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Regardless of the underlying reasons, narcissistic personality disorder often makes someone a harmful person to be around; the diagnosis is a reason, not an excuse. At the end of the day it's their own responsibility to change their behaviour, and to find a lifestyle that empowers them to exist safely in society without harming others.
What? It is the sick person's responsability to heal out of their own will? That would make medicine easy, but I am not sure it would really work...
I meant it's their responsibility to change; in contrast to others' responsibility to accept their behaviours. Ideally there would be medical professionals involved, but that may not be possible in certain regions.
But for someone in a wheelchair, who's responsaoility is it?
Wheelchairs are actually a great example of someone using supports to accommodate their limitations.
But do you think we should make an effort to adapt ourself, or that it is fully on them to make efforts? Such as, if they want to board a train, and it takes 2 steps, should some valid people help him? should they do nothing? should they scold him for being infront of the door and slowing others?
Wheelchairs are not a good analogy for Narcissistic Personality Disorder (NPD); but you're basically asking the old question of "who bears the burden of disability" in general right?
I don't have NPD disorder, and don't know anyone diagnosed with it; so I can't say with confidence what accommodation would look like.
You're right that it's not 100% the patient's responsibilty. I should have made that more clear in my other comment. My point was that in your wheelchair metaphor, it's the patient's responsibilty to acquire a "wheelchair" as the first step of treatment. Otherwise they're metaphorically expecting those around them to carry them around everywhere.
One of the problem with mental health, is that it is usually not obvious for the patient (at least until a proper diagnose is made). Even if you consider some severe cases with multiple sensorial hallucinations, from the patient's point of view everything is normal and logical.
So you are right that the wheelchair isn't a very good analogy. Should I suffer a physical disability, I would notice it easily. On an other hand, if I suffer of some mental disability/sickness, I would have to rely on you (on other people) to tell me about the problems so that I may look for a medical diagnose and help. Yet I am not pretending it would be easy to make me notice I may have a mental problem: I would need to use my brain to find out that my brain goes wrong, that my normal isn't normal ; and finaly find that my reality or logic doesn't match the real one (while still being in my reality).
The only diagnostic criteria for NPD that's related to harm is the one that says "interpersonally exploitative behaviour". Since a diagnosis required 5/9 criteria, it was very easy to get diagnosed without that criterion. And now that the DSM-5 is out with the new dimensional model of personality disorders, harming others isn't even a criterion anymore in the up to date model.
The idea that NPD is defined by harming others is old outdated pseudoscience. Leading experts on personality disorder no longer believe in that stereotype.
Self help gurus continue to sell you that old lie, because it's profitable. It makes you an easy mark who will buy useless books and stew in your trauma. Never getting better, just buying more.
I'm not talking about diagnostic criteria here.
You can have a diagnostic criteria of "a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy" (direct quote); but that doesn't mention the manifested practical effects of those symptoms often resulting in markedly increased harm to those around them. I'd personally argue that any condition with lack of empathy has a higher chance of leading to abusive behaviours.
It doesn't surprise me it was removed, though. Diagnosis is usually about the person themselves and how to treat them individually, rather than about anybody else; so it's weird that it was there in the first place. Even antisocial personality disorder has a diagnostic criteria of "egocentrism; self-esteem derived from personal gain, power, or pleasure", which again is talking about the individual across the table not their family at home.
Interpersonal stuff is more the realm of therapy. Diagnostic criteria is not the full picture of a disorder.
Autism is associated with reduced cognitive empathy, which is the ability to intuit others' thoughts. As an autistic being, it's harder for Me to tell what other people are thinking and what they mean to communicate, outside My areas of expertise. But having autism doesn't make Me abusive.
Another similarity between autism and NPD is the name. Autism is Latin for self-ism. Early psychiatrists believed us ASD folks were preoccupied with ourselves, same with NPD. NPD has had less social progress, so uneducated people still believe that about NPD, even though increased awareness has helped people grow beyond that thinking with ASD.
So we're just ignoring everything else I wrote and fixating on the subjective personal opinion? Ok then.
The name doesn't matter; Autism is nothing like Narcissistic Personality Disorder. The only thing I can see that overlaps at all is maybe communication difficulties; but again, the practical manifestation of these communication difficulties are extremely different.
Autism
Narcissistic Personality Disorder