Dragon Rider (drag)

Drag rides dragons and also “rides” dragons. drag/dragself person-independent pronouns. That means drag’s pronouns are the same in first, second, and third person.

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Cake day: September 29th, 2024

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  • All 9 of those criteria only apply if they distress or impair the patient. Also, they’re outdated. That’s the DSM-IV’s criteria. And they’ve been criticised -

    The NPD diagnosis in DSM has been criticized for being one-sided and relying primarily on external socially and interpersonally striking and provocative features.

    As such, it has failed to capture the full range of narcissistic personality pathology, especially the internal vulnerability and insecurity characterized by severe self-criticism, insecurity, confusion, shame, aloneness, and fear.

    Instead, the diagnosis has primarily emphasized external characteristics related to boasted grandiosity, and obviously adverse interpersonal functioning.

    https://www.mind-diagnostics.org/blog/narcissistic-personality/narcissistic-personality-disorder-dsm-5-criteria-and-treatment-options

    That’s why the DSM 5 criteria have more focus on the individual’s impairment and distress:

    The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and pathological personality traits.

    To diagnose a narcissistic personality disorder, the following criteria must be met:

    A. Significant impairments in personality functioning manifest by:

    1. Impairments in self-functioning (a or b):

    a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.

    b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high to see oneself as exceptional or too low based on a sense of entitlement, often unaware of their own motivations.

    1. Impairments in interpersonal functioning (a or b):

    a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.

    b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others‟ experiences and predominance of a need for personal gain

    B. Pathological personality traits in the following domain:

    1. Antagonism, characterized by:

    a. Grandiosity: Feelings of entitlement, either overt or covert self-centeredness; firmly holding to the belief that one is better than others, condescending toward others.

    b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.

    C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

    D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.

    E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).


  • I think the behaviors that contribute to this, though diagnostically and medically relevant, are generally deservedly stigmatized.

    Sure, but only one of the nine diagnostic criteria is a behaviour. Most of them are feelings. Oftentimes bad feelings cause bad behaviour, but a bad feeling isn’t enough evidence to call someone an abuser. If we start telling people they can’t feel certain ways, we’re basically inventing the concept of thoughtcrimes.

    And yeah, people with NPD are very often attacked by neurotypicals for their thoughtcrimes.


  • The caregiver or partner then continues to present the person as being sick or injured, convincing others of the condition/s and their own suffering as the caregiver.

    The causes of FDIA are generally unknown, yet it is believed among physicians and mental health professionals that the disorder is associated with the ‘caregiver’ having experienced traumatic events during childhood

    The primary motive is believed to be to gain significant attention and sympathy, often with an underlying need to lie and a desire to manipulate others

    Drag isn’t especially familiar with MBP, but this is what Wikipedia says in the introduction. That the caregiver is convinced that they’re suffering and that they need attention and sympathy. Those are the actions of someone who’s in pain, and a link to trauma makes it all make sense.

    But yes, the fact that medicine is for helping patients is controversial in the psychiatric community. There’s considerable debate on the subject. But the guy who wrote the DSM IV criteria for NPD has stated in multiple interviews that Trump doesn’t have NPD, because he isn’t suffering.

    American psychiatrists have to follow the Goldwater Rule, which says not to speculate on the disorders of public figures. Why? Because that’s not what diagnosis is for. Diagnosis is the first step in a plan to treat a patient and help them. Diagnosis should never be about insulting, labelling, or stigmatising a patient in the eyes of others. That’s a violation of the Hippocratic Oath.





  • Dragon Rider (drag)@lemmy.nztoAsklemmy@lemmy.mlWhy is NPD so stigmatized?
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    for a personality disorder that primarily manifests in traits that harm people

    Drag thinks you’ve misunderstood the diagnostic criteria. The criteria specifically refer to manifestations of the traits that harm the patient. Traits that harm others aren’t counted as diagnostically significant. Like, take the “excessive need for admiration” criterion. That one’s only medically significant if the patient is suffering because of their need. If they’re abusing other people into praising them and getting what they want, then they don’t have NPD.

    For example, Donald Trump has the traits as a layperson would understand them, but not as a psychiatrist would understand them. Because they’re not hurting him. Doctors only care if the patient is suffering. No pain, no disorder.



  • Dragon Rider (drag)@lemmy.nztoAsklemmy@lemmy.mlWhy is NPD so stigmatized?
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    People don’t understand that medicine is about helping the patient. They read the diagnostic criteria for NPD, and they don’t understand that those things are only medically significant if they harm the patient. They think the criteria is a list of bad behaviour that hurts others.

    Teach people what medicine is, and the stigma disappears.