Tip: click a paragraph to jump to the exact moment in the video.

1. 00:02 Sometimes when I read the latest iteration of the diagnostic and statistical manual, the DSM, the latest iteration is the text revision of the
2. 00:13 fifth edition published in 2022. That's not so long ago. But when I read it, I
3. 00:20 get this eerie, creepy feeling that I'm Marty McFly.
4. 00:26 You remember Marty McFly, the guy who was catapulted 30 years back in Back to
5. 00:33 the Future the franchise. So I have the same feeling. I keep
6. 00:39 trying to wake myself up. I'm saying it can't be. This text appears to have been
7. 00:45 written in the 1990s, not in 2022. And the reason is very simple. It has
8. 00:51 been written in the 1990s. The diagnostic and statistical manual
9. 00:57 fifth edition text revision 2022 has been copy pasted from a text that
10. 01:05 has been written in the late 1990s. It is as updated as accurate gets it right
11. 01:12 as often as what we used to know 30 years ago.
12. 01:18 My name is Sam Vaknin. I'm the author of malignant self- loveve narcissism revisited and a professor of psychology.
13. 01:24 And today we're going to discuss a far superior diagnostic manual, the 11th
14. 01:30 edition of the international classification of diseases. What does it
15. 01:36 have to say about pathological narcissism and narcissistic personality
16. 01:42 disorder? First, we need to understand the philosophy of the ICD.
17. 01:49 The ICD says there are no personality types. There's no such thing
18. 01:56 as personality disorder. There's no such thing as narcissistic personality disorder. There's no such thing as paranoid personality disorder. There's definitely definitely no such thing as
19. 02:07 histrionic personality disorder. There is a general problem with
20. 02:13 personality. There could be a general problem of personality. a personality functioning problem. And then this personality functioning
21. 02:24 problem can be described in a variety of ways. But there are no diagnosis.
22. 02:30 There's no categorical list. There are no bullet holes, a bullet list
23. 02:37 um kind of uh descriptions. So in the ICD11
24. 02:46 um the framework has completely dispensed with personality types.
25. 02:52 What do we have instead? What we have instead is a three layered approach
26. 02:58 which is modular much more realistic captures the clinical picture much
27. 03:06 better is adapted to how human beings function. Human beings are not static
28. 03:13 pictures. Human beings are constantly in flux. And so the new classification of the
29. 03:19 ICD11 deploys um several layers. The first layer is the severity the severity of the personality
30. 03:31 functioning. The second layer is the um trait
31. 03:38 domains. In other words, which traits are associated with the personality functioning and then there is the
32. 03:47 description of the personality functioning based on these two. The ICD11 allows you to capture the essence of the client to convert the
33. 03:59 presenting symptoms and signs into a living dynamic picture of the person in
34. 04:06 the clinical settings. The person who is seeking help. The person who is complex,
35. 04:12 who is replete with a life history, with experiences, with dreams, with
36. 04:18 expectations. The person who cannot be reduced to a single sentence or a bullet
37. 04:25 list of sentences. The person who has more dimensions than the disorder that
38. 04:31 feed into the disorder. The ICD11 therefore is a far more complex, far more nuanced, far more subtle diagnostic system than the DSM and vastly superior.
39. 04:44 It also reflects the recent cutting edge information and studies in each and
40. 04:51 every field. So let's start with the um personality
41. 04:59 fun the severity of the personality functioning or actually the severity of the personality dysfunction and let's apply it. Let's use the ICD11
42. 05:11 tools and instruments and apply them to what we call pathological narcissism to
43. 05:18 what the DSM calls narcissistic personality disorder.
44. 05:24 The uh ICD distinguishing distinguishes various severity levels.
45. 05:31 Let's start with what the ICD calls personality difficulty. Let's apply this to narcissism. Someone who is presenting, someone who
46. 05:42 comes to who attends therapy, someone who comes and seeks help, someone in the throws of a marital crisis or a family crisis or a workplace crisis, someone
47. 05:53 who um interacts with the therapist or the clinician or the psychiatrist
48. 06:00 by describing problems. This person, this client
49. 06:07 can be analyzed using various levels of severity,
50. 06:13 personality difficulty. So if we apply to narcissism, it's similar to mild severity description,
51. 06:22 but only intermittently or at low intensity. The problems are insufficiently severe
52. 06:29 to cause notable disruption in various relationships and they may be limited to
53. 06:35 specific relationships or situations. For example, narcissistic reaction to a self-esteem threatening situation such as serious physical injury, relationship
54. 06:46 breakup or personal failure. This kind of reaction may involve narcissistic injury. on the one hand petulin temper tentrum narcissistic rage
55. 06:58 or may involve attempts at self- enhancement self aggrandising using
56. 07:04 usually a fantasy defense so this is the first level of severity personality
57. 07:10 difficulty then we have a second level which is mild personality disorder
58. 07:16 particularly sensitive towards injuries to self-esteem narcissistic injury and mayor a
59. 07:24 pervasive martyrlike victim style. So, we're beginning to see the contours of a
60. 07:32 mild personality disorder emerging from the presentation of the client. This
61. 07:38 kind of client will be unable to set appropriate goals and to work towards accomplishing or attaining these goals. And this compromised capacity is what is
62. 07:49 known as narcissistic procrastination or narcissistic perfectionism. For example,
63. 07:56 in a mild personality disorder, there would be difficulty persisting in face of even minor setbacks due to underlying
64. 08:04 entitlement, dismissive devaluation of what cannot be easily achieved in order to protect the
65. 08:11 fragile self. And there will be minor interpersonal conflicts stemming from difficulties with authentic and empathic understanding and connection with others. But they will not be severe.
66. 08:24 These mild empathic disturbances will not be severe. They will not cause serious and longlasting depression.
67. 08:34 On we proceed to the next level of severity known as moderate personality
68. 08:40 disorder. This kind of person, this kind of narcissist has a pervasive and
69. 08:46 contradictory self view, blending themes of grandiosity, individual exceptionalism, and or vulnerability, for example, morosess or passive
70. 08:57 aggression. And none of this can be modified with evidence to the contrary.
71. 09:03 The ICD as distinct from the DSM recognizes vulnerable narcissism and also incorporates the latest research that shows that all narcissists are both overt and covert at different
72. 09:21 times and in reaction to changing circumstances and environmental cues.
73. 09:27 The ICD is really outstanding in reflecting current knowledge.
74. 09:33 In moderate personality disorder, the narcissistic person may persist
75. 09:39 unreasonably to pursue goals that have no chance of success. Narcissistic
76. 09:45 vanity, narcissistic perfectionism come into play. This kind of person will exhibit little genuine interest or
77. 09:53 efforts towards sustained employment. There is overt entitlement, nihilistic devaluation. There will there will be a lack of mutually satisfying relationships
78. 10:04 because of limited ability to appreciate other people's perspectives resulting in
79. 10:10 unbalanced, unhinged relationships in which the individual is highly dominant.
80. 10:16 And finally, in moderate personality disorder, relationships are highly conflictual, highly antagonistic, and there is persistent avoidance and
81. 10:27 devaluation of other people. The narcissist or the narcissistic person is always disappointed and let down in relationships by others. Again, the victimhood part. I'm a victim. And finally we come to what the DSM
82. 10:43 calls narcissistic personality disorder and is known in the ICD11 as severe
83. 10:50 personality disorder. So we have a severe level of personality disorder in
84. 10:56 conjunction with narcissism. This kind of individual would have a
85. 11:02 self view, a self-concept that is very unrealistic and typically highly unstable or contradictory with polarized extremes of self aggrandisement on the
86. 11:13 one hand and shame and self-loathing on the other hand. This is also cuttingedge
87. 11:19 research. We are beginning now to understand that all narcissists are all
88. 11:25 narcissism is compensatory. It compensates for a kernel for a core
89. 11:31 identity which is a repository of intolerable life-threatening shame.
90. 11:38 In severe personality disorder would be the emotional experience is dominated by envy, resentment and hatred negative effects. There's serious difficulty with
91. 11:50 regulation of self-esteem resulting in exquisite interpersonal sensitivity to
92. 11:56 slides or unwavering despair, hypervigilance coupled with what could be easily
93. 12:03 described as depressive illness. The relationships lack mutuality and are
94. 12:10 extremely one-sided. Interpersonal conflict may involve serious verbal abuse on rare occasions violence either directed towards others
95. 12:21 or towards the self via self-destructiveness. So here we have a borderline element in
96. 12:28 narcissism and this is this is the greatness of the ICD11
97. 12:34 because it does not have categorical demarcated diagnosis.
98. 12:40 It actually acknowledges the fact that every narcissist is sometimes a borderline and sometimes a psychopath. That every borderline is sometimes a
99. 12:51 narcissist and sometimes a psychopath. And every psychopath is sometimes a narcissist. this this acceptance, this acknowledgment
100. 13:02 that what the DSM calls personality disorders segue into each other
101. 13:08 seamlessly are intermixed puts places the ICD11 apart as a far
102. 13:16 superior diagnostic text. And here we are. One of the presenting
103. 13:22 um elements of severity in narcissism according to the ICD11
104. 13:28 is self-destructiveness, selfharming which in the DSM is
105. 13:34 exclusively reserved to borderline personality disorder and wrongly so
106. 13:40 erroneous. This is a mistake in the DSM. Narcissists are highly self-deeating and
107. 13:46 self-destructive. Interpersonal conflict according to the ICD may involve serious violence etc etc and aggression externalized aggression
108. 13:59 verbal or otherwise and this is a psychopathic element. This kind of thing in the DSM appears only in antisocial personality disorder
109. 14:11 and again it's a catastrophic mistake. Narcissists and border lines are highly
110. 14:18 abusive, highly aggressive. They externalize aggression and often can
111. 14:24 become violent. So to say like the DSM does that only
112. 14:31 antisocial people, people with antisocial personality disorder externalize aggression runs contrary to
113. 14:38 everything we know. It's a mistake simply. And finally, the ICD11 suggests that
114. 14:44 these kind of people are unwilling to sustain regular work due to entitlement,
115. 14:50 a lack of interest of or effort, parasetism, feats of temper, insubordination, in
116. 14:57 other words, psychopathic defiance, psychopathic consumaciousness.
117. 15:03 So as you see in the ICD11, there's no distinction between narcissism, borderline, psychopath,
118. 15:12 there's no distinction. The elements which are used to describe the severity of the pathological
119. 15:18 narcissism in an individual include critical clinical components, clinical
120. 15:24 features of borderline personality disorder and antisocial personality disorder in the DSM. And that's the
121. 15:32 right way to look at it because all narcissists are sometimes borderline and sometimes psychopathic. So having
122. 15:43 having specified the severity of the personality functioning, the clinician then moves on and begins to rate personality trait domains.
123. 15:55 The ones to focus on in the case of someone who is suspected of narcissism,
124. 16:02 the traits to focus on are negative affectivity, for example, emotional
125. 16:08 ability, exactly like in borderline, negativistic attitudes, passive aggressive in many cases, low
126. 16:15 self-esteem, and mistrustfulness. Another trait domain is detachment,
127. 16:23 social withdrawal, emotional avoidance. A critical feature of pathological
128. 16:29 narcissism is dissoci. It's not exactly antisocial like in the DSM. It includes
129. 16:37 antisocial clinical features, but it has other additional features. Disociality
130. 16:43 for example includes self-centeredness, egotism, lack of empathy.
131. 16:50 Another element is disinhibition, impulsivity, destructibility, irresponsibility, recklessness, usually attributed by the DSM to psychopaths
132. 17:03 and anastia. and encase are obsessive compulsive features such as perfectionism,
133. 17:10 emotional and behavioral constraint and so on so forth. The ICD11 recognizes something called the borderline pattern specifier in which individuals who meet
134. 17:22 the diagnostic criteria for borderline personality disorder in the DSM5
135. 17:28 can be identified and this addition is very pragmatic. It facilitates treatment. Uh it's not exactly clinical but it's very helpful to the clinician.
136. 17:39 So the clinician can say when the clinician is presented with a client and if the clinician uses the ICD11
137. 17:46 not the DSM5 the clinician the first thing a clinician does clinician says how severe
138. 17:53 is this case? How difficult is this case? How invasive and pernicious is the
139. 18:01 disorder? How ubiquitous and or pervasive is the disorder? And then the
140. 18:08 clinician rates the severity of the alleged personality disorder. The second
141. 18:14 thing the clinician does, the clinician identifies traits. Traits presented by the client. Is the client disinhibited? Is the client
142. 18:25 antisocial or dysocial? Is a client detached? Is a client a perfectionist or reckless or whatever? And then the
143. 18:33 clinician categorizes the various traits. And now we have a compounded picture.
144. 18:39 The severity of the disorder coupled with the traits that are typical of the
145. 18:45 specific client. At times the clinician can use what what
146. 18:53 Kber called borderline personality organization. The clinician can use the borderline pattern. When the clinician believes that despite a high severity
147. 19:06 and despite a confluence of trait domains which are intractable and difficult and honorous, despite all
148. 19:13 this, the clinician develops a belief that the patient can be treated. The
149. 19:19 treatment might be useful and beneficial for the patient. So in that case the clinician can add another layer of
150. 19:27 borderline pattern because borderline can be treated. The prognosis is good actually.
151. 19:33 And finally the clinician can create a perfect picture of the of the client of
152. 19:40 the patient and this perfect picture is known as clinician rating or of
153. 19:46 personality functioning. So different aspects of personality functioning
154. 19:52 come into play and the clinician creates essentially a description of the patient
155. 19:59 very akin to literature. So let's have a look at a typical clinician rating of personality functioning.
156. 20:11 Start with identity. There's a grandiose expression of identity, inflexible, rigid identity in
157. 20:19 conviction of a grandio self or self-concept. And there's a vulnerable expression. This kind of person feels
158. 20:25 empty, lacks identity, core identity, oscillates and contradicts his own self
159. 20:34 view and self-concept. The self-concept is highly volatile, highly labile.
160. 20:41 Next type, next element in personality functioning is self-worth. In the grandio expression, the person feels superior, devalues other people, is rotty, arrogant. In the vulnerable
161. 20:54 expression, the person feels worthless, incompetent, humiliated, and shamed. Now
162. 21:01 remember, all narcissists oscillate. All narcissists move between
163. 21:10 an a grandio state or overt state and a vulnerable state. All narcissists
164. 21:18 sometimes they are in a in overt mode sometimes they are in a covert fragile
165. 21:24 vulnerable mode. This depends crucially on the uninterrupted flow of
166. 21:30 narcissistic supply from the environment on avoiding a state of collapse. But when the narcissist is mortified or even severely injured when the narcissist endures a state of collapse, there is a
167. 21:42 transition from an overt state to a covert state. Okay, let's continue with
168. 21:48 the personality functioning the clinician rating. It's a table. Clinician creates a table. So, next element, self appraisal. In the grandio
169. 21:59 expression, this person believes that he has no weaknesses, minimizes personal
170. 22:05 failings, failures, defeats, wrong decisions and so on. And vulnerabilities are projected onto other people who are
171. 22:12 subsequently devalued. The vulnerable expression of self- appraisal. The person is relentlessly
172. 22:20 self-critical, anticipates other people to be similarly critical, has a fantasy of an ideal ego
173. 22:29 if you wish, omnipotent self, and this ideal sharply contrasts with the actual self. Next element in personality functioning,
174. 22:41 self-direction. The grandiose expression, the client sets unrealistically high expectations consistent with grandio expectations,
175. 22:53 entitled expectations of achieving goals without any commenurate efforts.
176. 23:00 The vulnerable expression of self-direction. This kind of person sets unrealistically
177. 23:07 high expectations that confirm the person's inadequacy and incompetence. Uses inability to achieve as a
178. 23:18 justification for entitlement and lack of effort. Next element in personality function relationship interest. the grandio
179. 23:29 expression. The client is extroverted yet detached.
180. 23:36 The relationships are superficial on the surface. The person acutely devalues other people
181. 23:44 and yet conflictually is dependent on other people for the purposes of self-esteem regulation. In other words, even though this kind of narcissist depends on other people for narcissistic
182. 23:55 supply, he tends to hold them in contempt, is contemptuous, is disdainful, and he devalues them.
183. 24:04 On the vulnerable expression side, when we discuss relationship interests, this kind of person is needy and even clinging in relationships and yet withdrawn and ambivalent, superficially
184. 24:17 idealizing others yet chronically devaluing and dismissing them in the same breath. What about empathy? It's another element, another ingredient, another
185. 24:28 component of personality functioning. What's a grandio expression of empathy?
186. 24:35 Dismissive of the thoughts and feelings of other people. Unwilling to authentically engage with alternative
187. 24:42 perspectives. What's the vulnerable expression of empathy? Preoccupied with thoughts and
188. 24:48 opinions of other people, but only as related to oneself. Very self-centered.
189. 24:56 And this leads of course to mutuality as a dimension of personality functioning.
190. 25:04 The grandio expression of mutuality. The client is selfish in relationship
191. 25:11 with others, instrumental in using relationships to bolster self-esteem needs and personal satisfaction, and is
192. 25:18 highly transactional. The vulnerable expression, the client is dependent and passive in relationships yet resentful and antagonistic of this
193. 25:29 perceived chronic victimhood. And finally, in personality functioning, we are now discussing the clinician rating, the clinical picture written
194. 25:40 down by the clinician which involves all these elements of personality functioning. So conflict management is the last element and there's a grandio expression and a vulnerable expression of conflict management. The grandios
195. 25:56 expression the person is highly conflictual antagonistic style of relating has
196. 26:03 regular intense disagreements with other people. The vulnerable expression, the person avoids direct conflicts with other people and is chronic passive
197. 26:14 aggressive, relates to other people in a hostile way undermines and sabotages
198. 26:20 them. This is the clinician rating of the personality functioning of the client of the patient.
199. 26:32 Let's sum it up until now. That's not the end. Let's sum it up until now.
200. 26:38 Someone comes, there's a clinician, a therapist, a psychiatrist. Someone comes to the clinic and presents himself or herself. We call it
201. 26:50 presenting signs and symptoms. So there's a presentation. There's a client presentation.
202. 26:56 The cl the first thing the clinician does the clinician asks himself or herself
203. 27:03 how severe what I'm witnessing right now how severe is it is it mild is it moderate is it
204. 27:12 very severe so first thing the cl the clinician does he rates the patient for severity the second thing the the clinician does the clinician describes the patient
205. 27:24 using traits specific traits They are known as trait domains. The third thing, the clinician creates a a clinical picture regarding the patients
206. 27:36 personality functioning using a variety of determinants and variables
207. 27:43 and then he divides these variables into grandio expression and vulnerable expression. He attempts to understand at which stage is the
208. 27:54 patient. Is the patient right now being overt, grandiose or is a patient right now in a vulnerable state, fragile, shy um state. So that's the second phase.
209. 28:07 The last phase is the clinician rating of the personality traits. This is done
210. 28:14 by by somehow somehow gauging the frequency of the appearance of the
211. 28:21 traits, the manifestation, the expression of the traits in clinical settings and outside clinical settings.
212. 28:27 How often do they appear? Each trait is giving given a number, a percentage like this trait appears 94% of the time. Imagine that the patient is always complaining, always depressed, always
213. 28:39 morose, always sees a negative side, always pessimistic and so on so forth. This kind of patient would have 94%
214. 28:47 negative effectivity. All other traits are given percentages
215. 28:54 and then the clinician creates a clinician rating of of uh trade domains.
216. 29:02 In a typical um narcissist, we would have the following percentages, more or less. Negative effectivity characterizes
217. 29:15 32% of overt narcissists and 94% of
218. 29:21 vulnerable narcissists. Emotional ability 27 versus 21. Depressivity
219. 29:28 5 versus 89. anxiousness seven in grandiose
220. 29:34 narcissist versus 80% 80% in vulnerable narcissist. So immediately we see that
221. 29:42 in the vulnerable phase of narcissism the person is uh depressed and anxious
222. 29:50 but not so much emotionally leile. Actually emotional ability is much
223. 29:57 higher in overt narcissism because these people overt narcissist or narcissists
224. 30:04 in the overt phase are much more sensitive to criticism. They are much more easily narcissistically injured. So their emotional ability is higher. What about
225. 30:15 detachment? 33% of overt narcissists are detached. 72% of vulnerable narcissists. Overt narcissists, 6 and a2% are socially withdrawn. Vulnerable narcissists, 54% are socially
226. 30:31 withdrawn. 32% of overt narcissists avoid intimacy. 44% of vulnerable. And 16% of narcissists, overt
227. 30:42 narcissists are effectively restricted. They have reduced effect display. They don't show
228. 30:48 emotions very well. They don't display emotions very well. 16% of overt narcissists, 34% of
229. 30:56 vulnerable narcissists. Dissociity, antisocial elements plus other
230. 31:02 restrictive or constrictive elements. So 91% of overt narcissists are dissoci.
231. 31:09 But only 12% of vulnerable narcissists. Manipulativeness.
232. 31:15 60% of overt grandio narcissists are manipulative but only 3% of vulnerable
233. 31:23 narcissists. Of course, online self-styled, self-proclaimed
234. 31:30 experts will tell you that the covert narcissist, the vulnerable narcissist is
235. 31:36 more manipulative than the overt grandio narcissist. That is completely untrue.
236. 31:43 Machavelianism scores in vulnerable narcissism are much much dramatically
237. 31:49 drastically lower than in overt narcissists. Overt narcissists are much
238. 31:55 more manipulative than covert narcissists. And I've made several videos about this. And of course, I've
239. 32:01 been told that I don't know what I'm talking about. Grandiosity.
240. 32:07 90% of overt narcissists are grandios. 5% of vulnerable narcissists.
241. 32:15 That is not exactly accurate because the grandiosity of the vulnerable narcissist
242. 32:22 masquerades, disguises itself. So it's very difficult to spot, but it's there.
243. 32:30 Hostility. 64% of overt narcissists are hostile. Only 8% of vulnerable
244. 32:37 narcissists are hostile. What about this inhibition? Acting in ways which defy social norms and conventions and mores and scripts
245. 32:49 acting acting in reckless ways reminiscent for example of someone under the influence of drugs or alcohol. So 44% of grandiose narcissist of overt
246. 33:02 narcissists are disinhibited but only 4% of covert narcissists.
247. 33:09 32% of overt narcissists are classic narcissists are 32% are irresponsible.
248. 33:18 Only 1% of vulnerable narcissists are irresponsible.
249. 33:24 28% of overt classic narcissists are impulsive. Only 4% of vulnerable
250. 33:30 narcissists. What about attention? Attention deficits. 4% of overt narcissists have
251. 33:38 attention deficits. Only 2 and a half% of vulnerable narcissists. And finally, anastia, obsessivempulsive elements. 58% of overt narcissists are anastic.
252. 33:51 They are obsessivecompulsive. And 53% there's not much difference here of covert narcissists are ananchcastic. When it comes to orderliness being orderly, being neat and organized, 2% of
253. 34:05 overt narcissists versus 4% of covert narcissists. Rigidity. 44% of grandio
254. 34:13 overt narcissist. They're rigid. They're not open to learning. They will never admit a mistake. They're stubborn.
255. 34:21 That's 44%. Only 19% of covert narcissists are rigid. And finally, perfectionism.
256. 34:29 47% of overt narcissists are perfectionist. 49% of covert
257. 34:35 narcissists. Here the clinician has completed
258. 34:42 her work or his work and we have a total picture very thorough very profound very
259. 34:48 deep all-encompassing picture clinical picture of the patient
260. 34:54 or the client. something that can absolutely not be accomplished with the diagnostic and statistical manual unless one uses somehow a conjunction of the
261. 35:06 diagnostic criteria and the alternative models. But the DSM offers only very few
262. 35:14 alternative models. One of them has to do with narcissistic personality disorder, another one for borderline,
263. 35:20 another one for antisocial, but that's more or less it. there are very few um alternative models
264. 35:28 and this renders the usability of the DSM extremely limited.
265. 35:34 So this is how the ICD11 captures and describes prototypical
266. 35:41 narcissistic subtypes using severity personality functioning and trait
267. 35:48 domains or dimensions. The ICD11 robustly
268. 35:54 demonstrates an ability to kind of capture diverse manifestations of the personality and to admit and to accept that there are no
269. 36:06 clean, pure, unadulterated diagnosis and types. That every patient and client has
270. 36:13 elements which can be attributed to narcissism. other elements attributable to borderline and definitely elements
271. 36:20 attributable to antisocial or psychopathic or dissoci type. And so a client or a patient would be diagnosed as mild, moderate or severe and then grandiose or vulnerable.
272. 36:38 And this would be a clinician rating. This would be the clinical picture with
273. 36:44 emphasis on trade domains highlighting relevant treatment options
274. 36:50 in the case of a borderline pattern. Pay attention to one last point. The ICD11
275. 36:56 does not make a distinction between male and female clients, ma male and female
276. 37:02 patients, male and female narcissists. That is also very correct. that reflects
277. 37:09 the latest knowledge. We now know that there is no clinical psychonamic
278. 37:15 psychological difference differences between male and female narcissist. None
279. 37:21 zero zilch. They're identical psychologically. However, cultural and societal
280. 37:29 constraints, expectations, conventions, norms, and mores
281. 37:35 dictate different expressions and manifestations of narcissism in females versus males.
282. 37:43 In other words, society expects women to behave differently and society penalizes
283. 37:50 women if they behave in a masculine way. Similarly males it applies to males in
284. 37:57 the other direction. So it is society and the prevailing culture that inform the female narcissist how she is allowed and expected to express her pathological
285. 38:09 narcissism and informs the male narcissist similarly. So any differences
286. 38:16 between male and female narcissist have nothing to do with psychology. They have to do with society. societal and
287. 38:24 cultural considerations. And with this I end my presentation of
288. 38:30 the approach of the ICD11 to pathological narcissism. Another video is coming where I will review a third diagnostic manual, the psychonamic
289. 38:41 diagnostic manual which is a masterpiece in its own right. And even the psychonamic diagnostic manual is
290. 38:48 superior to the DSM. Consequently, the DSM is being used
291. 38:54 in less than among less than 20% of humanity. 80% of humanity use alternative diagnostic manuals. Only in North America or mostly in North America, the DSM is used because of the commercial
292. 39:09 influence of insurance companies and pharmaceutical companies. There is a commercial contamination of the clinical
293. 39:16 picture which the head of the DSM6 committee has openly admitted in a speech recently. She said we cannot
294. 39:27 include all the relevant clinical information. We exclude a lot of clinical information because it would be
295. 39:33 inconvenient for the insurance companies. I'm kidding you not.