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Dealing with a Narcissistic Personality Disorder?
Handy links for more information
- Trapped in the mirror - families of narcissists
Very academic and comprehensive in scope, so it may be a little intimidating for the lay reader. Still definitely one of the best books I've ever read describing the experience if living with a narcissist and the origins of this disorder.
- Identifying and understanding narcissistic personality disorder
A somewhat more academic and technical piece focusing on some of the reasons for the development of this personality style.
- Cognitive behavioral treatment of narcissistic personality disorder
Link to a book describing one of the most commonly used treatment techniques with narcissistic personality disorder.
- Treatments and Supports
NAMI is one of the foremost agencies in mental health advocacy with extensive databases and information on resources, research and treatments. A description of cognitive behavioral therapy, one of the treatment options for personality disorders.
- MedlinePlus: Personality Disorders
MedLine is a great reference source with comprehensive medical and mental health information written for the lay person.
- Personality Disorders
The Mayo Clinic provides good, up to date and well researched information on personality disorders, their causes, symptoms and treatment options.
Day to day with Narcissistic Personality Disorder
So, what, specifically are people with narcissistic personality disorder like? In general they are extremely self centered, enjoy, no demand positive attention and acknowledgement from others, are considered entitled, self focused, have trouble empathizing with others or understanding what another person may feel like. They are often grandiose, self important and judgemental, seeing themselves as better than those around them, while at the same time being extremely sensitive to rejection - implied, perceived or real from others and may react with displays of aggression, threats or temper tantrums when denied. They tend to fall within what I affectionately call the 'yeller/screamer" category. Their view on life tends to be that the sooner everyone gets with the program and does what they want, the sooner things will get done, the right way, their way - and the easier it will be for everyone.
As long as people do what they need to do, which is obey immediately and ensure that nothing ruptures their worldview, things generally remain calm and narcissists can be as nice as the next fellow. The description "walking on eggshells" is commonly used by the families of people with narcissistic personality disorder and they are often considered difficult to treat due to their difficulty with empathy, extreme sensitivity and rejection of change. It doesn't mean they can't change, it just takes a while, after all, these are pretty ingrained habits - which may beg the question - why don't we spend more energy focusing on the signs which emerge in childhood when they might be easier to treat, but that's a complicated, political and social question beyond the scope of this article.
But back to what it's like for someone with a narcissistic personality disorder to face a threat. It may help to understand a little of where this comes from. Remember that people with narcissistic personality disorder view the world a little differently - not through rose colored glasses exactly, more like one's with the wrong prescription - things are kind of fuzzy, out of focus, distorted, flat becomes round, your head spins and you feel a little queezy, so imagine spending your life with badly fitted, out of focus glasses - you reach for the cup, but your vision is distorted so you miss, you misjudge the distance to the door and walk right into it, you try to walk over to someone and you trip and fall because the ground feels wobbly and is moving and undulating in a most disturbing manner.So, psychologically, these people are starting off at a distinct disadvantage.
The other thing, and the underlying reason for much of the mocking, the rage, the sarcasm, put downs and copious tears, is that for these people, much of what most of us would consider inconsequential is tantamount to a life or death struggle, psychologically. For these people, anything that threatens their world immediately threatens their very self - and that's the core of narcissism, it's a reaction (and none of this is conscious, by the way) to a deep seated fear that underneath all that bravado, boasting and general obnoxiousness that accompanies severe personality disorders that they will be unmasked as someone so unspeakably horrible that they will instantly be shunned and denounced by all who know and love them. It is this deep seated insecurity, self doubt and longing for unconditional attention that provokes the intensity of the reactions many of these people display. Something as minor as a disagreement about an outfit or movie choice can provoke this fear, in fact any questioning at all is threatening in the extreme because to these people, if there's a crack in the dam wall, catastrophe is imminent and certain (and what's more, it's probably because of something they've done or not done).
Obviously not all people with narcissistic personality disorder are this severe and certainly not all the time, but when they are triggered, their attacks can be biting and vicious and frequently guilt ladened. People with narcissistic personality disorder are so uncertain that they will be loved and cared for for themselves, that they frequently use manipulation, especially guilt to get what they want - and it works! People often comply, partly because of their own guilt being activated, but also because they know from experience that they are never going to win, and if by chance they do, there will be hell to pay.
One of the central deficits in narcissistic personality disorder is in the ability for empathy or being able to imagine oneself in another's situation and imagine what they would feel like. How would it be to try to imagine someone else's experience if you don't know how to. It's like telling someone with no art experience to reproduce a Monet with a screwdriver, at best you'd get a crude approximation.
Dealing a Narcissistic Personality Disorder
Well, where to start....
What exactly are personality disorders? Basically a personality disorder is a set of personality traits or characteristics that are both rigid and chronic. Generally personality disorders are not diagnosed in people under 18 as children's character or personality traits are assumed to still be somewhat flexible. Children may show characteristics of these disorders earlier than 18, but their essence is chronicity and inflexibility - and we have to get a little older for that.
Personality disorders are most often diagnosed by a mental health professional. Comprehensive interviews, information from the person's family, questionnaires and projective instruments like the Thematic Apperception Test and the Rorschach are all commonly used in the diagnosis of personality disorders.
What differentiates personality disorders from the rest of us? Like many mental health symptoms, personality disorders are the extreme manifestations of common characteristics. In the same way that everyone feels sad, but clinical depression significantly impacts day to day functioning, people with personality disorders (and those around them) are significantly affected by the person's personality style and despite these difficulties, the person is unable to change these characteristics. They continue to respond in the same way to everyone and every situation. They're the prototypical "when you're a hammer, everything looks like a nail" type.
Most of us consider our personalities pretty stable, we know if we tend to be introverted or outgoing, the people we like and the activities we enjoy. Although our internal base remains, we change ourselves subtly from day to day and in different situations. While a "hey bud, what's up?" may be fine for a friend, few of us would walk into a job interview saying that, and even fewer would be surprised by a negative result. But people with personality disorders are different, not only are they unable to make those essential changes, but they are often deeply confused, hurt and offended when their actions are not well received. Many of these disorders are also externally focused, in other words, it's everyone else's fault, which is part of what makes these people often very difficult to deal with, real "my way or the highway" people who don't generally play well with others.
The Diagnostic and Statistical Manual for Mental Disorders lists the following as general personality disorder criteria: An ongoing, chronic pattern of understanding the world and one's own experiences which deviates markedly from the expectations of the individual's culture. This is often expressed in cognitive or thought patterns (i.e., ways of perceiving and interpreting self, other people, and events) and in emotions (i.e., the range, intensity, lability, and appropriateness of emotional response). Interpersonal functioning is also affected and there are generally some problems with impulse control.
These patterns must occur over a significant period of time, in multiple situations and with multiple people. It's not just an occasional bad day, it can't be due to drugs or alcohol and other disorders need to be ruled out. While many people come to therapy because they feel bad, often people with personality disorders are dragged to therapy or are there because of an ultimatum, because other people can't deal with their behavior.
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The big problem comes in that despite these invisible impediments, people with narcissistic personality disorder are expected to live, work and interact with the rest of us in the world - and this poses 2 problems - they have to live with us and we have to live with them - and unlike many disorders which are temporary or intermittent, by definition, these are ongoing difficulties. Furthermore, the areas in which these people have deficits - self soothing, empathy and perspective are all areas which society generally attributes to personality, which is fair enough, but more specifically, we treat them as volitional. People with narcissistic personality disorder struggle with things that most of us take for granted and certainly things that many of us do reflexively. They don't know how to calm down, feel less anxious, angry etc. they don't know how to restore their fragile, wounded ego's and they have no innate sense of themselves as kind, loving etc, which they certainly can be.
Knowing some of these things can be helpful in alleviating the guilt that people in families of those with narcissistic personality disorder often feel - and some that those with the disorder feel too. On the whole, people don't like being uncomfortable or unhappy and tend to avoid it if they can. People with this disorder show definite deficits in skills, some of which can be taught. Although it can be difficult for people with narcissistic personality disorder to enter therapy, there can be significant changes with perseverance and practice by both the person with the disorder and their families.
So, in dealing with these people, try to have a sense that actions which seem spiteful and malevolent are actually their attempts at coping because they feel so bad and don't know how to do things differently. This often helps feel less angry towards the person and can help with problem solving. Also, look at your priorities and which things are worth fighting over, remember for them it probably feels a lot more personal so they'll put a lot of effort into it - is it worth it?
Now on important things it's different and here you might want to try stating what you need to say as neutrally as possible, if you're giving feedback focus on your feelings only, use "I statements" say something like "I feel that I'm not able to communicate with you right now because you are yelling, so I'm going to take some space for a few minutes", and yes, mostly you will have to take the high road and don't get lured back in with "so you think it's my fault" or any digs - the idea is to get out quick.
Living with a person with narcissistic personality disorder can be a little like being a meteorologist - and if it looks like rain take an umbrella, so be prepared with prepared things to say, no matter how silly you think it sounds, remember this technique is not just for you, it's for them too, the idea is you take the lead and show them better ways of dealing with things by how you interact with them. Over time, if you do things like self time outs or taking space, which quite honestly is the best way to sneak some undisturbed time, sooner or later, you'll be in the beginning of a conflict and you'll hear "I'm taking space for 10 minutes" instead of the escalating cycle.