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Behind the Mask
November 6, 2008 11:52 AM   Subscribe

A new article in the New Yorker discusses the work of Dr. Kent Kiehl, one of the world’s leading investigators in psychopathy. While Kiehl's research focusses on violent psychopaths, not all psychopaths are violent, or even criminal. At least one psychiatrist contends that the definition of a psychopath - first described by researcher Robert Hare and made manifest in his Hare Psychopathy Checklist (previously) - is more accurately attributed to narcissism.
posted by Marisa Stole the Precious Thing (56 comments total) 27 users marked this as a favorite

 
EDIT: The definition of psychopathy was not "first" described by Hare, but he is perhaps the leading 20th century authority on the subject.
posted by Marisa Stole the Precious Thing at 11:57 AM on November 6, 2008


(I'm looking forward to this thread, esp. thoughts regarding narcissism vs. psychopathy. Hope NickySkye shows up)
posted by Auden at 12:11 PM on November 6, 2008 [1 favorite]


I am what I am! Yuck yuck yuck yuck!
posted by doctorschlock at 12:16 PM on November 6, 2008


I'll admit that I only have a moderate layman's understanding of psychology, but I always understood narcissism to be a component of psychopathy; my wants are supreme, therefore I can do anything I want to achieve them, and my lack of conscience will leave me unbridled in doing so.
posted by jonmc at 12:26 PM on November 6, 2008


As the New Yorker article states, DSM-IV doesn't describe psychopathy, which would indicate that there is no common understanding of this condition (or disease). Is "narcissism" listed in DSM-IV?
posted by KokuRyu at 12:32 PM on November 6, 2008


Is "narcissism" listed in DSM-IV?

Yes.
posted by Marisa Stole the Precious Thing at 12:41 PM on November 6, 2008


Is "narcissism" listed in DSM-IV?

Yes, it is one of several personality disorders that sometimes seem to overlap. There is a book called the Psychopath Next Door that talks about non-violent psychopaths.
posted by Alexandra Kitty at 12:46 PM on November 6, 2008


not all psychopaths are violent

What can I say? I'm an underachiever.
posted by It's Raining Florence Henderson at 12:54 PM on November 6, 2008 [3 favorites]


Did you intend to refer to Hervey Cleckley's classic book ("book" link is a 485 pg. PDF since the book seems to be out of print) on the subject in your title? It is worth a read if you are interested in the subject. Many of you might have heard of Cleckley's other book, too.
posted by TedW at 1:01 PM on November 6, 2008 [1 favorite]


Did you intend to refer to Hervey Cleckley's classic ... on the subject in your title?

Heh. Actually, it was a bit less academic than that: it was a reference to Patrick Bateman's daily beauty treatment.
posted by Marisa Stole the Precious Thing at 1:08 PM on November 6, 2008


I'd imagine that non-violent or non-criminal psychopaths are generally ignored. What's interesting about someone who is not outwardly selfish? Then there are those who don't quite comprehend what acts of violence against others mean or implicate. The story doesn't go into the details of the kids, but one of them was in a local juvenile detention center, and oscillated between being a kid and being spooky as all fsk. And by spooky, I honestly not caring about others. Not in a jaded or pompous way, just no regard for others. That's the spookiness of it, some sort of detachment I can't fathom.
posted by filthy light thief at 1:08 PM on November 6, 2008


I think critical to the discussion is the ongoing fallacy that to understand that you might be hurting someone (physically, emotionally, etc.) would make you not do so. The bits in the DSM-IV indicates a person with poor self-control, ultimately self-damaging activities (without being self-mutilation), and no real concept of society or the "realness" of others.

While it's depicted in fiction often, we don't seem to have a corresponding clinical description of someone who does not have these flaws, but hurts others because they do not care.
posted by adipocere at 1:20 PM on November 6, 2008 [2 favorites]


Paging nickyskye!
posted by tiny crocodile at 3:10 PM on November 6, 2008 [1 favorite]


Anyone know anything about the self-administered instrument mentioned Mahmut article? I'm dying to know how much of a psychopath I am.
posted by oats at 3:34 PM on November 6, 2008


s/mentioned Mahmut/mentioned in the Mahmut/
posted by oats at 3:34 PM on November 6, 2008


That last link is from mefi's own, no?
posted by tiny crocodile at 3:47 PM on November 6, 2008


Marisa Stole the Precious Thing, thanks for this post. When I saw it I couldn't wait to have a look at your links.

The thing is that I run an online recovery group for (self link) Adult Children of Narcissists/Sociopaths and been busy there today. When I come to the blue I like to play more, not talk about "the Narcissist thing" so much. Then, when I do get a chance to talk about the Nthing, like when five fresh fish posted about the topic in your previously link, I tend to be a thread hog and feel badly about that. I was hoping other MeFites might contribute to this thread before I added my usual verbosity.

In light of the Lehman brothers and financial crash of the last month, it's important for people to know about non-overt sociopaths. Lehman CEO Dick Fuld, would be, imo, a classic example of a corporate sociopath, who knew full well in advance that his company was crashing, allowed his loyal employees, who held 30% of the company stock in good faith, to lose their savings, while he snuck out tens of millions of dollars (probably much more) to feather his own nest. Uncaring, conscienceless, devious, cunning, pathologically deceitful and he got away with it, so far. Like the corporate sociopaths of the Enron debacle.

The excellent documentary, The Corporation, watchable free online, is a superb examination of the nature of the corporation as a sociopathic entity. That's quite a fascinating thing to think about. Legal sociopathy. It makes sense why the CEOs of these vast corporations become more abusive over time. One feeds off the other. The Bottom Line becomes a sort of malignant force with the CEO surfing the greed wave.

A trait of sociopathic behavior is dizzying heights of adrenalin combined with crash and burn. The US economy is, sadly, a very good example of being run by corporate sociopaths.

*taking a break for a cup of tea. Want to discuss the New Yorker article
posted by nickyskye at 4:18 PM on November 6, 2008 [6 favorites]


Oh, Marisa Stole the Precious Thing, couldn't you please please please have waited a little bit past the election to do this? Let me get in a drunken weekend.

Do you not care about my feelings? Do you even understand that I have them? What kind of needs do you have? If my emotions are so obscure, why are they so important to you?
posted by Lesser Shrew at 5:00 PM on November 6, 2008


I was under the impression that "psychopath" is getting a bit dated as a designation. Aren't many of the sub-types being absorbed into personality disorder classifications? (e.g. classic violent psychopath (aka "callous psychopath" into antisocial personality disorder; "histrionic psychopath" into borderline personality disorder; "inadequate psychopath" into - say - avoidant personality disorder; and so on?).
posted by raygirvan at 5:48 PM on November 6, 2008


Gee, this is a disorganized opus. In case anyone is interested, a few links on the topic at the end:

Ok, looking at the New Yorker article:

"psychopathy, the condition of moral emptiness that affects between fifteen to twenty-five per cent of the North American prison population"

Not according to the statistics I've read over the last decade. More like 50 to 75%.

The true psychopath represents a much smaller percent of the prison population for two reasons, they outwit the authorities, get away with serial murder, serial rape, torture or mass murder, for example, endorsed by being in the military/intelligence complex and because there are fewer psychopaths than those with the less cunning and less depraved disorder of sociopathy.

argh. Reading that article I disagree with almost every sentence when it comes to describing the illness and think it's badly researched, which harms everybody because it passes on just more misinformation. For example, he confounds the terms sociopath and psychopath: the difference between the DSMIV term Anti Social Personality disorder (ASPD), which is called Sociopathy or sociopathic and the term Psychopathy, which has no listing in the DSMIV and is said to be the same thing, which it isn't. The terms are legally interchangeable for court, for insurance purposes, for inmate classification but *psychologically* they are not the same.

In a nutshell, heh, sociopathy could be said to be pathological narcissism with violence added.

Sociopaths and psychopaths have empathy (the ability to imagine what it's like in the other persons's shoes) but do not respond with caring. It's "partial empathy". If sociopaths had "a total lack of empathy" as he says, they couldn't function in society, they would be autists. Empathy is pretty basic and maybe a drug can be created to enhance empathy. But with sociopaths or psychopaths that is not going to make any difference, it may make them even more sadistic. They will be able to perceive others' vulnerabilities all the more astutely and go in for the kill.

Sociopathy an expensive illness all around. At the very least, in mere prison costs alone, it costs us taxpayers 41 billion a year.

This Kiehl guy has come up with an idea I've thought was true for the last 8 years, that pathological narcissists are limbically handicapped. "Kiehl hopes, will confirm his theory, published in Psychiatry Research, in 2006, that psychopathy is caused by a defect in what he calls 'the paralimbic system' ".

My own metaphor for this is that an emotionally healthy person has a four lane highway between their neo-cortex (higher thought processes) and their limbic system (neurological seat of the higher emotions). A pathological narcissist has a goat path. This lack of higher emotions usually allows pathological narcissists and sociopaths to be unburdened by tenderness, altruism, caring, compassion and well-wishing. Lacking these core human emotional strengths they can be Terminator-like in their drive to succeed, inevitably creating chaos and misery around them as they do, especially anybody close to them.

Even if a drug were created for sociopaths or psychopaths, to help them with their brain damage, a drug will not undo the behavioral pattern of the sociopath that was learned in childhood and developed over a lifetime of abusing people. Sociopaths and psychopaths basically need a new brain and I don't think Kiehl can cook that one up. But good luck to him!

Kiehl's dream is to confound the received wisdom by helping to discover a treatment for psychopathy. “If you could target the brain region involved, then maybe you could find a drug that treats that region”

Sounds like the doctor straight out of Clockwork Orange.

Rather than look to a drug for people who are already dangers to society, I think the effort needs to be made in educating people who are thinking of having a child about the socially devastating impact of bad parenting. And what is good parenting? There needs to be classes in that, in every school in America, taught from kindergarten. This is not Nobel Prize, find-a-drug drama-egotism. It's the complex, subtle and profoundly meaningful process of knowing how to love, care for, guide a child and be a parent. It's a skill that needs to be learned and put into practice.

Every obstetrician and insurance company should have mandatory classes about healthy parenting as part of the insurance payment, which requires both biological parents to attend. Or the biological mother and at least one other adult who will contribute to parenting that child. People procreate and have no idea about what impact parenting has or how to be a parent. When a sociopath or psychopath is created due to parental abuse, abandonment, trauma, it's way too late. Then it becomes the law enforcement system's job and legal system/ therapists helping the victims of sociopaths and psychopaths. Usually generations of victims.

As the article's author says, Antisocial Personality Disorder (ASPD) is a controversial term, badly defined by just about everybody as it gets all tangled up with psychopathy, violent narcissists, Conduct Disorder (CD), character disorder, serial criminal behavior. What he doesn't say is that there are a number of important divisions to this particular emotional, mental, behavioral illness, which have not been properly articulated by the DSM IV. In fact the entire section of Axis II Cluster B disorders are a mess in the DSMIV and are in need of a major revision.

Yes, pathological narcissism, Narcissistic Personality Disorder (NPD) is the default condition of ASPD and Psychopathy. But I think psychopathy is more in the range of a type of autism, insanity without delirium.

In trying to get to a more exact definition, I like this essay by Shaun Culwell, A Journey Into the Abyss. One book that does the topic some justice is The Antisocial Personalities By David Thoreson Lykken.

Points Lykken makes that I agree with are that, at the very least, the ASPD concept really needs to be divided into Primary Psychopath and Secondary Psychopath. In the Primary Psychopath heading there is a continuum, with, imo, the corporate sociopath on the lower end and serial killer, military monster, like Stalin or Pol Pot on the deep end.

On the Secondary Psychopath level, the term really should not be psychopath at all, but Sociopath, coined in 1930. There are a number of styles of this disorder and origins. On the low end of sociopathy is the kid who grew up in a poor family, surrounded by people who routinely bought things that "fell off the truck", all his friends are delinquent, so he is too, beaten by his mom or dad as a cultural right and was taught to be violent with either gender as an expression of testosterone/identity. Working class sociopaths on the low end of the continuum have a chance not to be monsters. A lot may depend on their substance addiction issues, their work ethic, if they allow at least one or two more emotionally healthy people into their lives as companions or role models.

As the sociopathy continuum progresses, it usually becomes co-morbid with substance or alcohol addiction, the brain deteriorates due to addiction and the violence escalates. "80% of ASPD have substance use disorder".

There is then the person, who by the time they are 6 are so damaged by traumatizing parenting or circumstances, they do not have a healthy sense of attachment to other humans combined with an intense aggression, mixed with malice. These are, imo, the true, sociopaths, people who bully as a matter of course. There is usually a very thin veneer of charm with violence busting to get out. This disorder is often co-morbid with BPD traits. Highly sexual (any orifice, any gender, any age will do), rape is second nature, heavy drinking/hard drugs, serious body workouts, heavy tats. Your classic Maximum Security Inmate.

But there is also the socialized sociopath with the real thing. These are the CEOs of Enron, the Savings and Loan people who think nothing of crippling entire economies. Snakes in suits.

Then there is the psychopath. I think this is a rare disorder and the name of the illness of people with not mere arrogance, entitlement issues but heavy perception problems in perceiving the other, a mental illness. Albert Fish is an example of a psychopath.

"Descriptions of psychopathy or sociopathic personalities speak of
their inability to imagine the other. Psychopaths are well able to
size up situations and charm people. They perceive, assess and relate
making use of any opportunity, hence their successful manipulation of
others. But the psychopath is far less able to imagine the other
beyond the fantasy of usefulness, the other as a true interiority with
his or her own needs, intentions and feelings." [by James Hillman]

Psychopaths often make successful businessmen or world leaders.

Antisocial Personality Style and Disorder

The Compensated Psychopath

There is a huge burden on parents to be loving, emotionally healthy. The Consequences of Unempathic Care are a rotten, sick society.

Psychopathy and Consumerism:Two Illnesses that Need and Feed Each Other

A nice little checklist for the garden variety sociopath one might meet dating.
posted by nickyskye at 7:39 PM on November 6, 2008 [12 favorites]


A census taker once tried to test me.
posted by turgid dahlia at 7:45 PM on November 6, 2008 [2 favorites]


A census taker once tried to test me.

what?
posted by nickyskye at 8:04 PM on November 6, 2008


Sounds like Dick Cheney to me.
The hunting accident episode shows it, let alone Iraq.
posted by bad grammar at 8:08 PM on November 6, 2008 [1 favorite]


what?

The correct answer is: "I ate his liver with some fava beans, and a nice chianti *sucksucksucksucksuck*."
posted by turgid dahlia at 9:52 PM on November 6, 2008 [1 favorite]


Marisa and nickyskye: thanks. I'll be spending a lot of time with the links in this thread at some point.
posted by painquale at 11:20 PM on November 6, 2008


Rather than look to a drug for people who are already dangers to society, I think the effort needs to be made in educating people who are thinking of having a child about the socially devastating impact of bad parenting. And what is good parenting? There needs to be classes in that, in every school in America, taught from kindergarten. This is not Nobel Prize, find-a-drug drama-egotism. It's the complex, subtle and profoundly meaningful process of knowing how to love, care for, guide a child and be a parent. It's a skill that needs to be learned and put into practice.

Every obstetrician and insurance company should have mandatory classes about healthy parenting as part of the insurance payment, which requires both biological parents to attend. Or the biological mother and at least one other adult who will contribute to parenting that child. People procreate and have no idea about what impact parenting has or how to be a parent. When a sociopath or psychopath is created due to parental abuse, abandonment, trauma, it's way too late. Then it becomes the law enforcement system's job and legal system/ therapists helping the victims of sociopaths and psychopaths. Usually generations of victims.


Repeated for emphasis
posted by Restless Day at 3:15 AM on November 7, 2008


nickyskye Every obstetrician and insurance company should have mandatory classes about healthy parenting as part of the insurance payment, which requires both biological parents to attend. Or the biological mother and at least one other adult who will contribute to parenting that child. People procreate and have no idea about what impact parenting has or how to be a parent.

While I don't disagree with this as such, the notion that such complex and universal measures are required to avoid or undo incipient psychopathy in children implies that the natural state of human beings is to have a fairly high percentage of psychopaths.

It seems that most of the authors of the linked articles, and nickyskye herself above, are attributing psychopathy (of various kinds) almost entirely to nurture rather than nature: asserting that if only kids are raised "right", it will be avoided. However, if psychopathy is a brain chemistry malfunction, I wonder how true that is. Brain chemistry malfunctions do tend to correlate strongly with genetics. Shared family environment and shared culture correlates strongly with genetics too.
posted by aeschenkarnos at 6:22 AM on November 7, 2008


aeschenkarnos it is safe to say that children have been abused and neglected since the dawn of Man, and it follows that "the natural state of human beings is to have a high percentage" of a wide range of socially maladapted adults. It's only in the last hundred years or so that we've begun to really understand the relationship between brain physiology and behavior, and the impact of childhood trauma on both.

Does the fact that men have been raping and killing for thousands upon bloody thousands of years mean we must accept such behavior, allow it to continue? A lot of people do argue that "you can't change human nature" (notably, Alan Greenspan said it in an interview not too long ago . . . on Bill Moyers, IIRC), and, arguably, we may not survive as a species long enough to prove the hypothesis that "if only kids are raised 'right,'" we will see a reduction in antisocial behaviors.

And we may never live to see legislation requiring the training and licensing of parents, I've heard too many parents say "Nobody's gonna tell me how to raise my own children." I know I won't live long enough to see the day. But I've memorized a passage from Martin Luther King's "Letter from the Birmingham Jail," and I recite it at every opportunity:

We shall have to repent in this generation not merely for the hateful words and actions of the bad people but for the appalling silence of the good people. Human progress never rolls in on wheels of inevitability; it comes through the tireless efforts of men willing to be coworkers with God, and without this hard work, time itself becomes an ally of the forces of social stagnation. We must use time creatively, in the knowledge that the time is always ripe to do right.
posted by Restless Day at 7:55 AM on November 7, 2008 [1 favorite]


aeschenkarnos, the brain is "plastic", flexible, mutable, changeable. It morphs, evolves, disintegrates, develops, changes under the influence of both external, internal and genetic impacts.

"In particular, the wiring of the developing brain seems to be dependent on the child's life experiences, with the first six years of life as a critical period. Because young children have not yet been able to develop a personality structure that allows for the integration of very stressful experiences, early and chronic childhood traumatization can shape the mind and the brain in ways that promote state-dependent functioning or functioning that is dependent on dissociative parts of the personality."

The Body Keeps The Score:
Memory & the Evolving Psychobiology of Post Traumatic Stress


Take a good brain fill it with meth or crack and in a year of so and you can have such brain damage the person may then have an all pervasive, rigid personality disorder. For life. The external changes are a little glimpse of the internal changes.

Booze can create personality disorders too. The brain damage done by trauma is immense. When trauma related damage is done to the vulnerable, evolving brain of a child, especially in the first 6 years of life, that child is likely, based on genetic vulnerability as well, to become personality disordered. A lifelong condition. 4 of these personality disorders listed in the DSM IV, the Axis II Cluster B disorders, are socially destructive. Of these 4, ASPD, Sociopathy (which incorrectly includes the related Psychopathy) is the most dangerous socially.

the natural state of human beings is to have a fairly high percentage of psychopaths

The percentage of those with personality disorders is estimated to be about 20 to 26% of the US population. Mental illness and depression can be added to that with another major percentage of the population. 15 million Americans suffer depression.

"Research by the World Health Organization and the World Bank estimated that in 1990, among the world’s population aged 15 to 44 years, depression accounted for more than 10 percent of the total burden attributable to all diseases. Two other illnesses, bipolar disorder and schizophrenia, accounted for another 6 percent of the burden. This research has helped governments recognize that mental illnesses constitute a far greater challenge to public health systems than previously realized."

Many people with ASPD have not been diagnosed because they are highly successful. Material success and wealth are seen as signs of mental/emotional/genetic health, big mistake. Scientists and psychologists are just now coming to understand the connection between ASPD and people in high-power businesses. The Sociopathy (ASPD) term has only been in use in the DSMIV since 1980, not so long ago.

I think the statistics will change over time to better represent the prevalence of ASPD. 8 years ago, on Tim Field's excellent BullyOnline site (now taken down after his death by cancer) I read an article stating that it is estimated that 65% of British CEO's have ASPD.

On any given day there are a million people in the USA being treated for drug/alcohol addiction. 12 million alcoholics in the USA.

There are a *lot* of unwell people in the world today, in spite of wealth, education, relative political peace in the USA, compared to other countries devastated by warfare. War itself creates horrendous trauma/ptsd for the survivors, especially children. Who knows what the long term social impacts of the horror in the many countries at war will be: Iraq, Afghanistan, Sudan, Nigeria, the list is long.

Is there a "natural state" for human beings? This implies an ideal peace, one without the impact of trauma, either domestic, political or military? When has this existed?

David T. Lykken, the "internationally renowned scientist and author" who wrote the excellent book about the types of sociopaths linked above, he talks about the fact that people are able to rise above their genetic tendencies - or not- due to nurture or personal decision. "Lykken and his collaborators demonstrated conclusively that the variability of virtually every psychological trait has a largely genetic basis...he introduced the concept of emergenesis, the idea that complex combination of genes work configurally, not additively, in determining many human traits." He basically believe people should get a license before having a child. And I agree with him.

Please check out his book about the impact of nurture on creating sociopaths. He's a highly respected forensic scientist on this matter. Yes, genetics have a very important part however he sees it not Nature *or* Nurture but Nature *via* Nurture;"whether we bounce along above it or slump along under it depends on our -- or our parents' -- good sense and good training."

Adult children of Alcoholics are genetically 30-85% more likely to become alcoholics but they can choose to deal with this genetic vulnerability through therapy or awareness and not succumb to an inherent genetic weakness.

Genes are not immutable, they can change, evolve "genes change in proportion to the selection pressure exerted".

A couple of examples of genes morphing: re diabetes, in just three months using food.

You said: "Shared family environment and shared culture correlates strongly with genetics too."

Ornish says, "Genes may be our predisposition, but they are not our fate".

posted by nickyskye at 9:33 AM on November 7, 2008 [1 favorite]


Wow, nickyskye. Guess I hadn't been lurking long enough! I'm glad you've got this group of yours together here; off the top of my head I can't recall hearing of anything like it. If I might ask, does sociopathy beget sociopathy, in your experience? Given their ability to cloak themselves, I know it might be difficult to say what percentage of children of sociopaths become one themselves, but do you have a ballpark estimate?

The subject is fascinating to me because sociopathy/psychopathy is ill-defined, seemingly impossible to treat, and difficult to identify in the high-functioning end of the spectrum. These are people written off by the psychiatric community as a lost cause that law enforcement needs to identify, and then incarcerate. And yes, it certainly is difficult to treat someone so adept at masking their own illness, but it's not impossible.

I think you hit on something when you talk about parenting classes. There's a lot of truth to this; most socio/psychopaths are made from horrible upbringings, and I agree that a basic parenting course can help prevent it. In some Scandinavian countries, new parents are visited by a nurse and/or midwife on a daily basis for the first week the child is born, and then once a week for the first few months, to provide counselling, answer questions, and point them in the direction of resources that can help them if they need assistance. A strong, child-focused social system overall gives parents the help they need in raising a child, makes every child feel wanted and cared for, and prevents monsters from growing out of abuse. This is not to say the physical and sexual abuse doesn't occur in such societies - there are monsters everywhere - but it does at least provide assistance to parents in need, and helps every child feel embraced by the world around them.

Now, researching the brain chemistry and structure of socio/psychopaths is also important. Is there some heredity involved here? To what extent would hereditary signs be indicative of "abuse begets abuse" as opposed to a socio/psychopathic genome?

Science marches on.
posted by Marisa Stole the Precious Thing at 9:45 AM on November 7, 2008 [1 favorite]


Absorbed by the excellent post and comments - not so thrilled by the New Yorker article.

I was actually oddly relieved when nickyskye said: argh. Reading that article I disagree with almost every sentence when it comes to describing the illness and think it's badly researched, which harms everybody because it passes on just more misinformation.

I've no expertise myself, but the piece itself seemed terribly uneven (though the author's a senior staff writer). I couldn't work out, quite, for who it was written. The Hamptons crowd? Prison life voyeurs? Aspiring mental health professionals? It was simultaneously dull with a few furtively flashy bits...
posted by Jody Tresidder at 10:55 AM on November 7, 2008 [1 favorite]


Marisa Stole the Precious Thing, Is there some heredity involved here?

Yes.

"40 to 60% of the recurrence of certain personality traits across generations can be explained by heredity: anxiousness, callousness, cognitive distortion, compulsivity, identity problems, oppositionality, rejection, restricted expression, social avoidance, stimulus seeking, and suspiciousness. Each and every one of these qualities is associated with a personality disorder. In a roundabout way, therefore, this study supports the hypothesis that personality disorders are hereditary."

However, for the non-personality disordered children of personality disordered parents, as Ornish said: "Genes may be our predisposition, but they are not our fate".

The author I know, who originally broached the Adult Children of Narcissists (ACONs) topic in 1996, is Elan Golomb, a therapist in NYC, who wrote Trapped in the Mirror. Now there are a few more books on the topic. I recommend: The Narcissistic Family: Diagnosis and Treatment Stephanie Donaldson-Pressman and Robert Pressman, 1997

The first online support group I know was started in March 1999 for people dealing with the abuse done by Narcissists., which unfortunately was handed over to a Narcissist to run. Not so good.

To the best of my knowledge I pioneered the ACON topic on the web with a group called Recovering Narcissist Codependents back in April 2000. It was mixed ACONs and people still in ongoing, long-term, serial enmeshments with Narcissists and sociopaths. Another group started in September 2000 called Adult Children of Narcissits [sic]
http://health.groups.yahoo.com/group/Adult-ChildrenOfNarcissits/

I started my online Adult Children of Narcissists and Sociopaths group in 2005 after being asked by another NPD abuse survivors support forum owner, who wanted my help with her ACON members. And slapped up (self link) a webpage, which is in dire need of making more contemporary (please hope me anybody, this pathetic Luddite, who loves the web and sees its potential to be of help to others).

The only therapist I know, one who I think is emotionally healthy and has a stated focus on helping Adult Children of Narcissists or people in enmeshments with a pathological narcissist, is Daniel Shaw in NYC. I highly recommend him.

There are no offline support groups for this I know of, yet.

Personality disorders have certain *behaviors* that may be treated, to some degree trainable. Underlying depression, mania, obsessiveness, delusions may be treated with meds. But the core personality disorder is all-pervasive and rigid. It's not fixable. Not yet.

To what extent would hereditary signs be indicative of "abuse begets abuse" as opposed to a socio/psychopathic genome?

To the extent that there was/is nobody loving in a child's life to help prevent the severe damage from taking place combined with the genetic vulnerability of that child. This protective loving may even be the love of a dog or a cat. Children are remarkably able to absorb whatever love comes there way, in any increment and benefit from that, unless a personality disorder sets in by the age of 6. Then they are stuck with that disorder or combination of disorders the rest of their lives.
posted by nickyskye at 11:28 AM on November 7, 2008


Jody Tresidder, Excellently concise and, imo, accurate review of the article. Agreed with your every point.
posted by nickyskye at 11:30 AM on November 7, 2008


*absorb whatever love comes their way
posted by nickyskye at 11:33 AM on November 7, 2008


Nicky, I have to disagree with you in a bunch of ways though I completely agree that empathic parenting is essential.

1) This is not true:
Take a good brain fill it with meth or crack and in a year of so and you can have such brain damage the person may then have an all pervasive, rigid personality disorder. For life. The external changes are a little glimpse of the internal changes.

There is no data to support this. The problem is that no one "takes a good brain and fills it with crack or meth for a year or so." People who take crack or meth heavily for years are pre-existingly damaged. If they weren't, they wouldn't do that. People who take crack or meth for just a year or so are not damaged in this kind of way. If they were, the entire 80's generation would be sociopaths.

I smoked crack and injected cocaine and heroin for about three years solid. I have many flaws-- sociopathy and all pervasive personality disorder are not amongst them. Many, many of the people whom I attended Columbia University with in the 80's did tons of crack for a year or so. Lots of them are highly successful-- and not in a sociopathic way but in a social services kind of way. The rest is just drug war propaganda.

In fact, most sociopaths are drug users-- but they are not addicts. And most addicts are not sociopaths, although people with antisocial personality disorder are overrepresented, particularly amongst male addicts.

Of course, the people who *do* fill their brains with drugs for years on end who *are* pre-existingly damaged are largely pre-existingly damaged by trauma. Many also have genetic issues that lead to impulsivity and reduced empathy.

2) Sociopathy and psychopathy are seen as identical terms by most of the people in the field. If you want to call them different, you are making a distinction that will not be understood. The original difference was that sociopaths were made by society being bad, psychopaths by individual difference. Since no one can tell (and most are born and made), it's silly.

It is worthwhile to distinguish between antisocial personality disorder-- which is problematic, but isn't serial-killer-level-problematic-- and psychopathy or sociopathy, which is. Those can be seen as the extremes of ASPD.

3) Empathy (understanding what someone else is feeling and thinking by mirroring) and theory of mind (understanding that other people are separate and have different thoughts and motivations) are two different things. Some people on the autistic spectrum lack theory of mind-- they don't lack empathy if they can learn theory of mind. In fact, many people with Asperger's and autism are actually over-empathetic in the sense that they feel other's pain *so much* because of their generalized oversensitivity that they actually do not behave empathically, but withdraw.

Sociopaths, OTOH, excel at theory of mind but fail at empathy. As I put it in my book with Dr. Bruce Perry in our discussion of this subject, they know what it's like to be in someone else's shoes, they just don't care. Autists don't know, sociopaths don't care.
posted by Maias at 3:57 PM on November 7, 2008


Maias, Congratulations on your addiction recovery. That's awesome and I respect your having written openly about that, now and what I've read of yours before.

I've known and known of very compassionate, loving, moral, sane former/recovering addicts of many drugs, including crack and heroin. You're one. Addiction does not mean personality disorder, I never said it did.

But meth and crack addiction can cause the type of brain damage which causes personality disorder. It's documented and written about. The best book I know about this is by Forrest. There's lots of info out there on The Relationship between Addiction and Psychopathology.

"The DSM is clear: the brain-injured may acquire traits and behaviors typical of certain personality disorders"

1) This is not true:

Yes, it is. More info.

There is no data to support this.

Yes, there is.

Long-Term Methamphetamine Abuse Can: * Lead to Hallucinations, Personality Disorders and Psychosis.

Forrest's work about the brain damage done by alcoholism causing pathological narcissism.

This isn't about doing a 1980's occasional quick line in the corporate bathroom or party, this is about hard core use. Brain damage done by serious meth and crack has many papers/citations on the web from various sources eg Harvard.

"both cocaine and alcohol abuse/dependence significantly worsen such pre-existing brain abnormalities as attention-deficit hyperactivity disorder (ADHD), major depression, mental distress, anxiety disorder, and paranoid schizophrenia, according to medical research by Eric R. Braverman, M.D.*, and Kenneth Blum, Ph."

People who take crack or meth for just a year or so are not damaged in this kind of way.

Yes, they are. "The changes are evident even for abusers who have not taken the drug for a year or more."

Obviously, the longer the use, the more severe, longer duration, the more vulnerable the person's constitution, age etc, the more damage done. This isn't a cookie cutter situation. My point is that hard core drug abuse/addiction, meth in particular, causes the type of brain damage, which can also cause pathological narcissism (not just Forrest's book but I've read about it on medical/forensic sites discussing meth and crack addiction). Often meth users are violent. Narcissism plus violence is the typical sociopathy combo.

Sociopathy and psychopathy are seen as identical terms by most of the people in the field.

Not true. There are numerous citations for that in my above post, in particular Lykken's research, which is world renowned.

"Dr. Robert Hare, one of the leading experts in the study of psychopathy, suggests that the difference between sociopathy and psychopathy may primarily reflect how the person using these terms views the factors contributing to the antisocial disorder."

"However, by the end of the paper I hope to convince the reader that the distinction between primary and secondary sociopaths is an important one because there are two different etiological paths to sociopathy, with differing implications for prevention and treatment."

Antisocial personality disorder + ASPD (or APD) = Sociopathy.

I know my opinion about people with Axis II Cluster B personality disorders, having partial empathy is controversial but Elliott Barker, M.D. and B. Shipton, Ph.D., share the same opinon. I stand by the definition of "partial empathy", spoken about in this link.

Elliott Barker, M.D. has worked"with criminally insane psychopaths in Ontario's maximum security mental hospital...to establish the Canadian Society for the Prevention of Cruelty to Children in 1975, in order to increase public awareness of the long-term consequences of emotional abuse in the earliest years."

I've given this considerable thought over the years and think that without empathy a person who is a pathological narcissist, sociopath or has any of the other Axis II, Cluster B disorders, would be unable to 1) read their victims or audience in the uncannily astute and emotionally perceptive, predatory way they do and 2) target the exact points of vulnerability that they do in highly skillful manipulation and/or sadism.

The word empathy is routinely used to not only mean the
1) ability to perceive what it is like in the other persona's shoes but
2) to respond caringly and appropriately to what is observed.

Elliott Barker, M.D. and B. Shipton say, (emphasis mine): "Empathy is loosely thought to be the capacity to put yourself in another person's shoes. But this seems to be only one part of what constitutes empathy in relation to the psychopath. What is different about the psychopath is that he is unaffected or detached emotionally from the knowledge that he gains by putting himself in your shoes. Thus, although he is able to very quickly glean during the briefest encounter with another person a lot of very useful information about what makes that person tick, this knowledge is simply knowledge to be used or not as the psychopath chooses. What is missing in psychopaths is the compelling nature of the appropriate affective response to the knowledge gained from putting himself in another persons shoes, in the way that this happens in the normal person. "

Autists are said to be empathy impaired. Autism, Empathy and Moral Agency.

Quite to the contrary, sociopaths are phenomenal at relating socially, schmoozing, seduction, mesmerizing, magnetizing, charming others, knowing just the right things to say. This is, imo, because they have "partial empathy", or what I think of as sadistic empathy. They use their ability to read people in a predatory way.

Autists don't know, sociopaths don't care.

"A common source of confusion in analyzing the interactions between empathy and autism spectrum disorders (ASD) is that the apparent lack of empathy may mask excessive sensitivity.[12] An apparant lack of empathy may also mask a failure to demonstrate empathy can arise from inability (or not knowing how) to express empathy to others, as opposed to difficulty feeling it, internally."

Autists don't know because they are empathy impaired. Sociopaths have partial empathy, they know and abuse. If they did not know, they wouldn't have the capacity to commit the types of abuses they do.

Imo, psychopaths, like Dahmer, have some autistic traits. As discussed here and here: Asperger's Disorder: A Possible Explanation for Behavior of Subgroup of Serial Killers?
posted by nickyskye at 10:45 PM on November 7, 2008


I met a woman several years ago who told me she had a bit of a problem with crack-cocaine, and because at the time I was blissfully unaware of the harsh realities of crack addiction, or addiction in general, and because I've experimented with a lot of recreational drugs myself without anything catastrophic happening to me ( I do, in hindsight, think it's a huge waste of time ), and because I was single and I found this woman attractive, I invited her into my life, and it was like that scene in the movie "Alien" where Kane peers into the opened egg-case, and--

What I mean is, I had no idea what I had gotten myself into; fortunately for me I found a book by Judith Lewis Herman MD called "Trauma and Recovery," and for anyone who, like me, is completely clueless when it comes to personality disorders, and the context in which personality disorders occur, I higly recommend taking the time to watch this hour-long video ( you can even skip past the first fifteen minutes ). Dr. Herman's compassion and empathy unmasks the monster to reveal the frightened child victim, and also explains the larger sociopolitical context which, I've come to believe quite strongly, everyone needs to understand, so we can all move forward out of a nightmare-dark past into a hope-bright future.
posted by Restless Day at 4:55 AM on November 8, 2008 [2 favorites]


Again, all those citations (some of which are not research at all) do not show that people with "a year or so of crack or meth" and a pre-existing "good brain" develop personality disorders.

Since no one can run the experiment because it is unethical to give people with "good brains" crack or meth for a year, it is simply unknowable. Sorry-- none of those cites show anything about *randomizing* people to crack or meth or placebo and seeing whether personality disorders develop. And without doing that, you can't prove that people's brains were fine *before*. In other words, this is the classic example of a "self selection" effect.

I am not saying that long-term use cannot produce psychosis. It is clearly the case. The rat data suggests this. But there aren't many previously completely OK people who use long-term. Typically, long-term heavy users have severe pre-existing problems-- trauma, depression, anxiety, personality disorder, etc. etc. etc. And typically *one year of use*-- you didn't say addiction-- doesn't produce this. The studies are all of addicts who typically have been using heavily for far longer than a year before they wind up in research studies.

And yes, people certainly do claim that a key problem in autism is impairment with empathy. But others argue that it is a problem with theory of mind, and not empathy itself. That's a theoretical disagreement-- but a few citations do not make it go away. There may be some who believe the primary problem is empathy-- but I tend to agree with those who say the primary problem is sensory overload that leads to underdevelopment of social brain regions. I have written about that for New Scientist here.

The other stuff is all semantic. There are researchers who claim a difference between sociopathy and psychopathy but since there is no "official" DSM diagnosis of either, it's a semantic argument. Since most people use the terms interchangeably, it's silly to say well "one is this" and "one is that" because unless DSM or some other authority produces a definition that is widely agreed upon, you can cite away and it won't make a difference. None of the experts who wants to make the case for *their* definition has won. So, until they do, it's all the same.

Same with empathy. No DSM definition, but as the author of a forthcoming book on empathy, I will argue that it requires compassion. Sociopaths have theory of mind-- they are very good at knowing other people's motivations and predicting what they will do. This is what I mean by "knowing" But they use that info to manipulate and harm-- not help. And I have seen no evidence that they have any empathy-- in the sense of caring about others. Again, theory of mind is not empathy. And that's what I meant when I said that sociopaths know but don't care and autistic people can care if they learn to know.
posted by Maias at 7:00 AM on November 8, 2008


P.S. People actually do take methamphetamine for years without psychosis: it's even prescribed to children as Adderall, for ADD. The devil is in the dose...
posted by Maias at 8:15 AM on November 8, 2008


Everybody's a psychopath online.

Well, not everyone, but the opportunity of anonymity inspires many people to express things that they would never say to others in person.

The behavior became familiar from Usenet days onwards. Never before could people say destructive things with so little cost; in the past, even sneaking nasty notes under your neighbors' doors ran the risk that you would be caught.

But I suppose that trolls are only minor psychopaths; being a spammer, phisher, eBay scammer or other form of Internet rip-off artist is more diagnostic.
posted by bad grammar at 12:49 PM on November 8, 2008


oats, Anyone know anything about the self-administered instrument mentioned Mahmut article? I'm dying to know how much of a psychopath I am.

Online Diagnosis from the Institute of Mental Health's webpage re Antisocial Personality Disorder

Online Screening for Personality Disorders

And from Theodore Millon's site.

Restless Day, seconding your appreciation of Judith Lewis Herman's Trauma and Recovery. A friend of mine who became a nurse in Canada said it's required reading as part of the nursing curriculum there in Vancouver, which I think is great. I've spoken with Ms Herman and found her to be a good person as well as excellent author.

For dealing with the upcloseandpersonal experience, you might consider the Betrayal Bond by Patrick Carnes.

huh. The things one comes across/discovers by accident in commenting on the blue. I was researching the various categories of sociopaths. These sites are for those who have dated/known a sociopath or psychopath:

TakeBackYourHeart.com

Types of sociopaths

Sub-Sociopaths and Sub-Psychopath Types

Characteristics of sociopaths in practical terms

Maias, this is not a thread about run of the mill addiction or routine, prescription use of speed, nor is it about the sensitivity of autists. It's about sociopathy and psychopathy.

That said, Crystal Meth addiction is now the biggest pandemic gripping the nation. According to the latest statistics, there are at least 1.5 million addicted

Alcohol and Other Drugs may induce, worsen, or diminish psychiatric symptoms, complicating the diagnostic process. Any therapist in the dual-diagnosis field knows this.

And without doing that, you can't prove that people's brains were fine *before*.

Oh yeah? Just ask any parent, relative, friend, child of the person they knew before becoming a heavy meth/crank or crack addict.

It takes no scientific research to note the development of obvious pathologically narcissistic traits in meth or crack addicts. Ask any parent or relative of a meth or crack addict about what happened to the person they knew. As just one example, comment #47 in this discussion of a female sociopath:

Or this anti-meth site discussing the traits of meth addicts:
Are meth addicts pathological liars?

"I was wondering if a side effect of Methamphetamine addiction is this same Sociopathic, Narcissistic behavior? I went from having a loving, caring daughter to having a daughter that abandoned her children and that lies so bad you cannot believe anything that comes out of her mouth. She only cares about herself and could care less about anyone else. She is everything you described in a Sociopath. She is a master manipulator as well as a liar and it saddens me. She has been addicted for 5 years now and has lost all of her children and does not even seem to care as long as she can derive sympathy or get something out of it."

Facts about addiction and personality disorder [pdf]

Neurological damage done by intense use of meth (crank, crystal meth, the street drug- not Adderal prescribed for people with ADD) or crack in their potential for creating personality disorder traits, has been well documented. Yes, there is research on this, plenty of research. It's not all tied into a neat academic or forensic bundle. This whole area of personality disorder, its etiology and its impact is an area of pioneering science. So is most of the field of psychology.

But here's some research on this:
Acquired Sociopathy and Frontotemporal Dementia

The cycle of drug use in addiction : a pathological narcissistic organisation

There's tons of stuff now on the web that wasn't there just a few years ago on Dual Diagnosis:

Dual Diagnosis refers to co-occurring Mental Illness, Drug Addiction and/or Alcoholism in various combinations.

Meth and crack addiction damage the brain, this is documented, the heavier the dose, the more vulnerable the constitution, the worse the damage. The parts of the brain damaged cause the addict to have traits of a person with the Axis II Cluster B personality disorders: parasitic lifestyle, poor behavioral controls, conning, shallow affect, irresponsibility, criminal versatility, lack of remorse or guilt, failure to accept responsibility for own actions, callousness, entitlement, pathological lying, reckless, underhanded, exploitative, impulsivity, manipulative, lack of realistic, long-term goals, promiscuous sexual behavior, aggressive, cunning, violence, emotional volatility, lack of empathy, grandiosity...not to mention they typically would do anything illegal for another fix issue, including destroy their family.

"Acquired sociopathy: a neuropsychological study of executive dysfunction in violent offenders.(New South Wales)"
Neurological dysfunction is linked with sociopathy in the prison popolation.

"While neurological dysfunction is reported at a rate of 1% to 2% of western industrialised populations, studies indicate that anywhere between 10% and 67% of offenders have some form of neurological dysfunction (Miller, 2002)."

Acquired sociopathy or acquired pathological narcissism due to cystal meth and crack addiction will, imo, become a routine part of the forensic/law-and-neuroscience assessment of criminals in years to come.

It's a little hard to determine brain damage and personality disorder connections in a lab using rats.

Those who are often familiar with dual-diagnosis of personality disorders and meth/crack/alcohol addiction are the forensic psychologists, people in the corrections service working with prisoners and they are not neuroscientists. So this will be an interesting field of research. For this reason alone, I'm glad that Kiehl, referred to in the New Yorker article of the OP, is opening the door to this topic of sociopaths in prison. Many sociopaths in prison are addicts and or have brain damage issues, so I think brain damage done by addiction may figure in the investigation, or I hope it does.

It's likely organizations like the Laboratory for Translational Neuroscience of Dual Diagnosis and Development, Institute of Psychiatric Research, Department of Psychiatry, Indiana University School of Medicine will come up with some decent papers on this in the near future, they're working on it.

"Although the evaluation of co-occurring personality disorders has been the subject of numerous studies by addiction researchers, very little attention is paid on the co-occurrence of substance abuse by personality disorder researchers. This state of affairs is difficult to understand when one considers that substance abuse and personality disorders are by far the most common forms of dual diagnosis."

Why do mental illness and drug addiction so often go together?

In Italy: Centre for the Study and Care of Personality Disorders and Addiction

PersonalityResearch.org - A good resource for those researching personality disorders.

Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion - R. Hare
posted by nickyskye at 1:16 PM on November 8, 2008



I simply do not believe that asking relatives of addicts about their children before and after drugs is more reliable than dozens, perhaps hundreds of peer-reviewed articles showing that addicts tend to have childhoods marked by trauma, histories of mental illness and lots of other things that make them pre-existingly different.

Maybe you can ask their abusive parents about how well their children were doing before they started taking drugs? Or the alcoholic parents about what angels their children were before the crystal meth came in there?

Nicky, I'm sorry, that's just not a good argument. Longitudinal studies of personality disorder repeatedly show that if you follow people with it from infancy, it turns up early in childhood, typically *before* drug use starts. You can see conduct disorder--which is linked with ASPD-- in three year olds. They aren't using meth (unless given it for ADD-- and yes, Adderall *does include* actual methamphetamine in it, its a mixture of amphetamine salts).

That rat study you cite linking personality disorders to addiction? What did it do? Damaged the rats brains *in infancy* then gave them drugs later in life!!!! In other words, personality disorder first, leading to higher risk of addiction. Some researchers try to make a case that with depression and alcoholism, the depression usually *follows* the alcoholism-- but there's more compelling research and much more logic to the idea of people feeling depressed first, drinking more than others do because they have the need to self-medicate, and then becoming alcoholics.

Here's just a few of the numerous studies looking at how personality disorders appear in childhood. Simply pubmed antisocial and longitudinal and you'll see many, many such studies.

Those sites about meth and lying really irk me because there's actually no data suggesting that addicts *without personality disorders* lie more than anyone else. Self-report data by addicts about drug use is about as reliable as other self-report data by non-addicts, so long as the addicts are truly anonymous. In other words, the lying tends to be instrumental: ie, to get drugs, avoid getting caught, etc-- not lying for the sake of it. Sure, people who do something illegal or something other people want them not to do will lie about it. Does that mean that they are chronically untruthful in all areas? Not necessarily.

This is just more stuff trying to make drugs into evils and the cause of sociopathy. The truth is, while drugs can certainly make things worse, if you want to prevent sociopathy, you are far better off fighting child abuse and poverty than you are fighting a drug war.

And, it's a good idea to look at the genetics, too. This study looks at how abused children with a particular gene grow up to be more likely to be violent, whereas that connection is less likely to occur without the gene. It's complicated!!!
posted by Maias at 5:51 PM on November 8, 2008


This is just more stuff trying to make drugs into evils and the cause of sociopathy.

oh, I see, that's your agenda. Axe grindy pro-drugs. I thought so. Nothing to do with sociopathy but that hard core drug addiction to meth and crack is just fine. No damage brain damage done by HEAVY CRYSTAL METH and CRACK use? I don't agree with you and neither do hundreds of other doctors, scientists, forensic psychologists.

I offer dozens of links, citations and books as examples, world renowned expert information and you offer nothing in return but disagreement. Your opinion on this just just doesn't cut it.

I simply do not believe that asking relatives of addicts about their children before and after drugs is more reliable than dozens, perhaps hundreds of peer-reviewed articles showing that addicts tend to have childhoods marked by trauma, histories of mental illness and lots of other things that make them pre-existingly different.

Maias, you apparently want to ignore the hundreds of articles about the damage done to the brain by hard drugs such as meth and crack and the research papers, dual-diagnosis specialists, doctors, forensic psychologists, connecting that brain damage with traits of personality disorders. It's transparently obvious the damage meth does to people of all ages and psychological types. C'mon.

Obviously doctors are not going to test a person who appears to be emotionally healthy for a personality disorder, if one is not exhibited. But if a person who is basically responsible, loving, sane, socially balanced becomes meth/crack addicted, there are typically staggering changes in the behavior and character of that person, in months, many of which are just the traits of the Axis II Cluster B Disorders. Brain damage has been documented. Peer reviews, lab tests, the whole shebang.

I've seen this personality change with my own eyes in somebody who up until age 40 had a wonderful, completely ordinary life in the best sense of that word and did not have any symptoms of any personality disorder whatsoever. then became meth addicted because she wanted to lose weight and a neighbor offered some. Boom, life destroyed in a year. Less than that. Still living but family shattered. This is one of the reasons I did so much research on it. Speaking to numerous forensic psychologists over the last decade I learned this is common knowledge among law enforcement, the personality change of meth/crack addicts and that it becomes worse over time.

I know Adderal is speed. It's just *not crystal meth*. I'm talking about CRYSTAL METH, heavy use of METH (the street drug) what is it you don't get about that?

As for the MAOA (monoamine oxidase) issue:

No main effect was found for the relationship between MAOA genotype and VASB. Genotypes associated with high levels of MAOA activity buffered abused and neglected whites from increased risk of becoming violent and/or antisocial in later life. This protective effect was not found for non-white abused and neglected individuals.
Conclusions

Possible explanations for this differential effect for whites and non-whites include differences in contextual factors (e.g., environmental stressors) and a question of the suitability of using the MAOA promoter VNTR polymorphism as a proxy for MAOA levels in non-white populations.


Hello! "Environmental stressors". huh. Surprise? Not. Yeah, it's so complicated.

"We examined the possible joint effects of testosterone (measured in CSF) and MAOA-LPR genotype on antisocial personality disorder and scores on the Brown–Goodwin Aggression scale in 95 unrelated male criminal alcoholics and 45 controls."

So the men with ASPD who were tested were alcoholics? Funny that. Do you suppose the alcoholism had any part in the ASPD?

"Antisocial personality disorder (ASPD) and aggression are phenomena that are likely to be caused by a complex interplay of environmental and hereditary factor"

This is exactly what Lykken said in the numerous references to him I made in the comments above.

The gist is that a person may be genetically predisposed to an Axis II Cluster B disorder and if there are external factors the vulnerability is exacerbated. An addiction, such as to CRYSTAL METH or crack or alcohol can cause enough brain damage to induce personality disorder traits, including sociopathy.
posted by nickyskye at 11:17 PM on November 8, 2008


Interesting discussion!

More reading is required (by me) but I am finding Maias argument here is quite valid:
Those sites about meth and lying really irk me because there's actually no data suggesting that addicts *without personality disorders* lie more than anyone else.

Also, the link to the lovely colour image by Dr Paul Thompson suggests that the brain can probably recover from any atrophy resultant from meth use, so the damage need not be permanent.

Giving out the message that once you are addicted to a drug, you have damaged your brain irreparably is something I would be very careful about doing. That is not a message that someone teetering on the brink of self destruction needs to hear, IMHO.

I am going to suggest that people who are on the ASPD spectrum are addicted to various stimuli (e.g. other peoples' attention, domination, power) and as such are 'hard wired' to behave like addicts, independent of external chemical input.
posted by asok at 4:55 AM on November 9, 2008


NB. In this argument the stimuli are used to distract oneself from the feelings of emptyness and worthlessness that can occur if one has a break from continually occupying ones mind in whatever way is available.
posted by asok at 6:55 AM on November 9, 2008


Good points, asok; but addiction is a personality disorder, to talk about "addicts without personality disorders" does not compute.

And if, as you say, brains are remarkably resilient and can recover from the insult of substance abuse, of course you wouldn't want to tell someone in rehab that "it's too late to stop now." But neither is it wise to send the broad message, as Maias seems to be doing, that there's no harm in casual use of meth and crack; that just sounds like a bad idea.

Your last point is extremely important: addiction/compulsion is not a "lifestyle choice," it is a behavior disorder, and again the evidence of a connection between behavior disorders and traumatic experiences in early stages of brain development is compelling. This paper by Bessel vander Kolk is one I ask all of you to read carefully; to me, it just explains an awful lot about the mechanism behind addiction and other compulsive behaviors.
posted by Restless Day at 6:59 AM on November 9, 2008


hi! *waves to asok, Restless Day and Maias

Excited this thread has a sort of comet tail out into cyberspace. Just a few short years ago there was little organized information on the web about neuroscience-and-the-Axis II Cluster B personality disorders. My hope is that if journalists or students were to examine these issues, they might come across this conversational thread and bunch of links and do something constructive with it. I wish I had a degree, were a scientist or an academic to have some sort of socially accepted permission to state the things I do.

I do have 20 years of studying psychology, a decade of which has been on the Axis II Cluster B disorders and a lifetime of experience with sociopaths and pathological narcissists, 8 years on the web studying this, countless conversations with forensic psychologists, psychiatrists, lawyers who have dealt with sociopaths in court and therapists.

But I am not a trained academic, not a good arguer. I'm a lousy arguer in fact. What I can offer is the academic, scientific expertise of others and my sincere determination to be informed on this particular topic so as to help others. My intention is not about judging addicts or even sociopaths but to offer information to others so their lives are less damaged by sociopaths, so people can protect themselves from the destructiveness and cunning that is part and parcel of the sociopathic mindset. Ultimately, knowing the terrible damge of bad parenting, my hope is that people learn to be better parents. If thes destructive personality disorder are to be bred even a little out of humanity so that it is less prevalent, it will be, imo, through healthier parenting and exposing children to less trauma.

I'm trying to keep the focus on sociopathy and the original post's information.

Those sites about meth and lying really irk me because there's actually no data suggesting that addicts *without personality disorders* lie more than anyone else.

asok, A personality disorder is not about a single behavior, like lying or addiction for that matter. It's an across the board ALL PERVASIVE, rigid mindset, the entire person is impacted to one degree or another depending on many variables, for life. There is no cure for an Axis II Cluster B disorder. It's incurable so far, only some behavior modification or treatment of co-morbid issues such as depression or mania have been found treatable with meds.

People who have any one of the Axis II, Cluster B disorders (NPD, ASPD, BPD and HPD) typically impact society in dreadful, destructive ways, particularly sociopaths and psychopaths. (Sopranos type damage) When a human being is born they may have a genetic predisposition to any number of behaviors and illnesses. External and internal factors of all kinds have a role in triggering those vulnerabilities. Lykken is renowned for his research on this.

He ALSO said it's nature *via* nurture. A person is not stuck with a genetic predisposition, changes of some kinds can be made, for better or worse.

This is where the toxic impact of addiction to a neurologically damaging drug like alcohol, crystal meth or crack come into the picture. One glass of wine a day is fine. A snort or two of cocaine is no big deal. I'm not talking about recreational use or misuse of any substance. This is about the serious brain damage done by heavy abuse of the the incredibly addicting meth and crack. Or long term heavy use of alcohol.

A person may be exposed to drugs and choose not to become an addict/alcoholic in spite of their predisposition. If a child with a genetic vulnerability to sociopathy is severely abused/tramatized, smothered, spoiled, abandoned, the disorder may be triggered. The extent of the expression of that illness also depends on external circumstances. If a person with a genetic predisposition to sociopathy, or has some sociopathic traits, then becomes alcoholic or uses hard street drugs like crystal meth or crack, the brain is likely to become damaged to one extent or another, for one duration or another. Some scientists believe some damage is permanent. Variables to include: the extent of the neurological damage done by the addiction, the extent of the genetic predisposition, the extent of the PD (personality disorder) already in play by the time of the addiction, the extent of the other external factors.

The problem with a personality disorder of the Axis II Cluster B group is the damage people, who have these disorders do to others. It's not merely the idea "Don't take drugs.", "Don't hurt yourself". It's the idea, that if a person with a genetic tendency to sociopathy becomes brain damaged due to their addiction they become criminal, abusive and this impacts not only their family and everybody close to the sociopath but society as a whole. If sociopaths make up from 30 to 75% of the prison population and this costs just America $41 billion a year in taxpayer money, the connection of hard drug addiction and sociopathic behavior is worth observing.

More scientific research into this topic is important and necessary! Any scientists reading this, please do research on the impact of hard drug abuse on the Axis II Cluster B disorders.

The message is not that drugs are evil but that people can and do become evil to others due to hard core substance addiction in ways that mimic sociopathic behavior. Sociopaths are noted for depraved crimes. The less sociopathy or sociopathic behavior in the world the better.

My basic focus is on healthier parenting in the first place. That way even if a person, who has genetic tendencies to be a sociopath, may not become one in childhood by age six (which is usually the set point age in personality disorders, worse by 15 and cement by 21).

The neurological damage done by alcoholism, meth and crack can be so severe that the person with the addiction may devolve into a personality disorder (as written about by Forrest). Then it can be a spiral down that is extremely hard to reverse, one issue feeding into the other, the addiction feeding the disorder feeding the addiction...

addiction is a personality disorder, to talk about "addicts without personality disorders" does not compute.

Restless Day, may I ask for citations that addiction is a personality disorder?

I've never read anything to validate that. Some are speculating that addiction may be a disorder, even internet addiction disorder or web dependency.

Addiction may be a disorder but it is not, a personality disorder.

These are the personality disorders listed in the DSM:

* Paranoid personality disorder: characterized by irrational suspicions and mistrust of others
* Schizoid personality disorder: lack of interest in social relationships, seeing no point in sharing time with others
* Schizotypal personality disorder: also avoids social relationships, though out of a fear of people

Cluster B (dramatic, emotional, or erratic disorders)

* Antisocial personality disorder: "pervasive disregard for the law and the rights of others."
* Borderline personality disorder: extreme "black and white" thinking, instability in relationships, self-image, identity and behavior
* Histrionic personality disorder: "pervasive attention-seeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions
* Narcissistic personality disorder: "a pervasive pattern of grandiosity, need for admiration, and a lack of empathy"

Cluster C (anxious or fearful disorders)

* Avoidant personality disorder: social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction
* Dependent personality disorder: pervasive psychological dependence on other people.
* Obsessive-compulsive personality disorder (not the same as Obsessive-compulsive disorder): characterized by rigid conformity to rules, moral codes, and excessive orderliness


Thanks for the link to that excellent paper Restless Day. The Compulsion to Repeat the Trauma essay makes great points. I'm going to include it in my little online recovery library/archive. In my experience, dealing with the compulsivity, prone-to-addiction issues of abuse survivors, a few things (among many) are very helpful: working on object constancy, training oneself in self-soothing that doesn't use addictive substances, reparenting combined with antidepressants.

The site on which that essay you linked is connected, The Trauma Center- Justice Resource Institute, is fantastic! What a great resource. whoo hoo. A gem. Much appreciated!
posted by nickyskye at 2:16 PM on November 9, 2008


In the early 1950s, the first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders grouped alcohol and drug abuse under Sociopathic Personality Disturbances, which were thought to be symptoms of deeper psychological disorders or moral weakness.

Chinks/Japs.
posted by Restless Day at 2:53 PM on November 9, 2008


Chinks/Japs.

huh. Don't get it. what does that mean?

As for the link. wow. Holy APA, I never knew that! Blew my mind. Thanks Restless Day. I do see, reading what you linked, that the concept changed in the following DSMs.
posted by nickyskye at 4:07 PM on November 9, 2008


The notion of addiction as a personality disorder is long discredited. And Nicky, I provided lots of citations-- we are arguing past each other because you are saying EVIL DRUG METH and I am saying, yes, it can sometimes cause brain damage but it's more complicated and usually, the stuff that pre-exists before the addiction is far more important to understanding the problem and helping recovery.

I don't think you have posted any evidence that methamphetamine can create a de novo personality disorder-- what you have posted suggests that it may be possible, but lack of randomization means you can't prove more than that.

Alcohol can certainly produce irreversible brain damage, but that's not what we are talking about here-- and the form that alcoholic dementia usually takes is not ASPD, but looks more like Alzheimer's. A drunk with this disorder is not going to make much of a serial killer, basically.

I did make one mistake in my post: methamphetamine is sold as a prescription ADD medication-- SAME DRUG SOLD ON THE STREET, BUT PURER-- but it is not Adderall, but Desoxyn.

One reason I argue strongly on this is that addicts can easily be demonized as sociopaths and you can get an antisocial personality disorder diagnosis very easily just for being an addict because of the illegality of drugs. Antisocial personality disorder is in part defined by committing crimes. If a drug is illegal, addicts are going to commit crimes by definition in order to use it. If you just look at the definition you can see how this false diagnosis could happen:

Three or more of the following are required:[1]

1. Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;
2. Deceitfulness, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;
3. Impulsivity or failure to plan ahead;
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults;
5. Reckless disregard for safety of self or others;
6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations;
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.


It has to start before age 15. So, you could have 1) 3) and 5) and just be an addict who is self-destructive. You could be the kindest, sweetest, most empathetic person in the world and get an ASPD diagnosis simply by repeatedly getting caught for drug possession, being impulsive and suicidal. You don't even need to lie to people or hurt anyone other than yourself.

So, yes, I'm touchy about this because I feel that it demonizes addicts for no good reason. I have seen people receive this diagnosis in that way. And these were people who were later lauded for charitable work, etc.

And yes, I also think it is dangerous to tell people "you're too damaged to recover,"-- but I never said anywhere in my post that casual methamphetamine and crack use is harmless. I do believe that exaggerating the harms of these drugs is dangerous because when kids see their friends doing these drugs without immediate harm, they disregard everything you tell them as lies. You want to be clear and honest-- the truth is scary enough without pretending "smoke crack once and you'll become a sociopath."
posted by Maias at 6:30 PM on November 9, 2008


Maias, You wrote:
"the primary problem is sensory overload that leads to underdevelopment of social brain regions. I have written about that for New Scientist here."

and linked an article you wrote about autism.

Do supercharged brains give rise to autism?

Ok, not getting how that relates to anything you said about sociopathy and drug abuse?

The next link is re: Observation that ASPD happens in females and males
Female and male antisocial trajectories: from childhood origins to adult outcomes.

So yeah, females also have ASPD.

The one related link:
Psychopathology in preadolescent children at high risk for substance abuse: a review of the literature.

The gist of which is that addicts beget children prone to addiction. Major revelation there. Not. It's incredible the academic gibberish about the totally obvious.

"Because these neuropsychiatric disorders are potentially treatable, their identification may lead to effective early intervention strategies."

So children of addicts/alcoholics who seek therapy might not end up being addicts? Old news to the Adult Children Recovery movement that has already known this for 20+ years.

And this is relevant to the discussion about how meth and crack addiction brain damage is enough to cause ASPD traits how?

But this you linked that I missed reading before:

Role of genotype in the cycle of violence in maltreated children.


"not all victims of maltreatment grow up to victimize others, and they provide epidemiological evidence that genotypes can moderate children's sensitivity to environmental insults."

Now that is awesome and interesting information. huh. It's the first info you linked that I found really intriguing in terms of Axis 2 Cluster B Personality Disorders.

Ok, off to google monoamine oxidase A.

Interesting this tidbit, "PET research has shown that MAO is also heavily depleted by use of tobacco cigarettes." I'm surprised that information isn't more commonly known as that would mean that cigarette smoking would tend to cause neurological damage leading to depression and possible personality disorder trait issues.

This makes me also think that other addictive drug/alcohol use would deplete MAO-A and that may be one of the reasons addicts may also develop Axis II Cluster B personality disorder traits.

Brunner Syndrome is a type of MAOA deficiency, "It is characterised by mild mental retardation and problematic impulsive behavior (arson, attempted rape, aggressive posturing)." That's sort of like the lunk thug in movies. Or Lenny in Of Mice and Men.

MAO-A is also found in the liver, gastrointestinal tract

Maybe that is in part why alcoholism, which damages the liver, may contribute to PD traits? Diminishing the MAOA?

Ok. Reading more thoroughly. It all gets straight back to Lykken's points, once again.

"The suggested mechanism for this effect is the decreased ability of those with low MAO-A activity to quickly degrade norepinephrine, the synaptic neurotransmitter involved in sympathetic arousal and rage. This is alleged to provide direct support for the idea that genetic susceptibility to disease is not determined at birth, but varies with exposure to environmental influences. Note however that most of those with conduct disorder or convictions did not have low activity of MAO-A; maltreatment was found to cause stronger predisposition for antisocial behavior than differences in MAO-A activity."

That bears repeating: maltreatment was found to cause stronger predisposition for antisocial behavior than differences in MAO-A activity.

So, back to Lykken's book in discussing the etiology and taxonomy of sociopathy. That still seems to stand the test of time.

You said:
the stuff that pre-exists before the addiction is far more important to understanding the problem and helping recovery.

Why say all or nothing? What pre-exists is important AND the addiction issue is important. BOTH.

I don't think you have posted any evidence that methamphetamine can create a de novo personality disorder-- what you have posted suggests that it may be possible, but lack of randomization means you can't prove more than that.

Forrest's book about chemically induced pathological narcissism is the main book I know, as Lykken's is for defining sociopathy types.

Aquired sociopathy traits due to neurological damage done by meth/crack addiction will be something neuroscientists will, imo, no doubt come up with. There are a gazillion things neuroscientists are working on. However, aquired sociopathy/pathological narcissism traits due to meth/crackaddiction is routine observation among those in the dual diagnosis field dealing with those addictions.

You know, it's so interesting to read the science papers talking about enzymes etc and never looking at the impact of love on human beings, especially children. Why aren't there neurochemical studies examining love, what kinds of love are nourishing, supportive, enhancing of well being in children's brains so that children can get the well being they need to be well adults?

Adding these links to the thread:
PubMed on ASPD and gene + MAOA issues in ASPD. Dictionary of disorders.

Empathy, imo, is used as a term meaning compassion.

But, on closer examination it is has a number of parts:
perceiving what the other person is going through,
imagining oneself in their position and
imagining what they might be feeling,
projecting on to them one's own feelings, in
relation to how one has felt in a similar circumstance.

And then, responding as one would want to be responded to, with compassion (which term implies a kind of a moral or spiritual awareness, not merely emotional. A do unto others as one would have them do unto you kind of thing.).

The astute perception part, the knowing full well the other person's feelings, almost like x-ray, is how, imo, the "pathological charm" of sociopaths operates. Charming a person, manipulatively, cannot be done without seeing the other person, relating to them, perhaps even seeing the other person as an extension. But then with Axis II Cluster Bs comes the malice, manipulation, exploitation.

I think empathy has been used sloppily in a number of instances, in speaking about autism, the Axis II Cluster Bs and in colloquial terms. I think it needs to be much better defined, perhaps a taxonomy of types of empathy?

Thanks for this dialogue Maias.
posted by nickyskye at 10:47 PM on November 9, 2008


Chinks/Japs.

huh. Don't get it. what does that mean?

It's a post-war Americanism that means "same thing." I use it here because in spite of its racist insensitivity most of us appreciate that there are significant differences between the Chinese and the Japanese, and the point I was trying to make is that it depends on how close one is to the issue how sharp a distinction there is: a psychiatrist will want to be as sure as can be the diagnosis is correct in order to treat the client most effectively; a judge will want to make an informed decision whether a defendant should be in jail or in a mental hospital. But to the people in the "peanut gallery" (another 50s expression) it probably doesn't matter whether it's Axis II, Cluster B, etc.

filthy light thief said upthread, "I'd imagine that non-violent or non-criminal psychopaths are generally ignored," and I think that as far as most people are concerned a person can be depressed, delusional, or a drunkard and as long as no one else gets hurt there's no problem. And it won't matter whether it's a personality disorder or a behavior disorder, or whether the correct term is sociopathy or psychopathy, it's only if a person engages in antisocial behavior that it becomes an issue of concern to [most people]. So I was wrong when I said "addiction is a personality disorder"--if any individual inflicts harm on another, it's bad behavior and I don't really give a shit what you call it.
posted by Restless Day at 9:02 AM on November 10, 2008 [2 favorites]


Restless Day, thank you for explaining that about chinks/japs. I never understood peanut gallery before either. Colloquialisms update appreciated.

You said:
But to the people in the "peanut gallery" (another 50s expression) it probably doesn't matter whether it's Axis II, Cluster B, etc.

That made me think. Would regular people, not academics or trained psychologists, care about exact terms for the the Axis II Cluster B disordered: narcissists, sociopaths, borderlines and histrionics?

Yes, I think they would for a number of reasons. There are over 15,000 people online in just one recovery group network alone discussing enmeshments with people with Axis II Cluster Bs, who were made to feel crazy, were abused usually over years and want to know who the hell was that crazy person who screwed them over and WHY were they like that?!

And those groups just started a few years ago.

People may have a parent, sister, brother, boss, neighbor, husband, wife, lover with one of those disorders and the differences in damage done could range as typical examples of behavior:

conned out of one's bank account - narcissist
conned out of one's life savings -sociopath
violently beaten - sociopath
drugged and date raped - sociopath
stalked - borderline
slandered in a public arena -histrionic
driven to one's wit's end with dramarama -borderline or histrionic
tortured and murdered - psychopath

When a psychopath or sociopath commits murder, drugs and date rapes one's niece, brings down Wall Street, an extended entire family, even a whole nation is devastated, a lifelong impact, and people want to know the motive, about the agenda of the killer/the rapist/the con artist.

Now on TV there is more info routinely used on all kinds of shows describing the personalities of criminals, which I think is a good thing, the more info, the more savvy, the more open discussion, the less likely people are to be victimized or maybe even drawn into war.

You quoted filthy light thief as saying:
I'd imagine that non-violent or non-criminal psychopaths are generally ignored," and I think that as far as most people are concerned a person can be depressed, delusional, or a drunkard and as long as no one else gets hurt there's no problem. And it won't matter whether it's a personality disorder or a behavior disorder, or whether the correct term is sociopathy or psychopathy, it's only if a person engages in antisocial behavior that it becomes an issue of concern to [most people]

See, the corporate sociopaths are ignored until they bankrupt a nation or when the situation becomes WWII or the Iraq War or whatever war. War and sociopaths go together. This impacts millions of people, tens to hundreds of millions of people on any given day in history.

So it's worthwhile for the layperson, the civilian to know about corporate or other types of not overtly criminal sociopaths BEFORE millions get stuck in a global depression, slaughtered, their niece gets drugged-and-date-raped or their aunt gets murdered.

I don't think a sociopath gets through life without devastating people around them, to one degree or another.

Sociopaths/Narcissists/Borderlines/Histrionics are fairly easy to see once one has a little info about their illness, how it works. Psychopaths (the serial murder whackjobs) are harder to detect. But on a mass scale they do way less damage that malignant sociopaths, like Stalin or corporate sociopaths like Lehman's Dick Fuld or the Enron gang.

Adding to the list of useful links:
free Google book: Cognitive Therapy of Personality Disorders By Aaron T. Beck, Arthur Freeman, Denise D. Davis

Unfortunately, a number of the psychiatrists, who have been renown for their writing about personality disorders, may themselves have traits of the disorders. As reading this review makes me wonder about the doctor.

A.M. Benis, Sc.D., M.D. is the expert on Mendelian genetics and personality traits. I like his European Royalty: Inherited personality traits Genetic character types of kings, queens...and other famous people Personality Typing Based on Mendelian Genetics .
posted by nickyskye at 1:58 PM on November 10, 2008


I fear it is too late to ask now, but ask I will: Do any of the linked studies or articles show or mention sizeable numbers of people who are diagnosed with both autistic spectrum disorders and personality disorders? Is such a dual diagnosis even possible/realistic? Or does it usually mean that it's really one or the other? (First post!)
posted by Ffortiwn at 9:02 PM on November 13, 2008


Rereading my comments my eyes rool with disappointment at the typos, bad editing and errors, discouraging.

My paragraph above should read:
Points Lykken makes that I agree with are that, at the very least, the ASPD concept really needs to be divided into Primary Sociopath and Secondary Sociopath. In the Primary Sociopath heading there is a continuum, with, imo, the corporate sociopath on the lower end and serial killer, military monster, like Stalin or Pol Pot on the deep end.

On the Secondary Sociopath level, the term really should not be psychopath at all, but Sociopath, coined in 1930. There are a number of styles of this disorder and origins. On the low end of sociopathy is the kid who grew up in a poor family, surrounded by people who routinely bought things that "fell off the truck", all his friends are delinquent, so he is too, beaten by his mom or dad as a cultural right and was taught to be violent with either gender as an expression of testosterone/identity. Working class sociopaths on the low end of the continuum have a chance not to be monsters. A lot may depend on their substance addiction issues, their work ethic, if they allow at least one or two more emotionally healthy people into their lives as companions or role models.
posted by nickyskye at 5:34 AM on November 14, 2008


Hi dear Ffortiwn, Please do consider posting your question to AskMetafilter.

Suggestions before you ask your AskMe question:

What are the traits you consider are Aspie,
what are the traits you consider sociopathic?
What are the traits you consider pathologically narcissistic?
did the person in question have a childhood in which they were abused?
What harm does that person do to others with their actions?
Have others indicated to this person that they cause others emotional pain?

Once the person has the diagnosis what then do they want to do?

Would that person seek treatment, or simply want to be diagnosed? Nobody on the internet -or anywhere- is going to diagnose anybody with a lifelong illness in a vague paragraph. Not going to happen.

Getting a diagnosis is a significant decision in a person's life. The diagnosis should be given by a professional:
http://www.millon.net/

"sizeable numbers of people who are diagnosed with both autistic spectrum disorders and personality disorders?"

No.

"Is such a dual diagnosis even possible/realistic?"

Yes.

"Or does it usually mean that it's really one or the other?"

The human mind is complex. Nobody has all the answers.

Aspies Narcissistic? Yes. Narcissist? No, not usually.

What are the TRAITS? One trait is not enough, there needs to be an ACCUMULATION of traits to add up to a Narcissist or other personality disorder. there are mony personality disorders, not just the Axis Ii Cluster B ones/ Which personality disorder is suspected and WHY?

Aspies misdiagnosed. 1, 2, 3.
posted by nickyskye at 5:38 AM on November 14, 2008


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