 Did you know that the diagnosis of narcissistic personality disorder exists only in the diagnostic and statistical manual and in the Chinese CCMD China's DSM these are two diagnostic manuals that cover the United States and parts of North America and China about half about one-third of the global population One quarter actually coming to think of it the rest of the world uses another book another diagnostic manual Known as the ICD International classification of diseases It's 11th edition has been published about two years ago the publisher is the World Health Organization and variations and variants of the ICD Roll the world well over 80% of the human population Are diagnosed with mental health issues according to the ICD not according to the DSM Why am I telling all this? because narcissistic personality disorder exists only Only in the DSM and to some extent some variation in the CCMD There is no such thing as narcissistic personality disorder in the ICD In other words four-fifth of the human population reject the diagnosis of narcissistic personality disorder But what's wrong with these people? Don't they acknowledge the existence of pathological narcissism? What am I going to do for a living? Should it be Eliminated from the DSM as well I'm gonna have to find another mental health issue and attribute it to myself, of course so Seriously now Don't people in other countries in the world Recognize the existence of pathological narcissism in its various manifestations as a personality style as a disorder The answer is they do What they don't recognize what they reject is What is known as differential diagnosis in other words? Breaking the mental illness continuum into discrete diagnosis This is what the DSM does. It provides lists Some of the lists are categorical other lists are dimensional on a spectrum, but all the same These are lists You go through the list and if you meet a certain number of criteria You're diagnosed with a specific mental health condition and the mental health conditions are demarcated. They're separate. They're discrete They don't overlap And consequently there's a problem known as Commobility we diagnose many mental health issues in the same person of the same patient Now I've been advocating for well over 30 years to eliminate these differential diagnosis and To put them together in one basket a basket, which I labeled Personality disorder a single basket. I also suggested a bit later that personality disorders Many of them not all of them definitely all cluster B personality disorders post traumatic conditions and akin to addiction So they involve what used to be known as addictive personality Okay, enough about my work. Let's talk about the ICD. The ICD has adopted this approach not because of me The ICD has adopted this approach and in the ICD. There's a single personality disorder With a variety of Severities and a variety of traits and then what you do like in a recipe like in cooking You take various ingredients and you combine them and you get the equivalent of the previous Now discarded Diagnosis, so if you combine two three traits with a specific type of severity You get the equivalent of narcissistic personality disorder without calling it narcissistic personality disorder and According to the ICD and my work if I may transitions between allegedly or ostensibly Desperate discreet mental health conditions transitions are very common In other words a narcissist is sometimes a psychopath and sometimes a borderline and sometimes a schizoid and sometimes a paranoid It's ridiculous to diagnose the same person with five Mental health conditions. There's no type constancy. There's not even there's not even psychodynamic Constancy everything is reactive to the environment Everything is encoded in what I call The footsteps of Philip Bromberg what I call self states. I Encourage you to watch the videos on The DSM versus the ICD and the video and the video on IPAM Intra-psychic activation model the links are in the description So in my world, which is essentially the world of the ICD There's a single personality disorder and it manifests in a variety of ways throughout the lifespan there's no constancy and There are people who tend to Display more specific traits than others So these people Are more for example Dissocial they are more negatively effective that the more the more commonly something and so We get a profile. We get a psychological profile of the patient Only we don't label the patient because these labels account a factual There are fantasy. They're wrong Any and every practitioner will tell you that the vast majority of these labels are idiotic They fly in the face of evidence. It's not evidence based And it's not medicine, of course The reason is that the DSM Was written at the behest and request of insurance companies and pharmaceutical companies So it doesn't reflect the current knowledge About a current knowledge in clinical psychology The ICD is about 25 years more advanced than the DSM the DSM Attempted to introduce alternative models of personality disorders in appendices at the end of the book and They're nice, but they still they still preserve the concept of differential diagnosis and the least like Attributes list of diagnostic criteria. So Wrong wrong approach People are rivers. They flow. They're in flux They can be captured in a single diagnostic basket with a list That's not how people work. That's not how the human mind works So now today There's a video and like everything Jewish is divided in two parts. The first part is for laymen The second part is for professionals, but you are welcome to watch it if you wish I Will start by giving a broad overview of the ICD ICD's approach To narcissistic personality disorder. I remember there's no such thing. No such diagnosis As narcissistic personality disorder or borderline or anything else by the way in in the ICD Still we can construct a profile of an emotionally dysregulated person emotional Eupd we can construct a profile of a narcissist Using the tools provided by the ICD when it comes to borderline by the way, there is something called Eupd Which has to do with emotional dysregulation rather than the classical Kernberg style borderline picture. So as you see, there is a cousin. There's an abyss between the United States the West not the West but the United States and the rest and So I'm going to explore this abyss today from the point of view of the rest Not the United States and I'll start by with an overview for laymen The ICD 11 the 11th edition of the ICD has diagnostic criteria for Borderline pattern of personality disorder opens what they call personality difficulty The ICD describes three levels of personality disorders The first question is does the person have a personality disorder that who feels the definition criteria the second question though is what is the level of severity of the Possibly diagnosed personality disorder and the third level is are there trait domain specifiers In other words domains that describe the characteristics of the individual's personality that are most prominent and Contribute to a personality disturbance. In other words, the ICD's philosophy is that Everyone has characteristics and traits and when these go all right when these are Exaggerated or out of control only then do we have a mental health issue with a personality? So it's a very interesting approach because in the ICD mental illness emerges organically from mental health It's not an exaggeration of mental health. It's not a caricature of mental health, but it does emerge from mental health Now the ICD focuses on global and shared features that apply to all personality disorders I'd like to read to you the definition of personality disorder in the ICD 11 It is in some respects Preferable and superior to the definition in the DSM They say Personality disorder is a marked disturbance in personality functioning Which is nearly always associated with considerable personal and social disruption The central manifestations of personality disorder are impairments in functioning of aspects of the self such as identity self-worth capacity for self-direction and Or problems in interpersonal functioning example developing and maintaining clothes and mutually satisfying Relationships understanding others perspectives managing conflicts in relationships Impairments in self-functioning and or interbus interpersonal function are manifested in maladaptive in other words inflexible or poorly regulated patterns of cognition emotional experience emotional expression and behavior Every disturbance has three levels of severity Once the diagnosis of personality disorder has been established It should be described in terms of severity. Is it mild? Is it moderate or is it severe and according to the ICD 11? Personality disorder and personality difficulty can be further described using five trade Domain Specifiers now what they call personality difficulty is what Lensperry and Theodomilion and others call personality style Okay, these are the trade domains so what are trade domains in in in the ICD 11 and Quoting these trade domains describe the characteristics of the individual's personality that are most prominent and that contribute to personality disturbance As many as necessary to describe personality functioning should be applied Now there are quite a few domain specifiers I will mention a few negative of activity detachment Dissociality disinhibition and encased here and encased here So I will deal with an encased here and just disocialty in a minute So how can we capture the equivalent of narcissistic personality disorder in the ICD 11? We are not denying no one is denying that there are people who are harmful to others Owing to something that could be described as narcissistic personality disorder. There's no denying this So how do we capture it? Diagnostically with the tools and instruments provided by the ICD 11 so first of all the ICD makes clear that Narcissistic personality disorder can be either mild or moderate or severe and that there is it's possible to have in Narcissistic personality difficulty Versus a narcissistic personality disorder although the ICD does not use the word Narcissistic or narcissism at least not in the main text So the trade domains that are relevant to narcissism are Disocialty and an encased here and I will explain The trade domain of disocialty Creates narcissistic features with an emphasis on self-centeredness How does disocialty? Manifest in daily life in relationships with others and even more importantly in relationships with oneself First of all, there's a sense of Exploitiveness towards others. What can they do for me? How can I extract benefits from other people? Then there is a belief that You deserve whatever you want and it should be obvious to others So if you are disocial you have a sense of entitlement The expectation of admiration from others and engaging in attention-seeking behaviors Becoming angry or denigrating others. This is normally in the DSM as antagonism When you don't receive expected admiration and attention The belief that your accomplishments are outstanding and have many admirable unprecedented qualities and a strong belief in the potential for greatness expectation of others to admire you for your incipient greatness. These are all elements of Disocialty. Now Bach, P-A-C-H, Bach like the composer and his associates in 2022 Expanded on it They said that someone with Disocialty and an Ancestia and so on is likely to have a fluctuating self-view Alternating between overly positive and overly negative Narcissistic individuals may struggle to recover from damage to their self-image They often exhibit poor Emotional regulation and have difficulty developing close relationships One-sided conflicts and dominance may characterize their relationships Some narcissistic individuals may struggle to maintain regular work conditions or collaboration Narcissistic individuals may also exhibit traits of affectionism, vanity and negative affectivity Now when you put perfectionism and vanity together, this is an Ancestia. An Ancestia is an attribute an element in Compulsive obsessive compulsive disorders, especially in the compulsion So an Ancestia is perfectionism coupled with vanity Being proud of your perfectionism and this sits well with OCD obsessive compulsive disorder But according to the ICD it characterizes narcissists as well. Although that again, they don't use the word narcissists Okay So Bach and his Co-authors said that the combination of dissociality, an Ancestia and negative affectivity May indicate distinct features of narcissism Including the factionalistic overcompensation and rule-bound narcissistic dominance Negative affectivity may include vulnerability, depression, anger, hostility and shame features Suggestive of vulnerable manifestations of narcissism The combination of dissociality and negative affectivity traits in the ICD May indicate vulnerable narcissism in individuals who ruminate over perceived slides Overreact to criticism and have low frustration tolerance Their low self-esteem may lead to envy of other success and be driven by past failures and procrastination experiences Different scales Different scales can capture various facets of narcissism such as grandiosity, need for admiration, vanity, arrogance, selfishness, reactive anger, shame, self-centeredness, lack of empathy and entitled superiority All these emanate emerge, as I said, organically and naturally By combining the various Domain-specific traits in the ICD. So we get an excellent Full-fledged description of narcissism without using the word narcissism Because when we say narcissism, we are committing ourselves to a diagnosis and We're excluding other diagnosis and this is not what the ICD is all about. The ICD says exactly the opposite We should incorporate all possible diagnoses Without regarding them as separate clinical entities. They are not separate clinical entities That's just a human being trying to cope with the environment by somehow Controlling and managing his traits over traits The traits of course determine how one copes with the environment. The traits determine how dysfunctional or functional one is The traits determine if one is perfectionistic or one is is vain or the traits determine your characteristics and behaviors Of course, you are given some kind of equipment. This equipment is either genetic or Environmental it's either an outcome of upbringing or an outcome of brain abnormalities Whatever the case may be, this equipment, your domain-specific traits and the severity of Your personality dysfunction or difficulty or disorder They determine your behavior But we cannot pigeonhole people. We cannot put them in boxes because people are phenomena in flux They are constantly evolving, constantly reacting, constantly changing Then you cannot capture them with a list of nine diagnostic criteria. In this sense, the ICD is Considerably more advanced than the DSF. Okay, this was the part for the layman Now you can sign off if you wish although I think you may find You may you you may find some of the things I'm about to say interesting even though they're directed at professionals You may find some of them interesting Narcissism is a psychological concept It is characterized by Self-adoration and disregard for the needs of others. These are the behavioral manifestations In my work, I postulate that narcissism has to do with two major problems a disruption in the formation of the self and An inability to recognize the separateness and externality of other people So this gives rise to all the the monopoly of manifestations of narcissism lack of empathy exploitativeness and so on so forth Now narcissism is nothing new The clinical manifestations of narcissism has been expertly and perfectly described In scriptures such as the Old Testament the New Testament and the Quran among others Narcissists have been around since Since the first step taken by homo sapiens there. I'm sure there were chroma neons and Leanderthals who are narcissists So this is nothing new clinically speaking Narcissism is an organizing principle is an entirely different story and I will deal with it with another video this week anyhow Narcissism is a source of concern Because exactly as the ICD says it's dissocial or the DSM uses the term antisocial Narcissists Rick Havoc on other people on institutions on On structures on the social contract on everything around them the very self destructive and the very other destructive even if they enjoy a period of success and Ostensible accomplishment they're gonna ruin it at the end. They're gonna ruin it somehow So the origins of narcissism can be traced back as far as the myth of Narcissus Ovid Smith Narcissus in metamorphosis, and that was like 2020 years ago And you know in this myth there's a Greek youth and he falls in love with his own Reflection not with himself mind you with his reflection with his false self Because he's unable to merge with this false self and to become one with it he wastes away and dies Today by the way, we would describe Narcissus the youth Not as an overt narcissists, but as a covert narcissists just something fun to ponder while you drink your coffee So the term narcissism was first going not by Freud, but by Ellis in 1898 At that time it was confined to auto erotism or auto eroticism In other words a sexual perversion Where an individual becomes sexually fixated on themselves and sexually attracted to their own bodies It was considered at the time a deviance And so it was pathologized this kind of attraction was pathologized and Ellis gave it the name Narcissism now This narcissism hasn't lost Throughout the the following centuries or decade a century and a half narcissism hasn't lost This particular aspect of it all narcissists are auto erotic all of them are Psycho sexually attracted to themselves all of them have sex with others and By Converting these other people into internal objects. So when they have sex with other people They're actually having sex with internal objects within their mind with themselves in other words The most widely accepted definition of not so Freud wrote about narcissism in 1914 1915 Brought it into wider use of popularity, but the most widely accepted definition of narcissism Is Hartmann's Hartmann's definition in 1950? He described it as the libidinal investment of the self Which is just a rendition or closely aligns with Freud's original formulation Freud said in in his essay on narcissism and introduction in 1914 That the narcissist directs his libido inwards at himself or herself and Hartmann just codified it Freud's theory Was very interesting in some respects because he tried to construct a physics Equate an equivalent in in psychology of a physics Kind of theory a theory in physics He said that there's energy some kind of energy in the body later It was called catexes the act of investing this energy was called catexes Word which Freud aborted and hated by the way anyhow Freud said everyone has a fixed amount of energy libido life energy The life energy includes a sexual element the sexual drive known as eros According to Freud when libido is directed towards other people it's object love or object libido When it is directed towards oneself It manifests as narcissism and this distinction is a fundamental aspect of Freud's understanding of narcissism and the relationship to others object libido According to Freud the narcissists the adult narcissists is simply incapable of directing libido including sex drive Towards other people. He's incapable of what came to be known Decades later as object relations now Many of these theories and ideas have been discarded I regret to say because I find a lot of merit in some of them not all of them, but some of them All of them have been this discarded when psychology attempted to become a branch of medicine kind of science Psychology is of course a pseudo science, you know my point my view now in In the in the 70s Kernberg came up with a new concept of narcissism which is best described in Russell's Russell's work in 1985 He said that pathological narcissism involves a pathological self-structure the grandiose self Also known as the false self It's a defense against rage and envy and shame Kernberg didn't dwell on shame shame was added later by others So it's a defense There is a pathological self-structure that serves as a firewall as a fortress against these emotions against these negative effects Inside that can ruin the narcissists if he were to get in touch with them Without the protection of the false self or the grandiose self-structure According to Kernberg normal immature narcissism is not the same as pathological narcissism and finally Narcissism is a subtype of borderline personality disorder according to Kernberg Ironically Kernberg's view came to dominate and today we do Like with the exception of the DSM we do believe that all Cluster B personality disorders are facets of a single clinical entity or the vast majority of Scholars tend to believe this And this is reflected of course in the ICD Kernberg's view prevailed compared to Kohut's view Kohut's view of pathological narcissism again summarized in Russell's work in 1985 Was different dramatically different to Kernberg's Kohut is the father he coined the phrase of narcissistic personality disorder in 1974 1975 Both giants were at work in the same years And Kohut's view of pathological narcissism is that it involves a fixation at an early stage of narcissistic development Normal immature narcissism is the same as pathological narcissism said Kohut does not such thing as healthy narcissism Now today we disagree with this vehemently Again, Kernberg prevailed not Kohut And finally Kohut said that there is a clear distinction between narcissistic personality disorder and borderline personality disorder They're absolutely not the same Kohut and Kernberg agreed though that pathological narcissism involves a defective self of some kind And is influenced by disrupted attachment experiences This was later developed by Boulby and others in attachment theory So the emphasis Was on what came to be known in Winnicott's term the good enough mother child symbiosis Which gives rise to healthy narcissism Pathological narcissism is when the mother is either Not good enough Or when the mother is good enough But the symbiosis has been somehow disrupted She died. She got sick. She got depressed. Whatever the case may be These are two developmental pathways on the way To narcissism pathological narcissism because narcissists lacked This secure base nurturing bond with a mother figure According to Russell Kernberg in 1970 Maintains that narcissistic personalities often experience their parents as callous and indifferent There is consistently a parental figure usually the mother who functions well on the surface But with a degree of non-verbalized spiteful aggression said Kernberg Shedler summarized in Feinstein Said that individuals with narcissistic personality are grandiose and entitled Dismissive and critical of others and often show underlying signs of vulnerability beneath a grandiose facade And this came to be the dominant position today. Today we believe that The most narcissists if not all narcissists are actually vulnerable They have what Adler called an inferiority complex. They have a core That is composed comprised of shame And an internally directed rage and anger and resentment and self-loathing and so on and they're trying to compensate for it By pretending to be everything which they are everything opposite to who they are So the facade the false self the grandiose Firewall or fortress that surrounds them the shell the grandiose shell is just a compensation for what really goes on inside them Which is really which is intolerable In modification the facade crumbles the false self is disabled the activated And the narcissist gets in touch directly with this reservoir of life-threatening shame and rage So this is this is the mechanical model of narcissism now in um in narcissism There is a group of well identified defense mechanisms that operate habitually they've been described by Russell in 1985 Millen and others in 2012 and so on so forth these defense mechanisms are idealization devaluation denigration unconscious repression conscious denial on nepotence distortion including cognitive distortion exaggeration minimization rationalization um Confabulation these all create an impaired reality testing psychological projection blaming some other people alloplastic defenses Enlisting the help of one or more or Co-dependent friends who will support the distorted view is very common. So the defense mechanisms often rely on a shared fantasy the defense the defenses operate optimally in a shared fantasy because shared fantasy isolates the narcissists and a few like-minded people from reality and this creates self-enhancing um and self-augmenting confirmation bias Now malignant narcissism is a combination of narcissistic and antisocial psychopathic traits it involves narcissistic grandiosity sadistic aggression demeaning degrading and defeating other people is necessary for the narcissists to feel important A recent uh overview of malignant narcissism is Feinstein 2022 Now malignant narcissists lack an internalized moral system. So they are amoral They sometimes act Immorally, but that's because they have no morality not necessarily because they are the evil or vicious They exploit other people. They harm other people and they experience no remorse whatsoever for doing so And this sets them apart for example from people with borderline personality disorder and even from other narcissists Uh, it is a common myth that narcissists are unable to experience remorse or regret. That is psychopaths psychopaths and malignant narcissists are like that vast majority of narcissists do experience remorse and regret. They have defenses that push away the remorse and the regret Morrison described the interplay between shame guilt remorse and regret within the narcissists psyche and how they're all repressed and denied Malignant narcissists externalize blame alloplastic defenses. They refuse to take responsibility for the consequences of their actions And so there's a convergence here of psychopathic traits psychopathic behaviors And propensities such as defiance recklessness, consumatiousness rejection of authority psychopathic deception exploitation Sadistic aggression externalization of aggression and other features with narcissistic grandiosity self importance All in all malignant narcissists are very very destructive It is a common view and mine as well That malignant narcissists are far more dangerous than psychopaths and definitely Definitely infinitely more dangerous than narcissists than plain vanilla narcissists Because a malignant narcissist uses psychopathic tools and behaviors to obtain narcissistic goals And one of these narcissistic goals is narcissistic supply. But the other is self destruction self punitive creating a self punitive cycle And so narcissists are malignant narcissists Who take everyone around him Into valhalla the way hitler did The way to some extent trump did He would take everyone with him into hell as he destroys himself The fantasy that he has constructed The environment in which a fantasy is embedded and he does it deceptive with deception exploitation sadism aggression And grandiosity and self importance and so on so forth Goethe-Dermond the twilight of the gods and if you want better insight into these dynamics Then I recommend definitely Dostoevsky And nichy, of course They are the greatest psychologists who have ever lived by the way Now Let's delve a bit deeper into the icd's view of all this mess You remember that the icd allows us to Characterize pathological narcissism as either mild moderate or severe That creates a lot of flexibility There's a spectrum there of narcissistic disturbances of the self Or of character or morality depending how you look at narcissism And this sits well With everything I have been saying and now others are saying I'm not implying anything That there is a spectrum of pathological narcissism Lance Perry, of course, suggested a distinction between personality style personality disorder, which is widely accepted today And millen upheld this view in his magnum opus personality disorders in daily life So the self view of narcissists according to the icd now we are in icd territory The self view of narcissists can vacillate between overly positive and omnipotent An extra ordinarily negative and devastating And this depends on the specific nature of the disorder Is it grandiose or is it vulnerable? But in the in the icd These features emerge As I said organically and naturally as the interplay as an outcome of the interplay between domain specific traits So Narcissistic individuals have difficulty to recover from injuries to grandiose and vulnerable self-image And this is why today We consider overt grandiose in your face happy go lucky narcissists to be actually psychopaths Not narcissists So narcissistic people exhibit poor emotional regulation in the face of setbacks and in this sense There is some affinity between narcissists a huge affinity because emotional dysregulation defines borderline personality disorder So there is a great affinity between narcissism and borderline Exactly as kernberg has suggested so many decades ago The self-focus and callousness of narcissists May compromise the quality of relationships For example, they ignore other people's opinions. They exploit other people Uh and this contributes to difficulties in developing close mutually satisfying and intimate interpersonal relationships The relationships of narcissists Are characterized by volatile conflicts These conflicts are usually one sided The narcissist tries to assert dominance tries to be always right tries to sustain his sense of infallibility and perfection We'll come to that unencased here a bit later And to maintain this sense of perfectionism sense of godlike perfection The narcissists argues All the time imposes conflict on situations Which never would have never led to conflict with with healthy people So the conflicts are very one sided And a some group of of narcissists are unable to sustain work conditions, teamwork, collaboration, marriage Or even to bring up children because they keep introducing aggression And conflict into utterly innocuous situations Now according to the icd narcissistic features Are mainly characterized by the trait of Dissociality with emphasis on self-centeredness The pattern of dissociality involves, as I said before, exploitativeness of others Believing in acting as if you deserve anything you want Entitlement and these features of narcissism are manifested as an expectations Expectations from others The narcissist has a list of expectations Entitlement is the active expression of this list of expectations Entitlement is when the narcissist tries to impose on other people His list of expectations and then when they don't comply with the expectations when they are not sufficiently Malleable or submissive or people pleasing or codependent or whatever you want to call it The narcissist becomes aggressive, viciously aggressive if he's a malignant narcissist He becomes a sadist in effect So the narcissist goes around With a list of expectations pinned to his sleeve And he presents his expectations to others and he expects them to immediately Drop everything and comply Admirations, attention-seeking Justification to tell the narcissist you're always right You're the greatest and so on and so forth This constitutes an integral part Of such a list of expectations And having such a list of expectations And coercing other to comply with such a list that's part of this sociality Now these lists Are sometimes overt and explicit The narcissist can come to you and say Do you agree that my work is groundbreaking and revolutionary and that I'm a genius? Or don't you think I'm drop dead gorgeous? I'm as simple as that And the list could be implicit for example in the shared fantasy There is a list of expectations The narcissist idealizes other people his intimate partner his friends whatever And then he expects them To conform to the idealized image to the idealized version That's that's that's what is called a hidden text He has an overt text and a hidden text. There's a hidden text of expectations I've idealized you now act The way I expect you to conform to your idealized version Don't deviate don't diverge. Don't challenge it. Don't undermine it. If you do I'll punish you I'll punish you severely the Aim of all this Is attention narcissistic supply Narcissists are addicts They're junkies. They're addicted to narcissistic supply They aim to remain the focus The center of other people's focus And they become angry and they denigrate others when The admiration and the attention are not granted or are insufficient or low-grade or fake So narcissistic individuals believe that their accomplishments are outstanding that they have many admirable qualities That they have or will achieve greatness, maybe post-mortem posthumously And that others should realize all this because it's so clear and Admire them for it Or fear them by the way, doesn't have to be positive supply could be negative supply to be feared Is supply the form of supply to be envied is a form of supply So This the dissociality trait in in the icd the domain specify the trait domain specify Doesn't appear specific to narcissism So many people criticize the icd and they say The traits are too wide too all-encompassing too fuzzy too blurred To serve they don't the consequently they cannot serve well as diagnostic tools But I disagree I tend to disagree it is not the traits That should serve as diagnostic tools It is the combinations of the traits when you begin to combine traits in a variety of permutations You get very fine-grained fine-tuned diagnosis actually More fine-grained and fine-tuned than the dsm in my view anyhow The trait domain specifiers of course are not Unique to narcissism or specific to narcissism or to borderline or to anything That's the greatness of the icd icd gives you lego bricks. You build your own castles diagnostic castles Dissociality for example Characterizes the social personality disorder known as anti-social personality disorder in in the dsm Kind of psychopathy And so many people with the diagnosis of narcissistic personality disorder in order to keep up with the subjective sense of superiority are also characterized by the trait domain of unencased here So Dissociality is not enough to capture the essence of narcissism. You need to combine it combine it with unencased here unencased here simply put is rule-based Rigid perfectionism coupled with vanity pride For being perfect proud For being perfect. So this is unencased here unencased here enhances competitiveness Upholds and buttresses self-esteem and creates grandiose self-recentations So if you combine unencased here and the sociality you get narcissism so The narcissist according to the icd Narcissism is a perfectionistic overcompensation and rule bound dominance Over others in order to exploit them sources of narcissistic supply partners and shared fantasy and so on so forth now additional features which Can be tacked on to and added to unencased here and and the sociality an additional feature Is negative affectivity? This negative affectivity gives rise to vulnerability depression anger envy hostility shame so negative affectivity captures the vulnerable manifestations of narcissism now we know today that all narcissists are both overt and covert there's no type constancy Narcissist cycle between overt phases and covert phases and overt phases and covert phases interminably This is known in practice However in academe They still make a rigid distinction A partition between overt grandiose and covert vulnerable So there is a gap There is an abyss in a huge debate between practitioners in the field And academics academicians and theoreticians The reality is of course that all narcissists are both overt and covert Anyone who has worked with narcissists for more than 10 minutes can tell you this But unfortunately that's not what you find in textbooks and in The majority of articles and so on so forth. So it's very misleading The literature is very misleading currently and the ICD Is the first official diagnostic text diagnostic manual that combines Vulnerable and grandiose narcissism into a single entity by By putting together Trades such as dissociality negative affectivity and unencased you ICD is far more realistic And far more flexible And far more factual Than the DSM actually And so when we combine dissociality and negative affectivity We get vulnerable narcissism These people ruminate over perceived slides and insults from other people They're over reactive to criticism They have low frustration tolerance And they become overtly or covertly upset Over minor issues We all know such people So the low self-esteem Involved with vulnerable or covert or shy or fragile narcissism. This low self-esteem manifests usually as envy of other people's Success other people's abilities other people's traits Other people's looks other people's possessions happiness. You name it And it is also driven By shameful experiences of repeated failures and procrastinations in the lives of vulnerable narcissists In other words, it is driven by collapse repeated collapse Now i'm not denying That some narcissists are much more covert than overt Even though there's no type constancy One type is dominant and the other is recessive A typical covert narcissists would spend 80% of his life being covert And only 20% being overt and vice versa Same applies to somatic versus cerebral narcissists I have spent 80% of my life being cerebral and only 20% being somatic so If you take all these together The individual manifestations of narcissism are captured perfectly By distinctive combinations of trait domains Where dissociality is perhaps the main ingredient And then the garnishes the added Traits are negative affectivity and unencased here Narcissistic features can also be illuminated by scales Developed in order to capture icd 11 trade facets and nuances Such as grandiosity the need for admiration vanity arrogance selfishness reactive anger shame self-centeredness lack of empathy and entitled superiority and there are quite a few instruments and scales developed for these purposes specifically Okay, that's why we are today there's two major debates That's three major debates one covert versus overt Are all narcissists both covert and overt? Or is it is there type purity across a lifespan? second argument is between Criteria diagnostic criteria, which are either categorical or dimensional And the icd type of model And so these debates Tearing the the community apart there's a growing gulf between the online world and practitioners and academics and theoreticians And finally there's a debate between This discussion of whether overt narcissism grandiose narcissism is not actually a form of psychopathy In other words, are all narcissists is all narcissism compensatory? Or do we have a kind of narcissism that is not compensatory? Do we have narcissists who truly believe that they're the greatest gift to humanity? Godlike Or is it all a kind of compensation for an inner Inner sense or inner conviction of inferiority what I call a bad object These are the debates So stay tuned And let's see what happens to narcissistic personality disorder in the sixth edition of the diagnostic and statistical manual The dsm 5 committee almost Removed narcissistic personality disorder from the manual almost and then ironically it Left it in And added to it an alternative model. So now many more pages are dedicated to narcissistic personality disorder In the fifth edition of the dsm Text revision then in the fourth edition of the dsm text Now NPD is spreading didn't I tell you it's contagious Even the dsm committee is not immune to its charms