Personality Couch

Ep 21: Narcissistic Personality Disorder | The 9 Symptoms

In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) delve into the complexities of narcissism and narcissistic personality disorder (NPD). We explore the historical origins of narcissism, the DSM criteria for diagnosing NPD, and the key characteristics of individuals with this disorder, including a lack of empathy and pervasive envy. Our conversation highlights the roots, characteristics, and the dual nature of narcissism, as well as the challenges in researching NPD. We highlight characteristics such as grandiose self-importance, the need for excessive admiration, and the interpersonal exploitation that can occur in relationships. We also give a preview on the vulnerable aspects of narcissism, highlighting how it can manifest as low self-esteem and social withdrawal, a topic that will be discussed in an upcoming episode!
Chapters00:00 Intro to Narcissistic Personality Disorder01:07 Historical Context of Narcissism06:02 Defining Narcissistic Personality Disorder09:32 First Symptom: Lack of Empathy     10:52 NPD vs Autism14:24 Second Symptom: Envy15:46 Third Symptom: Fantasies of Success, Power, Beauty16:33 Fourth Symptom: Grandiosity17:55 Fifth Symptom: The Need for Specialness20:54 Sixth Symptom: Excessive Admiration22:22 Seventh Symptom: Entitlement24:17 Eighth Symptom: Exploitation in Relationships26:25 Ninth Symptom: Arrogance and Haughty Attitudes27:37 Vulnerable Narcissism
References:
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th edition, text revision.). https://doi.org/10.1176/appi.books.9780890425787 Blaney, P. H., Krueger, R. F., Millon, T. (Eds.). (2014). Oxford textbook of psychopathology (3rd ed.). Oxford University Press.
Blashfield, R. K., & Intoccia, V. (2000). Growth of literature on the topic of personality disorders. American Journal of Psychiatry, 157(3), 472-473.
Millon, T. (2011). Disorders of personality: Introducing a DSM / ICD spectrum from normal to abnormal (3rd edition). John Wiley & Sons, Inc.
South, S. C., Eaton, N. R., & Krueger, R. F. (2011). Narcissism in official psychiatric classification systems: Toward DSM-5. In Campbell, W. K. & Miller, J. D. (Eds.), The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments (pp. 22-30). John Wiley & Sons, Inc.. https://doi.org/10.1002/9781118093108.ch3

Ep 20: Narcissism Gone Bad | 5 Signs Its Pathological

In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) unpack the 5 major signs of pathological narcissism, as well as 3 bonus invisible signs of narcissism. We explore warning signs of pride, superiority, vanity, and inauthenticity (among others!), providing insights into how these traits manifest in behavior and relationships. We also explore how anger and lack of empathy manifest. We end the episode by discussing vulnerable narcissistic themes that are less observable, like emptiness, helplessness, and low self-esteem. Our discussion highlights everyday narcissism, as well as darker aspects of it, including antisocial and murderous examples of such.
Chapters
00:00 Introduction to Pathological Narcissism01:28 Defining Pathological Narcissism04:55 Sign 1 of Pathological Narcissism: Pride & Self-Righteousness   07:06 Defining Defensive Self-Sufficiency   08:45 Vigilante Narcissism10:45 Sign 2 of Pathological Narcissism: Superiority & Inferiority   13:20 Specialness & Entitlement16:50 Sign 3 of Pathological Narcissism: Vanity & Inauthenticity19:23 Sign 4 of Pathological Narcissism: Anger & Contempt22:45 Sign 5 of Pathological Narcissism: Decreased Empathy & Callousness26:12 Invisible Signs of Pathological Narcissism (Vulnerable Narcissism)32:44 Summary and Closing
References:
Blaney, P. H., Krueger, R. F., Millon, T. (Eds.). (2014). Oxford textbook of psychopathology (3rd ed.). Oxford University Press.
McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press.

Ep 19: Is Narcissism Good? The Surprising Truth About Self-Importance

In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) delve into the complexities of narcissism, exploring its cultural labeling, the distinction between pathological and trait narcissism, and its development from infancy. We discuss the importance of understanding narcissism in contemporary society, the confusion surrounding its definition, and how it manifests in all personality pathology and personality disorders. The conversation emphasizes the need for clarity in labeling narcissistic behaviors, the balance between healthy and pathological narcissism, and the impact of parenting styles on narcissistic traits. Our discussion highlights the importance of understanding narcissism as a spectrum and the need for realistic self-reflection.
Chapters
00:00 Introduction to Narcissism and Misuse of the Term03:31 What is Narcissism?10:38 Narcissism in Childhood Development16:13 Pathological Narcissism24:12 The Role of Parenting in Narcissistic Development25:22 The Complexity and Variability of Narcissism
Personality Couch Links
Website https://www.personalitycouch.com/

Ep 18: The 6 Mental Health Trends: 2024 in Review

In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) explore the cultural and clinical trends of 2024, focusing on global unrest, political polarization, re-examining power dynamics, and the ongoing mental health crisis. We discuss the impact of trauma awareness and the complexities of the victim mentality, as well as state-specific mental health trends revealed through recent research. In this episode, we further explore the state of mental health in America, discussing various mental health trends across states, the impact of misinformation on mental health, and the public's outrage towards healthcare practices, as evidenced in the assassination of United Healthcare’s CEO. We delve into the role of venture capital in telehealth and the ethical implications of profit-driven healthcare. The conversation emphasizes the need for advocacy and ethical change in the mental health landscape, urging listeners to engage in positive dialogue and action.
Chapters
00:00 Cultural and Clinical Trends of 202403:54 Global Unrest and Political Polarization6:55 Re-examining Power Dynamics, Trauma, and Victim Mentality    12:22 Cosmetic Facial Scar Study    13:32 Attitudes Towards Trauma Study15:25 The Mental Health Crisis and Its Impacts    16:30 State-Specific Mental Health Trends 202423:08 Health Insurance and Public Outrage27:36 The Impact of Venture Capital on Telehealth31:03 Advocacy and Ethical Change in Mental Health
Personality Couch Episodes Referenced:
Personalities that Kill (Ep. 07): https://youtu.be/Ob7WLEX7ZvQ
What's Trending in Our Culture and How it Affects Mental Health (Ep. 09): https://youtu.be/uJKTb9Qj8RA
References:
Global Election Results:
https://apnews.com/article/global-elections-2024-incumbents-defeated-c80fbd4e667de86fe08aac025b333f95
https://abcnews.go.com/538/democrats-incumbent-parties-lost-elections-world/story?id=115972068
https://www.ft.com/content/e8ac09ea-c300-4249-af7d-109003afb893
https://time.com/6550920/world-elections-2024/
Trauma and Our Perceptions:
Jones and McNally Facial Scar Study (2022): https://psycnet.apa.org/record/1981-28014-001
Kleck and Strenta Study on Expectancy and Trauma (1980): https://psycnet.apa.org/record/1981-28014-001
Mental Health Trends By State:
https://mhanational.org/issues/state-mental-health-america
https://www.aol.com/mental-illness-plagues-va-n-184111928.html
Mental Health Venture Capital Companies’ Impact:
https://www.amha-or.com/the-toxic-impact-of-venture-capital-on-psychotherapy
https://www.reddit.com/r/therapists/comments/143v1yg/venture_capitol_funded_mental_health_companies/?rdt=44172
https://www.chesshealthsolutions.com/2023/08/17/the-dark-side-of-venture-capital-investments-in-healthcare/

Ep 17: BPD Part 5: Quiet Borderline: A Closer Look at Subtypes

In this episode of the Personality Couch Podcast, we continue to explore the complexities of Borderline Personality Disorder (BPD), particularly focusing on the lesser-known subtype: Quiet BPD. We delve into the historical origins of the term 'borderline,' discuss the various subtypes of BPD, and highlight the differences between Quiet and Noisy BPD. The conversation also touches on the lack of recent empirical research on Quiet BPD and the cultural emergence of the term. We further emphasize the importance of understanding the internal versus external presentations of BPD symptoms and the implications for treatment. The discussion emphasizes the importance of recognizing the different types of BPD and the need for nuanced understanding in both clinical practice and societal perceptions.
Chapters
00:00 BPD Name and Subtypes in History04:32 As-If Patients and Quiet BPD Connection11:09 Quiet BPD and Millon’s Discouraged Type14:44 Current Research on BPD Subtypes   15:52 Internalizing BPD   20:24 Externalizing BPD   25:42 Mixed-Ambivalent BPD31:30 Quiet BPD Today and Subtype Importance34:10 Summary and Closing
References
Cohen, C. P., & Sherwood, V. R. (1991). Becoming a constant object in psychotherapy with the borderline patient. Jason Aronson.
Deutsch, H. (1942). Some forms of emotional disturbance and their relationship to schizophrenia. The Psychoanalytic Quarterly, 11(3), 301-321. https://doi.org/10.1002/j.2167-4086.2007.tb00257.x
Gunderson, M. D. (2010). Revising the borderline diagnosis for DSM-V: An alternative proposal. Journal of Personality Disorders, 24, 694–708.
Johnston, J. (2010). Being disturbed: Integration and disintegration in the patient and professional relationship. Psychoanalytic Psychotherapy, 24(3), 231-251. https://doi.org/10.1080/02668734.2010.502306
Millon, T. (2011). Disorders of personality: Introducing a DSM / ICD spectrum from normal to abnormal (3rd edition). John Wiley & Sons, Inc.
Rosse, I. C. (1890). Clinical evidences of borderland insanity. The Journal of Nervous and Mental Disease, 15(10), 669-683.
Sherwood, V. R., & Cohen, C. P. (1994). Psychotherapy of the quiet borderline patient: The as-if personality revisited. Jason Aronson.
Stern, A. (1938). Borderline group of neuroses. The Psychoanalytic Quarterly, 7, 467–489.
Wolf, K., Scharoba, J., Noack, R., Keller, A., & Weidner, K. (2023). Subtypes of borderline personality disorder in a day-clinic setting—Clinical and therapeutic differences. Personality Disorders: Theory, Research, and Treatment, 14(5), 555–566. https://doi.org/10.1037/per0000624

Ep 16: BPD Part 4: What BPD Therapy Really Looks Like

In this episode of the Personality Couch Podcast, we dive into the complexities of Borderline Personality Disorder (BPD) treatment, in particular, the healing power of the invisible dynamics in therapy. We discuss the importance of motivation and insight in recovery for BPD, and the significance of the therapeutic relationship. The conversation emphasizes that while BPD is treatable, the journey is often non-linear and requires active participation from the patient. We also highlight the necessity of setting boundaries within therapy to create a safe and effective environment for healing. In this conversation, we discuss the importance of evaluating effort in therapy, the significance of attachment, and the challenges posed by boundary violations. Our conversation also explores the concepts of transference and counter-transference, the process of repairing ruptures in the therapeutic relationship, and the methods of facilitating insight and connections in therapy. Overall, this discussion emphasizes the individualized nature of treatment and the invisible dynamics that play a crucial role in the therapeutic process.
Chapters
00:00 Understanding Treatability and Recovery in Borderline Personality Disorder (BPD)05:50 The Role of Motivation in Treatment11:28 Which Treatment is Best for BPD?14:08 Our Approach to BPD Therapy: Invisible Concepts14:58 Boundaries in Therapy21:15 The Therapy Relationship22:51 Bad Therapy26:51 Transference and Counter-Transference33:35 Facilitating Insight and Connections36:35 Summary and Conclusion

Ep 15: BPD Part 3: Suicidal Behavior and Self Injury

In this episode of the Personality Couch Podcast, we delve into the complexities of Borderline Personality Disorder (BPD), focusing on the themes of suicidal ideation and self-harm. We explore the DSM criteria for BPD, the motivations behind self-harming behaviors, and the stigma associated with these actions. The conversation emphasizes the importance of understanding the emotional pain experienced by individuals with BPD and the impact on their relationships. We provide insights into navigating these dynamics, the need for professional help, and the significance of setting boundaries.
Chapters
00:00 Introduction to Borderline Personality Disorder (BPD) Series01:46 DSM Criteria for Suicidal Ideation and Self-Harm in BPD03:31 Triggers for Self-Harm and Parasuicidal Behaviors07:36 Reasons for Self-Harm and Parasuicidal Behaviors10:11 Defining the Parasuicidal and Self-Harm Spectrum13:59 Additional Reasons for Self-Harm and Parasuicidal Behaviors17:24 Self-Harm and Parasuicidal Behaviors Outside of BPD18:51 Hidden Self-Harm20:36 Stigma and Motives of Behavior29:39 Navigating Relationships and BPD38:29 Conclusion and Key Takeaways
CRISIS RESOURCES
Text Line: Text HOME to 741-741; a trained crisis counselor receives the text and responds quickly.
National Hopeline Network: https://www.thehopeline.com/
National Suicide Prevention Lifeline @ 988 or https://988lifeline.org/
American Foundation for Suicide Prevention @ https://afsp.org/ -https://www.mentalhealthishealth.us/better-together-summit/
Psychoeducation
https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
https://www.nami.org/learn-more/mental-health-conditions/borderline-personality-disorder
https://www.borderlinepersonalitydisorder.org/

Ep 14: BPD Part 2: Fear of Abandonment, Psychosis, and Dissociation

In our second episode of the Borderline Personality Disorder (BPD) series, we discuss how this condition manifests in relationships and clinical practice. We explore the pervasive patterns of instability, fear of abandonment, and the role of attachment theory in understanding BPD, while also touching on psychosis and dissociation. Our conversation highlights the challenges faced by individuals with BPD in their relationships and the dynamics that arise in therapeutic settings. We further emphasize the importance of understanding the multifaceted nature of BPD and the need for compassionate approaches in treatment.
Chapters
00:00 Borderline DSM Symptoms Overview 04:09 First Signs and Symptoms in Treatment07:45 Fear of Abandonment and Its Impact09:56 Attachment Theory and BPD16:58 Fear of Abandonment and the Dynamics of Therapy24:39 Episodes of Psychosis and Dissociation in BPD30:43 Conclusion
Book Referenced:
1984 Borderline Book- John Gunderson, M.D.: https://www.amazon.com/Borderline-Personality-Disorder-John-Gunderson/dp/0880480203
Other Resources:
BPD: https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
BPD: https://www.nami.org/learn-more/mental-health-conditions/borderline-personality-disorder
BPD: https://www.borderlinepersonalitydisorder.org/

Ep 13: BPD Part 1: History, the Media, and the DSM Symptoms

In this episode of the Personality Couch Podcast, we delve into the complexities of Borderline Personality Disorder (BPD). We discuss the stigma and misinformation surrounding BPD, the media's misrepresentation of the disorder, and the need for a more nuanced understanding of its symptoms and diagnosis. The conversation highlights the emotional experiences of individuals with BPD, the criteria for diagnosis, and the importance of recognizing the spectrum of presentations within the disorder. We advocate for a reboot in the classification of personality disorders to better reflect the lived experiences of those affected by BPD.
Chapters
00:00 Introduction to Borderline Personality Disorder01:16 Media Misrepresentation of BPD05:39 Borderline as a Movement, Not a Category11:20 The Need for a Reboot in BPD Classification15:09 Emptiness and Vague Symptoms in BPD17:16 BPD and No Emotional Skin18:37 Diagnosing BPD20:12 Impulsivity in BPD22:59 Instability in Sense of Self26:50 Unstable Relationships32:55 Unstable Moods37:16 Symptoms in Quiet BPD39:49 Summary and Closing

Ep 12: Myths About Being a Mental Health Professional

In this episode of the Personality Couch Podcast, we discuss common myths surrounding therapy and therapists. We debunk misconceptions about therapists being perfect, the necessity of shared experiences for effective therapy, and the idea that therapists are always analyzing everyone. The conversation emphasizes the importance of empathy, the reality of therapists' personal struggles, and the motivations behind choosing a career in therapy. We also address the financial aspects of being a therapist and encourage listeners to seek help without being deterred by myths.
Chapters
00:00 Introduction to Therapy Myths
01:02 Therapists Are Perfect and Have No Problems
05:02 Therapists Have to Experience the Same Problems to be Helpful
09:52 Therapists Are Always Analyzing Everyone
15:46 Therapists Have Favorite and Least Favorites
18:22 My Therapist Thinks I'm Crazy/a Burden
21:42 Therapists Get into this Profession to Work through Personal Issues
29:01 Therapists Are All About the Money
33:29 Conclusion and Encouragement for Therapy Seekers