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Anna, Mental Health Professional
Category: Mental Health
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Experience:  Licensed Clinical Social Worker with 29 years in addictions and mental health.
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How specifically can you assess whether a person has lack

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How specifically can you assess whether a person has lack of empathy thus demonstrating anti -social personality? Another diagnosis being postulated with this person is a person having high functioning autism but appearing to have no empathy because of poor boundaries and feeling justified that their whole world view is "right." Thirdly , if a diagnosis of paranoid personality disorder is present as co-morbid issues and paired with each of the prior diagnoses how would the assessment of empathy be made to help clarify the distinction between the diagnoses? And the lack of or apparent lack of empathy. Thank you.
Hello & Welcome to Just Answers.

Lack of empathy is usually very obvious...if you suspect it's an issue, it probably is. A person may have a tiny bit of it somewhere or in some situations, but for the most part a person either has it or doesn't.

Diagnosis of antisocial personality is accomplished more with observed or reported actions. Given a couple situations where they didn't hold up social norms and let others suffer for their own reward----and especially to the criminal extent, and you've got someone with anti-social traits.

If this question is for a class....PPD doesn't have to have any issues with empathy, so it wouldn't really be used in differential diagnosis. High order autism or aspergers will demonstrate lack of empathy, Aspergers will usually train themselves on the rules of empathy and go forward acting like they have the trait because they understand it's place in relationships. Antisocials can do this during the seduction phase, but it wears thin within hours or days.

Here is a rule of thumb: If they have a brittle presentation when stressed or challenged, are smart, aloof, OCD-ish and keep forgetting to include the human factor in relationships, you're pointing toward Aspergers.

If they go through the world feeling entitled and above the laws and norms to the point that they scam and lie to get their way without ever looking back, it's antisocial. They don't learn from their mistakes.

If they're consumed with 'what people are taking from me' in a wield way, it's usually Paranoid PD.

Empathy just isn't the deciding factor in this.

My best to you.

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Customer: replied 6 years ago.
Thanks I still can't tell if the person has empathy or not. It's very tricky. I am thinking PPD and maybe narcism. The empathy is there with the vulnerable such as an animal, child, homeless person. And then I wonder if the paranoia and resulting behavior is so strong that it covers the natural empathy response that may be there but because of the paranoia is covered. Narcism has also been suggested. Does a person with a diagnosis of Narcism have no empathy like in Antisocial personality?

when stressed this person gets harder and more aggressive with omissions and also evades truthfulness. yes they also get more pressured in speech, and they are smart, odd and the eyes dart around.In a middle stressed situation the voice is a odd and a bit robotic and pedantic sounding. I don't see brittle but I do see brutal in the higher stressed situation. Psychiatrist after 1 hours assessment states diagnosis in this adult is High Functioning Autism. Their child's psychologist feels the diagnosis may be Mania , paranoia and Narcism ( on the spectrum of personality disorder Control ) . Antisocial also suggested.

Can you tell me the purpose for your curiosity? Is there something you're trying to prove wrong or right? Is there a reason you don't believe the psychiatrist's diagnosis? I'm really not sure of what you're wanting me to address.

Customer: replied 6 years ago.
I am trying to understand what the true diagnosis or diagnoses is for this person.
The psychologist involved in this case for a year and a half with many interactions and communications with this person does not agree with the high functioning autism diagnosis. The psychiatrist who did a one hour assessment using the history of the person from that person made the diagnosis of high functioning autism. The psychiatrist says she is not an Autism expert and did not do any testing of the client. Likely the psychologist is also not an autism expert.   While there is certainly social dysfunction , to me the autism diagnosis does not explain the more obvious paranoid and highly aggressive manipulative behaviors.

To me empathy seems to be one defining difference between narcism vs autism. I may obviously be way off.
Having the empathy or not does not seem to be easy to tell from my perspective and also I might assume
not easy to tell from these 2 opposing practitioners perspectives. One important difference is that narcism and PPD falls in mental health diagnosis and I would assume autism falls in the category of a disability.
So Maybe I don't really have a clear question but rather there is a difference in people's subjective assessment that may just remain .   This person refuses a psychological assessment with testing that was court ordered but had opted to privately or independently go to this psychiatrist to bring assessment to court in lieu of pschological testing.

I think you're right that you've got 2 professionals with different opinions, and diagnosis is partially subjective, so I don't know that it will be resolved. Off the cuff, I think Narcissism.
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