Your 5 least and most favorite psych diagnoses

[nancysinatra]

I am bored lately so I have been posting a lot. Here's a question another thread inspired me to ask: What are your 5 least and most favorite psychiatric diagnoses to work with, and 5 things you'd like to see more often?

Here's my list.

Least favorite:
5) Somatization disorder and related complaints (i.e "I'm really sensitive to medications" but the person tolerates their vicodin and medical meds just fine)
4) PTSD
3) Run of the mill depression
2) Bipolar disorder
1) PseudoADHD (i.e. most adult ADHD claims)

Most favorite:
5) Uncomplicated but severe hypochondriasis
4) Aspergers, especially among university students majoring in a science. (Those patients are smart!)
3) ASPD (must have a verified conduct d/o history)
2) Qualifying classic cases of anorexia and bulimia (not just "someone's mom thinks so" and no unorthodox middle-aged onset cases)
1) Munchausens by Proxy and Munchausens, especially if caught in the act

Things I'd like to see more often (or just see once):
5) Body dysmorphic disorder
4) NPD (as chief complaint only, not merely accessory to another complaint) or Schizotypal PD
3) Simple phobias, especially of spiders and other animals
2) Pyromania
1) Dissociative fugue

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[OldPsychDoc]

I'll play...

Least favorite:
5) Cluster B personality disorders with Co-morbid opiate & benzodiazepine dependence
4) Chronic, untreated, life-long PTSD
3) Dysthymia
2) Pain disorder
1) #2-5 simultaneously in the same patient.

Most favorite:
5) Social phobia
4) Alcohol dependence in contemplation or preparation stages
3) New onset PTSD
2) Major depression with multiple neurovegetative features.
1) Catatonia (--because a couple of shocks and-- damn!--they get better!)

Things I'd like to see more often (or just see once):
4) Temporal lobe epilepsy
3) PANDAS
2) Real bipolar disorder, with discrete manic episodes.
1) Schizophrenia with preserved insight

 

[splik]

Least favorite:
5) treatment-resistant depression (yeah this patient has a terrible life story and they're 'treatment-resistant' because there's no pill for that or they have undiagnosed personality disorder)
4) disruptive mood dysregulation disorder (this pathetic diagnosis makes a mockery of the already shambolic process of psychiatric diagnosis)
3) pediatric bipolar disorder (no diagnosis has done more damage to so many young people and so much damage to American psychiatry)
2) schizoaffective disorder (this patient very likely has borderline personality disorder or PTSD or both but why is this so common when it's so rare?)
1) depression NOS (this is NOT a diagnosis; stop f***ing putting this in the chart)

Most favorite:
5) catatonia (fun, very often overlooked, nice response to ativan)
4) morbid jealousy (fun patients, nice forensic diagnosis, responds well to SSRIs and ERP)
3) Capgras syndrome (fun patients, often have brain rot, reminds me of invaders of the body snatchers!)
2) de Clerembault syndrome (nice forensic diagnosis, questions the nature of love- is romantic love always delusional?)
1) new onset-conversion disorder (easily hypnotized out of it!)

Things I'd like to see more often (or just see once):
5) psychiatric factitious disorder (how crazy is it to pretend to be crazy for unclear reasons?!)
4) Ganser syndrome (seen one possible case, just really interesting)
3) koro (i am waiting for the day a patient come into the office holding onto his penis in the fear it is retracting into his body)
2) amok (or any hystero-psychosis)
1) Fregoli syndrome (delusions of misidentification are really interesting)

 

[st2205]

Least favorite:

5. Pseudo schizophrenia
4. Pseudo bipolar
3. Not a diagnosis but CC of HI that we're forced to admit because society for some reason holds us accountable as if this is our bag.
2-1: Pretty much anything axis II can masquerade as.

Favorite:

1. Legit mania.
2. Substance-induced psychosis.
3. PCP anything.
4. Pleasant people with schizophrenia who don't just have underlying borderline traits.

 

[OldPsychDoc]

Oh--forgot this least favorite: Polysubstance Abuse. It doesn't exist and you're just being too lazy to figure out what they're actually using.

 

[notdeadyet]

Oh--forgot this least favorite: Polysubstance Abuse. It doesn't exist and you're just being too lazy to figure out what they're actually using.

Agree with this. Coffee and cigarettes? What????

For my favorite, it's probably prodromal psychosis. I've been working in an early psychosis clinic for a year and love it. Very diagnostically challenging.

My pet peeve diagnosis has to be substance induced psychosis, which is 90% of the time is misapplied (e.g.:. people use it incorrectly for things like meth intoxication) and the other 10% of the time it has no value (why attribute a single substance to what is a multifactorial process?).

 

[st2205]

My pet peeve diagnosis has to be substance induced psychosis, which is 90% of the time is misapplied (e.g.:. people use it incorrectly for things like meth intoxication) and the other 10% of the time it has no value (why attribute a single substance to what is a multifactorial process?).

I would imagine, at least in the way I see it, is that diagnosis is reached when all the others are unaccounted for, and more specific than a "psychosis NOS". i.e. a 50 year old female with no previous psychiatric history, no previous cognitive deficits and no family history, relapses on meth and has residual paranoia and delusions, without any negative symptoms, that resolves quickly with a little risperdal. A few months later, after another relapse, presents again with psychosis that resolves gradually over a 7 day period with zyprexa. I'm just not sure what else to call it.

 

[vistaril]

Agree with this. Coffee and cigarettes? What????

For my favorite, it's probably prodromal psychosis. I've been working in an early psychosis clinic for a year and love it. Very diagnostically challenging.

My pet peeve diagnosis has to be substance induced psychosis, which is 90% of the time is misapplied (e.g.:. people use it incorrectly for things like meth intoxication) and the other 10% of the time it has no value (why attribute a single substance to what is a multifactorial process?).

how are people generally misapplying it?

 

[SmallBird]

how are people generally misapplying it?

In my experience a common misapplication is substance induced mood disorder, for example when a patient is crashing of cocaine and has mood symptoms. I guess what NDY is suggesting is that someone can look psychotic when acutely intoxicated but that is part of the intoxication syndrome and doesn't warrant the diagnosis of a substance induced psychotic episode, which should presumably persist for some time after the drug is taken.

 

[splik]

In my experience a common misapplication is substance induced mood disorder, for example when a patient is crashing of cocaine and has mood symptoms. I guess what NDY is suggesting is that someone can look psychotic when acutely intoxicated but that is part of the intoxication syndrome and doesn't warrant the diagnosis of a substance induced psychotic episode, which should presumably persist for some time after the drug is taken.

well the DSM-5 for all its failings states: "This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention." - If I see a floridly psychotic patient in the ER whose utox is positive for meth and the next day there is a rapid resolution of symptoms then that is substance induced psychotic disorder. Most people on meth don't become floridly psychotic in the toxidrome, and most do not present to the ER. thus it seems to miss the point to call it simply a substance intoxication since it was psychosis rather than the intoxication per se that was the reason for presentation. Also if the psychosis is persisting once the substance is cleared I would be suspicious of an underlying psychosis or that there is trouble brewing...

I am not sure what the problem is, this is one of the few diagnoses in the DSM that I actually find useful.

 

[vistaril]

well the DSM-5 for all its failings states: "This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention." - If I see a floridly psychotic patient in the ER whose utox is positive for meth and the next day there is a rapid resolution of symptoms then that is substance induced psychotic disorder. Most people on meth don't become floridly psychotic in the toxidrome, and most do not present to the ER. thus it seems to miss the point to call it simply a substance intoxication since it was psychosis rather than the intoxication per se that was the reason for presentation. Also if the psychosis is persisting once the substance is cleared I would be suspicious of an underlying psychosis or that there is trouble brewing...

I am not sure what the problem is, this is one of the few diagnoses in the DSM that I actually find useful.

I generally tend to agree with coding it substance induced psychotic d/o above substance(in this case amphetamines) intoxication....dsm includes increased anxiety and hypervigilance under the spectrum of intoxication, but usually if psychiatry is going to admit a patient from the ER for a day or so because of this it's going to go beyond that and they are hallucinating.

 

[johnhoedack]

This has to be my favorite so far: I saw a case of Morgellon's the other day. Really fascinating. The patient had pulled chunks of flesh off and taken photos of it before saying "can't you see the worms crawling out there?" There was nothing there...

 

[Therapist4Chnge]

Least favorite:
5) "Polysubstance"…annoying dx (non-specific) & drug seeking behavior, etc.
4) Chronic Pain / Fibro. Throw in RLS and IBS…as they seem to be in the mix a lot too.
3) "Treatment Resistant" Depression…in quotes to specify the high non-compliance/no insight/not willing to try anything sub-group
2) (Misdiagnosed) Bipolar disorder/Borderline PD.
1) ASPD. We seem to get turfed these pts under the guise of "needing rehabilitation", when it was a concussion & they are at pre-morbid level of Fx.

Most favorite:
5) ASDs…low functioning respond well to behavioral interventions & higher functioning tend to have some proven interventions that work.
4) Mod/Severe TBI.
3) Most of the dementias.
2) Eating Disorders. Relatively rare, but always interesting cases.
1) Somatization Dx's

 

[nancysinatra]

Also if the psychosis is persisting once the substance is cleared I would be suspicious of an underlying psychosis or that there is trouble brewing...

Unless they were using inhalants, or some of the newer synthetic drugs, or marijuana mixed with formaldahyde... Then all bets are off.

 

[MacDonaldTriad]

What the patient says:
“I’m here so you can treat my Bipolar disorder”
What the doctor hears:
“I’m borderline.”

What the patient says:
“I’m allergic to Haldol.”
What the doctor hears:
“So I’m not the first doctor to think you would benefit from an antipsychotic.”

What the patient says:
“I have ADHD.”
What the doctor thinks:
“Great, another middle age onset need for stimulants that will not cooperate with any attempt at obtaining childhood records or collaterals.”

What the patient says:
“I don’t have schizophrenia.”
What the doctor hears:
“I have schizophrenia.”

Just my small start at a cynical primer on how not to communicate with a psychiatrist.

 

[slappy]

Unless they were using inhalants, or some of the newer synthetic drugs, or marijuana mixed with formaldahyde... Then all bets are off.

Now, I keep hearing about this but have never seen it in practice. My literature search had also led to a few published accounts but they were were all from the 90s. Do you still see patients smoking these "wet" cigarettes? If so, what are the neuro/psych effects, and how do you differentiate from marijuana laced with PCP (sherm stick)? Sorry for going off-topic.

 

[Firewood]

Now, I keep hearing about this but have never seen it in practice. My literature search had also led to a few published accounts but they were were all from the 90s. Do you still see patients smoking these "wet" cigarettes? If so, what are the neuro/psych effects, and how do you differentiate from marijuana laced with PCP (sherm stick)? Sorry for going off-topic.

You may know this, but just to clarify: "formaldehyde" and "embalming fluid" are nicknames for PCP. While you can get high off of true formaldehyde, it's supposedly not a pleasant experience, so around here the only people doing it are the kids (and adults) who don't realize the difference (which unfortunately can include the dealers/manufacturers). "Sherm sticks" are cigarettes dipped in PCP. "Wet" is MJ dipped in PCP that's supposedly still damp, and "fry" is the dessicated stuff. Of course, there's a fair amount of regional difference in terms, so YMMV.

Edit: My point is that the people who are actually using the "formaldehyde"/PCP laced marijuana may not even know that's what they're smoking, and may truly believe it's real formaldehyde. And I think it's even gotten to the point where this stuff is laced and just sold as regular pot. I've seen plenty of people pop on their UDS for THC and PCP, but were surprised to hear about the PCP and denied using "wet/fry". I don't, however, believe it when they say the cocaine they pop for must have been sprinkled in their pot.

 

[Firewood]

And the new synthetic drugs are nasty. Just like Nancy says, we've been seeing quite a few cases of persistent psychosis caused by it.

It's funny: Sometimes I ask the hard-core druggies if they use it and they usually say something like: "F**k no, that stuff'll mess you up!"

 

[nancysinatra]

You may know this, but just to clarify: "formaldehyde" and "embalming fluid" are nicknames for PCP.

I had no idea! Who knew? For over 5 years I have thought that wet or fry (one or the other) actually contained formaldehyde. Now I know better.

Ok if it's PCP though, then what explains the permanent hallucinations some of these people have? I thought that was due to the "formaldehyde" and didn't know it could be associated with PCP.

 

[slappy]

You may know this, but just to clarify: "formaldehyde" and "embalming fluid" are nicknames for PCP. While you can get high off of true formaldehyde, it's supposedly not a pleasant experience, so around here the only people doing it are the kids (and adults) who don't realize the difference (which unfortunately can include the dealers/manufacturers). "Sherm sticks" are cigarettes dipped in PCP. "Wet" is MJ dipped in PCP that's supposedly still damp, and "fry" is the dessicated stuff. Of course, there's a fair amount of regional difference in terms, so YMMV.

Yes, I knew the origin of the term. That PCP was referred to as "fluid" originally (since it also comes in the liquid form) and then somehow it started getting referred to as "embalming fluid" and that eventually became the source of confusion for what the "wet" cigarettes were because embalming fluid is formaldehyde. So, when people mention marijuana mixed with formaldehyde or embalming fluid, they generally mean marijuana mixed with PCP.

That said, PCP is really expensive (whereas formaldehyde is much less expensive and legally obtainable) so I do not know what kind of a dealer laces marijuana with real PCP (dessicated) and still makes a profit. Also, I have read a couple of random reports of marijuana smoked with real formaldehyde but the papers were really brief and inconclusive except a relatively recent one that only talked about the lung injury smoking such a combination causes with no mention of the neuro/psych effects hence I was curious.

 

[slappy]

It's funny: Sometimes I ask the hard-core druggies if they use it and they usually say something like: "F**k no, that stuff'll mess you up!"

Yes, people are also scared of those "sherm sticks", and rightfully so!

 

[shan564]

It's funny: Sometimes I ask the hard-core druggies if they use it and they usually say something like: "F**k no, that stuff'll mess you up!"

Ha yeah, I get that all the time too. When K2 first came out, I remember a bunch of college kids (i.e. my peers at the time) getting their hands on it and being really excited about a cannabis substitute that hadn't yet been illegalized. Now that it's been pretty conclusively linked to acute psychosis, I make sure to ask about it when I get a person who seems to have a substance-induced psychosis, and they always say something like "oh no, I never use THAT stuff... I stick with the natural drugs" or "I just used it once because I didn't want to drop dirty, but now that I see what it can do to you, I'm going back to just regular weed."

 

[smalltownpsych]

Least favorite:
5) ADHD - for kid with x,y, or z problems that cause him to struggle in the school setting
4) Dependent Personality Disorder with opiod dependence with chronic pain with chronic depression
3) Malingering
2) Borderline Personality Disorder when they have been through the mental health system for about 20 years
1) Borderline Personality Disorder that is diagnosed as Bipolar Disorder - I think someone else said that already, but I agree!
Most favorite:
5) Schizophrenia - quite a challenge to treat
4) Adjustment Disorder N.O.S it's amazing how quickly they return to pre-morbid level of high functioning
3) Substance-abuse without significant personality disorder features - see previous response
2) PTSD - especially with traditional masculine types who are resistant to "feelings" the
1) Borderline Personality Disorder when they are still young they appear to respond well to treatment

Things I'd like to see more often (or just see once):
5) Dissociative Identity Disorder (only had one true case so far)
4) Koro - how would I even treat that?
3) Substance-abuse without significant personality disorder features
2) Borderline Personality Disorder not treated with 6 psychotropics, that was actually a good diagnostic indicator at several places I worked
1) Money - not a diagnosis but wouldn't we all like to see more of it?

 

[slappy]

While I don't have favorite diagnoses, the mention of Koro got me thinking. I'd love to see syndromes as bizarre as Cotard, Stendhal, Diogenes, or Capgras/Fregoli once in my career. If anyone has experiences with any like them, do post or even PM. I'm sure those accounts would be properly fascinating to hear.

 

[Firewood]

Ok if it's PCP though, then what explains the permanent hallucinations some of these people have? I thought that was due to the "formaldehyde" and didn't know it could be associated with PCP.

You've got me. I've heard some anecdotal reports of various synthetics being mixed in with MJ by manufacturers and/or dealers to provide a more potent high. Unfortunately, there's no QC or purity standards for this stuff, so who knows what's really being smoked. The persistent psychosis (which I've also seen) could be from anything - synergism, added substances, etc.

Also, I have read a couple of random reports of marijuana smoked with real formaldehyde but the papers were really brief and inconclusive except a relatively recent one that only talked about the lung injury smoking such a combination causes with no mention of the neuro/psych effects hence I was curious.

There's no doubt the terms cause confusion, even among users/dealers/manufacturers, let alone physicians. Consequently, I'm sure there's plenty of people who at least try smoking real formaldehyde in various forms. Some people are even mixing real formaldehyde with PCP liquid and then soaking MJ in it. But I think straight up formaldehyde, even in combo with MJ, isn't very pleasant and likely isn't something people do often.

Again, there's so little known even by the user of exactly what's being smoked that I would think it'd be a hard subject to even do a case report on. Unfortunately, it's not like the old days where you could bring volunteers (read grad students) in and get them high on some known substance to study the effects. As an aside, one of my attendings was involved in that sort of research and has some pretty great stories he shares about it.

 

[nancysinatra]

But I think straight up formaldehyde, even in combo with MJ, isn't very pleasant and likely isn't something people do often.

Odd. Someone above mentioned lung injuries resulting from formaldehyde. If anything you'd think formaldehyde would be good for people, because of its abilities to preserve the body. But alas, no, it sounds like.

Unfortunately, it's not like the old days where you could bring volunteers (read grad students) in and get them high on some known substance to study the effects.

Why not? Is there a reason?

 

[nancysinatra]

Least favorite:
5) ADHD - for kid with x,y, or z problems that cause him to struggle in the school setting
4) Dependent Personality Disorder with opiod dependence with chronic pain with chronic depression
3) Malingering
2) Borderline Personality Disorder when they have been through the mental health system for about 20 years
1) Borderline Personality Disorder that is diagnosed as Bipolar Disorder - I think someone else said that already, but I agree!

I love the specificity of these dislikes, especially #4. I wonder if you had a patient just like that recently - DPD isn't all that common after all, at least not in a treatment setting. I think you may have a new syndrome there - dependent personality, dependent on opioids, with chronic pain and depression - call it "Chronic Dependent Syndrome."

 

[shan564]

I love the specificity of these dislikes, especially #4. I wonder if you had a patient just like that recently - DPD isn't all that common after all, at least not in a treatment setting. I think you may have a new syndrome there - dependent personality, dependent on opioids, with chronic pain and depression - call it "Chronic Dependent Syndrome."

I also took care of a patient who fits that description. But all 4 were legit problems - the dependent personality, chronic pain (with a genuine cause of the pain), opioid dependence (with full-blown withdrawal to the point that she was taking her opioids just to treat the nausea/vomiting rather than for the pain) and depression with a suicide attempt. The depression was probably caused by the opioids and exacerbated by the personality disorder, but it was still there.

 

[smalltownpsych]

I love the specificity of these dislikes, especially #4. I wonder if you had a patient just like that recently - DPD isn't all that common after all, at least not in a treatment setting. I think you may have a new syndrome there - dependent personality, dependent on opioids, with chronic pain and depression - call it "Chronic Dependent Syndrome."

Love that term! I have actually seen a few patients that meet that description. If anybody ever saw Celebrity Rehab, there was at least one celeb that appeared to present that way, as well.

 

[Therapist4Chnge]

While I don't have favorite diagnoses, the mention of Koro got me thinking. I'd love to see syndromes as bizarre as Cotard, Stendhal, Diogenes, or Capgras/Fregoli once in my career. If anyone has experiences with any like them, do post or even PM. I'm sure those accounts would be properly fascinating to hear.

I've seen 1 case of Cotard's (TBI w. multiple lesions present). The original consult was bc the pt wasn't eating and the working theory was severe depression. It took some time, but eventually the pt spoke….to correct me/the team that they didn't want to eat because they didn't need to eat anymore, on account that they were dead and it would just rot in them. The pt. didn't much care for hospital food anyway.

I also saw a pure case of neurologic psychosis (also post-TBI), which presented w. Capgras-like delusions. Once the pt became more aware of things (RANCHOS 5-6), the extent of their delusions became much more apparent. There were quite a few twists and turns with the case because it took a number of weeks to clear PTA, get the pt. participating in rehabilitation, etc. We tried all sorts of cocktails, but there was little progress in regard to the delusions (there were many).

 

[PistolPete]

Amazing how true all of this is.

What the patient says:
“I’m here so you can treat my Bipolar disorder”
What the doctor hears:
“I’m borderline.”

What the patient says:
“I’m allergic to Haldol.”
What the doctor hears:
“So I’m not the first doctor to think you would benefit from an antipsychotic.”

What the patient says:
“I have ADHD.”
What the doctor thinks:
“Great, another middle age onset need for stimulants that will not cooperate with any attempt at obtaining childhood records or collaterals.”

What the patient says:
“I don’t have schizophrenia.”
What the doctor hears:
“I have schizophrenia.”

Just my small start at a cynical primer on how not to communicate with a psychiatrist.

 

[bashir]

I've seen a case of Capgras delusions in a patient with a first psychotic episode, but seeing as it was a sibling of mine and these delusions made it nearly impossible for me to get her treatment I think it goes on my "least favorite diagnosis" list by default.

 

[slappy]

I've seen 1 case of Cotard's (TBI w. multiple lesions present). The original consult was bc the pt wasn't eating and the working theory was severe depression. It took some time, but eventually the pt spoke….to correct me/the team that they didn't want to eat because they didn't need to eat anymore, on account that they were dead and it would just rot in them. The pt. didn't much care for hospital food anyway.

I also saw a pure case of neurologic psychosis (also post-TBI), which presented w. Capgras-like delusions. Once the pt became more aware of things (RANCHOS 5-6), the extent of their delusions became much more apparent. There were quite a few twists and turns with the case because it took a number of weeks to clear PTA, get the pt. participating in rehabilitation, etc. We tried all sorts of cocktails, but there was little progress in regard to the delusions (there were many).

Those were both amazing. Thanks for sharing! I'm curious as to what happened to the patient with Cotard's?

I've seen a case of Capgras delusions in a patient with a first psychotic episode, but seeing as it was a sibling of mine and these delusions made it nearly impossible for me to get her treatment I think it goes on my "least favorite diagnosis" list by default.

I'm so sorry to hear that. Sorry also for inadvertently reminding you of the difficult times.

 

[AcronymAllergy]

While I don't have favorite diagnoses, the mention of Koro got me thinking. I'd love to see syndromes as bizarre as Cotard, Stendhal, Diogenes, or Capgras/Fregoli once in my career. If anyone has experiences with any like them, do post or even PM. I'm sure those accounts would be properly fascinating to hear.

I've seen one case of Capgras-style delusions in a patient with likely AD. He was actually fairly calm about them, saying that after about 30 minutes, his wife would "come back," and that the only distressing aspect was being worried about her safety during the half-hour she would be "missing." Not sure how he's been doing since I saw him, though, unfortunately.

Honestly, I found a particular patient with Korsakoff's to be one of the more interesting (and unfortunate) cases I've seen thus far. He literally went to the bathroom and then forgot who I was. He was also essentially "stuck" a solid two decades in the past with respect to most of his residual memories (e.g., his brother's occupation, whether his parents were alive/deceased, the current president, etc.).

 

[Therapist4Chnge]

I'm curious as to what happened to the patient with Cotard's?

No idea, as the pt was discharged from our unit shortly after the consult.

 

[TitaniumPhoebe]

I am bored lately so I have been posting a lot. Here's a question another thread inspired me to ask: What are your 5 least and most favorite psychiatric diagnoses to work with, and 5 things you'd like to see more often?




Things I'd like to see more often (or just see once):
5) Body dysmorphic disorder
4) NPD (as chief complaint only, not merely accessory to another complaint) or Schizotypal PD
3) Simple phobias, especially of spiders and other animals
2) Pyromania
1) Dissociative fugue

do people EVER admit they even have NPD? I would think usually it's the people who have to put up with them who seek treatment. Narcissists seem to think they have nothing wrong.

 

[shan564]

do people EVER admit they even have NPD? I would think usually it's the people who have to put up with them who seek treatment. Narcissists seem to think they have nothing wrong.

That tends to be true for a lot of personality disorders.

 

[TitaniumPhoebe]

That tends to be true for a lot of personality disorders.

that's what I've seen personally, which is how I ended up in this forum. I'm not a clinician but a person who has dated an NPD, a psychopath, and married a BPD. I am the one in therapy to learn about all this, but none of them thought they had a problem. Well, the BPD ex-husband gets depressed and is treated for that, but as far as I know, no diagnosis of a personality disorder. I wonder how any of them ever get diagnosed as having one unless it's through the courts.

 

[touchpause13]

do people EVER admit they even have NPD? I would think usually it's the people who have to put up with them who seek treatment. Narcissists seem to think they have nothing wrong.

I swear to god my MIL has NPD. I don't think she has ever apologized for anything in her entire life