Key moments, in order
- 3:44
There is danger in over-interpreting things as Axis I. Thinking in terms of personality gives you more control and more ability to change your surroundings. Everyone has had a personality since birth, and it does change over time.
- 4:19
A formulation is much deeper and richer than a diagnosis and actually gives you an idea of what is going on with a person.
- 4:30
Two people with the same DSM diagnosis can have radically different behaviors and lives. Diagnosis is not destiny.
- 6:12
Flanderization is when writers lean on one small personality trait until a normal character becomes a caricature. Early characters can look normal and later ones extreme, which is a caution against over-diagnosing from media.
- 7:09
The criteria are so loose that almost anyone can fit, and the diagnosis gets applied way too broadly to anyone with a lot of anxiety. That is a problem with the DSM, not the person.
- 10:21
Narcissism is a defense against a really low self-esteem. Under the grandiosity, arrogance and need for admiration is the narcissistic injury: the experience that who you really are is somehow unacceptable, covered by a false self that feels superior.
- 11:04
Early in life, typically the parents need the child to be substantially different from who they are: successful, never showing weakness. The child's normal naughty qualities get rejected, and the child has to be something they are not inside.
- 12:12
Many people reach for vulnerable narcissism without adequate evidence, assuming that subtype mainly because the patient is male.
- 16:24
The truly narcissistic person will simply adapt their worldview of the other person, in a quasi-psychotic fashion, to fit their own worldview.
- 19:20
Someone can have pathology and not fit a label perfectly. Then go further into formulation and the particular traits.
- 20:46
Rate each area by its level of impairment, for example: identity functioning at least moderately impaired, self-direction at least moderately impaired.
- 22:16
A person can be inhibited rather than disinhibited: calculating, weighing and deliberating too much, impulsive only under intense emotion. That argues against an ADHD explanation.
- 23:08
DBT is the gold-standard behavioral treatment for borderline personality disorder. Opposite action is one of its core skills.
- 29:27
Rigid, particular people often get called obsessive-compulsive, but without evidence of real obsessions or compulsions that is obsessive-compulsive personality, not OCD.
- 30:28
The core defense is little access to emotional life. These people are much more comfortable in the realm of thought and ideas than in their feelings.
- 31:21
A worldview that everything balances out can fit and reinforce emotional flattening. Humor can be a positive coping skill that lets rage at rules leak out productively.
- 32:13
The core conflict is obedience versus defiance. Obeying the rules and deferring to authority is experienced as humiliating submission and can lead to rage at whoever puts rules on them.
- 36:01
Those things are not outside the realm of normal variation, so do not attribute them to anything in particular.
- 39:20
The Hare Psychopathy Checklist can be broken into two factors, and further into four.
- 41:44
The antisocial personality disorder diagnosis is not psychopathy. It is purposefully broad, covering a low-grade tendency to break rules and a parasitic lifestyle as well as actual psychopaths.
- 42:39
Even a psychopath can show apparent affection. It does not come from a strong moral core or from weighing other people's reactions; it comes from what seems easy, doable and pleasurable in the moment.
- 46:26
Personality and other disorders are not separate islands. Gambling disorder, for example, is not a little pathology isolated from the rest of the personality.
- 50:37
IQ has diminishing returns. High intelligence without drive or an interest in applying it in a regimented, marketable way does not produce high achievement, since intellectual functioning differs from preferences and habits.
- 53:12
The ultimate goal of therapy is to expand degrees of freedom and to notice automatic reactions, since personality shapes how a person perceives and responds to events.
- 54:03
Only a complex formulation of why people do what they do gives them something actionable, and lets them weigh whether to change themselves or not.
- 55:24
There is danger in over-interpreting things as Axis I. Thinking in terms of personality gives the person more control and more ability to change their surroundings.
Each moment is a point made in the episode, linked to the second it was said. The topic links open everything the podcast has said on that topic.