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Identiopathy
Dear Colleagues:
Enclosed please find a supplemental addition to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Section 301.75: Identiopathic Personality Disorder, should be added to DSM-IV between 301.7: Anti-Social Personality Disorder, and 301.83: Borderline Personality Disorder.
As you know, the DSM-IV is a classification of mental disorders that was developed for use in clinical, educational, and research settings. The diagnostic categories, criteria, and textual descriptions are meant to be employed by individuals with appropriate clinical training and experience in diagnosis. This addition to the category of Personality Disorders is the product of the extensive research and clinical experience of the Task Force on DSM-IV and the Personality Disorder Work Group. We hope the identification of this new diagnosis will enhance your knowledge and understanding in a constantly evolving field.
Yours,
The Association
301.75 Identiopathic Personality Disorder
Diagnostic Features
The essential feature of Identiopathic Personality Disorder is a pervasive pattern of acute, inflexible mimetic attachment to an exaggerated and overly demonstrative identification of oneself with perceived subversive ideology. This pattern typically begins in early adulthood (though increasing reports of onset as early as age 10 are becoming significant) and persists well into the 30s and beyond, and is present in a variety of contexts.
This pattern has also been referred to as Identiopathy, Subsociopathy, and Inverted Self-Aggrandizing Psychosis.
Individuals with Identiopathic Personality Disorder can only perceive, relate to, or think about their environment or themselves through the filter of a perceived collective truth, specifically one which is—or appears to be—at odds with, or subversive of, received dominant cultural truths (Criterion 1). In a parody of Paranoid Personality Disorder, with which it is often mistaken, their attraction to oversimplified formulations of the world tend to make them wary and dismissive of ambiguous situations. This tendency resembles Paranoid Personality Disorder, as these individuals often behave as fanatics and form tightly knit groups with others who share "their" belief system. Unlike individuals with Paranoid Personality disorder, their understanding about the nature of the world is not in the least abstract or fantastical, but is extremely concrete and literal (Criterion 2).
Individuals with this disorder experience severe subjective distress regarding an overly rigid certainty on issues relating to identity, including long-term goals, lifestyle, friendship patterns, moral values, and group loyalty. They have a pattern of immediate demonstrative and intense relationships based predominantly on the notion of shared vision and struggle (e.g., social, political, personal). These relationships, though believed to be enduring, tend to be unstable over time. Beneath the sense of camaraderie lies a thinly veiled hierarchy based on a competitive mastering of the group identity (e.g., A exuberantly tells B, "I too once thought that until C called me on it..."). They demand consistency from themselves, others, and their environment, and are unable to accept or reconcile conflicting beliefs and desires. These relationships also tend to have an undercurrent of distrust which grows out of a fear that the individuals involved will prove inadequate to the demands of the group identity. As a result, these individuals often experience low-grade feelings of trepidation and one-up-myn-ship (Criterion 3).
Individuals with Identiopathic Personality Disorder cling to their identities in order to authenticate their existence in a manner that can be readily observed and taken note of by others. In doing so, the individual solemnifies his sense of self (Criterion 4). Identiopathic Personality disorder is often initially misdiagnosed as Borderline Personality Disorder, since in both we see a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and a chronic feeling of emptiness. However, whereas individuals with Borderline Personality Disorder suffer from a markedly and persistently unstable self-image or sense of self, in the Identiopathic Personality Disorder the sense of self is, although deeply flawed, unfortunately quite stable. Individuals with this disorder may perceive themselves as possessing superior intellectual powers and a vast capacity for empathy, causing them to have an unreasonable expectation of deference or automatic compliance with their values and beliefs (Criterion 5); they often appear haughty and arrogant, and believe they can only be understood by, or should only associate with, other "special people" (e.g., individuals believed to be like-minded, more knowledgeable and unique, or relevant to "the cause"). These individuals may interpret a lack of deference or directed difference of opinion to be a personal attack, and may quickly assume a combative and defensive stance. This is because their sense of self is inextricable from a rigid belief system. Because this enduring personality trait, which is exhibited in a wide range of social and personal contexts, deviates markedly from the expectations of dominant culture, individuals with this disorder tend to suffer distress and/or impairment in social and occupational settings.
Individuals with Identiopathic Personality Disorder tend to be more concerned with expressing impressions rather than ideas because of a fear that misinterpretation of the information they convey may be used against them. These individuals may use carefully regulated language and word choices to ensure consistency and avoid misinterpretation. Individuals with Identiopathic Personality Disorder are ever alert for, and intolerant of, views that are perceived to deviate from their "own" (Criterion 6). Any perceived deviation, whether it be through simple misunderstanding or difference of opinion, is believed to be untrustworthy and injurious, and reinforces the belief that the individual is in possession of the Ultimate Truth. They experience a compulsion to assert the wrongness of such deviations, often prefacing their tirades with a huff, hiss, gasp, or tsk, lest their silence be construed as tacit acquiescence; this compulsion is in no way lessened in situations where the offending viewpoint is directed at a general audience, or at someone else entirely: e.g., in classrooms, at the movies, at nearby restaurant tables (Criterion 7). Although it is most common for these individuals¹ beliefs to be grounded in an ideology based on tolerance and inclusiveness, they may in fact be highly intolerant (e.g., A verbally attacks B in public, on grounds that B¹s views are insensitive); the irony of this tends to be lost on them due to their chronic state of humorless literalism (Criterion 8).
Associated Features
A regressive need to belong, which is at odds with their determination to distinguish themselves from the dominant culture, may incline these individuals to co-opt the cultural, social, and spiritual practices of others. These individuals understand their born culture to be bland, ill-defined, and unexotic. They may adopt the beliefs and ideologies of other cultures (often more than one, creating a spiritual and cultural mélange), but most often they will focus on visible representations such as outward customs, garb, or icons to demonstrate their affinity and compassion, as well as confirm their allegiance and loyalty to the targeted identity. The result is often a recognizable sub-fashion which enables these individuals to identify each other and distinguish themselves from dominant culture.
Some identiopaths are quite charismatic and find easy converts in their counterparts with weaker self-constitutions. These converts are in a sense "brought out" by their own through a system of rewards and punishments (e.g., special treatment and excessive attention followed by sudden and severe disinterest) not dissimilar to the recruitment process of religious cults.
Authoritative pseudo-intellectual ramblings may be used to establish the authenticity of these individuals' identity and beliefs; these ramblings may vary in substance, but sometimes suffer from the absolute poverty of content seen in the condition of alogia. Interpersonal relations are typically impaired due to problems derived from arrogance, inflexibility, and a disregard for the sensitivity of others. Sometimes vocational functioning is limited where individuals are unable to reconcile the content of their work and workplace with their life criteria. Having initially adopted and applied theory of real import in artificial and isolated situations (e.g., graduate school), individuals with Identiopathic Personality Disorder experience cognitive impairment and dysfunction when the applicability of the theory is challenged by the ambiguities posed by the variations of day-to-day life. These individuals become distressed with any ambiguity when they are unable to reconcile their belief system with the external world, causing them to lapse into an echopraxic parroting of a party line.
Diagnostic Criteria for 301.75 Identiopathic Personality Disorder
A lemming-like pattern of behavior and ideas beginning in early adulthood (and quickly stagnating thereafter) whose so-called alternative vision of dominant culture is unoriginal, predictable, and un-open to discussion on any other terms, and which is present in a variety of contexts, as indicated by six (or more) of the following:
- inability to interpret any information or experience without first filtering for deviations from, or inconsistencies with, chosen vision
- extremely concrete and literal understanding of the world that disables capacity for thinking critically, or considering ambiguities
- is quick to bond with mirror-image-like peers for a solidarity that is ultimately superficial and trepidatious
- gnawing desire to be seen and perceived as not-like-everybody-else
- perception of being more intelligent, sensitive, and privy to a "Truth" which others could see if they would only just listen
- infertile imagination and cowardice, manifested as a fanatical need for control over speech acts
- uses (often inappropriate) repetition to convince self and others of ideas; regularly hisses in movie theatres
- is so literal as to be humorless, hypocritical, and helpless
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