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Mental Health Personality Disorder Recovery Therapy Treatment

Do I Have Narcissistic Personality Disorder?

We’ve all done it: called the arrogant, self-righteous, unsympathetic person we know a

Narcissus (oil on canvas) (Photo credit: Wikipedia)

“narcissist” and we may have even felt pretty confident that they are most certainly suffering from a Narcissistic Personality Disorder.  It’s a buzzword for the selfish and self-indulgent people we have difficulty with. We may even be right on occasion. I know I have, much to my chagrin. We never really want our laymen’s assessment to be true, do we?

 

While it’s true that someone can have narcissistic tendencies, to receive a diagnosis for Narcissistic Personality Disorder, you have to meet some significant traits and they have to have been present for some time. Because of this, adolescents aren’t typically diagnosed with this particular personality disorder because their brains are changing so rapidly. However, if an adolescent presents with the traits of Narcissistic Personality Disorder, they have to be actively present for at least a year.  I do think it’s important to remember that Narcissistic Personality Disorder is diagnosed as a result of it being a long-standing, enduring behavior.

 

It’s not common for someone with any personality disorder to seek help. Often times, one ends up in treatment or in a therapist’s office for something else and it’s determined then. Rather than trying to diagnose someone who is innately selfish, ensure that you have firm boundaries and limits around this difficult person.

 

I asked Noelle Rodriguez to give me some clinical insight on Narcissistic Personality Disorder:

 

“A narcissist is only interested in what reflects on them. All she/he experiences is a reflection of self, denial of profound feelings and grandiose fantasy as a shield from unworthiness caused by not feeling truly loved by their parent. A narcissist attacks separateness in everyone with whom he must have a relationship; either they fit into his ego-supporting mold or they are excluded from his life.

Narcissistic rage and aggression is based on fear. His entitlement and absolute control over others must go unchallenged.”

Noelle went on to expand on part of the child’s development that may contribute to Narcissistic Personality Disorder and where parental neglect or denial is a factor, “The child’s natural growth sets off a parental alarm: he or she is blamed for their emerging individuality as if it were a crime. He is made to feel that there is something wrong with such development.”

 

According the DSM-V, Narcissistic Personality Disorder is described thusly:

 

  • A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
  • Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
  • Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
  • Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
  • Requires excessive admiration.
  • Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
  • Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
  • Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
  • Is often envious of others or believes that others are envious of him or her.
  • Shows arrogant, haughty behaviors or attitudes.”

For more information about personality disorders, please speak to a therapist, or medical professional skilled in working within this genre of mental illness.

 

 

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Mental Health Mood Disorders Personality Disorder Recovery Self-Care

Mental Health is Mental Wealth

When someone suffers from mental illness, there is a deprivation of the joy and emotional wealth that’s present when there is ideal mental health. Mental illness can drain our joie de vivre, and make for a muddy emotional existence. Relationships with loved ones tend to be difficult, and there tends to be a propensity for loneliness and isolation. Worse yet, when mental illness is left untreated, the toll it can take on the one suffering and their loved ones can be taxing and sometimes devastating.

 

Some types of mental illness are more straightforward in their treatment: anxiety and depression, for example, are often treated with various modalities of psychotherapy and balanced with medication. Personality disorders are complex and there are some instances where the patient doesn’t recognize their illness despite their deep suffering. The work involved in treating all mental illness requires a nexus of therapeutic support and a desire for positive change from the patient themselves. The question many have is, Why are personality disorders so challenging?

 

Personality disorders are grouped into three clusters:

  • Cluster A personality disorders are “characterized by odd, eccentric thinking or behavior.” The disorders that fall into this category are:  paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder
  • Cluster B personality disorders are “characterized by dramatic, overly emotional or unpredictable thinking or behavior.” The disorders that fall into this category are: antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.
  • Cluster C personality disorders are “characterized by anxious, fearful thinking or behavior.” The disorders that fall into this category are: avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder.

 

Psychotherapy is the most common treatment for all types of mental illness; the most efficacious modality is determined by the needs of the client. Findings show that DBT (Dialectical Behavioral Therapy) in particular is the most effective therapeutic treatment for personality disorders and bipolar disorders. Other effective tools used in treatment may include:

  • Individual psychotherapy
  • MBSR (Mindfulness Based Stress Reduction)
  • Yoga
  • Meditation
  • Somatic Experiencing
  • Neurofeedback

 

To date, the FDA hasn’t approved of any medications to treat personality disorders. However, medications are often used to treat symptoms that are detrimental to the individual’s recovery. Medications like:

 

  • Antidepressents: for depressed mood, anger, irritability, mood swings, impulsivity and hopelessness.
  • Mood stabilizers: to even out mood swings, and to reduce impulsivity, irritability and aggression.
  • Antipsychotic medications (also known as neuroleptics): if symptoms include losing touch with reality (psychosis), and sometimes anxiety and difficulty with anger
  • Anti-anxiety medications: For anxiety, agitation or insomnia. Note, in some cases, they may increase impulsive behavior and are avoided with some personality disorders.

 

Treating mental illness requires the cultivation of balance. Participation from the client, a cohesive treatment team, and the correct combination of medication can create the desired environment of mental health.  It takes work, dedication, and a willingness to unveil one’s difficulties in order to create a healthy shift toward mental health. I have experienced the shadow side of untreated mental illness with family members who are unwilling to get help. It does, in fact, take a toll on everyone involved. I have learned that one of the key pieces for my own recovery is developing clear communication skills, creating firm, compassionate boundaries, and building consistent program of self-care. Families struggling with mental illness need to ensure that their own wells are filled, that they are getting their own needs met, and that they have a community of support around them.

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Cognitive Behavioral Therapy (CBT) Dialectical Behavioral Therapy (DBT) Mental Health Personality Disorder Therapy

Personality Disorders: Finding Solace in Therapeutic Care

According to the DSM-IV, “Personality Disorders are mental illnesses that share several unique qualities.  They contain symptoms that are enduring and play a major role in most, if not all, aspects of the person’s life.  While many disorders vacillate in terms of symptom presence and intensity, personality disorders typically remain relatively constant.” Further, the DSM-IV says that in order to be diagnosed, the following criteria must be met:

  • Symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder. The history of symptoms can be traced back to adolescence or at least early childhood.
  • The symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person’s life.
  • The symptoms are seen in at least two of the following areas
    • Thoughts (ways of looking at the world, thinking about self or others, and interacting)
    • Emotions (appropriateness, intensity, and range of emotional functioning)
    • Interpersonal Functioning (relationships and interpersonal skills)
    • Impulse Control 1

In layman’s terms, someone suffering from a personality disorder often views the world in their own way. Because the perceptions of those around them are often skewed to meet a reality only they see, the subsequent social issues stemming from the inability to interact with others appropriately is troubling–both for the one afflicted and those on the receiving end of the negative behaviors and perceptions. For the Borderline Personality Disorder (BDP), the major symptoms revolve around interpersonal interactions, negative sense of self, significant mood swings, and impulsivity. Where Narcissistic Personality disorder presents itself as grandiose and uncaring yet hungry for recognition, Borderline Personality Disorders can often be summed up like this: “I hate you…don’t leave me.”

Unfortunately, personality disorders are sometimes used as a quick label for a difficult client. However, the criteria are pretty significant and the diagnosis itself should be made after significant assessment by a qualified professional. Those ensconced in the emotional turmoil of a legitimate personality disorder need be able to find some solace in their psychiatric care and trust in the individuals providing care, especially since treatment for personality disorders are long term. The type of therapeutic treatment used depends upon the type of personality disorder being treated. The various types of therapy used to treat personality disorders may include:

  • Cognitive Behavioral Therapy (CBT)
  • Dialectical Behavioral Therapy (DBT)
  • Psychodynamic psychotherapy
  • Psychoeducation

Personality disorders are tricky and can be hard to address. Applying DBT, for example, has shown positive results in the treatment of BPD–recent studies have shown lower suicide rates, less self-harming incidents, and less self-removal from treatment. We must remember that psychiatry is a relatively young science, so the growth and change is happening quickly as practitioners eagerly seek resolution to some of the most challenging psychological quandaries. A therapist once said to me, “If someone were to observe a given client in a single session, they could come up with a variety of diagnoses, when the fact is, that client could have just been having a bad day.” So, whether a client is simply having that bad day or truly struggling with a bona fide disorder, it’s befitting to remember the words of Hippocrates as we unravel the mysteries of mental illness: “Cure sometimes, treat often, comfort always.”

1 https://allpsych.com/disorders/personality/index.html

Additional articles of interest:

 

Personality Disorder – What Is it, and What Does Diagnosis Mean?

With Mental Illness, “Serious” is a Slippery Term