Personality disorders are a significant, but barely recognized, public health problem in the United States and around the world. Two personality disorders, in particular, cause a great deal of disruption in the workplace, conflict in marital relationships, and are prevalent in criminal populations. And they appear to be increasing.
In 1994, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders was published (the DSM-IV). It stated that estimates of the prevalence of Narcissistic Personality Disorder (NPD) were “less than 1% in the general population.”1 Regarding sociopaths (the DSM uses the equivalent term Antisocial Personality Disorder or ASPD), it said that overall prevalence “in community samples is about 3% in males and 1% in females.”2
Between 2001 and 2005, the National Institutes of Health (NIH) funded the largest study ever done regarding the prevalence of personality disorders in the United States. Structured interviews were done with approximately 35,000 people who were randomly selected to be representative of the U.S. adult population in a variety of ways including age, income, gender and region. This study found that 6.2% of the general population would meet the criteria for NPD3 and 3.7% would meet the criteria for ASPD (5.5% male and 1.9% female).4
This could be seen as a huge jump for NPD and a significant increase for ASPD in about a decade. Or, this could be explained by the fact that the 1994 estimates were based on small studies with varying methodology, compared to the sheer size and standardization of the NIH study.
In either case, when the fifth edition of the diagnostic manual was published in 2013 (the DSM-5), it included a “range from 0% to 6.2% in community samples” for NPD5 and “twelve-month prevalence rates” of ASPD “are between 0.2% and 3.3%.”6 In both cases, the DSM-5 acknowledged the large NIH study, but considered it as simply part of a range of possibilities. While this is good cautious science reporting, we are left wondering whether these are significant mental health problems or significantly increasing mental health problems.
Public Health Problems
The NIH study was undertaken in large part to address the lack of data on the prevalence of personality disorders, given that they are “associated with several adverse consequences in the general population including marital difficulties, occupational dysfunction, and criminal behaviors.” While intended to “address a major gap in public health information,”7 in the past decade and a half there has been little public recognition of the problems these personalities are presenting on a large scale. When compared to the prevalence of alcoholism and addiction, personality disorders are just as large a problem.
Working as a family lawyer and high-conflict consultant for the past 25 years, I have noticed the increasing problem of narcissistic personalities in high-conflict divorces. Their lack of empathy often involves extremely demeaning behavior and public statements toward their former spouse, while using the children as a tool to enhance their own public image.
Antisocial personalities often have a secret life that their spouse or partner doesn’t even know about, until they separate and discover that all the family resources have been hidden or gambled away or otherwise destroyed.
The past decade or so has seen a significant increase in domestic violence court hearings, with restraining orders issued and then violated—often by one of these two personalities. And many murders and suicides related to divorce seem to involve one of these personalities, as they can’t cope with the sense of public humiliation, and the loss of dominance and control over their partner.
Workplace disrespect, bullying, and violence are often related to one of these two personalities, based on the feedback I get in my consultations and trainings of professionals in the workplace. Not surprisingly, the most-read article on our High Conflict Institute website is How to Manage Your Narcissistic Boss.
There is more discussion of narcissistic and sociopathic leaders in today’s business world and politics than ever before, or so it seems. Since the economic downturns of 2008, people really do fear what their organizational leaders may do to their companies and communities. When there is a lack of empathy (by narcissists) and lack of remorse (by sociopaths) in making organizational changes, whole communities can be set on edge.
While crime rates have significantly gone down over the past decade or so, mass murders and fear of public violence has dramatically increased. While this is often attributed to mental illness in vague terms, there is little public recognition that these two personalities may be the primary mental illness involved. Yet there is little public awareness of the patterns of these personalities and how deceptive and charming they can be. When the news media wonders what each killer’s motive was, they should also be wondering if they had a life-long personality pattern that may have given some warning signs. Killers with narcissistic and/or antisocial personality disorders don’t need a motive. Their drive to demean and destroy their Targets of Blame may be sufficient.
After 30 years as a conflict resolution professional in many settings, I believe that narcissists and sociopaths are an increasing public health problem. The feedback I get from professionals worldwide is that these two personalities seem to be on the rise and the cause of many marital, workplace and criminal problems.
I think it’s time that there is another large-scale study of the prevalence of personality disorders today. I do not expect that there will be funding soon for such a task. But if these personality-based problems continue to grow, we will have to finally recognize them on a large scale sooner or later. Then, sufficient resources and education may be appropriately invested for the safety of our communities, for the welfare of those who are close to these personalities in families and at work, and for the individuals themselves to be the most productive citizens that they can be.
1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000, 716. (DSM-IV-TR)
2. DSM-IV-TR, 704.
3. Stinson, F. S., D. A. Dawson, R. B. Goldstein, S. P. Chou, B. Huang, S. M. Smith, W. J. Ruan, A. J. Pulay, T. D. Saha, R. P. Pickering, and B. F. Grant. 2008. Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 69 (7):1033–45, 1036.
4. Grant, B. F., D. S. Hasin, F. S. Stinson, D. A. Dawson, S. P. Chou, W. J. Ruan, and R. P. Pickering. 2004. Prevalence, correlates, and disability of personality disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 65 (7):948–58, 952.
5. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013, 671. (DSM-5)
6. DSM-5, 661.
7. Grant, 948-949.