This article critically examines Louis Charland’s claim that personality disorders are moral rather than medical kinds by exploring the relationship between personality disorders and virtue ethics. We propose that the conceptual resources of virtue theory can inform psychiatry’s thinking about personality disorders, but also that virtue theory as understood by Aristotle cannot be reduced to the narrow domain of ‘the moral’ in the modern sense of the term. Some overlap between the moral domain’s notion of character-based ethics (...) and the medical domain’s notion of character-based disorders is unavoidable. We also apply a modified version of John Sadler’s “moral wrongfulness test” to borderline and narcissistic personality disorders. With respect to both diagnoses, we argue that they involve negative moral evaluations, but may also have indispensable nonmoral features and, therefore, classify legitimate psychiatric disorders. (shrink)

Personality-disordered individuals of certain types tend to exhibit behaviors that cause particular problems for the Ethics and Compliance (E&C) function inorganizations. This paper defines personality-disordered individuals and focuses on three types that might create such problems: the psychopath, the narcissist, and the obsessivecompulsive personality. We provide a working hypothesis about the problems that they may cause in organizations and then report the results of an exploratory study of E&C personnel. The paper concludes with recommendations for managers and (...) for future research. (shrink)

In this article, I argue for a reconsideration of the taxonomy of the Histrionic Personality Disorder. First, HPD does not carry the negative ethical implications of the other Cluster Bs, which are Anti-Social, Borderline, and Narcissistic. Using Aristotelian notions of character as a heuristic device, I argue that ontologically HPD is not a personality disorder, but instead a cultural disorder, a result of attitudes toward traditionally feminine styles of interaction. This explains the confusion in (...) the research between HPD and hysteria and also the curious paucity of literature on HPD itself in contrast to the other Cluster Bs. (shrink)

Medical professionals, including mental health professionals, largely agree that moral judgment should be kept out of clinical settings. The rationale is simple: moral judgment has the capacity to impair clinical judgment in ways that could harm the patient. However, when the patient is suffering from a "Cluster B" personality disorder, keeping moral judgment out of the clinic might appear impossible, not only in practice but also in theory. For the diagnostic criteria associated with these particular disorders (Antisocial, Borderline, (...) Histrionic, Narcissistic) are expressed in overtly moral language. I consider three proposals for dealing with this problem. The first is to eliminate the Cluster B disorders from the DSM on the grounds that they are moral, rather than mental, disorders. The second is to replace the morally laden language of the diagnostic criteria with morally neutral language. The third is to disambiguate the notion of moral judgment so as to respect the distinction between having morally disvalued traits and having moral responsibility for those traits. Sensitivity to this distinction enables the clinician, at least in theory, to employ morally laden diagnostic criteria without adopting the sort of morally judgmental (and potentially harmful) attitude that results from the tacit presumption of moral responsibility. I argue against the first two proposals and in favor of the third. In doing so, I appeal to Grice's distinction between conventional and conversational implicature. I close with a few brief remarks on the irony of retaining overtly moral language in an ostensibly medical manual for the diagnosis of mental disorders. (shrink)

Narcissistic personality disorder describes people who demonstrate an exaggerated sense of entitlement, lack empathy and crave admiration. But philosopher Simone de Beauvoir argued that, even if a person isn't a pathological narcissist, narcissism can be a strategy that some people use to help them cope with being undervalued. Through examples such as singer-songwriter Taylor Swift, I show how Beauvoir's philosophy gives us a framework to understand some narcissistic behaviour and possibilities for more authentic ways of being (...) in the world. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Narcissism A Focal Point for Examining the Interrelatedness of Psychology and PhilosophyLydia Amir, PhD (bio)In a groundbreaking article, Aleksandar Fatic challenges the view that mental health is to be dissociated from morality or ethics. His argument targets cluster B personality disorders, such as Borderline and Narcissistic Personality Disorders, but focuses mainly on narcissistic disorders, whether diagnosed or not. Although these persons are not exempt of (...) moral and legal responsibility, they are diagnosed by and relegated to the mental health system, which is often ineffective in treating them. Fatic suggests that addressing their faulty morality is the best policy. In my commentary of his article, I further probe the viability and desirability of doing so. I point to narcissism as a focal point for examining the necessary impact of psychology and philosophy insofar as psychologists may be considered experts in emotions and philosophers in normative ethics. I question the interest in any ethics that does not also supply the means of its implementation and suggest that narcissists may have a morality of their own, ethical egoism.As psychiatrist Bennett Simon notes, Socrates did not inquire into the mental health field; his presence is missed as the questions, “what is mental illness?” and “what are psychiatry and psychiatrists?” are not addressed. It follows that it is up to us, as Simon attempts to do in the first chapter of Mind and Madness in Ancient Greece: The Classical Roots of Modern Psychiatry (1978), to define the psychiatrist’s proper area of professional competence (p. 28). That which makes matters even more confusing, he notes, is that psychiatrists are only one group of professionals who deal with the “mentally ill” and that they are “far from unanimous” about which problems “pertain to their particular sphere” (Simon, 1978, p. 29). He thus lists a variety of problems which “a glance at both popular and professional literature…reveals that at one time or another, psychiatrists have claimed [End Page 169] (sometimes by public demand) for their proper sphere” (Simon, 1978, p. 29). Among them is the issue that Fatic’s break grounding article tackles: “Psychiatrists at times consider it their proper task to deal with people who are excessively selfish and self-centered (narcissistic personality disorder)” (Simon, 1978, p. 29).Thus, Simon sees as a matter of controversy whether narcissism is a psychiatric issue, and defines the disorder in moral terms (“selfish,” “self-centered”). Fatic broadens the argument: he questions the validity of the psychological approach not only to narcissism as a personality disorder, but also to narcissistic traits, and the effectivity of this approach given that this is an area in which therapists usually do not have much success even if the patients look for help, which is rare. Fatic suggests that these personalities, either those with narcissistic traits or those with full-fledged narcissistic personality disorder, should be better understood (and maybe also addressed, although this point is not explicitly made) when viewed through moral lenses. In doing so, Fatic not only questions the validity of one form of personality disorder––still a controversial category––but re-kindles the view that correlates aspects of mental health with virtue, a view that was valid up until the nineteenth century and that made of philosophers (and priests) doctors of the soul.1That which made of philosophers’ teachings an important part of one’s life before the advent of scientific psychology has been often associated with this view, that the virtuous are also the healthy. Without going as far as to suggest that philosophers should teach virtue to narcissists, which could be a further argument in favor of the new field of philosophical practice and a broadening of its legitimate concerns, Fatic notes that moral categories are better suited to approach those who are plagued by narcissism.One way to explain the historical role that psychology played in relation to the traditional one upheld by morality is that psychology stepped in to explain the origins of failures in morality. If the narcissist is to be judged according to moral categories (a judgment that he necessarily fails in so far as right emotions as relevant to morality), what might be the consequences?Ascribing... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Narcissism, Empathy and Moral ResponsibilityRonald W. Pies, MD (bio)Professor Fatic’s timely and wide-ranging essay demonstrates how the topic of narcissism has undergone a resurgence of interest in recent decades. This may owe, in part, to the controversial claim that narcissism is on the rise in the United States, at least among American college students (Twenge & Foster, 2010). As I discuss presently, the term “narcissism” is open to many (...) interpretations, and differs somewhat from the specific designation, Narcissistic Personality Disorder (NPD), as defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (American Psychiatric Association, 2013). As Fatic rightly notes,Narcissism as a personality structure may or may not be diagnosed as NPD, depending on various criteria, perhaps most importantly on whether the narcissistic person actually encounters functional and emotional difficulties and shows up for diagnosis and evaluation.As Professor Fatic’s essay clearly shows, narcissism (variously defined) has important “ethical ramifications.” Fatic is primarily interested in exploring the relationship between what he calls the narcissist’s “emotional incompetence” and that person’s degree of moral responsibility. To oversimplify Fatic’s complex set of interlinked arguments, Fatic concludes that “emotional incompetence does not in fact reduce the moral responsibility of a narcissist person, whether diagnosed with Narcissistic Personality Disorder or not.” Drawing on the moral theories of Philip Pettit and Michael Slote—in particular, Slote’s “sentimentalist ethics” with its emphasis on empathy (Slote, 2004)—Fatic argues that narcissism is both “a moral failure and a psychopathology.” Nevertheless, for Fatic, narcissists remain “fully morally responsible for their insensitivity and interpersonal emotional incompetence.” Why? Because they have the moral duty “to acquire the moral and emotional competence required for the making of moral choices.”Some Philosophical ConcernsAs I understand Fatic’s argument, he is asserting that the narcissist ought to be held responsible for a kind of self-education process that will ameliorate his or her emotional incompetence. Fatic writes,[W]e develop our morality through constant moral education and testing, which we receive both through socialization and through our own efforts later in life, as autonomous human beings. [End Page 173]We are thus responsible for what kind of moral actors we are and are becoming based on our way of life, and have a moral duty to improve our own moral senses and sensibilities by constantly working on the development of virtues.It seems to me that this line of reasoning assumes that all, or most, narcissists possess the capacity to seek and acquire this “moral education.” Perhaps so—but I am not sure Fatic has demonstrated this. It seems at least plausible that, in virtue of the adverse developmental and perhaps even neurological factors that may generate the narcissistic personality (Fan et al., 2011), some narcissists may lack the capacity to modify their psychopathology by means of “moral education.” This leads me to wonder whether Professor Fatic has adequately explored the very heterogeneous nature of narcissism. Indeed, Fatic’s thesis seems to point toward a kind of Platonic “essence” of narcissism, conveyed by his frequent allusion to “the narcissist”—one of whose defining or essential features is said to be a lack of empathy.But, as I will suggest presently, this is at best an oversimplification of narcissism as psychiatrists understand the term. Indeed, there are degrees and varieties of narcissism, differing in their capacity for empathy—which is itself a psychologically complex term. Recent research suggests that “narcissistic personality disorder symptomatology does not reflect a “narcissist” category but rather a continuum of narcissistic pathology” (Aslinger, Manuck, S. Pilkonis, Simms, & Wright, 2018).Furthermore, Professor Fatic’s thesis seems to view “moral responsibility” as a binary construct; i.e., either one possesses, or does not possess, full moral responsibility. But as I have argued elsewhere, moral responsibility may be viewed as lying along a continuum that reflects varying degrees of voluntariness for any given individual (Pies, 2007).Consequently, in my view, any valid assessment of the “the narcissist’s” moral responsibility must consider both the heterogeneity of narcissism and the non-binary (i.e., continuous) nature of moral responsibility.One way of conceptualizing this “two-track” model is... (shrink)

Theories of personality and personality disorders need, from time to time, to be revised and updated according to new empirical and conceptual developments. Such development has taken place in the realms of affective neuroscience, evolution and social cognition. In this article we outline a new personality theory which claims that phenomena we usually ascribe to the concept personality are best understood by postulating a web consisting of three major constituents: Temperament (mainly primary emotions), attachment and self-consciousness (...) (mentalizing). We describe these constituents, their neurobiological underpinnings, the subjective experiences they evoke and their behavioral implications. We discuss the relevance of the espoused theory for the field of personality disorders with references to borderline, narcissistic and avoidant personality disorders as well as the DSM-5 Alternative Model. Implications for social psychology, psychotherapy and common-sense self-understanding are outlined. The theory aims to bridge previous contradictions between natural sciences and hermeneutics by its propositions of the evolution of self-consciousness. (shrink)

Abstract:In this paper, I suggest that the moral incompetence in narcissism is associated with a particular type of emotional incompetence, namely the incompetence to experience the moral emotions, such as empathy, solidarity, loyalty, or love. I then move on to discussing the ethical ramifications of this incompetence, primarily from the point of view of sentimentalist ethics, and conclude that emotional incompetence does not in fact reduce the moral responsibility of a narcissist person, whether diagnosed with Narcissistic Personality (...) class='Hi'>Disorder or not. My argument is based on the three criteria of moral responsibility proposed by Philip Pettit, namely those of value relevance, value judgment, and value sensitivity. I suggest that a sentimentalist ethical perspective entails that the satisfaction of two of the mentioned criteria (awareness of the social meaning of one’s choices and sufficient control of one’s actions) constitutes a moral obligation for the agent to satisfy the third criterion, namely to develop the appropriate moral sensibility and competence to actually choose morally correctly. This type of structure of obligation elucidates why narcissism is at the same time a moral failure and a psychopathology. At the same time, my argument portrays narcissism as a particular type of personality disturbance that almost uniquely reaffirms the role of moral re-education as the psychotherapeutic approach. This conclusion points to a potential revival of some of the precepts of Pinel’s affective psycho-pathology, dating back to the very beginnings of the psychotherapeutic clinic. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Why Narcissists Are Morally ResponsibleAleksandar Fatic, PhDIn his insightful commentary of ‘Narcissism as a moral incompetence,’ Professor Pies proposes several principal objections to my line of argument. First, Pies mentions that I embrace a Platonic essentialism and a ‘binary’ view of narcissism, whilst in fact narcissistic traits present themselves in degrees, within a continuum of pathology.Let us clarify the meaning of essentialism. When applied to the phenomenology of (...) narcissism, Platonic essentialism would imply that there is an idea, or ideal, of ‘pure’ narcissism, which governs our cognition of narcissistic phenomenology. Without an ‘essentialist’ understanding of what narcissism as a more or less pure phenomenon would look like, it would make no semantic or logical sense to speak of various ‘types’ or ‘degrees’ of narcissism. In the 1940s, in The Concept of Mind, Gilbert Ryle offered the now infamous logical analysis of ‘false’ and ‘true coins’: if there were not true coins of which we had some idea, it would be logically impossible to speak of counterfeit coins (McDermid, 2004; Ryle, 1949, pp. 94–99). There are shoddily produced coins that bear only a vague resemblance to the original idea or mint of the real coin, however, for each we would ultimately have to decide whether the resemblance is sufficient for it to be considered a real coin. Shoddily produced coins represent various ‘degrees’ of resemblance of the idea, or form, of a coin, but to call them coins, and to decide whether they are true coins or not, it is a logical presupposition that we must first have an ‘idea’ of what an ‘ideal’ real coin is like. This, at its core, is essentialism.There is no escape from this type of essentialism in any rigorous argument, because Platonic essentialism is the foundation of the very meanings of the concepts we use. Plato’s ideas are paradigms, where the particular instantiations of their qualities are called ‘phenomena’ (Sedley, 2016; Taylor, 2016). Thus, the nuanced expression of ideas or forms in their various phenomena is the very substance of the essentialist theory of ideas. It appears that Professor Pies is also a Platonic essentialist, as am I.So why is it often impossible in clinical practice to ascribe necessary and sufficient conditions to narcissism? Well, let us remember Rosenhan’s experiments (1973). Rosenhan illustrates how the same individuals were diagnosed with very different disorders by different clinicians at roughly the same time, and how healthy individuals, once they had been instructed to ‘fake’ psychotic symptoms, remained under the same or more serious [End Page 177] diagnoses even when they stopped pretending and behaved completely normally. The reason for the arbitrariness of psych-diagnoses is the insufficiency of the psych-diagnostic language, including the actual diagnostic criteria, a kind of Lacanian ‘lack’ that is built into the very structure of psychodiagnostics (Ruti, 2008), and not a metaphysics behind such use of diagnostic language, whether it is essentialist or non-essentialist. Whether a particular patient actually has NPD or not in practice comes down to a consensual judgement—one that has been notoriously lacking in the history of psychiatry (Verhaeghe, 2008, pp. 71–125).Second, Pies suggests that empathy is ‘a complex, multidimensional construct comprising cognitive and affective components.’ I do not think this is a correct understanding of empathy. In fact, it is a conceptual revision of the original concept of empathy, which is one of a moral emotion (Kauppinen, 2014). What Pies calls ‘cognitive empathy,’ namely the ability to recognize and influence the emotions of others is an entirely different quality capacity that has recently been called ‘emotional intelligence’ (e.g., Conte, 2005). Many Cluster B personality disorders are characterized by an exceptionally high emotional intelligence and an almost complete lack of empathy, which allows them to use their emotional intelligence to manipulate and mistreat others. Surely such emotionally intelligent, but highly malignant strategies would not be considered ‘empathy.”Relatedly, Pies objects to Slote’s alleged view that only actions arising from factual empathy are morally justifiable. This is a ‘naturalist fallacy’ in reading Slote. The natural fallacy is a confusion between the ‘is’ and the ‘ought.’ Slote actually argues that only actions that are consistent with... (shrink)

The general concept of mental disorder specified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is definitional in character: a mental disorder might be identified with a harmful dysfunction. The manual also contains the explicit claim that each individual mental disorder should meet the requirements posed by the definition. The aim of this article is two-fold. First, we shall analyze the definition of the superordinate concept of mental disorder to better understand (...) what necessary criteria actually characterize such a concept. Second, we shall consider the concepts of some individual mental disorders and show that they are in tension with the definition of the superordinate concept, taking pyromania and narcissistic personality disorder as case studies. Our main point is that an unexplained and not-operationalized dysfunction requirement that is included in the general definition, while being systematically violated by the diagnostic criteria of specific mental disorders, is a logical error. Then, either we unpack and operationalize the dysfunction requirement, and include explicit diagnostic criteria that can actually meet it, or we simply drop it. (shrink)

Volume 17 of Progress in Self Psychology, _The Narcissistic Patient Revisited_, begins with the next installment of Strozier's "From the Kohut Archives": first publication of a fragment by Kohut on social class and self-formation and of four letters from his final decade. Taken together, Hazel Ipp's richly textured "Case of Gayle" and the commentaries that it elicits amount to a searching reexamination of narcissistic pathology and the therapeutic process. This illuminating reprise on the clinical phenomenology Kohut associated with (...) "narcissistic personality disorder" accounts for the volume title. The ability of modern self psychology to integrate central concepts from other theories gains expression in Teicholz's proposal for a two-tiered theory of intersubjectivity, in Brownlow's examination of the fear of intimacy, and in Garfield's model for the treatment of psychosis. The social relevance of self psychology comes to the fore in an examination of the experience of adopted children and an inquiry into the roots of mystical experience, both of which concern the ubiquity of the human longing for an idealized parent imago. Among contributions that bring self-psychological ideas to bear on the arts, Frank Lachmann's provocative "Words and Music," which links the history of music to the history of psychoanalytic thought in the quest for universal substrata of psychological experience, deserves special mention. Annette Lachmann's consideration of empathic failure among the characters in Shakespeare's _Othello_ and Silverstein's reflections on Schubert's self-states and selfobject needs in relation to the specific poems set to music in his Lieder round out a collection as richly broad based as the field of self psychology itself. (shrink)

: In direct opposition to the dominant nativist perspective tracing back to Descartes, William James suggested that the sense of self is constructed through a never-ending process of reflexivity. In more recent years, empirical data from various psychological domains have further strengthened this constructivist perspective. Notably, Gergely and Watson’s social biofeedback model has been proposed as a central mechanism in the development of emotional introspection, which itself constitutes a crucial step in the process leading to a mature sense of self. (...) In accordance with the social biofeedback model, it has been suggested that reiterated failures in biofeedback mechanisms predispose an individual to mental suffering. While borderline personality disorder and antisocial behavior have received the most attention, here I make a preliminary attempt to examine the impact of dysfunctional biofeedback on the pathogenesis of narcissism, suggesting that some central features of pathological narcissism may result from serious and reiterated disruptions in social biofeedback. This preliminary exploration aims to deepen our understanding of the origins of psychological suffering. In this sense, my effort could contribute to the construction of a causal model going beyond the purely categorical, atheoretical analysis of mental diseases typical of the diagnostic and statistical manuals. Keywords: Self; Self-ing Process; Social Biofeedback Model; Narcissism Il farsi e il disfarsi del sé. Biofeedback sociale, meccanismi causali e narcisismo patologico Riassunto: La prospettiva costruttivista sullo sviluppo del sé, efficacemente difesa da William James in opposizione all’innatismo di stampo cartesiano, è oggi ulteriormente avvalorata da numerosi dati empirici provenienti da diversi ambiti della psicologia. Il modello del biofeedback sociale di Gergely e Watson è stato proposto quale meccanismo centrale nello sviluppo dell’introspezione emotiva. In accordo a tale modello, ripetuti gravi fallimenti del biofeedback predispongono al disturbo mentale, segnatamente al disturbo borderline di personalità e al comportamento antisociale. In questo saggio mi occuperò di disturbo narcisistico di personalità, suggerendo che anche alcuni dei sintomi principali di questa patologia potrebbero derivare da disfunzioni gravi e reiterate del biofeedback. Nonostante la sua natura preliminare, la mia indagine si inscrive nell’alveo di quelle ricerche che mirano costruzione di un modello causale che vada oltre l’analisi puramente categoriale e ateoretica tipica dei manuali statistico-diagnostici. Parole chiave: Self; Identità personale; Social Biofeedback Model; Disturbo narcisistico di personalità. (shrink)

Four couple therapy first consultations involving clients with diagnosed narcissistic problems were examined. A sociologically enriched and broadened concept of narcissistic disorder was worked out based on Goffman’s micro-sociology of the self. Conversation analytic methods were used to study in detail episodes in which clients resist to answer a therapist’s question, block or dominate the development of the conversation’s topic, or conspicuously display their interactional independence. These activities are interpreted as a pattern of controlling practices that were (...) prompted by threats that the first couple therapy consultation imposes upon the clients’ self-image. The results were discussed in the light of contemporary psychiatric discussions of narcissism; the authors suggest that beyond its conceptualization as a personality disorder, narcissism should be understood as a pattern of interactional practices. (shrink)

The self allows us to reflect on our own behavior and to imagine what others think of us. Clinical experience suggests that these abilities may be impaired in people with personality disorders. They do not recognize the impact that their behavior has on others, and they have difficulty understanding how they are seen by others. We collected information regarding pathological personality traits—using both self and peer report measures—from groups of people who knew each other well . In previous (...) papers, we have reported that agreement between self-report and peer-report is only modest. In this paper, we address the question: Do people know that others disagree with their own perceptions of themselves? We found that expected peer scores predicted variability in peer report over and above self-report for all 10 diagnostic traits. People do have some incremental knowledge of how they are viewed by others, but they do not tell you about it unless you ask them to do so; the knowledge is not reflected in ordinary self-report data. Among participants who expect their peers to describe them as narcissistic, those who agree with this assessment are viewed as being less narcissistic by their peers than those who deny being narcissistic. It therefore appears that insight into how one is viewed by others can moderate negative impressions fostered by PD traits. (shrink)

In this paper, I explore a number of issues related to a life lived with borderline personality disorder (BPD). Primarily, I am interested in discussing how one unwillingly changes their personal identity by forced medicating—demanded by others implicitly and explicitly. My motivation is something deep and invasive in me. I want to know, I have always wanted to know, why others want me to not be Me so badly. I have thought about this question for years, and though (...) others may simply chalk it up to just one of the standard paranoid or narcissistic traits of borderline personality disorder, there is something more to this question that many of us agonize over most of our lives. There is a deeply normative component to this question that extends beyond the mere fear of abandonment; it is tied to a desire by others to erase—literally—who we are for their own comfort. In this sense, then, I invite you to travel along a path of what it can mean to be a BPDer, from a narrative, phenomenological, and cognitive lived, embodied perspective. My purpose is to show that the treatments for us that others desire cannot avoid (and usually do not want to avoid) the unraveling of who we really are. Whether we want to or not, we give up our self to keep other people with us. And for many, this is too much to ask, and can be one, though not the only, reason suicide and self‐harm seem to be necessary recourses. One in 10 people with BPD commit suicide. So this is a serious matter, indeed. (shrink)

This book is the second volume of an interdisciplinary study, chiefly one of philosophy and psychology, which concerns personality, especially the abnormal in terms of states of aloneness, primarily that of the negative emotional isolation customarily known as loneliness. Other states of aloneness investigated include solitude, reclusiveness, seclusion, desolation, isolation, and what the author terms “aloneliness,” “alonism,” “lonism,” and “lonerism.” Insofar as this study most explicitly focuses on abnormal personalities, it employs the general and specific definitions of personality (...) aberrations as formulated by the American Psychiatric Association in its latest edition of the _Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)_. The author views personality as preeminently comprised of the individual's interpersonal relationships. Unlike the _DSM-IV_, he proposes that people with personality disorders not only possibly but necessarily manifest deviancy regarding interpersonal functioning via serious shortcomings in shared inwardness, paramountly reciprocated intimacy. This work also engages in an analysis of five social factors that are conducive to predisposing, precipitating, and maintaining negative kinds of personality and aloneness. The author has formed these factors into an acronym titled _SCRAM_ since when they are present, intimacy scurries away and in its absence, loneliness and other sorts of unwanted aloneness scamper in and fill the person with unhappiness via, for instance, sadness and self-worthlessness. The constituents of SCRAM are the following social illnesses: _S_uccessitis (for example, the fixation on fame and fortune), _C_apitalitis (greed-driven, unfettered capitalism), _R_ivalitis (competitivitis), _A_tomitis (hyper-individualism), and _M_aterialitis (for example, the anti-spirituality of consumeritis). In sum, this book provides a different perspective on personality via the lenses of various types of aloneness and their lack of public and private intimacy, especially love. (shrink)

Anger is probably one of the mostly debated basic emotions, owing to difficulties in detecting its appearance during development, its functional and affective meaning (is it a positive or a negative emotion?), especially in human beings. Behaviors accompanied by anger and rage serve many different purposes and the nuances of aggressive behaviors are often defined by the symbolic and cultural framework and social contexts. Nonetheless, recent advances in neuroscientific and developmental research, as well as clinical psychodynamic investigation, afford a new (...) view on the role of anger in informing and guiding many aspects of human conducts. Developmental studies have confirmed the psychophysiological, cognitive and social acquisition that hesitate in the pre-determined sequence appearance of anger and rage in the first two years of life. The so-called affective neurosciences have shown the phylogenetic origin of the two circuits underlying the emergence of anger along with its evolutionary role for promoting survival. This view has been integrated by the psychodynamic theory of motivational systems that attribute a double role to anger: on the one hand, this affect works as an inwardly directed signal concerning a pressure to overcome an obstacle or an aversive situation; on the other hand, anger is also an outwardly directed communicative signal establishing differentiation and conflict within interpersonal relationships and affective bonds. Of course, human peculiar mental functioning requires the appraisal of such signals by higher cortical functions and, there is little doubt that the meaning that orientates individual behaviors is, eventually, construed on a social and cultural level. At the same time, everyday life experiences as well as clinical insights into psychopathic, narcissistic and borderline personality pathology clearly illustrate the necessity to correctly interpret and give answers to the basic questions raised around the topic of anger as a basic emotion. (shrink)

The diagnosis of psychopathic personality disorder has salience for forensic clinical practice. It influences decisions regarding risk, treatability and sentencing, indeed, in certain jurisdictions it serves as an aggravating factor that increases the likelihood of a capital sentence. The concatenation of symptom that is associated with modern conceptions of the disorder can be discerned in early writings, including the book of Psalms. Despite its forensic clinical importance and historical pedigree the concept remains elusive and controverted. In this (...) paper I describe an attempt to map the concept of psychopathic personality disorder—the Comprehensive Assessment of Psychopathic Personality (CAPP). I outline the processes used to create the concept map; I summarise evidence in support of the content validity of the map and describe different operations designed to operationalise the construct. It is only when conceptual clarity is achieved that valid operations and measures can be created. I end with a plea for more carefully considered application of statistical methods; applications that better fit the theoretical questions being posed. (shrink)

'Cruel' simply ignores the supposed fact/value dichotomy and cheerfully allows itself to be used sometimes for a normative purpose and sometimes as a descriptive term.Personality disorders have always attracted considerable attention within the philosophy of psychiatry. It was not until two papers written by Louis Charland, however, that they simulated a wider and lively debate. The importance and, at least partly, the strength of Charland's analyses lie in the fact that they are relatively particular and focused in their...

Many feminist researchers have been critical of the psychiatric category of borderline personality disorder 1 and have emphasized the gendered nature of the diagnosis. It is estimated that people diagnosed with BPD comprise 1 to 2 percent of the general population in the United States in a given year, and that women represent 75 percent of those diagnosed.2 Critics have argued that the diagnosis reinforces double-binds for women and pathologizes traits associated with both conventional femininity, such as emotionality, (...) dependency, and self-destructiveness, and unconventional femininity, such as rebelliousness and sexual promiscuity (Lester 2013; Potter 2009; Shaw.. (shrink)

Borderline Personality disorder is a severe personality dysfunction characterized by behavioural features such as impulsivity, identity disturbance, suicidal behaviour, emptiness, and intense and unstable relationships. Approximately 2% of the population are thought to meet the criteria for BPD. The authors of this volume - Anthony Bateman and Peter Fonagy - have developed a psychoanalytically oriented treatment to BPD known as mentalization treatment. With randomised controlled trials having shown this method to be effective, this book presents the first (...) account of mentalization treatment for BPD. The first section gives an overview of BPD, including discussion of nosology, epidemiology, natural history, and psychosocial aetiology. It additionally summarises the present state of our research knowledge about effective psychotherapeutic treatments and use of medication. The second section outlines the authors' theoretical approach and contrasts it with other well known methods, including DBT, CAT, and CBT. In the extensive final section, the authors outline their clinical approach starting with how treatment is organised. A detailed account of the transferable features of the model is provided along with the main strategies and techniques of treatment. Numerous clinical examples are given to illustrate the core techniques and detailed information provided about how to apply aspects of the mentalization based treatment approach in everyday practice. Aimed at mental health professionals, along with counsellors, psychotherapists, and psychoanalysts, the book will be a valuable tool, providing an effective means of treating those suffering from Borderline Personality Disorder. (shrink)

The diagnostic category of borderline personality disorder (BPD) has come under increasing criticism in recent years. In this paper, we analyze the role and impact of epistemic injustice, specifically testimonial injustice, in relation to the diagnosis of BPD. We first offer a critical sociological and historical account, detailing and expanding a range of arguments that BPD is problematic nosologically. We then turn to explore the epistemic injustices that can result from a BPD diagnosis, showing how they can lead (...) to experiences of testimonial injustice which impede patient engagement in meaning-making activities, thereby undermining standard therapeutic goals. We conclude by showing how our arguments bolster ongoing efforts to replace the diagnostic category of BPD with alternatives such as complex post-traumatic stress disorder. (shrink)

Exploring the factors influencing entrepreneurial intention is crucial to entrepreneurial practice and education. For a comprehensive understanding of the influence of narcissistic personality on entrepreneurial intention, this study analyzed the relationship between narcissistic personality, entrepreneurial self-efficacy, and entrepreneurial intention in college students sampled from three higher vocational colleges in Beijing, China. A total of 252 valid questionnaires were collected. The results show that the narcissistic personality of the college students has a significant positive effect (...) on entrepreneurial intention and entrepreneurial self-efficacy. Entrepreneurial self-efficacy of the college students has a significant positive effect on entrepreneurial intention and plays a partial mediation role in the relationship between narcissistic personality and entrepreneurial intention. Thus, the study results provide some reference for further improving entrepreneurial practice and education. (shrink)

I am delighted that Zachar and Potter have chosen to refer to my work on the DSM-IV cluster B personality disorders in their very interesting and ambitious target article. Their suggestion that we turn to virtue ethics rather than traditional moral theory to understand the relation between moral and nonmoral factors in personality disorders is certainly original and worth pursuing. Yet, in the final instance, I am not entirely sure about the exact scope of their proposed analysis. I (...) also worry whether they may have inadvertently presented a slightly inaccurate account of my views on the cluster B personality disorders, as they seek to formulate and defend their own views, which seem to be far wider in scope. I .. (shrink)

Several researchers point to disorganized attachment as a core feature of borderline personality disorder (BPD). However, recent studies suggest that specific internal working models (IWMs) of each parent combine to account for child outcomes and that a secure relationship with one parent can protect against the deleterious effects of an insecure relationship with the other parent. It was thus hypothesized that adolescents with BPD are more likely to be disorganized with both their parents, whereas non-clinical controls are more (...) secure with at least one of their caregivers. Thirty-six adolescents with BPD and 30 control participants (aged 13-19) were included. Psychiatrist diagnosis was verified with the SIDP-IV and comorbidity was assessed using the Kiddie-SADS. Reported trauma was assessed with the Childhood Trauma Questionnaire. Attachment IWMs of each parent were assessed with the Attachment Multiple Model Interview (AMMI), which enables separate coding for each attachment figure and in which disorganization is conceptualized as conflicting attachment strategies within a specific relationship. Results of a logistic regression analysis suggested that beyond insecure attachment, being disorganized not just with one but with both parents is particularly characteristic of adolescents with BPD. Conversely, belonging to the non-clinical group was predicted by higher security scores with the father and lower deactivation with the mother. Although higher levels of childhood abuse or neglect were reported by adolescents with BPD, the retained attachment dimensions predicted group membership over and above reported trauma. These findings have important implications for clinical intervention and highlight the protective role fathers may have. (shrink)

Whether treatment decision-making capacity can be meaningfully applied to patients with a diagnosis of “personality disorder” is examined. Patients presenting to a psychiatric emergency clinic with threats of self-harm are considered, two having been assessed and reviewed in detail. It was found that capacity can be meaningfully assessed in such patients, although the process is more complex than in patients with diagnoses of a more conventional kind. The process of assessing capacity in such patients is very time-consuming and (...) may become, in itself, a therapeutic intervention. (shrink)

The traditional view that having a personality disorder, unlike other mental disorders, is not usually reason enough to consider a person incompetent to make healthcare decisions is challenged. The example of a case in which a woman was treated for a physical disorder without her consent illustrates that personality disorder can render a person incompetent to refuse essential treatment, particularly because it can affect the doctor–patient relationship within which consent is given.

Marie Cardinal's novel Les Grands Desordres explores the power of biography and fictional writing to reveal the human world in ways that elude the grasp of an abstract and academic psychology. This essay examines Cardinal's narrative treatment of a Parisian psychologist who, at the beginning of her career, is convinced that natural science will contribute to human knowledge and will reduce suffering. However, a personal crisis makes her question her basic assumptions and leads her to discover the spiritual wealth and (...) revealing powers of narrative writing. The bond between reader and writer is interpreted as an alliance between a host and a guest that conquers narcissism and isolation by building and inhabiting a neighborly world. (shrink)

Once common, therapeutic privilege—the practice whereby a physician withholds diagnostic or prognostic information from a patient intending to protect the patient—is now generally seen as unethical. However, instances of therapeutic privilege are common in some areas of clinical psychiatry. We describe therapeutic privilege in the context of borderline personality disorder, discuss the implications of diagnostic non-disclosure on integrated care and offer recommendations to promote diagnostic disclosure for this patient population. There are no data in this work.

People with personality disorders should be treated fairly. Potential crime victims should be protected. That much is uncontroversial. The hard questions ask what is fair, when is protection adequate, and how should we achieve fairness and protection together. Peay outlines five main hurdles that the law must jump to reach these goals. All five raise serious challenges. To begin to address these challenges, we must first clarify what a personality disorder is. The notion of a personality (...) disorder is defined very broadly in DSM-IV-TR as any inflexible, pervasive, enduring, stable, and early-onset pattern of experience and behavior that deviates markedly from cultural expectations, leads to clinically .. (shrink)

Personality disorders: illegitimate subject positions The diagnosis of personality disorder is common in mental health nurse settings and is a term often used without critical consideration. In clinical practice, the term personality disorder has pejorative connotations, which arise out of the way in which these behaviours are constructed as behavioural rather than psychiatric. The discursive construction of categories of personality disorder are inculcated into clinical practice and become taken‐for‐granted by those in practice culture. (...) The construction of some personalities as disordered and, therefore, illegitimate becomes natural. This paper provides a critical analysis of the diagnosis and suggests an approach to mental health nursing care that is more legitimising for those people who receive psychiatric diagnoses. (shrink)

This chapter argues that the conditions under the umbrella “personality disorders” actually constitute two very different kinds of theoretical entities. In particular, several core personality disorders are actually moral, and not medical, conditions. Thus, the categories that are held to represent them are really moral, and not medical, theoretical kinds. The chapter works back from the possibility of treatment to the nature of the kinds that are allegedly treated, revisiting 18th-century ideas of moral treatment along the way. The (...) discussion closes with a reflection on how the ambiguous medical status of personality disorders and their treatment today is reminiscent of the ideological tug of war that pits alienist “mad doctors” like Pinel against their lay counterparts such as Tuke as they battled over who should be in charge of treating the mad. (shrink)

In “Personality Disorders: Moral or Medical Kinds—or Both?” Peter Zachar and Nancy Nyquist Potter (2010) reject any general dichotomy between morality and mental health, and specifically between character vices and personality disorders. In doing so, they provide a nuanced and illuminating discussion that connects Aristotelian virtue ethics to a multidimensional understanding of personality disorders. I share their conviction that dissolving morality–health dichotomies is the starting point for any plausible understanding of human beings (Martin 2006), but I register (...) some qualms about their discussion of responsibility. Zachar and Potter target the morality-health dichotomy as it appears in Louis C. .. (shrink)

Individuals with conditions like borderline personality disorder experience chronic, pervasive impairments that interfere with moral functioning. Even in recovery these individuals are plagued by residual symptoms, requiring diligence and management. First, I stipulate that some individuals who recover from BPD act morally. I argue that by acting morally while managing residual symptoms these individuals expand the boundaries of traditional Aristotelian virtue. Individuals who recover from BPD are simultaneously virtuous and outside the boundaries of traditional Aristotelian virtue if they (...) meet the following conditions: they experience marked, unchangeable morally-relevant difference in moral faculties; act morally at approximately the same rate or better than other moral agents; and act morally for the right reasons. These individuals challenge the boundaries of traditional Aristotelian virtue by demonstrating that many views of temperance and virtue are too restrictive. I evaluate multiple interpretations of McDowell’s [1] silencing view and call for a more inclusive virtue ethics that embraces continence in the vein of Foot’s [2] corrective view. (shrink)

All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood. (Article 1, Universal Declaration of Human Rights 1948) This resounding statement encapsulates a number of problematic themes for lawyers with respect to personality disorder, and acutely so for the extremes of personality disorder embraced by designations such as psychopathy or dangerous and severe personality disorder (...) (DSPD). These designations are in themselves contentious; they do not have commonly agreed definitions either across disciplines or across jurisdictions. Morse (2008), for example, argues in a fascinating account that .. (shrink)

A striking feature of post-modernism is its distrust of the subject. If the modern period, beginning with Descartes, sought in the subject a source of certainty, an Archimedian point from which all else could be derived, post- modernism has taken the opposite tack. Rather than taking the self as a foundation, it has seen it as founded, as dependent on the accidents which situate consciousness in the world. The same holds for the unity of the subject. Modernity, in its search (...) for a single foundation, held the subject to be an indissoluble unity. Post-modernism’s position, by contrast, is announced by Nietzsche: “The assumption of one single subject is perhaps unnecessary; perhaps it is just as permissible to assume a multiplicity of subjects, whose interaction and struggle is the basis of our thought and our consciousness in general? ...My hypotheses: The subject as multiplicity.” Given this, there is a natural correspondence between the success of post- modernism and the current interest in multiple personality disorder. In the latter, we actually have the experience of a “multiplicity of subjects” in their interaction and struggle. The subject stands there before us “as multiplicity.” It gives us a concrete case, one which raises some of the pressing questions associated with the post-modern denial of the subject. Confronting it, we ask: how real are the personalities composing the multiplicity of this disordered self? What, in fact, does this multiplicity tell us about the self? about its genesis and status? What does it reveal about “our thought and consciousness in general”? I plan, in the short compass of this paper, to sketch some answers to these questions. §1. A brief description of MPD. The American Psychiatric Association gives two criteria for (MPD) multiple personality disorder. First, and most obviously, there is “the existence within the person of two or more distinct personalities or personality states (each with its own relatively enduring pattern. (shrink)

Louis Charland has argued that the Cluster B personality disorders, including borderline personality disorder, are primarily moral rather than clinical conditions. Part of his argument stems from reflections on effective treatment of borderline personality disorder. In the argument from treatment, he claims that successful treatment of all Cluster B personality disorders requires a positive change in a patient’s moral character. Based on this claim, he concludes (1) that these disorders are, at root, deficits in (...) moral character, and (2) that effective treatment of these disorders requires a sort of moral education rather than clinical intervention. In this paper, I evaluate the argument from treatment through a critical analysis of two psychotherapeutic interventions that have shown recent effectiveness against borderline personality disorder. I suggest that both Dialectical Behaviour Therapy and Mentalization-Based Treatment indicate that borderline personality disorder is, at root, a deficit in non-moral cognitive and emotional capacities. I suggest that these non-moral deficits obscure the expression of an otherwise intact moral character. In light of this, I conclude that effective treatment of borderline personality disorder requires primarily clinical intervention rather than moral edification. (shrink)

The DSM-IV-TR (American Psychiatric Association 1994, 689) defines personality disorder (PD) as: An enduring pattern of experience and behavior that deviates markedly from the expectations of an individual’s culture. This pattern is manifested in two (or more) of the following areas: 1 Cognition (i.e., ways of perceiving and interpreting self, other people, and events); 2 Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response); 3 Interpersonal functioning; and 4 Impulse control. B The enduring ..

When i was in graduate school, I inadvertently walked in on a fellow student taking his comprehensive exams. He was extremely frustrated because two of the questions asked about conceptual issues in personality and personality disorders. This student was not expecting such questions and considered them to be unfair. I knew other students in that same program who would have considered it a gift to get such “interesting” questions. Those clinical and counseling psychologists with theoretical–philosophical interests are often (...) attracted to the topics of personality and personality disorders. It has, therefore, puzzled me why these same topics are largely ignored by those philosophers who study the conceptual issues of .. (shrink)

Interpersonal sensitivity, particularly threat of potential exclusion, is a critical condition in borderline personality disorder (BPD) which impairs patients’ social adjustment. Current evidence-based treatments include group components, such as mentalization-based group therapy (MBT-G), in order to improve interpersonal functioning. These treatments additionally focus on the therapeutic alliance since it was discovered to be a robust predictor of treatment outcome. However, alliance is a multidimensional factor of group therapy, which includes the fellow patients, and may thus be negatively affected (...) by the exclusion-proneness of BPD patients. The aim of this pilot study was to examine the predictive value of threat of social exclusion for the therapeutic alliance in MBT-G. In the first part of the study, social exclusion was experimentally induced in 23 BPD inpatients and 28 healthy subjects using the Cyberball paradigm, a virtual ball tossing game. The evoked level of threat was measured with the Need-Threat Scale (NTS) which captures four dimensions of fundamental human needs, i. e. the need for belongingness, for self-esteem, for control, and for a meaningful existence. In the second part of the study, therapeutic alliance was measured on three dimensions, the therapists, the fellow patients and the group as a whole, using the Group-Questionnaire (GQ-D). BPD patients scored higher in their level of threat according to the NTS in both, the inclusion and the exclusion condition. The level of threat after exclusion predicted impairments of the therapeutic alliance in MBT-G. It was associated with more negative relationships, lower positive bonding and a lower positive working alliance with the fellow patients and lower positive bonding to the group as a whole whilst no negative prediction of the alliance to the therapists was found. Consequently, our translational study design has shown that Cyberball is an appropriate tool to use as an approach for clinical questions. We further conclude that exclusion-proneness in BPD is a critical feature with respect to alliance in group treatments. In order to neutralize BPD patients’ exclusion bias, therapists may be advised to provide an “inclusive stance”, especially in initial sessions. It is also recommendable to strengthen patient to patient relations. (shrink)

It is concisely explained what Borderline Personality Disorder is and how it differs from psychopathy.

Marya Schechtman argues that psychological continuity accounts of personal identity, as represented by Derek Parfit's account, fail to escape the circularity objection. She claims that Parfit's deployment of quasi-memory (and other quasi-psychological) states to escape circularity implicitly commit us to an implausible view of human psychology. Schechtman suggests that what is lacking here is a coherence condition, and that this is something essential in any account of personal identity. In response to this I argue first that circularity may be escaped (...) using quasi-psychological states even with the addition of the coherence condition. Second, I argue that there is something right about the coherence condition, and a major task of this paper is to identify its proper theoretical role. I do so by reflection on integration therapies for people with multiple personality disorder (MPD). The familiar distinction between the moral and the metaphysical concept of the person is developed alongside such reflection. Connecting these two issues I argue that coherence acts as a normative constraint on accounts of personal identity, but that the normative dimension of personhood is not essential to our notion of a person tout court. (shrink)

Most clinicians and mental health practitioners are reluctant to work with people with dangerous and severe personality disorders because they believe there is nothing that mental health services can offer. Dangerous and severe personality disorder also signals a diagnosis which is problematic morally. Moral philosophy has not found an adequate way of dealing with personality disorders. This paper explores the question: What makes a person morally responsible for his actions and what is a legitimate mitigating factor? (...) How do psychiatric nurses working with this client group understand the awful things some clients do? What concepts do they need, if they are to know how to explain and how to react? It is suggested that dangerous and severe personality disorder is best regarded as a moral category, framed in terms of goodness, badness, obligation and other ethical concepts. It seems plausible that in important ways the dangerous and severe personality disordered client does not understand morality or understands it differently. The peculiar position of the dangerous and severe personality disordered individual in our system of moral responsibility stems from his apparent inability to see the importance of the interests of others. It might be more helpful to regard personality disordered clients as we do children: partially but not fully reasonable for their actions. We might regard the dangerous and severe personality disordered client responsible for those actions which he most clearly understands, such as causing others physical pain, but not for those with which he is only superficially engaged, such as causing emotional pain. The paper concludes by suggesting that the dangerous and severe personality disordered individual does not fit easily into any conventional moral category, be it criminal, patient, animal or child, and thus an assessment of his moral accountability must take into consideration his special circumstances. (shrink)