DSM-5 Narcissistic Personality Disorder Criterion 1: “Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).”
Karen Woodall, you assert that you are an “expert”… I have a quiz for you.
You’re a mental health person, right? So you should know symptom terms and definitions. I have one for you. I’ll describe the symptom and you give me the clinical term. Ready, okay here:
The Symptom: A fixed and false belief that is maintained despite contrary evidence.
What’s that called, Karen?
Right, a delusion. I was pretty sure you’d get that one. So here, let me give you a clinical application scenario and see how you do.
Say you have this person who thinks that they’re inventing something that will save the world, or that they’re making some earth-shattering new “discovery” but then it turns out that it’s not true. It’s a false belief. Other people have already invented the stuff or made the discoveries. So the person’s belief that they are making great and grand new discoveries or inventing wonderful new inventions, well, it’s not true, it’s a false belief.
And then, the person is shown the contrary evidence, they are shown that someone else has already invented the things or made the discoveries, and there’s evidence that this is a false belief. But the person ignores the evidence, the person goes into sort of fingers-in-the-ears la-la-la denial, and the person continues to insist that they are actually making these wonderful “new discoveries” that have already been discovered, despite being presented with the contrary evidence… is that a delusion?
That’s right, it is. It is a fixed and false belief that is maintained despite contrary evidence, that’s the definition of a delusion in professional psychology.
Let me try one that’s a little harder. If the person has a fixed and false belief, a delusion, the content of which is that they are inventing some sort of great and marvelous new invention or making some sort of historic “new discoveries,” what – TYPE – of delusion is that? You can go ahead and think about that one for a moment.
It’s a grandiose delusion. A false belief in being special, in being superior or above other – ordinary people – that someone has “special” talents or knowledge beyond that of other people is called a grandiose delusion.
Okay, final question, Karen… what are the main types of pathology that have grandiose delusions as a symptom feature?
Answer… ready?… there’s mania, a grandiose delusion would be considered a “mood congruent” psychotic feature of mania, and… that’s right, Karen, narcissistic personality disorder. Delusional grandiosity is a symptom feature of narcissistic pathology.
DSM-5 Criterion 1: “Has a grandiose sense of self-importance”
Karen, I want you to listen carefully… there is no such pathology in professional psychology called “parental alienation” – it is not a real pathology in professional psychology. There is contrary evidence to your belief that this is a new form of pathology in professional psychology. There is no new form of pathology, Karen.
(It’s just your ignorance showing, Karen. You may want to tuck that away because everyone is seeing it)
Contrary Evidence 1:
Minuchin, Bowen, and Haley all identified and fully described this pathology a full decade BEFORE Gardner proposed his new form of pathology he called “parental alienation” and in 1993 Minuchin even provided a structural family diagram for EXACTLY this pathology. There is no “new form of pathology” – that is a false belief.
Here is the definition of a cross-generational coalition provided by Jay Haley in 1977 – a decade before Gardner and his proposal that there is a “new form of pathology” that Gardner called “parental alienation.”
From Haley: “The people responding to each other in the triangle are not peers, but one of them is of a different generation from the other two… In the process of their interaction together, the person of one generation forms a coalition with the person of the other generation against his peer. By ‘coalition’ is meant a process of joint action which is against the third person… The coalition between the two persons is denied. That is, there is certain behavior which indicates a coalition which, when it is queried, will be denied as a coalition… In essence, the perverse triangle is one in which the separation of generations is breached in a covert way. When this occurs as a repetitive pattern, the system will be pathological.” (Haley, 1977, p. 37)
Minuchin provided a clinical description of the pathology in his 1974 book, Families and Family Therapy.
From Minuchin: “An inappropriately rigid cross-generational subsystem of mother and son versus father appears, and the boundary around this coalition of mother and son excludes the father. A cross-generational dysfunctional transactional pattern has developed.” (p. 61-62)
From Minuchin: “The parents were divorced six months earlier and the father is now living alone… Two of the children who were very attached to their father, now refuse any contact with him. The younger children visit their father but express great unhappiness with the situation.” (p. 101)
From Minuchin: “The boundary between the parental subsystem and the child becomes diffuse, and the boundary around the parents-child triad, which should be diffuse, becomes inappropriately rigid. This type of structure is called a rigid triangle… The rigid triangle can also take the form of a stable coalition. One of the parents joins the child in a rigidly bounded cross-generational coalition against the other parent.” (p. 102)
These are recognized expert people in families and family conflict – real ones – and Salvador Minuchin described this pathology in 1974. Fully. It is an established pathology in family systems therapy called a “cross-generational coalition” – you are not “discovering” anything, Karen.
A child’s rejection of a parent is called an “emotional cutoff” Karen. It was described by the renowned family systems therapist, Murray Bowen in 1978, Karen.
From Bowen Center: “The concept of emotional cutoff describes people managing their unresolved emotional issues with parents, siblings, and other family members by reducing or totally cutting off emotional contact with them.”
You are not “discovering” a new pathology, Karen. You are simply ignorant of family systems therapy. The pathology is fully and completely explained in family systems therapy and has been since the mid-1970s. You are not “discovering” something, you are simply ignorant about how families work – Minuchin, Bowen, Haley, Madanes.
Contrary Evidence 2:
In 2013, the American Psychiatric Association made a decision. The DSM-5 Committee had fully and completely reviewed the construct of “parental alienation” as a pathology. You, and Bill Bernet, and all the Gardnerian PAS “experts” had a full and complete opportunity to present all of your best evidence and arguments in favor of a “new form” of pathology called “parental alienation.” What did the American Psychiatric Association say, Karen?
They said, “No” didn’t they. The American Psychiatric Association, after reviewing all of the evidence, after you and Bill Bernet and all of your group of Garnerian PAS people had a full and complete opportunity to present all of your best arguments to the American Psychiatric Association… the APA made their judgement. They said there is no such pathology as “parental alienation” – not a mention anywhere in the DSM-5.
If they had wanted to throw you a bone they could have included the term in their V-Code diagnosis of Child Affected By Parental Relationship Distress – a perfect spot to include the term “parental alienation” in the description. They deliberately chose NOT to include the term, Karen.
Do you know why, Karen? I have a YouTube series on the eight symptom features proposed by Gardner for a diagnosis of “parental alienation” – you should watch it. Because those are all questions that you must address about your proposed “parental alienation” diagnostic model. This is a professional critique of your work Karen:
The Gardnerian proposal of a “parental alienation” pathology is quite probably the WORST diagnostic model of anything ever. It’d be up there with medieval diagnoses of “witchcraft” and “demon possession” for THE worst diagnostic models of anything ever, and “parental alienation” would likely take the top spot. That’s why the American Psychiatric Association pointedly EXCLUDED the term “parental alienation” from the V-Code diagnosis they added, V71.29 Child Affected by Parental Relationship Distress. They were sending you a very clear message.
They created a new V-Code, and they deliberately EXCLUDED the term “parental alienation.” They did that to send you a very clear communication. There is something here… but your “parental alienation” new pathology is quite probably the WORST diagnostic model of anything ever – in the history of mankind.
No, Karen, there is no “new form of pathology” called “parental alienation” – it doesn’t exist. The American Psychiatric Association, a lot of smart people, and the DSM diagnostic committees of the top-top people in diagnosis and pathology, they had a full and complete examination of your beloved Gardnerian PAS pathology and they said… there is no such thing.
They made their decision, the “new pathology” of “parental alienation” doesn’t exist, you’ll will have to describe the pathology using standard and established constructs and principles. That’s what the American Psychiatric Association told you, Karen. Back in 2013.
Those are TWO pieces of contrary information, Karen. The first is that the pathology is already – already – fully and entirely explained within family systems therapy, and has been fully explained since the mid-1970s. There is no “new pathology” Karen – you are simply ignorant of family systems therapy and how families function.
And two, the American Psychiatric Association’s select DSM diagnostic committees had a full and complete review of your beloved Gardnerian “parental alienation” diagnostic model, and they quite clearly and quite pointedly, said… “No.” There is no “new pathology” called “parental alienation” – that is the clear diagnostic decision made by the American Psychiatric Association after a full and complete review of your beloved pathology proposal. They said no.
And all you were asking for was just a mention, somewhere, anywhere in the DSM-5. You weren’t even seeking a diagnostic category, you just wanted them to use the term “parental alienation” somewhere, anywhere, in the DSM-5. They said, “No” – there is no such pathology as “parental alienation.”
They created a V-Code for specifically this pathology – Child Affected by Parental Relationship Distress – AND they deliberately and pointedly did NOT include the term “parental alienation” in their description of this V-Code. They could have dropped the term “parental alienation” directly into that V-Code description – and they deliberately chose NOT to.
You, and Bernet, and Miller, and Baker, all of you “parental alienation” people have received a clear communication from the DSM diagnostic committees of the American Psychiatric Association – there is no “new pathology” of “parental alienation.” I live in reality, Karen. The APA reviewed the evidence and made a decision. It was the correct decision. The diagnostic model you propose for a “new pathology” of “parental alienation” is probably the WORST diagnostic model in all of history. That’s why the APA pointedly said, “No.”
You have two – irrefutable – pieces of contrary evidence to your false belief that there is a “new pathology” you are “discovering” and are somehow an “expert” in, that you are an important and special “expert” in this new form of pathology – that doesn’t exist – that you are simply making up.
But despite clear contrary evidence, you still believe that there is a “new form of pathology” that you’re “discovering,” don’t you Karen? You still believe you’re making these special discoveries about this new pathology, and you still believe that you’re somehow this special “expert” in this new form of pathology… that actually doesn’t exist. But you believe it exists – even though it doesn’t.
A fixed and false belief, Karen, that is maintained despite contrary evidence. What’s that called again? That’s right, a delusion. A fixed and false belief that is maintained despite contrary evidence… that’s the definition of a delusion, Karen. Not my definition, the clinical definition in professional psychology for a delusion.
And if the person has a delusion about being “special” – about being important and in a position of elevated status – like being a special “expert” in something – and believing that because of their “special” status that everyone should pay attention to what this person says, because the person believes they are making important “discoveries” – but none of it is true – that would be a classified as grandiose delusion, wouldn’t it Karen. You’re a mental health person, you know how diagnosis works.
A fixed and false belief that is maintained despite contrary evidence that the person is somehow “special” – a special “expert” making grand “new discoveries” – that aren’t true… that would be a grandiose delusion.
Final Question, Karen
Let me ask you one last thing, Karen, and remember, I’m a clinical psychologist.
Two questions, actually. First, is there a new form of pathology, this “parental alienation” thing you’re proposing, is that a real form of pathology?
Second, do you believe that you are making special and important “discoveries” about this supposedly new form of pathology?
And, as long as I’m here, let me ask a final, third, question… do you believe that you have “special” knowledge about this pathology that other people, us ordinary people, don’t have? Do you believe that you are a special “expert” Karen?
Your answers are – yes – yes – yes – aren’t they, Karen. You know they are, I know they are, we all know you answered yes, yes, yes.
Do you think this “new form of pathology” exists? – yes.
Do you believe you are making important “new discoveries” about his supposedly new form of pathology? – yes.
And do you believe that you have “special knowledge” about this supposedly “new form of pathology” that you’re discovering that makes you an “expert” – someone important – who people should listen to, because you’re important? – yes.
Karen… you appear to be delusional. It’s called a grandiose delusion. Now I’m not diagnosing you, Karen, because I have not personally conducted a clinical interview with you… but I’m just sayin’ – looks like a duck quacks like a duck.
Seriously. A fixed and false belief that is maintained despite contrary evidence is the clinical definition of a delusion, and the contrary evidence to your belief in a “new form of pathology” that you are supposedly “discovering” is that Minchin, Haley, and Bowen a full decade BEFORE Gardner, fully and completely described the pathology – cross-generational coalition, emotional cutoff, multi-generational trauma – AND – AND – that the American Psychiatric Association said, after a full and complete review of your beloved “parental alienation” new pathology proposal, that there is no such pathology of “parental alienation” – contrary evidence, Karen. The APA told you, it is a false belief. That is contrary evidence to your belief, the American Psychiatric Association told you, “It is a false belief.”
If THAT is not evidence to convince you, Karen, the American Psychiatric Association directly rebuking the construct of a “new form of pathology” – what evidence would you need? Seriously, Karen… there is no evidence EVER that would ever convince you, is there Karen? Because it’s a delusion. It’s a fixed and false belief that is maintained DESPITE contrary evidence. That’s the definition. There is no way to alter a delusional belief with evidence – evidence is completely ignored – that is the definition of a delusion – despite contrary evidence.
Tell us, Karen, what evidence WOULD convince you that there is no “new pathology” and that this thing you’re calling “parental alienation” is entirely describable using the already existing and already established constructs and principles of professional psychology?
One final question, Karen, for bonus points. You’re a mental health person, but still, I’m not sure how much you know about psychotic disorders, so this might be a toughie for you… what is it called when two or more people share the same delusional belief?
That’s right, it’s called a shared delusional disorder (ICD-10: F24).
So let’s see, you’re an “expert” in this “new pathology”- anyone else? Bill Bernet, okay. Anyone else believe that there is a “new form of pathology” and that they are a “special” expert with “special knowledge” about this “new form of pathology” they’re creating? Anyone else have this fixed and false belief that and they are making important new “discoveries”?
Wait… you may have an out, Karen. There is an escape clause to delusions if it is a shared belief system – it’s called a sub-cultural exception. It’s like when a bunch of people go to the wilderness and build a compound because they all believe space alien angels are going to lift them to heaven in rapture on a certain date, and then that date passes, but they just change the date. Them. We may not call them “delusional” and instead we call it a “sub-culture” belief. That’s the technical term. The more common term is a cult.
So diagnostically, Karen, we appear to be looking at either a shared delusional belief system or you’re part of a cult if you claim the sub-culture exemption from a delusional diagnosis. Did you know all this about diagnosis, Karen? Do you realize that, diagnostically you are showing all the symptom features of a grandiose delusion, and that you appear to potentially be part of a cult – a “sub-cultural” exception to a shared delusional diagnosis.
Although, I might still go with the shared delusional diagnosis for you all. It would depend on the clinical interviews. You’re all mental health people, you’re not supposed to be part of a cult, you’re supposed to be living in reality with the rest of us, so I’m not sure I’d allow the sub-cultural cult exception for a delusional diagnosis.
There is no “new pathology,” Karen. You are simply ignorant of family systems therapy. You are not a special “expert” in any “new pathology,” Karen. You are simply grandiose. It’s called an encapsulated grandiose delusion, if you don’t have manic symptom in your history, I’d think about the potential for narcissistic pathology. I’m not diagnosing you, Karen. I haven’t interviewed you. I’m just saying, that’s what I’m seeing.
DSM-5 Narcissistic Personality Disorder Criterion 1: “Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).”
You know what would be interesting, Karen? To take a look at your vitae relative your your claims of achievements and talents – your being an “expert” – to see if they are exaggerated claims of achievements and talents – if you have a desire “to be recognized as superior” – as an “expert”… “without commensurate achievements.”
Where did you receive your training in attachment pathology, Karen? Where did you receive your training in family systems therapy, Karen? And yet, you are claiming to be a special “expert” in attachment pathology occurring in the context of family conflict… “recognized as superior without commensurate achievements”… you have no training in either attachment pathology or family systems therapy.
It’d be interesting to see your vitae, Karen. To see if substance matches assertion.
Oh, Karen… and just to give you a reference for what an expert looks like, this is the professional background description for Keith Nuechterlein. I worked with Keith at UCLA for over a decade, you’ll see it listed on my vitae, the Aftercare Clinic. Keith attended my wedding in Yosemite.
Keith Nuechterlein is an expert in schizophrenia. This is what an expert vitae background looks like. Notice he has authored over 235 journal articles – and none of them are “opinion pieces” they are all NIMH major-journal research articles – over 235 of them. When we’d sent his vitae to NIMH as part of grant submissions, it’d be 25 pages long of major journal research studies. This is what an expert in professional psychology looks like, Karen.
This is the standard you need to meet to be considered an “expert” Karen, in the real world of actual reality.
Keith Nuechterlein: A Real Expert, Karen
From Nuechterlein UCLA Profile: The Center is led by Keith H. Nuechterlein, Ph.D., Professor of Psychology at the University of California, Los Angeles, and Director of the Aftercare Program, a research clinic for schizophrenic patients, UCLA Semel Institute of Neuroscience and Human Behavior. Dr. Nuechterlein specializes in neurocognitive processes in schizophrenia, especially as they relate to both the developmental course of the disorder and to functional outcome. Dr. Nuechterlein’s ongoing longitudinal study of the early course of schizophrenia, “Developmental Processes in Schizophrenic Disorders”, has closely examined the influence of specific neurocognitive vulnerability indicators on the early course of first-episode patients, with an emphasis on occupational and educational outcome. He holds a joint appointment in the Department of Psychiatry and Biobehavioral Sciences and the Department of Psychology (Clinical and Behavioral Neuroscience areas) at UCLA.
From UCLA Profile: Keith H. Nuechterlein, Ph.D., is a Professor in the Departments of Psychiatry and Biobehavioral Sciences and of Psychology at the University of California, Los Angeles. He serves as the Director of the UCLA Center for Neurocognition and Emotion in Schizophrenia, an NIMH-funded Translational Research Center in Behavioral Science. He also is the Director of the UCLA Aftercare Research Program, a research clinic devoted to research and treatment with patients who have had a recent onset of schizophrenia. Dr. Nuechterlein received his B.A. in psychology in 1970 and his Ph.D. in Psychology (Clinical) in 1978 from the University of Minnesota. His expertise focuses on cognitive deficits in schizophrenia, their role as genetic vulnerability factors, their connections to functional outcome, and their remediation. Dr. Nuechterlein has authored more than 235 journal articles and is among the scientists on the ISI Web of Knowledge Highly Cited list for Psychology/Psychiatry. He has been on the editorial boards of the Journal of Abnormal Psychology and Schizophrenia Bulletin and is currently on the editorial board of Psychological Medicine. He has received numerous research grants from NIMH and other sources. Dr. Nuechterlein served as the Co-Chair of the Neurocognition Committee for the NIMH-funded initiative, Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS). This group guided the development of the MATRICS Consensus Cognitive Battery, a standardized outcome measure for clinical trials to assess the impact of new interventions on core cognitive deficits in schizophrenia. Dr. Nuechterlein is a past-president of the Society for Research in Psychopathology.
Jim Swanson: A Real Expert, Karen
I worked with Dr. Swanson at UCI when I was with Childrens’ Hospital of Orange County. I was recruited by Choc specifically to work as the lead clinical psychologist on Dr. Swanson’s project for ADHD in preschool-age children.
This is what an expert in pathology looks like, Karen. In reality. In the real world where I come from. His research list on the website is just a smattering, his research vitae is also 25 pages long. He was one of the principle investigator sites for the big MTA study of ADHD back in the 90s, and almost all of the school-based research on ADHD comes from his lab, the UCI Child Development Center. He is the UCI Child Development Center.
This is what an expert looks like, Karen. Notice he’s a PhD psychologist yet sits as a full professor at the UCI School of Medicine.
From Swanson UCI Profile
Director, Child Development Center, Pediatrics
School of Medicine
School of Medicine
School of Medicine
PH.D., Ohio State University
ADD, ADHD, Child Development
Dr. Swanson’s research focuses on hyperactivity, attention deficit disorder and conduct disorder in children. Through his research, Dr. Swanson has developed procedures for monitoring the cognitive effect of stimulant medication, the most frequent treatment for this group of patients. His research also focuses on biochemical and genetic factors related to these disorders
Dr. Swanson is also investigating the effect of intensive, early intervention for children with attention and conduct disorders through a school-based treatment program conducted in cooperation with the Orange County Department of Education. This program is carried out at the Child Development Center. In addition, he is evaluating the risk and protective factors for anti-social behavior of hyperactive children as they mature.
Swanson JM, Kraemer HC, Hinshaw, SP, Arnold, LE, Conners, CK, Abikoff, HB, Clevenger W, Davies M, Elliott, G, Greenhill, LL, Hechtman, L, Hoza, B, Jensen, PS, March, JS, Newcorn JH, Owens L, Pelham, WE, Schiller E, Severe, J, Simpson S, Vitiello, B, Wells, CK, Wigal, T, Wu, M. (2001). Clinical Relevance of the Primary Findings of the MTA: Success Rates Based on Severity of ADHD and ODD Symptoms at the End of Treatment. J. Amer. Acad. Child & Adolesc. Psychiatry, 40(2): 168-179.
Swanson JM, Posner M, Wasdell M, Sommer T, Fan J. (2001). Genes and Attention Deficit Hyperactivity Disorder. Current Psychiatry Reports, 3: 92-100.
Swanson JM, Hanley T, Simpson S, Davies M, Schulte A, Wells K, Hinshaw S, Abikoff H, Hechtman L, Pelham W, Hoza B, Severe J, Molina B, Odbert B, Forness S, Gresham F, Arnold LE, Wigal T, Wasdell M, Greenhill L. (2000). Evaluation of Learning Disorders in Children with a Psychiatric Disorder: An Example From the Multimodal Treatment Study for ADHD (MTA Study). In L.L. Greenhill (Ed.), Learning Disabilities: Implications for Psychiatric Treatment, 19(5): 97-125
Swanson JM, Volkow N. (2001). Pharmacokinetic and Pharmacodynamic Properties of Methylphenidate in Humans. In M.V. Solanto, A.F.T. Arnsten, F.X. Castellanos. (Eds.), Stimulant Drugs and ADHD: Basic and Clinical Neuroscience, (pp. 259-282). Oxford University Press.
Swanson, JM. (1992). School-based Assessments and Interventions for ADD students. Irvine, CA: K.C. Publishing.
Swanson JM, Riederer SA, Young RK. (1974). IMPS: Interactive Math Package for Statistics. Publication IM/18/8/23/74 of Project C-BE, University of Texas, Austin.
Malone MA; Kershner JR; Swanson JM. Hemispheric processing and methylphenidate effects in attention-deficit hyperactivity disorder. Journal of Child Neurology, 1994 Apr, 9(2):181-9.
Malone MA; Swanson JM. Effects of methylphenidate on impulsive responding in children with attention-deficit hyperactivity disorder. Journal of Child Neurology, 1993 Apr, 8(2):157-63.
Craft S; Gourovitch ML; Dowton SB; Swanson JM; Bonforte S. Lateralized deficits in visual attention in males with developmental dopamine depletion. Neuropsychologia, 1992 Apr, 30(4):341-51.
Forness SR; Swanson JM; Cantwell DP; Youpa D; Hanna GL. Stimulant medication and reading performance: follow-up on sustained dose in ADHD boys with and without conduct disorders. Journal of Learning Disabilities, 1992 Feb, 25(2):115-23.
National Children’s Study (NCS)
Senior Fellow, Sackler Institute at Cornell University
Child Development Center
Your turn, Karen.
You claim to be an “expert” in this attachment-related family conflict pathology. Post your vitae, let’s have a look at the actual substance of your claimed “expertise” in attachment-related family pathology – or are you expecting to be “recognized as superior without commensurate achievements” – let’s have a look at your vitae, Karen.
You are the one who is so prominently claiming to be an “expert” – back it up, Karen, because I don’t believe you are an “expert” in anything – I suspect it’s simply a grandiose delusion.
Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857