So we'll start with a quote. The goal of therapy or any program of growth for one with a personality disorder must be maturation and integration. And with that, I introduce Dr. Fu.
That's supposed to be an introduction. Do you want me to comment on that? Your whole thing is integration. Oh, yeah, that's nice. I would say that I'm deriving from the quote, not the other way around. I can't claim any credit for that. Whose quote is that? Don't worry about it. Don't worry about it. Is it yours?
No, but I'm just saying, integration seems to be the theme of this podcast.
I found a quote with integration. Oh, come on. I know I'm giving you a hard time here. Look, I don't know what's the theme of the podcast. I think it should be the theme of treatment work in general. That's what I'm going to go after. And certainly I'm not going to take any, uh, personal credit for that. This is something that you're going to see across disciplines.
Yeah, but you could take personal credit for having it be what you cling to, the thing that sticks with you. Cling to? Wow, that's a little...
How could you... On the theme of personality disorders, how could you, Dr. Malzberg, accuse me of such an awful thing to cling to people? You must hate me. Oh my God. You're killing me.
All right, we're starting the podcast.
Okay.
All right. So I'm going to start with some softball... Questions that are very hard.
Okay. And again, to get under your skin, I actually do want to go back to that quote a bit. I do think that it's funny because it's very important to talk about maturation integration when you think about personality disorders. Yeah, it's baked in, right? And I'm guessing I'm going to predict your first question being, what is a personality disorder? And I was wrong. What's up? Wrong. Okay.
Anyway, the point is, what is it? I think it functionally is a lack of maturation and integration. And so that is the core pathology. And so that's going to be the core treatment. Anyway, what was going to be the question? What is personality? Okay. Good question. Hard to define. I think most people outside of personality researchers would struggle to define this too. It doesn't help that there's actually two very different ways to think about it.
Basically, the easiest way to talk about this is that we can boil it down to normal and abnormal psychology, right? First, we encounter the concept of personalities that are disordered or pathological. Right. That's more from the world of psychiatry, from the clinic, from the consulting room, from psychoanalysis. And then we also have the concept of normal psychology, trying to characterize and quantify differences and trends in personality across the general population seen today in the ocean traits.
So what is personality? Personality is just personality. the habits of who you are how you do things how you relate think and feel about yourself and others that are present from early on in development but are also developed in development that get you to who you are today and how you choose to quantify that depends on the researcher or the thinker Okay, I like that.
Can you walk us through, I know these are huge questions, so I know they're overwhelming. How do you understand how personality develops? How does an adult personality develop from childhood things?
Wow, development itself. Basically, I like to use the framework, and this is a very standard framework, of thinking that we all come with a temperament, hearkening back to our first podcast. You all come with a temperament. That's everybody. There's a certain way that we respond intrinsically to different environmental and internal experiences. And that's temperament. Okay. And then on top of that, you begin to build the way you relate to yourself and others early on.
Some people think in infancy, right? The first year. Some people think primarily up to the age of four or six. But I would basically say it doesn't stop. Right away, you begin to interact with other people. That's the key part. So you start with temperament. Your temperament interacts with other people over time, the environment naturally, but importantly, other people. Then around the age of, quote, unquote, being developed, when we start to use language and interface with society in a way that conforms to reality to some respect, at least social reality, we begin to learn values and morals and virtues and knowing what other people want out of us in a more abstract way.
That leads us to what most people would at least, I think, be happy to say is the adult personality or the teenage personality.
Beautifully put. It's very impressive how you... I'm not going to give you compliments. I don't feel like it.
Don't worry about it. This may seem, oh, I'm just doing this off the top of my head. No, I give lectures on this. I have lectures on this. Yeah, but still. I've done it many times.
Okay, so to repeat, personality and pathology as a result of personality... Develops in particular constellations as a consequence of the interaction of a broad but finite range of instinctual needs, which is related to temperament, as you said, and the environment's ability or inability to respond to them.
Oh, very nice. How do we like that? Much more concise and clear, I think, way of putting it. Yeah, though, instead of needs, I probably would say needs and tendencies. Yeah. Needs and responses, ways of responding. So that's why for, oh, go on. No, you got it. So that's why for psychodynamic ways of conceptualizing personality, many authors really just think of it as a pattern of defenses.
And if that sounds too weird and archaic for you, think of it as a pattern of coping mechanisms, right? That's the personality.
Yeah, and connecting it to history, we go back to Freud. We talked a little bit about how we view Freud in the previous podcast. Freud connected the drives and the instinctual needs. He connected those to like instinctual biological processes. So he, oral, anal, phallic, which today sounds really silly, but the underlying theme there of developing internal needs, pressures, internal, you said something else besides needs that I liked.
Responses. That concept is fundamental to how we understand it today. And today we've now added more of the needs and responses and systems, including attachment systems, including the need to explore, the need to individuate. Essentially, a lot of people tacked on a better understanding of those needs without using the bizarre biological framework that Freud used.
Yeah. I would say that's true from the standpoint of people who are still tuned into the psychodynamic psychoanalytic end of things. I'm not necessarily sure that's how people talk or think about this kind of thing. Personality on the other hand, I would say that unfortunately there is a output focused way of looking at psychology and psychopathology. not necessarily a bad thing it's much more objective measurable scientific if you will but just take how they develop the ocean traits so the ocean traits being openness experience conscientiousness extroversion agreeableness and neuroticism how they found those was that what they they actually started i believe from looking at just a huge dictionary of words that you might use to describe somebody Okay, how would people generally describe somebody else?
Take those words, group them into categories that are related to each other and start to coalesce them into more umbrella categories that can be the master of the more abstract term for all the other words we use to describe someone. And they were able to find that there's more reliable through observation of others and self-report constructs of the ocean traits. O-C-E-A-N. That doesn't tell you about where it comes from, right?
It doesn't necessarily have an eye towards development. And maybe that's responsible to say that these theories towards development are not set in stone scientific, even if they're very compelling and we have a lot of supporting data, if you look at it closely.
Yeah, and I do want to point out that major limitations of the ocean traits is you can have, let's say you have someone's perfectly the percentile or whatever of each of their traits, how those traits actually play out is not at all understood within that theory. So you really can't understand a person's motives, the etiology. The ocean traits have a limitation, right? that the more psychoanalytic interpretations, actually, you better understand the behavior and you can predict some behavior.
With the ocean traits, you can have two people with perfectly overlapped ocean traits and they'll have totally different life stories.
Yeah, yeah, I think you're right. But again, it's because one side, let's say output researchers want to be scientific. They want to say, I'm not going to say anything I can't prove. Right. Very responsible. So they're not going to comment on why someone does what they do. They're just going to comment on what is this person doing that I can show you objectively in some fashion. Right.
Yeah. And that's responsible. But I think where we run into trouble is that there's that research and then there's lay people and clinicians who look at that and say why that person does what they do is because they're doing it. Right. That's like saying, why is this person neurotic? Because they're neurotic. It's circular. Their neuroticism trait is very high. That's why they're doing that. No, we know their neuroticism trait is high because they're doing it.
That's what it's describing. We don't have a theory for why they're doing it just yet, though we might, but it would have to take a different framework.
Yeah, I think an extreme example would be Ted Bundy. If we knew all of his openness, conscientiousness, extroversion, agreeableness, neuroticism, we would not predict that he would chop up bodies. Yes. And continue. The behavior does not flow from, you can't say, oh, he was a serial killer because he's low in agreeableness. Like that, there's a jump there that is unexplained.
Unfortunately, we're just too complicated to be explained in simple terms. And then you can try to paint out someone's development and their habits and cobble it together. But it's pretty limited. By the way, I feel like we run the risk for this episode of getting too wonky.
Let's get wonky.
I'm getting the impression that both of us are a little bit too in deep in terms of personality and personality pathology. And it could get it's overly enthusiastic. We're getting too particular.
Yeah, I do get I do forget that. Yeah, dynamic thought isn't not just dynamic.
Again, I don't know. Honestly, I don't know what most people mean by personality. Clinicians, clinicians. OK, my impression of what most people mean when they say personality or personality disorders is everything the person is doing on purpose. And that I can hold him responsible. Which is not what personalities. It's so much more than that. I don't know. What's your impressions so far in your life about how clinicians tend to conceptualize personality?
Not based on an interview of these clinicians, of course, but looking at the phenomenon of when they recognize or talk about personality.
Yeah, when you said they're doing it on purpose, which makes me cringe hard because so much of personality pathology intent, purposeness is not... It fades away when we're talking about things that people are driven to do. A lot of these things are unconscious. Yeah. Sorry. In psychiatry, especially in the emergency room, if someone were to come up to you and go, oh, this is just personality. What they're saying is that this it's this person is it's their fault.
They have control over what they're doing. There's a sense of this person is manipulating you. So in the emergency room, if someone comes in and says, I'm hearing voices, and then you talk to them and they're a little difficult, it's a difficult interview. Afterwards, you'd say, oh, this is just personality, which implies, oh, this is not a bipolar manic process. This is not a psychotic process. This person is trying to get something from you.
yeah yeah it is almost like clinicians are saying this is more of a ted bundy case you know i mean it's cruel i think because to ascribe a volitional aspect purely to personality no i'm saying that wrong to only say that volitional things are personality is really missing a lot of the fact that much of personality pathology is basically, at least from a subjective experience of the person, involuntary or compulsive in some fashion, right?
Automatic. And of course, this would take a really drill down into the deep overview, which we shouldn't do today. But whether or not you do something on purpose is also not the same thing of whether or not you had control over it.
Yeah, and those things come into question whenever you're talking, when you see the lower severe personality pathology and cases of Munchausen's, where these people are driven to really odd behaviors that I'm sure they can't understand.
Yeah, what I worry about mostly is that I think... People aren't taking the time to get in a little bit deep with personality. And because of the construction of the DSM, traditionally they see personality and personality disorders as this very constrained set of things in human life. When really everybody has a personality, everybody has personality traits and studies actually show that for both inpatient and outpatient clinical populations in psychiatry.
Most people can meet criteria for a DSM personality disorder. It doesn't mean that's the main issue going on. But I guess this is another problem with the good concept of diagnosis parsimony. You ideally do not want to be trying to explain a patient's life and what they're doing with multiple different diagnoses if you can help it. Right. Yeah. At the same time, some people almost seem ideologically driven to say, I'm going to identify one major controlling diagnosis and everything is going to be explained by that.
And so I think that a lot of clinicians, when they say this is personality, what they're saying is, I feel like I have ruled out all access one pathology. And therefore, I'm going to treat this person in a certain way. Or think about them or feel about them in a certain way.
Yeah. Sorry, I'm thinking about that. To go one step further, it's in a sense like if it's personality, this person has control over it. And there's a sense of feeling less responsible for treatment and typically less empathy for that patient. Yeah. In a sense that it's like... And we have kind of words that... imply that cluster B, if we say borderline, what that implies is that this is a manipulative person and dismissed.
It's very dismissive.
Yeah, absolutely. We can see this in just both the movement of the field and in individual conditions. I remember one time was communicating about a shared patient with a therapist. And I mentioned that personality was higher in the differential. And the response that I got was, I don't like to jump to personality. Imagine if you said that about any other diagnosable psychiatric condition. Oh, I don't like to jump to bipolar.
Oh, I don't like to jump to an eating disorder. I don't like to jump to an anxiety disorder. What does that mean? These are all things that you have to consider based on their relative share seen in the general population, right? You have to know what your chances are of running into something. And you also have to base your diagnosis on what you're seeing in front of you.
Yet there is this reluctance. And I know why there's a reluctance. There's good reasons. It's because there is a stigma. It's a feedback loop. So I would love the field to get over it, to understand that they are not looking at all personalities and they're reserving that diagnosis for patients they don't like. And they're doing harm to all patients because of that.
Yeah, I remember a comment of like, I'll consider borderline when they're in their fifth emergency room visit for cutting or for suicide, suicidal ideation, and how problematic it is to only view personality as the most severe problem. personality pathology that we understand it to be and not respecting that there are people with severe personality pathology that are really quiet and when i say quiet isn't that there are problems that other people that affect other people and there are problems that occur only internally a lot of severe personality pathology it's it's an internal struggle these people aren't manipulative problematic causing interpersonal whatever they're struggling internally and To only think of the most severe pathology as personality is missing how it's not understanding human beings and pathology in general.
It's confusing. We can't blame people. I think that there's a problem where we try to just patchwork concepts across different frames of looking at human life. And we run into trouble. It's the whole, is this on purpose or not thing, right? That's like a social or legal consideration about people. And then they try to apply that to a clinical setting when in a clinical setting, we don't diagnose to decide if something is purposeful or whether the patient is responsible, right?
We're diagnosing to inform our treatment plan and to inform the patient of, What are your treatment targets? What's causing you problems, right? But I also don't trust society to not patchwork those concepts across from each other and confuse them. I know it happens all the time in forensics, but in an ideal world, I think that we would more medicalize personality disorders for patients, but then we would also understand more broadly that in society in society understand as a society more broadly that if there is a medical condition doesn't mean that they're not responsible yeah it's moving the needle in both directions that's integration i would call i would call it integration of viewpoints and it's very difficult on a social level i think let alone individual
Now, while you tell people to integrate, I'm going to tell people to disintegrate here. Okay. I think it's also helpful to understand, this is a little tangential from what we're talking about, that if someone has a personality pathology or doesn't, it's not something that's on 24-7. Everyone has... the ability to... has like a mixed ability to function. And that you... Some people are operating with... They meet...
They're acting as if they have personality disorder at all times. Some people only get... to a lower level of functioning when they're dealing with their key problems or when they're under stress or if they're given very little support. And I think it's best to try to empathize. You can find these problems in yourself if you try to be honest. Narcissistic problems are not... don't just occur with people with narcissistic personality disorder.
Every human being is dealing with narcissistic issues. And given in residency, when in second year, when I was under a ton of stress, and I felt like I had very little support, more problematic aspects of my personality came out. I started, there were aspects that I started splitting. And when I had a mentor, they were a great mentor, or they were... We all have the ability... Common for residents.
Very common for residents. We all have the ability to operate at different levels of functioning. And if you are honest with yourself, you'll see that there's a ton of times in your lives that you regress. During breakups, that's a big one that... people start acting a little borderline, have more borderline tendencies, those things come out. It's not that you have high ego functioning and you're healthy defense mechanisms all the time or you're low ego functioning.
We're all constantly changing depending on our environment.
That's right. That's right. That actually makes me think maybe that's why it's hard for people to accept personality as a pathology or to look at it accurately. It's easy to say that person has a Psychosis, right? That's very unlike what most of the population will go through in their lives. Yet personality issues are so close to us. Maybe if we recognize the milder versions as pathology, that requires us to understand ourselves as, in some sense, pathological, or that we have some room for improvement.
That might be an uncomfortable thing for a lot of people.
Yeah, and as you're saying, I approach things with the opposite mentality. The way for me to better understand things is for me to get into mindset and to understand it from an internal standpoint. I can understand narcissistic pathology because I'm able to see my own narcissistic struggles. I'm able to understand borderline pathology by thinking about how I felt when I was undergoing a breakup and I said stupid things I didn't intend.
The fix for that is I think you can really find yourself in nearly every single... Because I guess you were saying even psychosis... Yeah, I guess that's a tougher one.
Everyone can be induced into something like psychosis if we give you the right drugs. But yeah, I think you're still right that... Generally speaking the mind is capable of everything that the mind is capable of right even the pathology is extremes of normality every person can probably tap into something where They have felt at least something like it before or even encountered it before in their lives, right?
Mm-hmm.
There's very little that is completely alien to the average person and
Yeah, even one that's silly, psychopathy. The way I can help tap into that is... How do I treat objects? If I break an object, I feel nothing, truly nothing. And if you told me, if you came up to me and said, how do you not care about that jar that you just broke? I can lie to you and say, oh, yeah, I got it. I feel bad for it.
But I have no internal guilt. I have no feelings towards if I cause damage to objects other than the way it impacts me. If I break my iPhone, all I care about is this sucks for me.
Of course, I'm sure there are some people out there who feel very close to their objects who are just saying, this guy's a real psychopath right now. I like that example. I haven't thought of that before. I think that's a good way to help people get a little closer to that. Psychopathy is an interesting one. By the way, the literature on this topic is not uniform. So what people mean when they say psychopath or sociopath, you can't really reliably know what they mean.
For my purposes, anytime I'm saying sociopath, someone who has not internalized or learned or developed the social ethics and values of whatever situation they're in, so that it causes a problem. And then a psychopath, I've referred to something a little bit more fundamental. Some kind of a either lack of development or genetic predisposition towards not being able to perceive others as independent people and to feel that you can hurt them and have some responsibilities towards them.
That's what I mean by psychopathy.
Yeah, to tack on to that, one thing that helped me to better understand it is the classical people you think of as psychopaths, Ted Bundys, all that, they have what you just described with something on top of it, which is sadism and high self-esteem. Like the average psychopath isn't chopping up bodies. They're not. It's just that if they were to do that, they wouldn't feel it. But they're not also driven to do sadistic things.
The serial killers are psychopaths and sadistic, whereas your average psychopath is not wreaking that kind of havoc because they don't have a drive to those.
We think so. Anyway, that's our hypothesis. And I can take this opportunity to malign our great colleagues in surgery. They are chopping up people and feeling pretty good about it. Yeah, I'm kidding there. That's, though, a good example to show how traits of psychopathy or at least ability to not react with significant negative feelings when you potentially harm somebody or actually have to harm them for some greater cause is adaptive.
It's necessary in society. Surgeons being one small example of many different jobs where you're put in uncomfortable positions, but if that job didn't exist, things might go awry.
Yeah. And everyone in the medical field has some degree of to be able to get through medical school and residency. You have to have some degree of turning off those empathetic responses in order to do those things that you need to do to help that person.
Though I also think that this is where a lot of lay people and clinicians run to trouble with social policy and clinical treatment of truly psychopathic antisocial people. And that they think that these people are doing what they're doing. Because some awful thing happened to them so that they have to turn it off. The same way that they themselves turn off those responses under stress. Sometimes that's the case.
I wouldn't call those people actually antisocial or psychopathic. But a lot of these people who chronically harm others or violate their rights, I think they are lacking innately in that sense of guilt and remorse. And then you have to manage people like that very differently than somebody who does have the capacity for guilt and caring for others.
Sorry, I didn't sometimes have a tough time in the moment. So you're saying that psychopaths absolutely lack the ability. And then there are some people who are able to turn it on and off given situations. Is that what you're saying?
I'm saying that we should reserve the term psychopathy for people who have a true innate impairment, not just a psychological problem when it comes to feeling remorse, guilt and concern for others.
Mm hmm.
I think it's a sliding scale. I think there's various degrees of feeling strongly or weakly about it. You might have someone who feels guilt if they break a mug. I'm sure those people exist. I've met them. And then you might have, as we said, Ted Bundt, right? It's a wide sliding scale. And somewhere in the middle, you have maybe a slightly problematic, but still talented and productive CEO somewhere, right?
Or a politician somewhere. It's a murky, broad category.
Now, the point you just made actually makes me want to ask a question that hopefully... Yeah. I want you to talk... I almost want you to give the answer that I'm thinking in my head, but I think that you'll say it better. You know, a lot of times I'll hear people say, is this borderline or is this narcissism? Because they'll see someone who has typical borderline traits, but they have when you actually there's a lot of things that we typically associate with narcissism.
And then I guess on your point, you'll see someone who is they're acting just like a narcissist, but then they have what I would consider psychopathic traits and that they don't care about others necessarily. Can you talk about how you can understand why are these borderlines acting narcissists? Why are these narcissists acting borderline? Why are these narcissists acting psychopathically?
Yeah, now I'm curious about what your answer is. But my answer is that those questions fundamentally exist because the personality disorder categories as described in DSM are terrible in the primary section, not the alternative model, by the way, section three. The DSM-5 has an alternative model that I think is very good and that people should be really familiarizing themselves with. I can't remember the exact stats. There's been research where if you meet criteria for one named DSM personality disorder, the traditional type, you have a very high likelihood of meeting criteria for a second one.
Okay, these categories are just ways to describe people. And since there's a lot of shared underlying issues that are producing the DSM diagnosis, then comorbidity suddenly becomes the rule rather than the exception. This is very similar to what we see with, for example, major depressive disorder and generalized anxiety disorder, right? Supposedly different categories, but very comorbid, maybe because they have similar base causes. Similar thing, for example, of intellectual disability and psychotic disorders.
There's actually a threefold higher risk of developing a schizophrenia if you have an intellectual disability. Is that because maybe we're artificially categorizing them as different things based on output when really there's a lot of shared genetic basis or shared mechanism? Who knows? Mm-hmm. We still need to research. But that's why categorizing personality simply by traits is insufficient, right? And if we look at the alternative model, or for example, the work from the Personality Disorders Institute with Kernberg and the Borderline Personality Organization, organization, not disorder, these people would all fall under the category of having an impaired personality.
They have a personality disorder writ large or impaired personality functioning, And then different traits can come out. And whether or not they're psychopathic, we can have an individual assessment of that based on their level of guilt capacity and their moral and ethical development.
Yeah. And I do want you to talk more about the alternative model. We talked about a little bit, but if you go in more detail.
Oh, yeah. Briefly, it is on the DSM-5-TR. It's page 882. concise, readable. Instead of saying, what are the different criteria that will bring us to, in terms of symptoms, bring us to one personality disorder diagnosis, they ask you instead to assess for and rate the level of personality dysfunction. How much impairment in personality functioning do you see? They break down personality functioning into two major subcategories with four total elements.
There's the self-functioning, which is your identity functioning and your self-direction. And then there's interpersonal, which is empathy functioning and intimacy relationships. That's what a personality disorder is proper. Of course, under this model, we probably have to acknowledge as well that Certain things like the cluster A personalities may not really be a personality disorder. Maybe they are, but they're probably a little closer genetically to psychosis.
Yeah, I guess I'll take a second to answer that. how I formulated and connected those things in that the way that I understand, and I think this aligns more with the personality, alternative personality model. Essentially, certain pathologies develop out of problems in a certain developmental period. And I understand borderline issues stemming from issues with attachment and bonding, which occurs earlier than issues of the self and development of self and others.
So if you have a problem that occurs earlier in development, then it's... more likely that you're going to have problems subsequently in other developmental areas. Someone with a borderline pathology is going to have issues with self-esteem as a result of the fact that they went into that developmental phase at a disadvantage in some sense. I don't think it's as linear as age one, this occurs, age two, this occurs.
I think it's more complicated than that. But I guess I understand it as if you have trouble with one sector of functioning, when the next developmental period comes, you're going to have trouble with that one, more likely to have trouble with that one as well.
Yeah, I definitely agree with that major point, right? That if you're impaired or you undergo any kind of impairment or trauma early on, that's going to color your later development and your ability to withstand further stressors and problems in your life. Only thing that might change in terms of what you said is that I would probably go as far as to say that the only things that we should consider are personality disorders are things that would fit under the category of borderline personality organization.
Yeah. In terms of cluster C personality problems, I would sooner just talk about those as sub-threshold ways of manifesting risk factors for named DSM disorders. Avoidant personality disorders. Right. And dependent personality are a little bit more, to me, milder versions of anxiety and depressive disorders. Especially the anxiety disorders. OCPD would be probably some I would theorize. I don't know, actually, if we have the data for this, a subthreshold or risk factor manifestation of the obsessive and compulsive and related disorders.
Right. And then naturally, the cluster A would be the genetic cousins, the prodromes, the risk factors to the psychotic disorders.
I do see what you're saying, and I partially disagree with it, especially with OCPD. With OCD, there's... I don't have a... I think actually... Nancy McWilliams has talked about this, that someone with OCD, their symptoms are egodistonic, and that if you were to say, like, why are you doing that, they would get very upset about the fact that they're doing it. Someone who has OCPD, there's... fundamental problems of safety with regards to their symptoms and that their odd behaviors.
I think she talks about how there's a woman who would boil the sheets every single night for her kids. So after her kids went to sleep, she would go and boil the sheets. And when she said, isn't that a little odd? The woman responded as if she was a, like someone who was attacking her. And it's, what do you mean? You have to, don't you care about your kids?
And that she interpreted the response that's a little odd as very intrusive as like getting underneath her fundamental safety. So there was core issues in the woman's development of self that had her have the OCPD symptoms, not I guess what I would view as.
Yeah, no, that's valid. I think that's definitely true when we think about DSM categories of OCD and OCPD. Because OCPD, all the personality disorders in traditional DSM require you to have some measure of interpersonal dysfunction or disrupts, right? And when it comes to OCPD, the way it's constructed, people with OCPD, obsessive compulsive personality disorder, they like their symptom by definition. And so therefore you lose all the people who don't like their symptom, still have OCPD traits and are not so aggressive that they would come to clinical attention for this problem.
So that's what I'm trying to capture there. I hypothesize, my suspicion is, that there's an underlying genetic or temperamental trend towards obsessionality. And yes, some smaller proportion of that group will convert to OCD. some small proportion of that group will convert to OCPD, and the rest of them will simply exist in the population.
All right, that wraps up part one of this discussion. We got part two coming out next week. Some other things maybe you want to check out.