so the omission of is not a minor omission. It’s a major omission because many of these co-diagnosis, many of these co-occurring diagnosis also feed into the dynamic of the personality disorder. They also synquinon. They’re also crucial elements in the personality disorder itself. For example, you cannot conceive of borderline personality disorder without depression. There’s no way to conceive of it without a mood disorder. In borderline personality disorder, of course, we have mood liability as a clinical feature. And so the omission of
37:17 all this, the fact that there is no linkage between axis one and axis 2 or what used to be axis one and axis 2 is a very major deficiency in the DSM. The DSM also ignores completely ethology completely ignores childhood, adolescence, chronic developmental issues, neurodedevelopmental issues. All this is completely ignored in the clinical text, the diagnostic text of cluster B disorders. So when you ask yourself how did this person acquire the personality disorder? How did the personality disorder emerge and came to all this, the fact that there is no linkage between axis one and axis 2 or what used to be axis one and axis 2 is a very major deficiency in the DSM. The DSM also ignores completely ethology completely ignores childhood, adolescence, chronic developmental issues, neurodedevelopmental issues. All this is completely ignored in the clinical text, the diagnostic text of cluster B disorders. So when you ask yourself how did this person acquire the personality disorder? How did the personality disorder emerge and came to
38:07 be? The diagnostic the DSM does not provide you with an answer and does not provide you with a way to find the answer. It’s as if the patient or the client either was born with a personality disorder or acquired it a few minutes before they met the therapist or the clinician. As if these patients and clients don’t have a past, never had a childhood or adolescence and never experience childhood psychopathology of any kind. Consequently, the definitions are very narrow. For example, you will not find in the be? The diagnostic the DSM does not provide you with an answer and does not provide you with a way to find the answer. It’s as if the patient or the client either was born with a personality disorder or acquired it a few minutes before they met the therapist or the clinician. As if these patients and clients don’t have a past, never had a childhood or adolescence and never experience childhood psychopathology of any kind. Consequently, the definitions are very narrow. For example, you will not find in the
38:51 DSM in cluster B disorders. You will not find the words abuse or trauma, the anticidence, the the ethological precedence of abuse and trauma which are very very very very common in cluster B personality disorders are not mentioned in the DSM at all. Shockingly, if you allow me, I find this shocking. Now let’s go to the operational side. I discussed the theoretical the theoretical deficiencies and lacunas and so on. Let’s have a look at the diagnosis themselves. How useful are they you as a clinician? DSM in cluster B disorders. You will not find the words abuse or trauma, the anticidence, the the ethological precedence of abuse and trauma which are very very very very common in cluster B personality disorders are not mentioned in the DSM at all. Shockingly, if you allow me, I find this shocking. Now let’s go to the operational side. I discussed the theoretical the theoretical deficiencies and lacunas and so on. Let’s have a look at the diagnosis themselves. How useful are they you as a clinician?
39:39 You’re sitting in your clinic. There’s a patient, there’s a client. How useful is the DSM? How much does it help you to conceive of the client, the client’s state of mind, the client’s place in the world, the client’s interactions, interpersonal interactions with other people? How helpful is a DSM to visualize the client, to get a grasp and understanding and comprehension of a client, to go deep into the client, to put yourself in the client’s shoes, or to summarize, how helpful is a DSM in You’re sitting in your clinic. There’s a patient, there’s a client. How useful is the DSM? How much does it help you to conceive of the client, the client’s state of mind, the client’s place in the world, the client’s interactions, interpersonal interactions with other people? How helpful is a DSM to visualize the client, to get a grasp and understanding and comprehension of a client, to go deep into the client, to put yourself in the client’s shoes, or to summarize, how helpful is a DSM in
40:13 allowing you to empathize with a client? The answer is almost not at all. For example, the DSM does not recognize any spectrum. There’s no spectrum, no continuum of any cluster B personality disorder. So the attitude is in the DSM, the attitude is binary. Either you have personality a personality disorder or you don’t have a personality disorder. It’s similar to pregnancy. Either you are pregnant or you’re not pregnant. You can’t be half pregnant on the way to being pregnant. allowing you to empathize with a client? The answer is almost not at all. For example, the DSM does not recognize any spectrum. There’s no spectrum, no continuum of any cluster B personality disorder. So the attitude is in the DSM, the attitude is binary. Either you have personality a personality disorder or you don’t have a personality disorder. It’s similar to pregnancy. Either you are pregnant or you’re not pregnant. You can’t be half pregnant on the way to being pregnant.
40:55 Maybe pregnant. There’s no such thing. We all agree. But according to the DSM, narcissistic personality disorder, antisocial personality disorder, borderline personality disorder, they all yes or no, exist, doesn’t exist, a switch, binary. Any clinician would tell you that this is so completely wrong. So completely wrong. There is definitely a spectrum not only a spectrum of severity how severe the disorder is but there is also a spectrum of ethology and a spectrum of dynamic. These disorders Maybe pregnant. There’s no such thing. We all agree. But according to the DSM, narcissistic personality disorder, antisocial personality disorder, borderline personality disorder, they all yes or no, exist, doesn’t exist, a switch, binary. Any clinician would tell you that this is so completely wrong. So completely wrong. There is definitely a spectrum not only a spectrum of severity how severe the disorder is but there is also a spectrum of ethology and a spectrum of dynamic. These disorders
41:38 metamorphosize. These disorders metastasize. These disorders wax and wayne. They have a life of their own. There is the patient and the client and there is the disorder. And the disorder has its own dynamic. The disorder feeds on other dynamics. The disorder grows. The disorder shrinks. The the disorder is an organism. To pretend that the disorder is a a photograph, a snapshot, that it can be captured with a bullet list. That is so wrong. so dramatically wrong and yet this is the philosophy underlying the DSM. There metamorphosize. These disorders metastasize. These disorders wax and wayne. They have a life of their own. There is the patient and the client and there is the disorder. And the disorder has its own dynamic. The disorder feeds on other dynamics. The disorder grows. The disorder shrinks. The the disorder is an organism. To pretend that the disorder is a a photograph, a snapshot, that it can be captured with a bullet list. That is so wrong. so dramatically wrong and yet this is the philosophy underlying the DSM. There
42:23 is no recognition of the trajectory of the disease. There is no recognition of the way the disease interacts with or the disorder interacts with other issues both physical physiological and mental. It’s a very ideal view of the disorder. Like the disorder is an entity that is completely isolated, completely soypistic, completely theoretical, can be captured completely with words. Oh, and of course, mental illness is very very fuzzy. It’s very unclear. It’s very ambiguous. It’s very equivocal. is no recognition of the trajectory of the disease. There is no recognition of the way the disease interacts with or the disorder interacts with other issues both physical physiological and mental. It’s a very ideal view of the disorder. Like the disorder is an entity that is completely isolated, completely soypistic, completely theoretical, can be captured completely with words. Oh, and of course, mental illness is very very fuzzy. It’s very unclear. It’s very ambiguous. It’s very equivocal.
43:07 Mental illness is shapeshifting cannot be captured really is intuitive. Mental illness is in other words human. And so the DSM has a massive failure in this sense. For example, the DSM does not recognize the existence of personality styles. We have scholars, eminent scholars, not second rate scholars, major scholars like Lin Sperry and Theodoro Milan who suggested insisted wrote books about personality styles. A personality style is like personality disorder light. A personality style is like having some Mental illness is shapeshifting cannot be captured really is intuitive. Mental illness is in other words human. And so the DSM has a massive failure in this sense. For example, the DSM does not recognize the existence of personality styles. We have scholars, eminent scholars, not second rate scholars, major scholars like Lin Sperry and Theodoro Milan who suggested insisted wrote books about personality styles. A personality style is like personality disorder light. A personality style is like having some
43:59 of the traits, some of the behaviors of a personality disorder, but you are subclinical. You cannot be diagnosed. It’s not severe enough. So that’s a personality style. We all know, for example, people with a narcissistic personality style. They’re obnoxious. They’re aggressive. They’re not so empathic. They’re in your face. They’re defiant. They’re not pleasant. that we all know such people and yet these are not narcissists. They have a narcissistic personality style. of the traits, some of the behaviors of a personality disorder, but you are subclinical. You cannot be diagnosed. It’s not severe enough. So that’s a personality style. We all know, for example, people with a narcissistic personality style. They’re obnoxious. They’re aggressive. They’re not so empathic. They’re in your face. They’re defiant. They’re not pleasant. that we all know such people and yet these are not narcissists. They have a narcissistic personality style.
44:37 They have some features. They have some traits. They are reminiscent of narcissist. A narcissist is someone diagnosed with narcissistic personality disorder. And a narcissistic personality disorder is not an exaggerated version of the narcissistic personality style. No way. It includes critical clinical features that do not exist in the personality style. The same applies to borderline. As we will see, I will discuss Kberg’s um conception of borderline. And yet the DSM does not recognize this. They have some features. They have some traits. They are reminiscent of narcissist. A narcissist is someone diagnosed with narcissistic personality disorder. And a narcissistic personality disorder is not an exaggerated version of the narcissistic personality style. No way. It includes critical clinical features that do not exist in the personality style. The same applies to borderline. As we will see, I will discuss Kberg’s um conception of borderline. And yet the DSM does not recognize this.
45:16 There is no hint of less severe manifestations of the personality or the personality style or the personality disorder. There’s no gradation. There’s no nothing. There’s it’s the either you’re diagnosed or you’re not. And that’s very wrong because think for example about what is known as dark personalities. The work of Paulas and others. dark personalities, dark triad personalities, dark tetrd personalities. In dark triad personality, we have someone, an individual who has features, There is no hint of less severe manifestations of the personality or the personality style or the personality disorder. There’s no gradation. There’s no nothing. There’s it’s the either you’re diagnosed or you’re not. And that’s very wrong because think for example about what is known as dark personalities. The work of Paulas and others. dark personalities, dark triad personalities, dark tetrd personalities. In dark triad personality, we have someone, an individual who has features,
45:57 some features, some traits, some behaviors of a narcissist together with some traits and behaviors of a psychopath, together with machavelianism, manipulativeness. When you put the three together, you get a dark personality, a dark triad personality. But dark triad personalities are not narcissists. They are not psychopaths. It’s a common mistake even in the scholarly literature. They are not. They are subclinical narcissists, subclinical psychopaths. They cannot be diagnosed with a disorder. some features, some traits, some behaviors of a narcissist together with some traits and behaviors of a psychopath, together with machavelianism, manipulativeness. When you put the three together, you get a dark personality, a dark triad personality. But dark triad personalities are not narcissists. They are not psychopaths. It’s a common mistake even in the scholarly literature. They are not. They are subclinical narcissists, subclinical psychopaths. They cannot be diagnosed with a disorder.
46:43 Similarly, in dark tetrd personalities, we have a dark triad personality who is also a sadist. Yet all of these conditions are subclinical. They do not amount to tantamount to with or they are not the same as the disorder. And there is no hint of any of this in the DSM because the text of the DSM is 90% copy-pasted. That’s a fact. 90% copy pasted from a text that was written in 1990, you heard me well. 35 years ago 90% of the DSM fifth edition text revision 90% of the text has been copy pasted Similarly, in dark tetrd personalities, we have a dark triad personality who is also a sadist. Yet all of these conditions are subclinical. They do not amount to tantamount to with or they are not the same as the disorder. And there is no hint of any of this in the DSM because the text of the DSM is 90% copy-pasted. That’s a fact. 90% copy pasted from a text that was written in 1990, you heard me well. 35 years ago 90% of the DSM fifth edition text revision 90% of the text has been copy pasted
47:40 from text that was written in 1990 and in 2000 25 years ago and 35 years ago. Of course there’s no hint of recent developments. Of course, there’s no inclusion of recent studies, recent practice, nothing. Nothing. It’s an antiquated, irrelevant, wrong in many ways text that is defining the conversation because of the power and prowess of American industries, not the least of which is American media. This is the only reason otherwise no one would have used the DSM. I don’t know much about schizophrenia or from text that was written in 1990 and in 2000 25 years ago and 35 years ago. Of course there’s no hint of recent developments. Of course, there’s no inclusion of recent studies, recent practice, nothing. Nothing. It’s an antiquated, irrelevant, wrong in many ways text that is defining the conversation because of the power and prowess of American industries, not the least of which is American media. This is the only reason otherwise no one would have used the DSM. I don’t know much about schizophrenia or
48:26 psychotic disorders. I don’t know much about autism spectrum disorders. I don’t know much I don’t know much about much but I know a lot about cluster B personality disorders. And I can tell you that DSM is is drastically wrong in most everything that it writes that is written in the text. That’s a catastrophic state of things. You know also in the in the DSM um I mentioned that there is little clinical practice and consequently you have a proliferation of what is known as not otherwise specified psychotic disorders. I don’t know much about autism spectrum disorders. I don’t know much I don’t know much about much but I know a lot about cluster B personality disorders. And I can tell you that DSM is is drastically wrong in most everything that it writes that is written in the text. That’s a catastrophic state of things. You know also in the in the DSM um I mentioned that there is little clinical practice and consequently you have a proliferation of what is known as not otherwise specified
49:12 diagnosis the the NOS NOS diagnosis not otherwise specified which is an admission of failure not otherwise specified is a basket basket category where you dump everything you don’t understand or everything you didn’t bother to research or everything you cannot is not actually a clinical entity or what what on earth is a not otherwise specified thing I mean it’s it’s in itself shocking imagine you open a medicine book Harrison’s internal medicine and at the very end there is like diagnosis the the NOS NOS diagnosis not otherwise specified which is an admission of failure not otherwise specified is a basket basket category where you dump everything you don’t understand or everything you didn’t bother to research or everything you cannot is not actually a clinical entity or what what on earth is a not otherwise specified thing I mean it’s it’s in itself shocking imagine you open a medicine book Harrison’s internal medicine and at the very end there is like
49:47 one10enth of the book where it says here are many conditions and problems in medical problems that um I’ve not specified we don’t know it’s it’s inconceivable in other I’m a physicist I have a PhD in physics it’s inconceivable in physics when I transitioned from physics to psychology I was shocked I had a culture shock I had a culture shock with how lax and relaxed is the attitude to doing proper science you know and the belief that if you do statistics, you are scientists. one10enth of the book where it says here are many conditions and problems in medical problems that um I’ve not specified we don’t know it’s it’s inconceivable in other I’m a physicist I have a PhD in physics it’s inconceivable in physics when I transitioned from physics to psychology I was shocked I had a culture shock I had a culture shock with how lax and relaxed is the attitude to doing proper science you know and the belief that if you do statistics, you are scientists.
50:28 Of course, the DSM does not include any longitudinal studies or longitudinal approach. It’s a pinpoint. It’s an eventbased. So when when I read when I read the text on antisocial personality disorder or histrionic personality disorder and so on so forth, I’m not getting any longitudinal picture. The only thing remotely longitudinal is when the DSM says that psychopaths or people with antisocial personality disorder tend to get in trouble with the law. So they end up being in prison a Of course, the DSM does not include any longitudinal studies or longitudinal approach. It’s a pinpoint. It’s an eventbased. So when when I read when I read the text on antisocial personality disorder or histrionic personality disorder and so on so forth, I’m not getting any longitudinal picture. The only thing remotely longitudinal is when the DSM says that psychopaths or people with antisocial personality disorder tend to get in trouble with the law. So they end up being in prison a
51:05 lot or investigating the law. It’s the only longitudinal thing. And even that is not exactly the DSM. It’s actually Robert Hair and Nathan Babiaak who disagree with the DSM because I think the DSM is confusing antisocial personality disorder with psychopathy. So there’s nothing longitudinal. I don’t get a picture of development. There’s no developmental approach. I don’t know what is happening to a narcissist when the narcissist transitions from age 18 to age 28 to age 38 to age 48 for example. What happens lot or investigating the law. It’s the only longitudinal thing. And even that is not exactly the DSM. It’s actually Robert Hair and Nathan Babiaak who disagree with the DSM because I think the DSM is confusing antisocial personality disorder with psychopathy. So there’s nothing longitudinal. I don’t get a picture of development. There’s no developmental approach. I don’t know what is happening to a narcissist when the narcissist transitions from age 18 to age 28 to age 38 to age 48 for example. What happens
51:43 to a narcissist when the narcissist grows old like me becomes 65 years old? What happens to the narcissist? There’s no hint in the DSM. I wouldn’t know. There’s no distinction related to age, society, culture, expectations, family, nothing. And of course, there’s no mention at this stage of anything to do with genetics or heredity or whatever. It is not easy to use the DSM from the clinician’s perspective because when you don’t know the role of childhood and adolescence in the to a narcissist when the narcissist grows old like me becomes 65 years old? What happens to the narcissist? There’s no hint in the DSM. I wouldn’t know. There’s no distinction related to age, society, culture, expectations, family, nothing. And of course, there’s no mention at this stage of anything to do with genetics or heredity or whatever. It is not easy to use the DSM from the clinician’s perspective because when you don’t know the role of childhood and adolescence in the
52:36 disorder that you are treating it’s a major problem. Let me give you one example. personality disorders. The DSM and other texts, they suggest that you can diagnose personality disorder at the age of 12. You can diagnose borderline personality disorder at the age of 12. You can even diagnose psychopathy or antisocial personality disorder at the age of four. It is it has another name. It’s called conduct disorder. But essentially, it’s psychopathy. Psychopathy for children. And this raises a major issue because do disorder that you are treating it’s a major problem. Let me give you one example. personality disorders. The DSM and other texts, they suggest that you can diagnose personality disorder at the age of 12. You can diagnose borderline personality disorder at the age of 12. You can even diagnose psychopathy or antisocial personality disorder at the age of four. It is it has another name. It’s called conduct disorder. But essentially, it’s psychopathy. Psychopathy for children. And this raises a major issue because do
53:19 children have a personality? Do we really believe that someone who is four years old has a personality? Do we really believe that someone who is a 12year-old has a personality? We know that the brain matures all the time and that critical executive functions are missing in childhood and adolescence. We know that the brain becomes fully evolved and is full-fledged only only at age 25. What’s the meaning of saying that someone 12 years old has a personality disorder when it’s very debatable whether they children have a personality? Do we really believe that someone who is four years old has a personality? Do we really believe that someone who is a 12year-old has a personality? We know that the brain matures all the time and that critical executive functions are missing in childhood and adolescence. We know that the brain becomes fully evolved and is full-fledged only only at age 25. What’s the meaning of saying that someone 12 years old has a personality disorder when it’s very debatable whether they
54:01 have a personality at all? What about neuroplasticity? There’s no hint in the DSM of neuroplasticity. And yet we know that neuroplasticity is the critical feature in people who have been abused and traumatized in childhood. We also know that neuroplasticity is the only hope of people with cluster B personality disorders because the only hope is somehow rewire the brain and if we fail with that we fail. So, how can a diagnostic manual ignore the fact that the brain is malleable, mutable, not full-fledged until age 25, that the have a personality at all? What about neuroplasticity? There’s no hint in the DSM of neuroplasticity. And yet we know that neuroplasticity is the critical feature in people who have been abused and traumatized in childhood. We also know that neuroplasticity is the only hope of people with cluster B personality disorders because the only hope is somehow rewire the brain and if we fail with that we fail. So, how can a diagnostic manual ignore the fact that the brain is malleable, mutable, not full-fledged until age 25, that the
54:47 brain is exceed is extremely different at age 12 than later on in life, and definitely extremely different at age four. How can you ignore all this? And yet the DSM does ignore all this. Physical health, physical disease, brain, all of them are ignored. In the 19th century, there was a construction worker. His name was Phineas Gage. One day being a construction worker, Fineas Gage went to a construction site and there was a rod of iron, a rod of metal that fell from high on fell and penetrated the skull of Phineas brain is exceed is extremely different at age 12 than later on in life, and definitely extremely different at age four. How can you ignore all this? And yet the DSM does ignore all this. Physical health, physical disease, brain, all of them are ignored. In the 19th century, there was a construction worker. His name was Phineas Gage. One day being a construction worker, Fineas Gage went to a construction site and there was a rod of iron, a rod of metal that fell from high on fell and penetrated the skull of Phineas
55:32 gauge. There are photographs. There’s a metal rod penetrating here and exiting here, severing his brain in effect. Mysteriously Phineas Gage survived. Doctors from all over the world, medical doctors, psychiatrists from all over the world studied the phenomenon of Phineas Gage. That’s his brain. There’s a traumatic brain injury and they described the personality of Phineas Gage before the accident and after the accident. and Phineas Gage after the traumatic brain injury would have qualified easily for the gauge. There are photographs. There’s a metal rod penetrating here and exiting here, severing his brain in effect. Mysteriously Phineas Gage survived. Doctors from all over the world, medical doctors, psychiatrists from all over the world studied the phenomenon of Phineas Gage. That’s his brain. There’s a traumatic brain injury and they described the personality of Phineas Gage before the accident and after the accident. and Phineas Gage after the traumatic brain injury would have qualified easily for the
56:20 diagnosis of narcissistic personality disorder. Before the accident, Phineas Gage was a nice, pleasant, empathic, loving, compassionate, affectionate person. Everyone loved him. After the accident, he became an obnoxious narcissist for life. That would tend to indicate, it’s not the only case. Of course, we know of similar changes in personality in dementia and so on. But that would tend to indicate that brain injuries, brain abnormalities, trauma to the brain would somehow change the personality diagnosis of narcissistic personality disorder. Before the accident, Phineas Gage was a nice, pleasant, empathic, loving, compassionate, affectionate person. Everyone loved him. After the accident, he became an obnoxious narcissist for life. That would tend to indicate, it’s not the only case. Of course, we know of similar changes in personality in dementia and so on. But that would tend to indicate that brain injuries, brain abnormalities, trauma to the brain would somehow change the personality
57:07 and yield the equivalent of personality disorders. And yet, if you look at the DSM, there’s no mention of any of this. On the very contrary, the DSM says that changes to personality owing to brain trauma should be excluded from the diagnosis rather than actually included. And that’s the only time there’s an illusion in passing, a fleeting illusion to an enormous body of research on traumatic brain injury from Australia Eckles to Germany. huge body of of evidence on changes in personality, and yield the equivalent of personality disorders. And yet, if you look at the DSM, there’s no mention of any of this. On the very contrary, the DSM says that changes to personality owing to brain trauma should be excluded from the diagnosis rather than actually included. And that’s the only time there’s an illusion in passing, a fleeting illusion to an enormous body of research on traumatic brain injury from Australia Eckles to Germany. huge body of of evidence on changes in personality,
57:48 lifelong changes in personality. None of it is mentioned in the DSM. And consequently, the DSM may be very misleading when it comes to the selection of treatment modalities. The DSM attempted to do something. the latest edition, edition five in 2013, they attempted to do something. They redefined personality disorders. And here is the new definition. A personality disorder is an impairment in personality, self, and interpersonal functioning plus the presence of pathological personality traits. Now, this sounds a lot like the ICD. lifelong changes in personality. None of it is mentioned in the DSM. And consequently, the DSM may be very misleading when it comes to the selection of treatment modalities. The DSM attempted to do something. the latest edition, edition five in 2013, they attempted to do something. They redefined personality disorders. And here is the new definition. A personality disorder is an impairment in personality, self, and interpersonal functioning plus the presence of pathological personality traits. Now, this sounds a lot like the ICD.
58:38 This is a dimensional definition because it includes traits and functioning. It’s dynamic. And within the DSM committee, there was a big debate. Should they dump the categorical approach completely and rewrite the DSM with a dimensional approach similar to what happened between the 10th edition of the ICD and the 11th edition of the ICD. The 10th edition was categorical. the 11th edition is dimensional. So there was a similar debate on the DSM5 and then they decided no we’re going to stick with a categorical approach but This is a dimensional definition because it includes traits and functioning. It’s dynamic. And within the DSM committee, there was a big debate. Should they dump the categorical approach completely and rewrite the DSM with a dimensional approach similar to what happened between the 10th edition of the ICD and the 11th edition of the ICD. The 10th edition was categorical. the 11th edition is dimensional. So there was a similar debate on the DSM5 and then they decided no we’re going to stick with a categorical approach but
59:18 we’re going to provide an alternative and in the DSM5 including the text revision you can find what is known as alternative models there’s an alternative model of narcissistic personality disorder an alternative model of borderline personality disorder order and an alternative model of antisocial personality disorder. It is on page 881 of the text revision, the fifth edition text revision. And what they’ve done, they have written a diagnostic text which is dimensional and they put it at the very end of the we’re going to provide an alternative and in the DSM5 including the text revision you can find what is known as alternative models there’s an alternative model of narcissistic personality disorder an alternative model of borderline personality disorder order and an alternative model of antisocial personality disorder. It is on page 881 of the text revision, the fifth edition text revision. And what they’ve done, they have written a diagnostic text which is dimensional and they put it at the very end of the
60:03 book as an alternative. while the official diagnosis was copy pasted from the DSM4 and is still categorical bullet list. So if you as a clinician in the United States, if you want to diagnose a patient or a client and you want to get reimbursed by the insurance company, you have to use the text of the fourth edition as it has been copy pasted into the fifth edition because this is the demand of the insurance company. The fact that this text is 30 years old, three decades old. The fact that this book as an alternative. while the official diagnosis was copy pasted from the DSM4 and is still categorical bullet list. So if you as a clinician in the United States, if you want to diagnose a patient or a client and you want to get reimbursed by the insurance company, you have to use the text of the fourth edition as it has been copy pasted into the fifth edition because this is the demand of the insurance company. The fact that this text is 30 years old, three decades old. The fact that this
60:48 text is wrong in many places. The fact that this text, these diagnostic criteria ignore critical aspects, for example, vulnerable or covert narcissism is totally ignored. All these facts are not relevant because this is the way the insurance companies want you to work. Period. So as a clinician you have to work with the nine bullet points for each diagnosis in order to get paid by the insurance company. The DSM provides you with an alternative model that you as a clinician in your spare time and not getting paid you then text is wrong in many places. The fact that this text, these diagnostic criteria ignore critical aspects, for example, vulnerable or covert narcissism is totally ignored. All these facts are not relevant because this is the way the insurance companies want you to work. Period. So as a clinician you have to work with the nine bullet points for each diagnosis in order to get paid by the insurance company. The DSM provides you with an alternative model that you as a clinician in your spare time and not getting paid you then
61:30 can apply to the patient or the client maybe if you want to. It’s up to you. Let’s have a look at how the alternative model of narcissism works and then we go to the ICD. So in the alternative model of narcissistic personality disorder for example, there are no diagnostic criteria. You don’t have a list of nine criteria and you don’t have to select five because there are no criteria. What you do have have is a list of functioning and a list of traits. So in the functioning the alternative model discusses identity can apply to the patient or the client maybe if you want to. It’s up to you. Let’s have a look at how the alternative model of narcissism works and then we go to the ICD. So in the alternative model of narcissistic personality disorder for example, there are no diagnostic criteria. You don’t have a list of nine criteria and you don’t have to select five because there are no criteria. What you do have have is a list of functioning and a list of traits. So in the functioning the alternative model discusses identity
62:15 issues, intimacy issues, self-direction issues and empathy issues. And then there’s a list of traits and the traits include antagonism, grandiosity, attention seeking and suggested negative effectivity. This be begins to be very close to the approach of the ICD. This is actually ICD light or wannabe ICD ICD on the way. If in the DSM6 they’re going to get rid of the bullet list of diagnostic criteria. If in the DSM6 they’re going to adopt the alternative models as the only way to diagnose issues, intimacy issues, self-direction issues and empathy issues. And then there’s a list of traits and the traits include antagonism, grandiosity, attention seeking and suggested negative effectivity. This be begins to be very close to the approach of the ICD. This is actually ICD light or wannabe ICD ICD on the way. If in the DSM6 they’re going to get rid of the bullet list of diagnostic criteria. If in the DSM6 they’re going to adopt the alternative models as the only way to diagnose
63:00 then in effect there will be a convergence between DSM and ICD. I personally don’t believe this will happen because it’s very difficult to for the insurance companies to tick or to check the boxes. They want boxes. They have nine boxes. They can check five, you get paid. You cannot do this with a text which is open-ended which sounds a lot like dsttoyki. It’s very difficult for insurance companies to work with this. And so I believe the insurance companies will apply pressure and I believe even then in effect there will be a convergence between DSM and ICD. I personally don’t believe this will happen because it’s very difficult to for the insurance companies to tick or to check the boxes. They want boxes. They have nine boxes. They can check five, you get paid. You cannot do this with a text which is open-ended which sounds a lot like dsttoyki. It’s very difficult for insurance companies to work with this. And so I believe the insurance companies will apply pressure and I believe even
63:36 in the DSM6 we are still going to be stuck with text that was written in 1990. Can you wrap your mind around it? Many of you were not born in 1990. This is a very old text. But this is the DSM5 tax revision 2022. Let’s transition to the ICD and become a bit more optimistic with a sunny predisposition and a lot of smiling because I love the ICD 11. I dislike the ICD10. The ICD10 has all the flaws and shortcomings and problems of the DSM. But the ICD11 is a courageous revolution. Two things in the ICD11. in the DSM6 we are still going to be stuck with text that was written in 1990. Can you wrap your mind around it? Many of you were not born in 1990. This is a very old text. But this is the DSM5 tax revision 2022. Let’s transition to the ICD and become a bit more optimistic with a sunny predisposition and a lot of smiling because I love the ICD 11. I dislike the ICD10. The ICD10 has all the flaws and shortcomings and problems of the DSM. But the ICD11 is a courageous revolution. Two things in the ICD11.
64:23 Nuance. There is nuance. People are nuanced. People are subtle. It’s difficult to capture people. People are fuzzy. People are not objects. People are in flux. People are dynamic. They’re like a river. They’re not like a pond. And so to capture people you need to create texts which are highly literary texts, literature in effect. Of course the greatest psychologist to have ever lived was DSKI. So the ICD is very literary. It sounds a lot like literature. So it’s nuanced. It captures humanity at its worst and at Nuance. There is nuance. People are nuanced. People are subtle. It’s difficult to capture people. People are fuzzy. People are not objects. People are in flux. People are dynamic. They’re like a river. They’re not like a pond. And so to capture people you need to create texts which are highly literary texts, literature in effect. Of course the greatest psychologist to have ever lived was DSKI. So the ICD is very literary. It sounds a lot like literature. So it’s nuanced. It captures humanity at its worst and at
65:11 its best. And the second thing is the erudition in the ICD10 A11. The ICD11 is up to the up to scratch. It incorporates the latest knowledge, the latest studies. It’s light years ahead of the DSM. It’s much more authoritative. It relies on multiple studies and it incorporates enormous amounts of clinical practice. It’s very pragmatic. It tells you how to work as a clinician. And yet, it is founded on the latest, I’m talking about the year 2022, on the latest information that had existed in its best. And the second thing is the erudition in the ICD10 A11. The ICD11 is up to the up to scratch. It incorporates the latest knowledge, the latest studies. It’s light years ahead of the DSM. It’s much more authoritative. It relies on multiple studies and it incorporates enormous amounts of clinical practice. It’s very pragmatic. It tells you how to work as a clinician. And yet, it is founded on the latest, I’m talking about the year 2022, on the latest information that had existed in
65:55 2022. For example, while the DSM ignores the vulnerable expressions of narcissism, in the DSM, there’s no hint or mention of covert narcissism, vulnerable narcissism, fragile narcissism, none. The ICD includes it. There is reference to covert narcissism in the ICD. And covert narcissism is is cutting edge. It’s the new knowledge starting in 1989 when Akar and Cooper created the famous table for covert narcissism. This is the hot button topic. This is the buzzword. It’s all about covert narcissism. That’s why 2022. For example, while the DSM ignores the vulnerable expressions of narcissism, in the DSM, there’s no hint or mention of covert narcissism, vulnerable narcissism, fragile narcissism, none. The ICD includes it. There is reference to covert narcissism in the ICD. And covert narcissism is is cutting edge. It’s the new knowledge starting in 1989 when Akar and Cooper created the famous table for covert narcissism. This is the hot button topic. This is the buzzword. It’s all about covert narcissism. That’s why
66:39 we that’s what we are studying in the field now. And when you go to the DSM, there is a hint, a very remote hint in arcane dec encrypted language. there’s a hint that there might be a vulnerable presentation. They don’t use the word vulnerable and they don’t use the word covert. That’s a DSM. In the alternative model, mind you, not in the diagnostic criteria. When you read the diagnostic criteria and the text afterwards, no hint of mention of covert and vulnerable narcissism. we that’s what we are studying in the field now. And when you go to the DSM, there is a hint, a very remote hint in arcane dec encrypted language. there’s a hint that there might be a vulnerable presentation. They don’t use the word vulnerable and they don’t use the word covert. That’s a DSM. In the alternative model, mind you, not in the diagnostic criteria. When you read the diagnostic criteria and the text afterwards, no hint of mention of covert and vulnerable narcissism.
67:12 I don’t know what to tell you. It’s as if I would talk to you about cancer and why I would not discuss the proliferation of cells more or less. It’s crazy. So the ICD is bleeding edge cutting edge latest data and is nuance in the ICD. Of course I don’t need to tell you many of you use the ICD and you’re all acquainted with it. But there are some students. So for the benefit of the students in the ICD there there’s no such thing as a personality type. There’s no such thing as a personality I don’t know what to tell you. It’s as if I would talk to you about cancer and why I would not discuss the proliferation of cells more or less. It’s crazy. So the ICD is bleeding edge cutting edge latest data and is nuance in the ICD. Of course I don’t need to tell you many of you use the ICD and you’re all acquainted with it. But there are some students. So for the benefit of the students in the ICD there there’s no such thing as a personality type. There’s no such thing as a personality
67:49 disorder. In the ICD11 there’s no such thing as a differential diagnosis because they are not diagnosis in effect as we know them. And there is an emphasis on functioning in effect an emphasis on people. What happens if you’re using the ICD as a clinician? What you’re doing, you’re creating a highly specific idiosyncratic individual unique profile for each client. If you have two clients or four clients, each one of them will have a highly unique profile, highly specific profile. disorder. In the ICD11 there’s no such thing as a differential diagnosis because they are not diagnosis in effect as we know them. And there is an emphasis on functioning in effect an emphasis on people. What happens if you’re using the ICD as a clinician? What you’re doing, you’re creating a highly specific idiosyncratic individual unique profile for each client. If you have two clients or four clients, each one of them will have a highly unique profile, highly specific profile.
68:30 And this is exactly what’s happening in medicine. In medicine, we are beginning to tailor treatments and we are beginning to tailor medication according to the genetic information of the patient. Not two patients receive the same treatment if they are genetically profiled. Same in the ICD. Not two clients end up with the same diagnosis, with the same description. Each client comes out with his or her highly specific, highly idiosyncratic story or narrative that captures the essence of the client. And I love this. It’s And this is exactly what’s happening in medicine. In medicine, we are beginning to tailor treatments and we are beginning to tailor medication according to the genetic information of the patient. Not two patients receive the same treatment if they are genetically profiled. Same in the ICD. Not two clients end up with the same diagnosis, with the same description. Each client comes out with his or her highly specific, highly idiosyncratic story or narrative that captures the essence of the client. And I love this. It’s
69:11 customizable. It’s modern. I don’t know to how to say the DSM is hide the bound. This the ICD is dynamic and modern in its approach. And the ICD has a layered approach. An approach with layers. The first layer is the severity of the personality functioning. I think it’s the wrong usage of language in the ICD. It should have been the severity of the personality dysfunction. But severity of personality functioning. You could have mild, severe. So there’s a spectrum of severity. Very true. Very customizable. It’s modern. I don’t know to how to say the DSM is hide the bound. This the ICD is dynamic and modern in its approach. And the ICD has a layered approach. An approach with layers. The first layer is the severity of the personality functioning. I think it’s the wrong usage of language in the ICD. It should have been the severity of the personality dysfunction. But severity of personality functioning. You could have mild, severe. So there’s a spectrum of severity. Very true. Very
69:50 correct. And now you can capture personality styles. You can capture intermittent intermittent behaviors. You can capture many many things that the DSM does not allow you to capture because it’s rigid. So there’s a severity ranking. You need to rank the patient or the client for severity. And then the next level is you need to identify the traits of the client. All kinds of trait domains. I will come into it a bit later. And the third layer you need to describe the client. You create a description which puts together the correct. And now you can capture personality styles. You can capture intermittent intermittent behaviors. You can capture many many things that the DSM does not allow you to capture because it’s rigid. So there’s a severity ranking. You need to rank the patient or the client for severity. And then the next level is you need to identify the traits of the client. All kinds of trait domains. I will come into it a bit later. And the third layer you need to describe the client. You create a description which puts together the
70:27 traits and the severity and you write a story about the client, the clinician ranking and the clinician description. At the end of the ICD process, the descriptions read a lot like short fiction, like stories. Clinicians who work with the ICD need to write stories. They need to create narratives in order to capture the client, the essence of the client. And so in narcissism for example we have if we take the issue of narcissism there’s no diagnosis of narcissistic personality disorder in the ICD11 but traits and the severity and you write a story about the client, the clinician ranking and the clinician description. At the end of the ICD process, the descriptions read a lot like short fiction, like stories. Clinicians who work with the ICD need to write stories. They need to create narratives in order to capture the client, the essence of the client. And so in narcissism for example we have if we take the issue of narcissism there’s no diagnosis of narcissistic personality disorder in the ICD11 but
71:12 they don’t ignore the fact that there is a hereditary genetic trait of narcissism. Every human being alive has this trait. Every human being has a narcissism trait. The trait can go malignant. The trait can become dysfunctional owing to environmental pressures and stressors, but everyone has a trait. So the ICD because it’s trait oriented accepts the fact that everyone has a narcissism trait and then provides a ranking or a spectrum or a continuum of severity. So someone presents to to the they don’t ignore the fact that there is a hereditary genetic trait of narcissism. Every human being alive has this trait. Every human being has a narcissism trait. The trait can go malignant. The trait can become dysfunctional owing to environmental pressures and stressors, but everyone has a trait. So the ICD because it’s trait oriented accepts the fact that everyone has a narcissism trait and then provides a ranking or a spectrum or a continuum of severity. So someone presents to to the
71:53 clinician and they could have mild severity, they could have a mild personality disorder, a moderate personality disorder or a severe personality disorder. It’s a lot more flexible. Allows you to really understand the client much more deeply. At the same time, you are supposed to describe the client’s traits. We’ll come to it a bit later. Here I will make a deductic pause and I will describe the differences between the way the DSM captures narcissism for example and the way the ICD captures narcissism. clinician and they could have mild severity, they could have a mild personality disorder, a moderate personality disorder or a severe personality disorder. It’s a lot more flexible. Allows you to really understand the client much more deeply. At the same time, you are supposed to describe the client’s traits. We’ll come to it a bit later. Here I will make a deductic pause and I will describe the differences between the way the DSM captures narcissism for example and the way the ICD captures narcissism.
72:34 First of all in the ICD there’s no gendering whereas in the DSM there is gender and in my view gender bias. This does not exist in the ICD. The ICD does not make a distinction between men and women. Not in the traits, not in the severity, not in the functioning, not in the manifestations and expressions of the disorder. None. There’s no difference between men and women. We know this to be true. There is no clinical difference or psychonamic difference between men and women. That’s a myth, a misogynistic First of all in the ICD there’s no gendering whereas in the DSM there is gender and in my view gender bias. This does not exist in the ICD. The ICD does not make a distinction between men and women. Not in the traits, not in the severity, not in the functioning, not in the manifestations and expressions of the disorder. None. There’s no difference between men and women. We know this to be true. There is no clinical difference or psychonamic difference between men and women. That’s a myth, a misogynistic
73:15 myth, if I may add. started with the hysteria. You remember hysteria in the 19th century? Hysteria. It was a female thing. You know, women had hysteria. And Freud was very big on hysteria. Initially in the end at the end of the 19th century, there was always gender bias. The fact is men and women are the same psychologically, psychonomically, clinically, they’re the same. So why do we think that when men and women are not the same? because of social pressures, cultural pressures, expectations, socialization has to do myth, if I may add. started with the hysteria. You remember hysteria in the 19th century? Hysteria. It was a female thing. You know, women had hysteria. And Freud was very big on hysteria. Initially in the end at the end of the 19th century, there was always gender bias. The fact is men and women are the same psychologically, psychonomically, clinically, they’re the same. So why do we think that when men and women are not the same? because of social pressures, cultural pressures, expectations, socialization has to do
73:52 with society, not with individual. The way the disorder manifests, for example, if you are a female narcissist or a male narcissist, a female psychopath or a male psychopath, a female borderline or a male borderline, the way the disorder manifests is different. Of course, it’s different, but it has nothing to do with psychology. It has to do with society, with culture, with norms and mores, with conventions, with history, with your place where you live, your location, with your period in history. Nothing to do with psychology. with society, not with individual. The way the disorder manifests, for example, if you are a female narcissist or a male narcissist, a female psychopath or a male psychopath, a female borderline or a male borderline, the way the disorder manifests is different. Of course, it’s different, but it has nothing to do with psychology. It has to do with society, with culture, with norms and mores, with conventions, with history, with your place where you live, your location, with your period in history. Nothing to do with psychology.
74:27 And the ICD reflects this information. In the ICD, there’s no distinction between male and female. ICD also introduces into the description of narcissism. I’m taking narcissism as a case study. Yes. also introduces elements that are either completely missing in the DSM or wrongly allocated. Let me give you an example. The DSM says that antisocial behavior is typical only of people with antisocial personality disorder. You will not find in the diagnostic criteria of narcissistic personality disorder, you And the ICD reflects this information. In the ICD, there’s no distinction between male and female. ICD also introduces into the description of narcissism. I’m taking narcissism as a case study. Yes. also introduces elements that are either completely missing in the DSM or wrongly allocated. Let me give you an example. The DSM says that antisocial behavior is typical only of people with antisocial personality disorder. You will not find in the diagnostic criteria of narcissistic personality disorder, you
75:10 will not find antisocial behavior. You will not find in the diagnostic criteria of borderline personality disorder antisocial behavior. You will find antisocial behavior only in the diagnostic criteria of antisocial personality disorder. So what’s wrong with it? What’s wrong with that is that it is completely wrong. Of course, narcissists engage in antisocial behavior. Otto Kernburg even suggested that there is a subtype of narcissist who is antisocial, the malignant narcissist, the psychopathic narcissist. will not find antisocial behavior. You will not find in the diagnostic criteria of borderline personality disorder antisocial behavior. You will find antisocial behavior only in the diagnostic criteria of antisocial personality disorder. So what’s wrong with it? What’s wrong with that is that it is completely wrong. Of course, narcissists engage in antisocial behavior. Otto Kernburg even suggested that there is a subtype of narcissist who is antisocial, the malignant narcissist, the psychopathic narcissist.
75:49 Borderlines, people with borderline personality disorder of course engage in antisocial behavior. Any clinician would tell you this. Massively so, frequently so. Antisocial behavior is definitely a clinical feature of borderline personality disorder, especially when the p when the person or the patient or the client with borderline personality disorder is acting out. When she or he is acting out, antisocial behavior is very common. When there is decompensation, the defense mechanisms crumble. the Borderlines, people with borderline personality disorder of course engage in antisocial behavior. Any clinician would tell you this. Massively so, frequently so. Antisocial behavior is definitely a clinical feature of borderline personality disorder, especially when the p when the person or the patient or the client with borderline personality disorder is acting out. When she or he is acting out, antisocial behavior is very common. When there is decompensation, the defense mechanisms crumble. the
76:27 borderline becomes defenseless. Basically, she behaves recklessly or he behaves defiantly. Antisocial behavior is a feature, a clinical feature of all cluster B personality disorders and it is wrong of the DSM to suggest otherwise. The ICD gets it right. Dissociity which is a trait dissociity is in the ICD common to all cluster B type of behaviors. So it is definitely a part of narcissism. Similarly we believe that um emotional dysregulation or emotion dysregulation is a feature of borderline personality disorder. borderline becomes defenseless. Basically, she behaves recklessly or he behaves defiantly. Antisocial behavior is a feature, a clinical feature of all cluster B personality disorders and it is wrong of the DSM to suggest otherwise. The ICD gets it right. Dissociity which is a trait dissociity is in the ICD common to all cluster B type of behaviors. So it is definitely a part of narcissism. Similarly we believe that um emotional dysregulation or emotion dysregulation is a feature of borderline personality disorder.
77:19 It’s not a feature of narcissism. It’s not a feature of psychopathy. Why do we have this belief? Because of the DSM. It’s the DSM that closely links emotion dysregulation or effective dysregulation with borderline personality disorder. That is completely wrong. Emotion dysregulation is very common in narcissism in someone with narcissistic personality. Very common. Narcissists. People with narcissistic personality become emotionally disregulated when they are em when they are narcissistically injured, when they It’s not a feature of narcissism. It’s not a feature of psychopathy. Why do we have this belief? Because of the DSM. It’s the DSM that closely links emotion dysregulation or effective dysregulation with borderline personality disorder. That is completely wrong. Emotion dysregulation is very common in narcissism in someone with narcissistic personality. Very common. Narcissists. People with narcissistic personality become emotionally disregulated when they are em when they are narcissistically injured, when they
77:56 experience narcissistic motification, when they have referential ideation. They’re all the time emotionally dregulated. Psychopaths are emotionally disregulated. Anyone who has observed psychopaths in prisons, for example, would tell you that psychopaths very often become emotionally dregulated. So it’s wrong and the ICD gets it right. The ICD gets many many things right. For example, the ICD includes, as I said, vulnerability as a critical feature of cluster B personality disorders. The ICD experience narcissistic motification, when they have referential ideation. They’re all the time emotionally dregulated. Psychopaths are emotionally disregulated. Anyone who has observed psychopaths in prisons, for example, would tell you that psychopaths very often become emotionally dregulated. So it’s wrong and the ICD gets it right. The ICD gets many many things right. For example, the ICD includes, as I said, vulnerability as a critical feature of cluster B personality disorders. The ICD
78:31 introduces hypervigilance. The ICD says that people with what the DSM calls cluster B personality disorder, they’re hypervigilant. They’re constantly suspicious. They have paranoid ideation. They scan the room to see if anyone is mocking them, talking about them, gossiping, uh, ridiculing them, joking about them, and so on. They’re constantly looking for sllights and insults, and they have a thin skin. This is common to all cluster bees. You dare to talk to a psychopath the wrong way, you’re dead. They have thin skin, introduces hypervigilance. The ICD says that people with what the DSM calls cluster B personality disorder, they’re hypervigilant. They’re constantly suspicious. They have paranoid ideation. They scan the room to see if anyone is mocking them, talking about them, gossiping, uh, ridiculing them, joking about them, and so on. They’re constantly looking for sllights and insults, and they have a thin skin. This is common to all cluster bees. You dare to talk to a psychopath the wrong way, you’re dead. They have thin skin,
79:07 border lines. Of course, hyper vigilance is not mentioned in the DSM, not even once. So the ICD mentions it. One of the major contributions of the ICD where the ICD gets it right is ICD suggests that many of these disorders, so-called disorders are compensatory. They compensate for something. That is very true. We know for example that pathological narcissism is compensatory. It compensates for a disregulated self-concept, a self-concept, a self-image that is highly variable and that is highly fragile and border lines. Of course, hyper vigilance is not mentioned in the DSM, not even once. So the ICD mentions it. One of the major contributions of the ICD where the ICD gets it right is ICD suggests that many of these disorders, so-called disorders are compensatory. They compensate for something. That is very true. We know for example that pathological narcissism is compensatory. It compensates for a disregulated self-concept, a self-concept, a self-image that is highly variable and that is highly fragile and
79:54 vulnerable and that includes probably negative effects like shame. Pathological narcissism is a defense against this and it compensates for it. And yet there’s no hint of the compensatory mechanisms in the DSM. There is in the ICD. But the greatest revolution in the ICD and the greatest contribution in my view and there are many. It’s difficult to choose. When it comes to what the DSM calls cluster B personality disorders, erratic or dramatic personality disorders, when it come to this kind of individuals with vulnerable and that includes probably negative effects like shame. Pathological narcissism is a defense against this and it compensates for it. And yet there’s no hint of the compensatory mechanisms in the DSM. There is in the ICD. But the greatest revolution in the ICD and the greatest contribution in my view and there are many. It’s difficult to choose. When it comes to what the DSM calls cluster B personality disorders, erratic or dramatic personality disorders, when it come to this kind of individuals with
80:37 this combination of specific traits and specific behaviors, where the ICD makes a revolution, absolutely revolutionizes the field is when it introduces what is known as the borderline pattern specifier. That’s my choice. I choose it as number one revolution. You may choose other things maybe but I think it’s a major courageous very brave revolution. What the ICD says is the following. Someone a client can come to you a patient can come to you and okay you identify the severity. Let’s say it’s a severe personality this combination of specific traits and specific behaviors, where the ICD makes a revolution, absolutely revolutionizes the field is when it introduces what is known as the borderline pattern specifier. That’s my choice. I choose it as number one revolution. You may choose other things maybe but I think it’s a major courageous very brave revolution. What the ICD says is the following. Someone a client can come to you a patient can come to you and okay you identify the severity. Let’s say it’s a severe personality
81:20 disorder and you identify the traits dissociancia negative affectivity and some antagonism. Ah you say if I put the two together I what I’m getting is the equivalent of narcissistic personality disorder in the DSM. So that’s a narcissist but at the same time you observe emotional emotion dysregulation. You observe selfharming behaviors. You observe in the same individual suicidal ideiation. How to reconcile all this? What the ICD tells you, you could add to the diagnosis, add on, plug in to the disorder and you identify the traits dissociancia negative affectivity and some antagonism. Ah you say if I put the two together I what I’m getting is the equivalent of narcissistic personality disorder in the DSM. So that’s a narcissist but at the same time you observe emotional emotion dysregulation. You observe selfharming behaviors. You observe in the same individual suicidal ideiation. How to reconcile all this? What the ICD tells you, you could add to the diagnosis, add on, plug in to the
82:03 diagnosis, a borderline specifier, a borderline pattern specifier. Essentially what the ICD is saying, and I will go into it in depth in a minute because it’s a major revolution. Essentially what the ICD is saying any client that comes to you even if you are think the client has is a narcissist even if you think the client is a psychopath even any client that comes to you could also be in effect a borderline borderline what the ICD is saying the borderline personality organization the borderline state diagnosis, a borderline specifier, a borderline pattern specifier. Essentially what the ICD is saying, and I will go into it in depth in a minute because it’s a major revolution. Essentially what the ICD is saying any client that comes to you even if you are think the client has is a narcissist even if you think the client is a psychopath even any client that comes to you could also be in effect a borderline borderline what the ICD is saying the borderline personality organization the borderline state
82:41 is a universal specifier is not unique to an individual or to a description, but you can add it on to anything and to everything. In other words, the ICD takes away the diagnostic status of borderline personality. The ICD says borderline personality is not a clinical entity, is not a diagnosis. It’s an add-on. It’s a plug-in. It’s a specifier. You can add it onto a diagnosis. So, that’s a major revolution because we used to think and those who who work with the DSM, they still think that is a universal specifier is not unique to an individual or to a description, but you can add it on to anything and to everything. In other words, the ICD takes away the diagnostic status of borderline personality. The ICD says borderline personality is not a clinical entity, is not a diagnosis. It’s an add-on. It’s a plug-in. It’s a specifier. You can add it onto a diagnosis. So, that’s a major revolution because we used to think and those who who work with the DSM, they still think that
83:30 borderline personality disorder is a clinical entity is a diagnosis. So if you are diagnosed according to the ICD with specific trade domains and personality dysfunction and at the same time you are you have unstable interpersonal relationships you have an unstable self-image you have a fluctuating or unstable effect. So you have emotion dysregulation. You have marked impulsivity in a way secondary psychopathy and there are many studies now where scholars begin to reconceive of borderline personality disorder as a form of borderline personality disorder is a clinical entity is a diagnosis. So if you are diagnosed according to the ICD with specific trade domains and personality dysfunction and at the same time you are you have unstable interpersonal relationships you have an unstable self-image you have a fluctuating or unstable effect. So you have emotion dysregulation. You have marked impulsivity in a way secondary psychopathy and there are many studies now where scholars begin to reconceive of borderline personality disorder as a form of
84:13 secondary psychopathy. So if you have all these things, you can safely diagnose the individual not only with the core diagnosis which is customized to the individual but you can also add onto the diagnosis a borderline overlay a borderline pattern. It is not borderline personality disorder but it adds the borderline features to the individual. This is a highly flexible, nuanced, subtle, brilliant uh approach to diagnosis because from 30 years of experience it captures cluster B personality disorder exactly as they secondary psychopathy. So if you have all these things, you can safely diagnose the individual not only with the core diagnosis which is customized to the individual but you can also add onto the diagnosis a borderline overlay a borderline pattern. It is not borderline personality disorder but it adds the borderline features to the individual. This is a highly flexible, nuanced, subtle, brilliant uh approach to diagnosis because from 30 years of experience it captures cluster B personality disorder exactly as they
85:02 are. They are all borderline. All people with cluster B personality disorder are borderline. And you know what? Any clinician will tell you that a client presents as a narcissist on Monday, a borderline on Wednesday, and a psychopath on Friday. It’s nonsense. These differential diagnosis are nonsensical. Completely counterfactual against clinical practice. It’s not true. They all have all of this. They all people with these issues, with these alleged disorders, all of them have all these clinical features. are. They are all borderline. All people with cluster B personality disorder are borderline. And you know what? Any clinician will tell you that a client presents as a narcissist on Monday, a borderline on Wednesday, and a psychopath on Friday. It’s nonsense. These differential diagnosis are nonsensical. Completely counterfactual against clinical practice. It’s not true. They all have all of this. They all people with these issues, with these alleged disorders, all of them have all these clinical features.
85:43 Not all the time, but from time to time. So the ICD allows you to add the borderline diagnosis, borderline pattern specifier to anything and everything. And we know that borderline is not just a name is not the borderline. When we say that someone has a borderline pattern or even a borderline personality if we use Kberg’s work when we say this about an individual it allows us to predict many things and it allows us to give the right treatment. It’s very crucial to identify borderline clinical features in an individual Not all the time, but from time to time. So the ICD allows you to add the borderline diagnosis, borderline pattern specifier to anything and everything. And we know that borderline is not just a name is not the borderline. When we say that someone has a borderline pattern or even a borderline personality if we use Kberg’s work when we say this about an individual it allows us to predict many things and it allows us to give the right treatment. It’s very crucial to identify borderline clinical features in an individual
86:31 because then we are very likely to give him the right treatment and to understand the individual a lot better. So for example there is something that the ICD calls externalizing features. If you are diagnosed with a borderline specifier, you’re very likely to experience depression, anxiety, uh CPTSD, complex trauma. These are internalizing features, but you are also likely to abuse substances. You are also likely to be suicidal. You are likely to self harm and self mutilate. You are likely to have eating because then we are very likely to give him the right treatment and to understand the individual a lot better. So for example there is something that the ICD calls externalizing features. If you are diagnosed with a borderline specifier, you’re very likely to experience depression, anxiety, uh CPTSD, complex trauma. These are internalizing features, but you are also likely to abuse substances. You are also likely to be suicidal. You are likely to self harm and self mutilate. You are likely to have eating
87:12 disorders, attention deficit deficits. All these are externalizing features. The minute I the minute you come to me, if I’m a clinician, I’m not a clinician, but if I were a clinician, the minute you come to me as a client and I I observe that you have a borderline pattern, I can instantly map out your anomnesis. Instantly realize your personal history. If I know that your relationships are unstable, your self-image is unstable, your effect is unstable, etc., etc., and maybe you are impulsive. If I know all this, I disorders, attention deficit deficits. All these are externalizing features. The minute I the minute you come to me, if I’m a clinician, I’m not a clinician, but if I were a clinician, the minute you come to me as a client and I I observe that you have a borderline pattern, I can instantly map out your anomnesis. Instantly realize your personal history. If I know that your relationships are unstable, your self-image is unstable, your effect is unstable, etc., etc., and maybe you are impulsive. If I know all this, I
87:52 also know that you suffer depression. I also know that you have anxiety. I also know that you abuse substances. I also know all these things. I also know that you are selfharming or at least self-defeating. I know this automatically. automatically. So it slapping the specifier on someone also instantaneously provides you with an encyclopedic knowledge about the client, dynamic knowledge, not static. In the DSM, there are some features that are absent in the ICD and I think should be included in a also know that you suffer depression. I also know that you have anxiety. I also know that you abuse substances. I also know all these things. I also know that you are selfharming or at least self-defeating. I know this automatically. automatically. So it slapping the specifier on someone also instantaneously provides you with an encyclopedic knowledge about the client, dynamic knowledge, not static. In the DSM, there are some features that are absent in the ICD and I think should be included in a
88:34 future edition of the ICD. For example, the DSM says that people with borderline personality disorder are reckless. They are. It’s true. They engage in selfharming and self-endangering behavior because they don’t anticipate the consequences and outcomes of their actions. the but more importantly the the DSM suggests that borderline people with borderline personality disorder suffer from time to time psychotic clinical features they it’s a kind of pseudo pseudocychosis hallucinations future edition of the ICD. For example, the DSM says that people with borderline personality disorder are reckless. They are. It’s true. They engage in selfharming and self-endangering behavior because they don’t anticipate the consequences and outcomes of their actions. the but more importantly the the DSM suggests that borderline people with borderline personality disorder suffer from time to time psychotic clinical features they it’s a kind of pseudo pseudocychosis hallucinations
89:11 dissociation paranoid ideiation now this is an echo a distant echo of the work of Otto Karnburg Otto Karnburg suggested that narcissist istic and borderline personalities and personality organizations they are on the verge of psychosis they are pseudocsychotic that’s why we say borderline the border between neurosis and psychosis so this is an echo of this thinking I want to show you the difference between the DSM and the ICD when it comes to ethology when you read the text in the DSM With regards to borderline personality dissociation paranoid ideiation now this is an echo a distant echo of the work of Otto Karnburg Otto Karnburg suggested that narcissist istic and borderline personalities and personality organizations they are on the verge of psychosis they are pseudocsychotic that’s why we say borderline the border between neurosis and psychosis so this is an echo of this thinking I want to show you the difference between the DSM and the ICD when it comes to ethology when you read the text in the DSM With regards to borderline personality
89:56 disorder, there’s no meaningful mention of a theology. It’s as if borderline personality disorder is something you wake up with one clear morning. You were not borderline the day before. You wake up, you’re borderline kind of. There’s no timeline, no course of the disease, not nothing in the DSM. And of course we know that borderline personality disorder is somewhat hereditary. Hereditary heredity explains some of the variance. And we know that there are brain abnormalities in people disorder, there’s no meaningful mention of a theology. It’s as if borderline personality disorder is something you wake up with one clear morning. You were not borderline the day before. You wake up, you’re borderline kind of. There’s no timeline, no course of the disease, not nothing in the DSM. And of course we know that borderline personality disorder is somewhat hereditary. Hereditary heredity explains some of the variance. And we know that there are brain abnormalities in people
90:30 with antisocial personality disorder and borderline personality disorder. None of this is mentioned in the DSM. The DSM leaves you dangling in the air. If you want to understand what the hell happened to this person, why did they become borderline? The ICD provides an answer. If you read the ICD11, you learn something new. I learned from for example that while trauma exists in the backgrounds of everyone with borderline personality disorder, there is trauma in the personal histories and autobiographies of people with antisocial personality disorder and borderline personality disorder. None of this is mentioned in the DSM. The DSM leaves you dangling in the air. If you want to understand what the hell happened to this person, why did they become borderline? The ICD provides an answer. If you read the ICD11, you learn something new. I learned from for example that while trauma exists in the backgrounds of everyone with borderline personality disorder, there is trauma in the personal histories and autobiographies of people
91:08 with and biographies of people with borderline. Trauma is not the reason that they develop borderline. There were massive studies by Porter and meta analysis later on that have demonstrated conclusively that the ethiology of borderline does not involve trauma. It involves neglect and invalidation much more that than trauma. Whereas in all the textbooks and even myself, I believed that trauma is the core issue. like if you’re sexually abused as a child, you’re likely to develop borderline. with and biographies of people with borderline. Trauma is not the reason that they develop borderline. There were massive studies by Porter and meta analysis later on that have demonstrated conclusively that the ethiology of borderline does not involve trauma. It involves neglect and invalidation much more that than trauma. Whereas in all the textbooks and even myself, I believed that trauma is the core issue. like if you’re sexually abused as a child, you’re likely to develop borderline.
91:48 Actually, that’s not the case. So, the ICD is also a great textbook. You can learn from it. They bother, you can see that they bother. They bother to summarize the studies. They It’s It’s a It’s a wonderful book to read also and I recommend to read it. It’s uh now the borderline pattern specifier in the ICD is definitely an encapsulation and reflection of the work by Otto Kernberg borderline personality organization first suggested in 1967. If my memory doesn’t fail me, Karnberg Actually, that’s not the case. So, the ICD is also a great textbook. You can learn from it. They bother, you can see that they bother. They bother to summarize the studies. They It’s It’s a It’s a wonderful book to read also and I recommend to read it. It’s uh now the borderline pattern specifier in the ICD is definitely an encapsulation and reflection of the work by Otto Kernberg borderline personality organization first suggested in 1967. If my memory doesn’t fail me, Karnberg
92:30 is mentioned in the ICD as the originator. If uh I mean I’m not sure but if my memory doesn’t fail, it was KB who suggested in 1967 that there is a type of personality which involves instability of identity, volatility of relationships, affect liability, primitive defenses, impulsivity, separation insecurity also known as abandonment anxiety, impaired reality testing and that lies somewhere between the roses and psychosis and the ICD. adopted it lock stock and barrel. What I’m trying to say is that the ICD11 is mentioned in the ICD as the originator. If uh I mean I’m not sure but if my memory doesn’t fail, it was KB who suggested in 1967 that there is a type of personality which involves instability of identity, volatility of relationships, affect liability, primitive defenses, impulsivity, separation insecurity also known as abandonment anxiety, impaired reality testing and that lies somewhere between the roses and psychosis and the ICD. adopted it lock stock and barrel. What I’m trying to say is that the ICD11
93:11 is in touch with the history of psychology. Whereas the DSM pretends that Kernburgg and Cohort and not to mention Freud and Jung Yeah. But Karnburg and Koh and Gunrip and Fairburn and uh Winnott and all these people never ever existed. There’s no hint of their names or their work in the DSM. They have never existed. Skinner, you name it. Nothing before 1985 has ever existed. The ICD gives credit to these giants, these giants of psychology. I’m not saying they got everything right. They actually probably got everything wrong. is in touch with the history of psychology. Whereas the DSM pretends that Kernburgg and Cohort and not to mention Freud and Jung Yeah. But Karnburg and Koh and Gunrip and Fairburn and uh Winnott and all these people never ever existed. There’s no hint of their names or their work in the DSM. They have never existed. Skinner, you name it. Nothing before 1985 has ever existed. The ICD gives credit to these giants, these giants of psychology. I’m not saying they got everything right. They actually probably got everything wrong.
93:59 That’s not the issue. But look how insightful they were. Look how close to what constitutes a human they were. Look how brilliant their pros was. Look at the amazing experiments they have designed. To throw all this to the garbage, to trash it as the DSM does is an abomination. And the ICD does not do this. Does not do this. It is full of insights from psychoanalysis, psychoynamic theories, object relations theories, um behaviorism, social cognition theory up to the latest narrative theory, role theory, it’s all That’s not the issue. But look how insightful they were. Look how close to what constitutes a human they were. Look how brilliant their pros was. Look at the amazing experiments they have designed. To throw all this to the garbage, to trash it as the DSM does is an abomination. And the ICD does not do this. Does not do this. It is full of insights from psychoanalysis, psychoynamic theories, object relations theories, um behaviorism, social cognition theory up to the latest narrative theory, role theory, it’s all
94:41 in the ICD. It’s truly encyclopedic. It gives credit to previous thinkers which the DSM does not do. In other words, the DSM is fashionable and trendy, whereas the ICD is reliable and accurate. I want to I want to finish. So, as you see, everything bad has an end. So you should remain optimistic in life. I want to finish with uh with a few points. The ICD describes cluster B personality disorders without ever using the word cluster B or personality disorders. No use of these words. And yet it succeeds to capture the in the ICD. It’s truly encyclopedic. It gives credit to previous thinkers which the DSM does not do. In other words, the DSM is fashionable and trendy, whereas the ICD is reliable and accurate. I want to I want to finish. So, as you see, everything bad has an end. So you should remain optimistic in life. I want to finish with uh with a few points. The ICD describes cluster B personality disorders without ever using the word cluster B or personality disorders. No use of these words. And yet it succeeds to capture the
95:44 essence of these personality disorders much better than the DSM and much more accurately. And I want to read to you a list and only a list I will not go I will not go in depth into any any of this but only a list of things that you find in the ICD and you do not find in the DSM. It’s a long list. Brace yourself. injury, for example, narcissistic injury. Remember, these are things you find in the ICD and you don’t find in the DSM. Self-enhancement, which is a foundational cornerstone behavior in all class personality essence of these personality disorders much better than the DSM and much more accurately. And I want to read to you a list and only a list I will not go I will not go in depth into any any of this but only a list of things that you find in the ICD and you do not find in the DSM. It’s a long list. Brace yourself. injury, for example, narcissistic injury. Remember, these are things you find in the ICD and you don’t find in the DSM. Self-enhancement, which is a foundational cornerstone behavior in all class personality
96:28 disorders, especially narcissistic, but not only self aggrandisement, grandiosity. It’s a core feature. It’s a cognitive distortion in borderline in antisocial and in narcissistic personality inrionic. All of them missing in action. Fantasy defense. The role of fantasy. Compromised efficacy. Compromised self-efficacy and efficacy. Procrastination. Perfectionism. No hint in the DSM. The role of shame and self-loathing. A critical insight in cluster B personality disorders. No hint in the disorders, especially narcissistic, but not only self aggrandisement, grandiosity. It’s a core feature. It’s a cognitive distortion in borderline in antisocial and in narcissistic personality inrionic. All of them missing in action. Fantasy defense. The role of fantasy. Compromised efficacy. Compromised self-efficacy and efficacy. Procrastination. Perfectionism. No hint in the DSM. The role of shame and self-loathing. A critical insight in cluster B personality disorders. No hint in the
97:13 DSM. Not even an illusion. Nothing. Generally, negative effects receive a very brief and cursory treatment in the DSM. While they are a critical trade domain in the ICD, internalized bed object, what used to be called primitive super ego in the 30s, the voices, the constellation of voices and introjects inside that keeps informing people with cluster B personality disorders that they are unworthy, unlovable, etc. negative effectivity, self-destructiveness and self-def personality disorders. Disordered people DSM. Not even an illusion. Nothing. Generally, negative effects receive a very brief and cursory treatment in the DSM. While they are a critical trade domain in the ICD, internalized bed object, what used to be called primitive super ego in the 30s, the voices, the constellation of voices and introjects inside that keeps informing people with cluster B personality disorders that they are unworthy, unlovable, etc. negative effectivity, self-destructiveness and self-def personality disorders. Disordered people
97:59 are highly self-destructive, self-defeating, selfharming, self- thrashing, self-mutilating, self-injurious one way or another. Recklessness is a form of self-injury. And yet there’s no hint of this in the DSM except for the borderline in borderline in borderline personality disorder there is recklessness as a diagnostic criteria. That’s it. The narcissist according to the DSM is not self-destructive. The the psychopath is not self-destructive. They are the psychopath only ends up in prison time are highly self-destructive, self-defeating, selfharming, self- thrashing, self-mutilating, self-injurious one way or another. Recklessness is a form of self-injury. And yet there’s no hint of this in the DSM except for the borderline in borderline in borderline personality disorder there is recklessness as a diagnostic criteria. That’s it. The narcissist according to the DSM is not self-destructive. The the psychopath is not self-destructive. They are the psychopath only ends up in prison time
98:34 and again. Yeah, that’s not self-destructiveness. That’s probably a hobby. The narcissist ends up in in a string of failed interpersonal relationships. That’s not self-destructiveness. No hint in the DSM. Externalized aggression is not mentioned in the DSM except for the uh psychopath, the antisocial category. According to the DSM, the narcissist may be envious. Narcissist may be exploitative. Narcissist may be disempathic. No empathy. It’s wrong by the way. Narcissists do possess empathy and and again. Yeah, that’s not self-destructiveness. That’s probably a hobby. The narcissist ends up in in a string of failed interpersonal relationships. That’s not self-destructiveness. No hint in the DSM. Externalized aggression is not mentioned in the DSM except for the uh psychopath, the antisocial category. According to the DSM, the narcissist may be envious. Narcissist may be exploitative. Narcissist may be disempathic. No empathy. It’s wrong by the way. Narcissists do possess empathy and
99:17 psychopath possess empathy. Okay? But according to the DSM, but the narcissist is not aggressive, is not violent. Even the borderline is not aggressive or violent. No mention of acting out. Aggression is totally omitted in the DSM except in the antisocial personality disorder. Externalized aggression, defiance, consumaciousness, the rejection of authority, parasitism, entitlement. Entitlement is mentioned in the DSM in in the narcissistic personality disorder list of diagnostic criteria, but not for psychopath possess empathy. Okay? But according to the DSM, but the narcissist is not aggressive, is not violent. Even the borderline is not aggressive or violent. No mention of acting out. Aggression is totally omitted in the DSM except in the antisocial personality disorder. Externalized aggression, defiance, consumaciousness, the rejection of authority, parasitism, entitlement. Entitlement is mentioned in the DSM in in the narcissistic personality disorder list of diagnostic criteria, but not for
100:02 example in borderline personality disorder. In antisocial personality disorder, these people are highly entitled. Anyone who has ever worked with a psychopath or a borderline would tell you how entitled they are. traits, traits that are mentioned in the ICD that are super critical traits, defining traits and have no hint or mention in the DSM. Emotional ability, mood liability is mentioned. Emotional ability is mentioned in the borderline criteria but nowhere else. Narcissists are highly emotionally labile. example in borderline personality disorder. In antisocial personality disorder, these people are highly entitled. Anyone who has ever worked with a psychopath or a borderline would tell you how entitled they are. traits, traits that are mentioned in the ICD that are super critical traits, defining traits and have no hint or mention in the DSM. Emotional ability, mood liability is mentioned. Emotional ability is mentioned in the borderline criteria but nowhere else. Narcissists are highly emotionally labile.
100:47 Psychopaths are totally disregulated. That’s the core of psychopathy. They don’t have impulse control. They are completely disregulated. And yet there’s no hint of this in the DSM. It is mentioned in the ICD. Detachment, social withdrawal, avoidant behaviors, schizoid phases, phases which are schizoid like are very common in all cluster B personality disorders. border lines. When they are faced with stress, with rejection, with abandonment, with anxiety, with tension, border border lines withdraw, they constrict, they Psychopaths are totally disregulated. That’s the core of psychopathy. They don’t have impulse control. They are completely disregulated. And yet there’s no hint of this in the DSM. It is mentioned in the ICD. Detachment, social withdrawal, avoidant behaviors, schizoid phases, phases which are schizoid like are very common in all cluster B personality disorders. border lines. When they are faced with stress, with rejection, with abandonment, with anxiety, with tension, border border lines withdraw, they constrict, they
101:26 avoid. Same with narcissists. When they are narcissistically injured, when they are humiliated, when they experience narcissistic motifications, narcissists withdraw, they avoid. Skoid behaviors and sktoid phases, detachment, avoidance, withdrawal are crucial in cluster B. And there is not a hint of this in the DSM text. None, by the way, in any of the of the disorders. Disociality. While the DSM does mention antisocial traits and behaviors, the DSM’s definition is extremely narrow. According to the DSM, to be antisocial avoid. Same with narcissists. When they are narcissistically injured, when they are humiliated, when they experience narcissistic motifications, narcissists withdraw, they avoid. Skoid behaviors and sktoid phases, detachment, avoidance, withdrawal are crucial in cluster B. And there is not a hint of this in the DSM text. None, by the way, in any of the of the disorders. Disociality. While the DSM does mention antisocial traits and behaviors, the DSM’s definition is extremely narrow. According to the DSM, to be antisocial
102:12 is to do something against society or against other people. That is the meaning of being antisocial. The ICD expands the definition of dissociity to include all antisocial traits and behaviors, but also for example egotism, parasitism, a pronounced lack of effective empathy. They’re all forms of dissociity. Disinhibitions, disinhibition, impulsivity, recklessness. Recklessness is mentioned in the diagnostic criteria of borderline in the DSM. End of story. Impulse control is mentioned in passing. is to do something against society or against other people. That is the meaning of being antisocial. The ICD expands the definition of dissociity to include all antisocial traits and behaviors, but also for example egotism, parasitism, a pronounced lack of effective empathy. They’re all forms of dissociity. Disinhibitions, disinhibition, impulsivity, recklessness. Recklessness is mentioned in the diagnostic criteria of borderline in the DSM. End of story. Impulse control is mentioned in passing.
102:57 Disinhibition is not mentioned at all. ICD mentions all three. Very critical. Impulsivity is critical. We even know that there is a subtype of psychopath, the secondary psychopath who is very impulsive. And we know of course that borderline people with borderline personality disorder, people with narcissistic personality disorder are highly impulsive. They have severe problems with impulse control. And yet total neglect in the DSM. And finally, anastia. Anastasia is a fancy word for compulsive features, Disinhibition is not mentioned at all. ICD mentions all three. Very critical. Impulsivity is critical. We even know that there is a subtype of psychopath, the secondary psychopath who is very impulsive. And we know of course that borderline people with borderline personality disorder, people with narcissistic personality disorder are highly impulsive. They have severe problems with impulse control. And yet total neglect in the DSM. And finally, anastia. Anastasia is a fancy word for compulsive features,
103:38 a behavior that is compulsive in some way. And so anastia is not mentioned in the DSM. Compulsion is not mentioned in the DSM where compulsion is a super critical feature in borderline narcissism because the borderline the person with borderline personality disorder experiences or goes through cycles of idealization and devaluation of other people. Cycles which are compulsive. Freud called it repetition compulsion. Similarly, in narcissism, we have compulsive cycles. And the pursuit of narcissistic supply in pathological a behavior that is compulsive in some way. And so anastia is not mentioned in the DSM. Compulsion is not mentioned in the DSM where compulsion is a super critical feature in borderline narcissism because the borderline the person with borderline personality disorder experiences or goes through cycles of idealization and devaluation of other people. Cycles which are compulsive. Freud called it repetition compulsion. Similarly, in narcissism, we have compulsive cycles. And the pursuit of narcissistic supply in pathological
104:21 narcissism is the very rarification of compulsion. It’s very compulsive. And yet compulsion is not mentioned or hinted it in the DSM. Perfectionism is not mentioned. Erh constrained behavior is not none of it is mentioned. an uncasio ICD is the only one that mentions it and so ultimately the clinician who is using the ICD has to rate rate the client and this is known as clinician rating. Now the clinician knows the severity of the disorder. The clinician knows the traits. The clinician described the patient, narcissism is the very rarification of compulsion. It’s very compulsive. And yet compulsion is not mentioned or hinted it in the DSM. Perfectionism is not mentioned. Erh constrained behavior is not none of it is mentioned. an uncasio ICD is the only one that mentions it and so ultimately the clinician who is using the ICD has to rate rate the client and this is known as clinician rating. Now the clinician knows the severity of the disorder. The clinician knows the traits. The clinician described the patient,
105:04 created a short story about the patient, and now it is time to rank the patient using numbers, using percentages. And the ranking involves several parameters, identity, self-worth, self-appraisal, self-direction, relationship, interest, empathy, mutuality, and conflict resolution or conflict agreement. The clinician gives a percentage to each and every one of them and there’s a formula to calculate using these percentages a formula to calculate in a way that yields ultimately a diagnosis which is unique to the patient. One created a short story about the patient, and now it is time to rank the patient using numbers, using percentages. And the ranking involves several parameters, identity, self-worth, self-appraisal, self-direction, relationship, interest, empathy, mutuality, and conflict resolution or conflict agreement. The clinician gives a percentage to each and every one of them and there’s a formula to calculate using these percentages a formula to calculate in a way that yields ultimately a diagnosis which is unique to the patient. One
105:44 thing the second major revolution and with this I will finish the lecture. Yeah. The second uh major revolution of the ICD is the introduction of vulnerability versus grandiosity scales. Every one of the parameters of the rating has a grandio manifestation and a vulnerable manifestation. So for example, identity uh has a grandio and vulnerable manifestation which reflects the self-concept. Same with selfworth. Same with uh in in selfworth for example the grandiose manifestation of the selfworth is the thing the second major revolution and with this I will finish the lecture. Yeah. The second uh major revolution of the ICD is the introduction of vulnerability versus grandiosity scales. Every one of the parameters of the rating has a grandio manifestation and a vulnerable manifestation. So for example, identity uh has a grandio and vulnerable manifestation which reflects the self-concept. Same with selfworth. Same with uh in in selfworth for example the grandiose manifestation of the selfworth is the
106:26 pursuit of narcissistic supply attention whereas the vulnerable manifestation of selfworth is when the narcissist collapses unable to obtain supply or experiences public shaming and humiliation which is abrupt known as narcissistic motification. Similarly in self uh in self- appraisal there is a vulnerable manifestation which I in my work I call it grandiosity gap the gap between the inflated fantastic counterfactual self-concept and reality and that creates vulnerability. The gap is big. The individual is vulnerable. pursuit of narcissistic supply attention whereas the vulnerable manifestation of selfworth is when the narcissist collapses unable to obtain supply or experiences public shaming and humiliation which is abrupt known as narcissistic motification. Similarly in self uh in self- appraisal there is a vulnerable manifestation which I in my work I call it grandiosity gap the gap between the inflated fantastic counterfactual self-concept and reality and that creates vulnerability. The gap is big. The individual is vulnerable.
107:07 In self-direction there is a grandio manifestation which is indistinguishable from Freud’s ego ideal. For those of you who know psychoanalysis in the relationship interest, you have a grandio manifestation which is contemptuous or when the individual experience dissonance. He’s dependent on other people but he resents the dependency and so he hates them. He devalues them. He attacks them. So this is the grandio manifestation. And there is a vulnerable manifestation which is indistinguishable from In self-direction there is a grandio manifestation which is indistinguishable from Freud’s ego ideal. For those of you who know psychoanalysis in the relationship interest, you have a grandio manifestation which is contemptuous or when the individual experience dissonance. He’s dependent on other people but he resents the dependency and so he hates them. He devalues them. He attacks them. So this is the grandio manifestation. And there is a vulnerable manifestation which is indistinguishable from
107:39 codependency or dependent personality disorder. In empathy which is the the next parameter for the ranking or the rating in empathy you have a grandio manifestation which Bolas Christopher Bolas called violent innocence. It’s when you refuse to listen to other people. You don’t care about their opinions, judgments, input, life experience. You just shut them out. You don’t listen to them. So that’s a grandio manifestation of empathy. And a vulnerable uh manifestation is when you care very much about other people. But codependency or dependent personality disorder. In empathy which is the the next parameter for the ranking or the rating in empathy you have a grandio manifestation which Bolas Christopher Bolas called violent innocence. It’s when you refuse to listen to other people. You don’t care about their opinions, judgments, input, life experience. You just shut them out. You don’t listen to them. So that’s a grandio manifestation of empathy. And a vulnerable uh manifestation is when you care very much about other people. But
108:14 the only thing that concerns you what do they think about me? So that’s and referential ideation as well. When you think that other people are concerned with you somehow mutuality, the vulnerable manifestation of mutuality is what we call victimhood. Victimhood mentality. And finally in conflict management the vulnerable manifestation would be passive aggression. When you don’t dare to externalize aggression or for social cultural reasons you don’t externalize aggression and so you become sabotaging the only thing that concerns you what do they think about me? So that’s and referential ideation as well. When you think that other people are concerned with you somehow mutuality, the vulnerable manifestation of mutuality is what we call victimhood. Victimhood mentality. And finally in conflict management the vulnerable manifestation would be passive aggression. When you don’t dare to externalize aggression or for social cultural reasons you don’t externalize aggression and so you become sabotaging
108:46 you undermine you become passive aggressive. In all these parameters which feed into the client rating into the clinician rating in all these parameters there is a grandiosity scale and a vulnerability scale. absolutely the latest knowledge we have cutting edge whereas the DSM is nowhere near this no hint I mean there’s a hint in the alternative model about about vulnerability and that’s it nothing I I would say if I have to summarize this lecture the DSM is about 25 years behind the ICD in terms of professional you undermine you become passive aggressive. In all these parameters which feed into the client rating into the clinician rating in all these parameters there is a grandiosity scale and a vulnerability scale. absolutely the latest knowledge we have cutting edge whereas the DSM is nowhere near this no hint I mean there’s a hint in the alternative model about about vulnerability and that’s it nothing I I would say if I have to summarize this lecture the DSM is about 25 years behind the ICD in terms of professional
109:30 knowledge and in terms of prescriptive prescriptions as to treatment modalities and the process of diagnosis. Thank you for suffering. And now if you want to further victimize yourself, I am open to questions. >> Thank you very much for the lecture. Does anyone have any comments, reflection, question to the professor? Please don’t hesitate to ask. This is very great opportunity to continue the discussion. >> I I want to ask a qu I want to ask a question. Can Can I >> There is a question from the audience. knowledge and in terms of prescriptive prescriptions as to treatment modalities and the process of diagnosis. Thank you for suffering. And now if you want to further victimize yourself, I am open to questions. >> Thank you very much for the lecture. Does anyone have any comments, reflection, question to the professor? Please don’t hesitate to ask. This is very great opportunity to continue the discussion. >> I I want to ask a qu I want to ask a question. Can Can I >> There is a question from the audience.
110:20 >> Okay. And then I will ask a question. >> Of course. So I would like to ask you professor why uh there’s nowadays there’s more and more women with narcissistic uh personality disorder as you say in your channels and during your seminars that now it’s 50 5050% men and 50 women why it’s changing so many years ago there were majority were men and now Yeah. So first of all, >> first of all is not not what I am saying. This is uh this is the text as amended in the DSM uh 5 text revision. >> Okay. And then I will ask a question. >> Of course. So I would like to ask you professor why uh there’s nowadays there’s more and more women with narcissistic uh personality disorder as you say in your channels and during your seminars that now it’s 50 5050% men and 50 women why it’s changing so many years ago there were majority were men and now Yeah. So first of all, >> first of all is not not what I am saying. This is uh this is the text as amended in the DSM uh 5 text revision.
111:07 Now in the DSM5 officially uh it says that 50% of people diagnosed with NPD may be women politically correct maybe women. And yes, recent studies and clinical experience because I interact with the hundreds of clinicians in uh my seminars, lectures, correspondents and so on. Clinical experience is that women are now equal to men in terms of representation. Although in when it comes to antisocial personality disorder, psychopathy, women are still a minority. They’re a growing minority about onethird but they used to be 10%. Now in the DSM5 officially uh it says that 50% of people diagnosed with NPD may be women politically correct maybe women. And yes, recent studies and clinical experience because I interact with the hundreds of clinicians in uh my seminars, lectures, correspondents and so on. Clinical experience is that women are now equal to men in terms of representation. Although in when it comes to antisocial personality disorder, psychopathy, women are still a minority. They’re a growing minority about onethird but they used to be 10%.
111:43 So they are still a minority. I don’t know why, but I can speculate. I think narcissism is linked to masculinity. I think it’s a masculine disorder. When I say masculine, I don’t mean men and women. A woman could be masculine. Um, a man could be feminine. Masculinity and femininity are socially constructed performative gender roles which anyone can adopt regarding of genitalia. Yeah. So I think narcissism pathological narism is intimately linked with masculinity because it involves defiance, rejection So they are still a minority. I don’t know why, but I can speculate. I think narcissism is linked to masculinity. I think it’s a masculine disorder. When I say masculine, I don’t mean men and women. A woman could be masculine. Um, a man could be feminine. Masculinity and femininity are socially constructed performative gender roles which anyone can adopt regarding of genitalia. Yeah. So I think narcissism pathological narism is intimately linked with masculinity because it involves defiance, rejection
112:29 of authority, consummaciousness. It involves ambition. It involves superiority. It involves competition. It’s very manly, you know. And what has happened definitely according to studies I will mention a few in a minute. What has happened is women came to identify themselves in masculine terms in the past 45 years. So we have studies in the 1980s where we asked women to describe themselves using u adjectives. We gave them a list of adjectives, a big list of adjectives and we asked them to describe themselves. of authority, consummaciousness. It involves ambition. It involves superiority. It involves competition. It’s very manly, you know. And what has happened definitely according to studies I will mention a few in a minute. What has happened is women came to identify themselves in masculine terms in the past 45 years. So we have studies in the 1980s where we asked women to describe themselves using u adjectives. We gave them a list of adjectives, a big list of adjectives and we asked them to describe themselves.
113:12 And women in 19 in the 1980s, the first study was 1980, women described themselves using feminine terms, stereotypically feminine terms. So each each um subject each individual in the in the experiment in the study was uh allowed to use nine adjectives and statistically women chose eight out of nine adjectives which were feminine. Compassionate, caring, empathic, holding, loving, identified with feminine. Fast forward to to 2018, we administered the same tests and women in these much bigger studies And women in 19 in the 1980s, the first study was 1980, women described themselves using feminine terms, stereotypically feminine terms. So each each um subject each individual in the in the experiment in the study was uh allowed to use nine adjectives and statistically women chose eight out of nine adjectives which were feminine. Compassionate, caring, empathic, holding, loving, identified with feminine. Fast forward to to 2018, we administered the same tests and women in these much bigger studies
114:01 chose eight out of nine adjectives which were masculine, strong, competitive, ambitious, winner, superior, etc. The self-perception, the self-concept of women had become a lot more masculine. Some of it because of ideology, feminist ideology, but some of it because of circumstances. Men have not exactly been manly lately. Let’s put it this way. So, it’s a reflection of gender roles, I think. And now it’s I think as as women adopt masculine behaviors, masculine traits, a masculine mindset, etc., etc., chose eight out of nine adjectives which were masculine, strong, competitive, ambitious, winner, superior, etc. The self-perception, the self-concept of women had become a lot more masculine. Some of it because of ideology, feminist ideology, but some of it because of circumstances. Men have not exactly been manly lately. Let’s put it this way. So, it’s a reflection of gender roles, I think. And now it’s I think as as women adopt masculine behaviors, masculine traits, a masculine mindset, etc., etc.,
114:44 they are also automatically becoming more narcissistic. I think narcissism is an integral element in mus in masculinity. I’m sorry. That’s my speculation. >> Thank you very much for the input. Any other question please? Is it true that ID ICD was authorized by World Health Organization? because I checked that DSL was authorized by American Psychiatric Associates Association >> association. Is it true? >> Yes, it’s true. The ICD is um published published by the World they are also automatically becoming more narcissistic. I think narcissism is an integral element in mus in masculinity. I’m sorry. That’s my speculation. >> Thank you very much for the input. Any other question please? Is it true that ID ICD was authorized by World Health Organization? because I checked that DSL was authorized by American Psychiatric Associates Association >> association. Is it true? >> Yes, it’s true. The ICD is um published published by the World
115:26 Health Organization endorsed by it and is available portions of it are available on the WHO website. So absolutely who is identified with the with the ICD. The ICD process involved scholars from more than 80 countries whereas the DSM involves only American scholars. No one from the outside is allowed to contribute and not only American scholars but American scholars who are members of the American Psychiatric Association which competes with the American Psychological Association. And so because of this conflict, the American Health Organization endorsed by it and is available portions of it are available on the WHO website. So absolutely who is identified with the with the ICD. The ICD process involved scholars from more than 80 countries whereas the DSM involves only American scholars. No one from the outside is allowed to contribute and not only American scholars but American scholars who are members of the American Psychiatric Association which competes with the American Psychological Association. And so because of this conflict, the American
116:06 Psychiatric Association is excluding psychologists and is allowing only psychiatrists or medical doctors to write the DSM. So the very process of authorship shows you that by definition the DSM is inferior to the ICD. In the ICD you have inputs from India and China and Bangladesh and Egypt and and Poland by the way and you know so it’s much more reflective of humanity and one fact which is not nice to mention not politically correct to mention and by the way 90% of the things that I’m saying in Cambridge they don’t like it Psychiatric Association is excluding psychologists and is allowing only psychiatrists or medical doctors to write the DSM. So the very process of authorship shows you that by definition the DSM is inferior to the ICD. In the ICD you have inputs from India and China and Bangladesh and Egypt and and Poland by the way and you know so it’s much more reflective of humanity and one fact which is not nice to mention not politically correct to mention and by the way 90% of the things that I’m saying in Cambridge they don’t like it
116:47 I’m very controversial where I teach yeah so but one politically incorrect thing is that uh the vast majority of studies in the United States uh psychological studies are conducted on white college students mostly men. I’m kidding you not the vast majority like I don’t know the number but I would not be surprised if it’s 90%. Because the professors there they take a group of students they experiment on them and that’s a study and they publish a study. So not representative whereas WH studies and other studies I’m very controversial where I teach yeah so but one politically incorrect thing is that uh the vast majority of studies in the United States uh psychological studies are conducted on white college students mostly men. I’m kidding you not the vast majority like I don’t know the number but I would not be surprised if it’s 90%. Because the professors there they take a group of students they experiment on them and that’s a study and they publish a study. So not representative whereas WH studies and other studies
117:29 which are not WH uh usually include a much for example in Scandinavia studies from Scandinavia they’re very wide they include every segment of population totally representative samples and so on do you know what is the average number of subjects in a psychological study in the United States give me a number you’ll be shocked Sorry. >> 90. >> I can’t can’t hear you. >> Someone said 90. >> Ah, you’re optimistic. Maybe there will be a new optimism optimism personality which are not WH uh usually include a much for example in Scandinavia studies from Scandinavia they’re very wide they include every segment of population totally representative samples and so on do you know what is the average number of subjects in a psychological study in the United States give me a number you’ll be shocked Sorry. >> 90. >> I can’t can’t hear you. >> Someone said 90. >> Ah, you’re optimistic. Maybe there will be a new optimism optimism personality
118:05 disorder. The average the average number is three and a half. The study >> the study that I mentioned I mentioned a study when we were all much younger and much more awake. I mentioned a study or where with warning stam and and Campbell these are the giants of narcissism. They are the authorities on narcissism and I mean it I mean Keith Campbell is an authority definitely and Warning Stam is an authority. I’m not disparaging them. They published a study that said that narcissism can be cured. Narcissism can disorder. The average the average number is three and a half. The study >> the study that I mentioned I mentioned a study when we were all much younger and much more awake. I mentioned a study or where with warning stam and and Campbell these are the giants of narcissism. They are the authorities on narcissism and I mean it I mean Keith Campbell is an authority definitely and Warning Stam is an authority. I’m not disparaging them. They published a study that said that narcissism can be cured. Narcissism can
118:40 be healed. Okay, these are the joints. Do you know how many people participated in the study? Eight. Eight people. Do you know how many of them had only narcissistic personality disorder? Pure unadulterated sample. People with only narcissistic person. How many of the eight? >> Zero. >> Zero. Yes. >> Zero. >> Do you know how many of them had also borderline personality disorder? >> Eight. >> Eight. You’re right. Do you know how many of them were abusing substances which changes your be healed. Okay, these are the joints. Do you know how many people participated in the study? Eight. Eight people. Do you know how many of them had only narcissistic personality disorder? Pure unadulterated sample. People with only narcissistic person. How many of the eight? >> Zero. >> Zero. Yes. >> Zero. >> Do you know how many of them had also borderline personality disorder? >> Eight. >> Eight. You’re right. Do you know how many of them were abusing substances which changes your
119:19 mind of course rewires your brain habitually abusing substances do you know how many of them now you can be optimistic three is this a serious study I’m asking you do you know any those of you who know statistics I’m a physicist so I know statistic really really well I know statistics much better than most psychologists and psychiatrists do you know what is the lower level for statistical significance. How many participants you need to produce statistically significant numbers, normatively validated numbers? Do you mind of course rewires your brain habitually abusing substances do you know how many of them now you can be optimistic three is this a serious study I’m asking you do you know any those of you who know statistics I’m a physicist so I know statistic really really well I know statistics much better than most psychologists and psychiatrists do you know what is the lower level for statistical significance. How many participants you need to produce statistically significant numbers, normatively validated numbers? Do you
119:57 know? Nine >> nine. >> This is the state. This is the state of the discipline. I’m sorry to say, but I would say the state of the discipline in the United States. So why do we all know about the DSM? Why we are talking? Because they’re great. They control social media. They control television. They control, you know, they’re very good at self-promotion. They’re good businessmen and so on. I if I had as a clinician, if I were a clinician, I’m not, thank God, but if I know? Nine >> nine. >> This is the state. This is the state of the discipline. I’m sorry to say, but I would say the state of the discipline in the United States. So why do we all know about the DSM? Why we are talking? Because they’re great. They control social media. They control television. They control, you know, they’re very good at self-promotion. They’re good businessmen and so on. I if I had as a clinician, if I were a clinician, I’m not, thank God, but if I
120:28 were a clinician, I would never use a DSM. >> Thank you very much for this valuable feedback. We already appreciate that you highlight the coorbidity and so many issues that we should be aware of. Unfortunately, the time is running too fast and the students needs to go out for another lectures, I guess. >> So, we much appreciate your support, your lecture. Thank you very much and we are looking forward to hearing you tomorrow. >> Thank you. One one thing about one thing about tomorrow’s lecture before you clap were a clinician, I would never use a DSM. >> Thank you very much for this valuable feedback. We already appreciate that you highlight the coorbidity and so many issues that we should be aware of. Unfortunately, the time is running too fast and the students needs to go out for another lectures, I guess. >> So, we much appreciate your support, your lecture. Thank you very much and we are looking forward to hearing you tomorrow. >> Thank you. One one thing about one thing about tomorrow’s lecture before you clap
120:59 before you clap. Thank you. One thing about tomorrow’s lecture, tomorrow I’m going to discuss mostly the romantic lives and the intimate lives of people with cluster B personality disorders. Oh, if you have a spouse or a child or a boyfriend or a girlfriend who are narcissists or psychopaths or border lines or I don’t know what this lecture tomorrow is for you. I will explain the dynamic in interpersonal relationships with cluster B especially romantic and intimate. Now you can clap. before you clap. Thank you. One thing about tomorrow’s lecture, tomorrow I’m going to discuss mostly the romantic lives and the intimate lives of people with cluster B personality disorders. Oh, if you have a spouse or a child or a boyfriend or a girlfriend who are narcissists or psychopaths or border lines or I don’t know what this lecture tomorrow is for you. I will explain the dynamic in interpersonal relationships with cluster B especially romantic and intimate. Now you can clap.
121:35 >> Now clap. Thank you. Thank you for coming. Appreciate it. >> Now clap. Thank you. Thank you for coming. Appreciate it.

Summary Link:

https://vakninsummaries.com/npd-american-hype-or-clinical-entity-dsm-5-tr-vs-icd-11-university-of-applied-sciences/

https://vakninsummaries.com/ (Full summaries of Sam Vaknin’s videos)

http://www.narcissistic-abuse.com/mediakit.html (My work in psychology: Media Kit and Press Room)

Bonus Consultations with Sam Vaknin or Lidija Rangelovska (or both) http://www.narcissistic-abuse.com/ctcounsel.html

http://www.youtube.com/samvaknin (Narcissists, Psychopaths, Abuse)

http://www.youtube.com/vakninmusings (World in Conflict and Transition)

http://www.narcissistic-abuse.com (Malignant Self-love: Narcissism Revisited)

http://www.narcissistic-abuse.com/cv.html (Biography and Resume)

Summary

Abuse, narcissism, narcissist, Personality, Psychology, Reality, Sam Vaknin, Trauma, Vaknin, Vaknin Summaries

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