You can think of personality as a landscape of possibilities. Personality disorders would be places on that landscape that are undesirable where a certain percentage of people tend to congregate and which we have given names to. You will always have cases of people that are in the dysfunctional region of that landscape but cannot neatly be labelled by the classifications that are agreed upon at this time.
Someone I know got the diagnosis of "personality disorder NOS" back in the mid 90s. He would just say the wildest things you could imagine but he wasn't delusional at all and had no psychosis. In high school it was funny to have him around because he would blurt out the strangest things but he's in his mid 30s and is still like that and hasn't matured past that of a 14 year old. He was usually friendly and seemed to always be in a great mood. I bet he fits in with ASPD as well and spent much of his adult life in prison and is very manipulative and criminal. I saw him a few years ago and asked him how he was doing. He told me he lived in a graveyard and ate corpses. I said ok Josh that's great have a nice day.
Kristine He'll be headed back to prison or the state hospital soon, no doubt. If he kills someone, you could be called as a witness in the penalty phase to offer evidence of a mitigating factor.
I would like to hear your expertise on the effects of near total social isolation (including social rejection in the equation) as well as chronic loneliness on mental health. Have a very nice day.
@@kevinhornbuckle Indeed. There seem to be a lot of cases like Robin Williams (actor), that is to say, who has a very active social life with people who do not really match them. So they feel "alone". But this is not those cases that interests me.
@@kevinhornbuckle People do not need to have a mediatised life to feel the same emptiness that Robins Williams felt. But again, I'm not talking about this kind of loneliness. There are people who have been living alone for years, who have no friends or family, no childrens. The only social interactions they have, is limited with the cashier to pay their groceries. When the phone rings at home, they become almost nervous to answer it, since it's so rare that someone deigns to talk to them. Even on social networks, only sadistic trolls respond to them to insult them. In short, they have become almost social hermits.
I know someone assessed by 4 psychiatrists of which two of them said she has personality disorder " nos" and the other two said she has Bpd. I reckon "nos" is not listed in the current version of DSM. I think clinicians and psychiatrists should delve deeper into personality disorders as i think they are still lacking a lot and behind in this specific field as far as diagnosis, therapy and prognosis. As for the case study, i think this guy is just a smug with Ocpd traits. Maybe reading this piece of literature you mentioned would change my shallow opinion. You're doing a great job anyways. There's something about your seriousness that's really likable. Thanks for the detailed and objective infos. Good luck!
Dr. Grande, love the case studies. They give insight into complex conditions. It would be interesting to hear case studies on pedophilia. Seriously, I think it's a complex problem that is poorly understood.
Yes, it's a very dark and uncomfortable topic but i think it is really important to bring more light to it. If anyone hasn't heard it yet, "Hunting Warhead" is a podcast focusing mostly on the ben faulkner case but touched on some general issues too regarding pedophilia. Really well done and fascinating podcast, but some of the subject matter is extremely disturbing and truly horrible, so fair warning.
"Generalized Craziness with Artistic..." (look it up in the ICD-9! ... there's a copy in the Reference section at the library. It's an outragious index of every possible reason that might need medical intervention. Fun.)
My brother has an old electric can opener that was from the late 80s and hasn't worked in 20 years. I asked him why we wouldn't throw it away and he said because it was the first can opener he ever had.
Maybe it is part of the process of reconciling the ideal and the real. I have always loved vintage high performance cars and many years ago bought a 6 series used BMW which was incredible, however, the reality of virtually monthly shop maintenance/repair with high priced parts quickly disabused me of this fantasy. As boring as they may be, the reliability of a Honda or Toyota product was better aligned with the amount of time and money I wanted to devote to transportation expenses. So I now appreciate the homely `beauty' of a nondescript, reliable, mundane Honda who is called Young Lochinvar.
Thanks for this interesting case study video Dr. Grande. It was very surprising to hear, knowing from studies, that being high on conscientiousness on the FFM, but not being near having OCPD is not unsual. I wish you could explain more about this in maybe doing once a video about the relationship between being (very) high on conscientiousness and having OCPD, yes or no 😃🇳🇱
(Sam Vaknin says that psychology is really literature; and that the greatest psychologist ever was not Sigmund Freud--it was Fyodor Dostoevsky, the great Russian novelist. Vaknin says that "Raskolnikov," in "Crime and Punishment," is the most accurate portrait we have of a psychopath.)
It's hard to imagine even the possibility of a therapeutic alliance being formed between a clinician so focused on formal diagnosis and a client so unapproachable. I don't recall if Dr. Grande said the client was self referred. Did he perceive himself to be in need of psychological help? The clinician is said to be psychodynamically oriented. However, it seems that malformed attachment (from a family systems perspective) would have been a more helpful line of inquiry. The male client over-identified with his mother and it seems obvious the mother reinforced in her son a dim view of his father. That attachment malformation appears to have left the son injured for life. There was no mention of prognosis or outcome. I am assuming there was no improvement.
I know this is old, but “Michael” was self-referred because he was scheduled for jury duty and was worried about it because he thought he might hate the other jurors.
Happy Turkey Day doc! You are the only one I ever hear talking about OCPD, but I think it's probably much more common than we realize. Is there an overlap with NPD? My ex made me organize the canned food alphabetically in the pantry and label all the drawers and shelves and organize the medicine by organ system.
I think with NPD the person has a lot of issues.They have an obsessive need to control us and most situations.The pantry need for control I haven't heard much about on comments and that made me smile a bit because that is completely understandable.The narc always has to be in control, it must make all their deep seated insecurities feel more comfortable.
@@Adara007I hope all goes well for you with your healing.Covert narcs are the worst in my eyes as they really play the victim and do a good job of making people believe their lies.The covert narcs that I have dealt with are extremely stubborn people,ignorant and unreasonable.They are very unchangeable and stuck in their denial.No or low contact with them is necessary for our mental and physical health. Keep well.
Michael strikes me as being chronically immature. One thing that sticks out to me - your Rolls Royce story reflects this - is that Michael's perfectionism is not just about idealisation but also mistaken attribution of value; not just wanting things to be "perfect" but also conceiving of what perfection would look like in a very distorted, single-dimensional manner. Is it possible that perfectionism is less about wanting things to be "perfect" and more about misattribution of the value of things? This would also imply that while, to some extent, perfectionism might be in the eye of the beholder, a categorical definition for it might be around the presence of a rigid and maladaptive conceptualisation of value.
Very Intriguing indeed!!! I agree that there was a lack of information regarding childhood, interpersonal relationships etc etc The dynamics of which could totally change the way that this case study presents & clinical diagnosis. I did think that the notions of Idealized Prestige & the things of Beauty were an expression of Grandiosity. What say you Dr Grande?
Thank you for the analysis, Dr. Grande!! I'm not an expert on this, but learn step by step through your channel😌 Again, thank you for your work, and Happy Thanksgiving, Doc, and God bless🙏🤞
Just going off of what's here ASD seems likely. Perfectionism, eccentricity, inflexibility, resistance to change (refused to learn software), loner, sensitive to sound (noise complaints), life long special interest, people found him annoying, few friends with no shared interests during childhood. Social, sensory and restricted interests are all present here.
I have a unspecified personality disorder. Doctor grande I finally learned how I am. Borderline, narcissistic and antisocial . I don’t fit any of these.
Very compelling Case. I absolutely see the prominence of Obsessive Compulsive traits. This is someone who could never bring himself to color outside the lines, or get over a minor scratch in the paint job. For the edification of all: The artistic style associated with the 18th Century French Royal Court is called "Baroque." The Music is marked by tedium and lack of dynamism (even tempo), architecture & interior design & appointments see high polish and ultra-fine detail. Lavish fashions (think Marie Antoinette). Visual art is full of beautifying the Royal Court and fantasy romance where the high-brow dandy dressed to the "nines" courts the elegant Lady with powdered wig and corset. It's actually got some merit to it, though could underlie some Nazi-ish sentiments. Hopefully, not the case here. Anyhow, the perfect decadence that was the Royal French Baroque style is just not a reasonable existence to expect today. And, of course, then came the Guillotine, and with it, Michael's dreamscape was dashed asunder. I think the non-clinical diagnosis here is: Severe Mama's Boyism. Thanks, Doctor. Great Case Study.
Maybe it wasn't included but I would be very curious to hear A LOT more about the culture he grew up in and how it shaped him. Since he immigrated here perhaps he and his family had a very difficult time adapting to what some might consider a maladaptive culture. There are many financial and social stressors in doing so. How did those play out in his POV? Also, were there any religious beleifs? Having been involved in the art community for many years, I can say that being narcissistic (as a trait, not disorder) can be adaptive within the community as many people are "outcasts" and want to feel important. Acting as though you are more talented than others is a common behavior. There is also a tremedous amount of neroticism and poor interpersonal skills within the community. The upside to that is if I am uncomfortable around people its easier to "fit in" around others who are also masking discomfort with overt behaviors. Several questions there about the client's perspective would be helpful. A Rolls Royce may have a certain connotation in our culture but in other European cultures it may hold MUCH more value. While, they are, from an engineering POV, of poor reliablility and have many issues, from a craftsmanship POV Rolls Royce is one of the last large businesses in the world that still builds SOME parts of the car by hand AND is a rarity in that they STILL have an apprenticeship where the old take on the young for many specialties within the assembly-line. That in itself may add to the allure of the car and represent something to the client. Or maybe not. Only questions will tell. Finally, I would like to know more about how he sees his own lonliness. If he came from a culutre where he felt isolated and then immigrated to another culture did that intensify the anxiety? Did the lonliness increase? What does it mean to him to be lonlely? Specialness and lonliness go hand in hand often times regardless of whether the specialness is authentic or not.
What part of the Art World have you been exposed to? I agree that people who act as though they are more talented then others is common in certain circles. I wondered which Arts you are speaking of?
I do not know whether you have read a book called Psychoanalytic Diagnosis, by Nancy McWilliams (2011) (it is about personality from a psychoanalytic viewpoint), but in my opinion Michael seems fairly well to match what she calls a "schizoid" personality -- difficulty negotiating with people, loneliness, creativity, living in fantasy, belief that he is special.
I had one client with OCPD and found it to be a very difficult case. I get the impression that the rigidity makes these clients always difficult to effect change.
I think this case study was quite interesting it was like he met SOME criteria but didn't fully stay in one place, you know? I feel like he had a clustered of different personalities disorders but it would have helped to have a bit more detail on him. Thank you for sharing this case study! Really enjoying your channel Dr Grande.
Hello dr. Grande and congratulations on your always interesting content. I love your precise, scientific approach. I think my husband qualifies for ocpd. He Is a perfectionist, extremely preoccupied with his job and with housechores. He often distrusts the way i handle things. They have to be done his way. Sometimes when he's under stress he would redo the dishes i have just done. He Is capable of getting upset if i spill one drop of water on the kitchen floor and he can barely sleep if the bed hasn't been remade entirely, even at midnight if it hasn't been made for some reason. He only sleeps on one side and Is easily bothered by my moving around in bed. He Is not miserly with spending but he Will procrastinate for weeks or months when a bigger expense Is on the plate, such as a vacation or a household appliance or a wifi subscription. He Is 90 per cent focused on work and would not do anything much else if my daughter and i didn't request It. He's very High on conscientiousness and very dependable but not always relaxing to live with
Very interesting, and you said a lot in the very beginning: “east european immigrant”- there is a lot of general societal conditioning that explains his tendency for perfectionism, idealization of a foreign long gone era- French 18th century- in short many elements of inculcated societal morays
I have 7 of the characteristics associated with OCPD, as Dr. Grande described it. Personally I think that everyone should be this way. It is a superior form of living and it baffles me that the medical community considers these traits to be somehow abnormal and undesirable.
I think the Rolls Royce car depends on the cultural context. Here in the UK they are most certainly perceived as being beautiful / iconic and as having superior workmanship! Owning a Rolls Royce is seen by many Brits as being a very aspirational luxury and would probably be offended to hear you speak that way about our beloved car 😂
Status symbol that's supposed to reflect its owners wealth typically form has surpassed substance/ practicality. But you might sell the shadow for the substance to another narcissistic collector.
I absolutely thought of autism to be honest! also... laughing a little because according to the 5 factor model, we have basically the same personality and I kept thinking before this was mentionned "ok... relatable..." ahah. I have autism and adhd.
It all goes back to our childood and the family environment it seems.Michael would have witnessed a dysfunctional relationship between his parents for sure.His mother sounds like the caring one and as the father is described as having a lot of narcissistic traits, he wouldn't have known how to develop a close relationship with his son.Michaels dreams about rescuing females says a lot about the sadness or frustration his mother probably displayed towards the father.Michael was going to have a few issues coming from a home environment such as this,he probably was a confused young boy.As young children, we are learning from our caregivers how to function in life.If people come from an unstable home it is going to give them self esteem issues of some kind,either inflated or deflated.
Having trouble diagnosing need help the subject. crossover symptoms anxiety depression, ocd, npd, nuerotic, narcisism 1. Repeats stories about people in his past also repeats news stories where people act crude and people died or suffered ( at least thats not me) 2. Stubborn rationilization, rigid philosophy and rituals, ocd behavior, wont shake hands, goes through bottles of rubbing alcohal , but then sleeps on the floor and lets dirty laundry get wet and mold. 3. thinks hes perfect human specimen , definately grandiose 4. uses his mental disorder as an excuse, says #1 priority is to get better and become true self but wont take any responsibility for it, wont change behavior or thought patterns. False self protecting himself from ego 5. Lazy, distracts himself with mickey mouse tasks, gets involved with people he feels are lesser than him and borrows money and pays back high interest, pays $50 for someone to do laundry when it could cost $3 with the washer in the apt. Lost car on loan max loan, let condo get foreclised, uses money from trust to leverage and loses it, spends on eating out. 6. amiable and talkative but always steers conversation to repetitive nostolgic self. Obsesssed with useing money to even up with people he wronged in his past, or like he runs over a dog and then gives money to spca, uses money in place of emotion. Subject history 55yr old at12yrs old grandma died, dad left, anxiety started, early 20s criminal activity daredevil stuff, low end jobs getting fired over incompetence, 26 breakdown mental hospital, jail 5 yrs for drug running, since 35 on straight and narrow lives off trust, 20yrs of just eating and mismanaging money and repeat. Has criteria of many disorders, wont try any change in behavior or thought but at same time thinks he will get better. Blames it on dna, brain damage, takes no responsibilty or understands behavior and thoughts can heel himself.
Hi - just found this channel, kinda a relief finding some legit data on Mixed Personality Disorder which mine usually show up as (traits of A,B,C plus full) This on top of BP1, major anxieties, autism and physical limitations...also CPTSD which makes life even more fun, I have extremely bad night terrors. This is not new to me, I’ve known since my early teens/20’s... but it’s way easier to say “I have Bipolar” than “Borderline” (full) or Mixed Personality Disorder because 1) No one knows what the freck frack I’m on about and 2) what they do hear is horrifying and filled with negative stigma. I’ve read a few times the pain of having Borderline PD is like being on a pain scale at a constant 8. I have strong empathy I have a lot of toxic traits I have a lot of good traits I’m human, I take my meds But I’ll never function in the society created as a whole without life long help. I have a specialist team and everyday I just try to be a bit better
the way "michael's" coworkers described him...those were his own words, right? i am assuming the therapist didn't interview his coworkers to get these assesments...so, really, the poor impressions were michael's own inferences....additionally the rolls-royce might have appealed to him because it is a brand with "old england" stylistic features...class, elegance, and dignity...function might not have even factored in.
Isn't it true that the word Unspecified along with a category of illnesses whould never be recorded on any medical file or case history? After all, how can any personality disorder be recorded as unspecified for posterity unless either the person being dignosed is living in a dictatorship environment or the person died of suicide before being assessed? In Michael's case, depending on what happened next after he did or did not get any treatment for a mental illness and/or after he did or did not get any treatment for what some clinicians at the time of reviewing the case were hoping would be the right mental illness or personality disorder combination in Michael that would best fit his signs and symptoms -- The fact that his medical history still has the phrase Unspecified PErsonality Disorder on it could be evidence that he was living in a dictatship situation both in his private life and the nation of his birth. For example if Michael was travelling to get away from that dictatorship situation but after a series of setbacks died of exposure instead of getting only appropriate treatment for a mental illness only then in my own opinion I would call it some evidence that Michael was in a tough situation when making the wrong decision to leave before all of his ducks were in order and perhaps becausse he didn't get proper treatment for a mental illness soon enough he died. Another example that would be evidence of a dctatorship factoring in would be if instead Micheal got treatment for a mental illness and then later got extradited to a different nation in which there his electronic medical history was used not long before he was found dead in his room while professionals there were still trying to agree on some personality disorder again that to me would be evidence that a dictatorship was factoring into the case as to why Unspecified Personality Disorder could still be associated with his name and file.
Definitions are labels . And labels can be outgrown or not fit at all because as we have seen in your you tube psychotherapists are somewhat like economists they can and do disagree on diagnoses and treatment . Just look at the dsm adding and subtracting .
When I got diagnosed she (the psychologist) called it in letter Personality trait disorder but now just Personality Disorder. I want to add that mine is not specified though.
The old car & hanging onto the fantasy image of mom seems like the "reluctance to part with old objects" criteria. Also, the fine art angle - I bet there's a bunch of crappy French style furniture at home.
I take it there are way more people who fall short of satisfying across the broad category of Personality Disorders than those that satisfy them (RE DSM4 rev). They are still entitled to prescription meds right?
I tried to read the article but couldn't login without a Wilmington U password. I guess it's enough to say here that "Michael" has an extreme case of MOM and maybe even Oedipal, but mostly, he just sounds kinda like a jerk. Good thing I'm not the diagnoser. 😄 Thank you, Dr. Grande. 👍🌹
Doesn’t the subject have to have sexual feelings towards the mom to qualify as Oedipal complex? Does this ancient Freudian diagnosis even exist in the updated versions of the handbook? Can you use OCEAN to diagnose a patient as being jerk?
I know this isn’t kind or professional but I couldn’t help but think of Norman from the movie Psycho when he described “Michael’s” relationship with his mother.
It doesn't get more 'Machiavellian', in a literal sense, than having frequent fantasies about being an aristocratic European courtier from a previous century (which Machiavelli was, of course)!
thank you for this interesting video. I am not able to open the cast study from the link. is there any chance you could add a PDF file of this case study?
sometimes, with all the diagnoses labelling, i quite lose the idea of what you’re talking about. i’m going to have to find a good list of diagnoses liste in clusters of similarity and the basic labels like a diagnosis and what is meant when personality is added to one. ocdp and ocd. - with short definitions. any suggestions? thanks much :) 🌷
This"Michael" sounds rather disagreeable (as per the OCEAN criteria) so I was surprised that he apparently was agreeable. He definitely was overly critical towards others. I'm glad I wasn't his clinician - I think I'd find him as much a "maintenance nightmare" as his car! And he sounds overly attached to his idealised version of his mother who I'm sure "Michael" would be shocked to discover actually was far from 'perfect.' I enjoy some SCA and historical matters but this "Michael" sounds far too invested in idealising certain historical periods to instead enter a fantasy world where knights 'rescued' women and he was a "cultured, sophisticated" man who was never satisfied with the women he met. I'm unsurprised by the fact mostly the women ended the relationships with him - he really sounds not just "stuffy" but full of hubris and grandiosity with ridiculously unrealistic perfectionism. It would be helpful to have more research in the area of personality disorders. Thank you for another case study. I always find these particularly helpful as well as interesting.
I've been diagnosed with unspecified personality disorder with traits of borderline personality disorder. I originally thought I was just autistic but apparently not
You probably are autistic. Get a second or even third opinion. Don’t bring up the PD diagnosis, just present yourself how you are and see what conclusion they come to
This character sounds like he borrowed from a Robin William's movie . HES HIGH IN KNIGHTHOOD FANTASIES . MOTHER PROJECTED HER IDEALIZED FANTASIES UPON HIM AND MADE HIM PSYCHOLOGICALLY INFANTILLY DEPENDENT. Youd have used the MMPI . HES GRIEVING HIS MOTHERS LOSS AND PERSEVERATING HER MEMORY PROJECTING HER IDEALS UPON ANY PROSPECTIVE MATE. NONE OF THEM CAN LIVE UP TO HIS INFANTILE IDEALIZATION. Control of his environment and others reflects his idealization of his past.