Hi Dr Vaknin
I am hoping that you can shed some light on my ex-partner (mother of my children) and diagnostic criteria in DMS 5.
I will try to be brief. She is undiagnosed and I am not qualified to make a diagnosis. However, I have known her for over 20 years (in an intimate relationship for 10 years) and in my exasperated search for meaning, I have read widely.
To cut right to the chase, I am certain that she has a personality disorder, as all conditions (A to E) under the "General Criteria for a Personality Disorder", as outlined in DSM 5, appear to be satisfied. My question here is around criterion C. When considered from my perspective, her impairments in personality functioning and personality trait expression are obvious, stable across time and consistent across situations. However, aside from myself, I am not aware of any other adult person that is adversely affected by, or even aware of, her psychopathology. It seems to me that no other adult in her life has sufficient access and insight to identify and/or understand; to the outside world, she appears a normal-range mother and her family appears normal. It also feels like I am the only person that suffers the wrath of her condition. Her current partner and my kids do, obviously, but her 'family', which I call the regime, operates like a mini-cult, with my ex-partner as the leader and, therefore, in control of the other members. Is it possible that I am the only adult person outside the regime that sees her for what she is?
In terms of a specific disorder, I am certain that she has Narcissistic Personality Disorder (NPD), as this is the only personality disorder for which she satisfies all criteria set out in DSM 5. But, in my unqualified opinion, she has impairments in personality functioning and the presence of pathological personality traits that strongly correlate with other disorders.
For example, she appears to satisfy all criteria for Antisocial Personality Disorder (ASD), apart from those under B2 (disinhibition characterised by irresponsibility, impulsivity and risk-taking). From my perspective, the pathological personality traits for APD (manipulativeness, deceitfulness, callousness and hostility) are more representative of her behaviour than the corresponding traits for NPD (grandiosity and attention seeking), but she demonstrates all of them. I note that 'antagonism' is a pathological personality traits shared with NPD, which seems to further confirm my feeling of correlation between the conditions.
Furthermore, she appears to satisfy all criteria for Borderline Personality Disorder (BSD), apart from those under B2 (disinhibition characterised by impulsivity and risk-taking). In particular, I have much exposure to her dissociative states under stress (lies, distorts reality and rewrites history), inclination for interpersonal hypersensitivity (prone to feel slighted or insulted), perceptions of others selectively biased toward negative attributes or vulnerabilities (splitting, persecutory delusions), frequent mood changes that are easily aroused, intense, and out of proportion, and fear of losing control (complete control freak). I also note that 'antagonism' is a pathological personality traits shared with APD and NPD, which seems to further confirm my feeling of correlation between the conditions.
Finally, she also exhibits the majority of the impairments in personality functioning that align with Schizotypal Personality Disorder SPD), but most of the associated pathological personality traits appear to be absent, with the clear exception of B3 (negative affectivity characterised by suspiciousness).
Dr Vaknin, can you provide any advice, insight or information on my ex-partners apparent co-morbidity? I feel that she manifests the majority of the impairments in personality functioning and personality trait expression for two of the referenced disorders (APD and BPD), along with the majority of the impairments in personality functioning that align with SPD, yet satisfies all of the personality functioning and personality trait expression criteria for only one, NPD.
Clearly, she is a nightmare to deal with at the best of times, but is particularly difficult when under stress.
I hold grave fears for my children, whom she is working hard to alienate from me, and am torn between legal action to remove them from her custody (which would ensure a lengthy period of dealing with her at her absolute worst) and/or appeasement, to reduce her impact on the boys through their adolescence (they are twins, turning 13 in January).
As it stands, we share care 50/50, which makes it difficult for her to gain much traction in her attempts to alienate the boys from me.
Thanks in advance for any advice, insight or information you can provide.