Translate

Saturday, August 8, 2015

Grandiosity- a hallmark of Narcissistic Personality Disorder

Grandiosity is another hallmark of Narcissistic Personality Disorder (NPD), and is featured prominently in the Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition (DSM-IV) published by the American Psychiatric Association (www.psychiatry.org) and the 5th Edition published in 2013. The Webster Dictionary definition of grandiose is "characterized by affectation of grandeur or splendor or by absurd exaggeration". What this manifests as is a person who essentially thinks they are better than others and deserve better than others and should only associate with those whom they perceive to be better then others. 
 They need attention on themselves at all times and will find ways to make everything about themselves at all times.
As the daughter of an NPD mother, I have many many examples of how this plays out in everyday life. I will give 3 examples from my own life experience that illustrate this behavior.

1) One day shortly after I had graduated from medical school I was with my mother having lunch. My mother holds a master's degree and is currently a retired teacher. I had recently finished reading a book about Iran and was discussing what I had read with my mother. We came to a point of disagreement and though she had not read the book nor ever been to Iran, she insisted her point was right and when I continued to try and share what the book said that contrasted with her opinion she became very angry, and while pouring the glass of red wine she had been sipping on over my head she yelled "I am more educated than you".

2) My mother has a set of friends she has known since college. Ken and Mary have been a part of our lives since I was born. They have been present at every family gathering for as long as I can remember. Ken works for the police department and his wife Mary has been on medical disability for many years. One day my mother decided to have a barbecue and to invite some of my father's co-workers. My father and his co-workers are engineers. She does not invite Ken and Mary to this party but lets them know she is having the party and is not inviting them because "they are not of the same caliber as the engineers."

3) When I graduated from medical school, many of my friends' families were holding parties to celebrate the event and I was no exception. My mother decided to throw "me" a party. She invited many people to this party, not once asking me who I would like to invite. On the day of the party, I was surprised when I found I barely knew or never even met MOST of the people there. She had invited all of HER friends and acquaintances and very few of mine.

These previous examples illustrate how my mother thinks she is better than those around her and makes every occasion about her. In example 1, though I had obtained a BA degree from a more prestigious university than my mother AND had an MD while mother had a Master's degree, she was simply unable to allow FACTS to interfere with her over exaggerated sense of personal accomplishments. It also illustrates how she cannot handle being told her opinions are wrong. Simply implying she is incorrect injures her fragile ego to such a point that it elicits a very extreme reaction.
In example 2, she shuns her own friends because she does not deem them worthy to present to my father's co-workers. Her grandiose sense of self requires that others view her in the same way she views herself which is a person worthy of only keeping the most prestigious company. In example 3, she turns the celebration of MY graduation which should have been an occasion to celebrate MY achievements into a party for HER by inviting HER friends and acquaintances.

I hope these examples have helped to illustrate how grandiosity may manifest itself in everyday situations. 
Desert sunset, Nevada

Tuesday, August 4, 2015

Lack of Empathy- The hallmark of a narcissist

A lack of empathy is the hallmark of someone with Narcissistic Personality Disorder (NPD). Webster's Dictionary defines empathy as: "the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner; also :  the capacity for this"

To lack empathy is to lack the ability to understand another person's feelings or thoughts. Someone who lacks empathy simply can't put themselves in someone else's shoes to imagine how another might feel. 

There are all sorts of manifestations of this in real life and I will give 3 examples from my own recent past. 

Example 1) I was 15 weeks into my second pregnancy and was expecting a baby girl. We were over joyed with excitement and being past the 12 week mark we had begun to tell people I was expecting and I was wearing pregnancy clothes. Then one day as I was attending a conference on ultrasound, I found I was unable to detect a heartbeat or any movement when I placed the ultrasound on my belly. ( I am a physician. ) When I got home from my conference I went to see the Obstetrician who confirmed I had lost the baby. I was devastated. Naturally I called my mother who initially gave what one might consider to be a normal response- she came over to the house to console me. But later that week as I continued to feel upset she told me "I don't know why you are so upset. It was so small it wasn't even a person yet." 

Example 2) Several months ago my sister announced she was getting divorced. My mother immediately arranged a visit to help her move her things and watch the kids as my sister took care of business. When my mother returned from her trip and was having dinner with me she began to discuss my sister and the divorce and said " Well you know it is just so hard for me to just suddenly change my mind about John just like that!" as she dramatically waves her hand around in a circular motion. 

Example 3) Several weeks ago I heard from a long time family friend that my mother was telling people she didn't know that my husband was abusive to me and I was too spineless to leave him (both without evidence or merit of course). Naturally this upset me so when she sent me text messages about silly things a few days later and I did not respond she began to e-mail several of my friends to ask why I wasn't responding to her messages. Of course my friends told me so I sent her the following message: "The reason I don't answer every text you send me is very simple: you say horrible things about my husband to anyone who will listen. This is not okay and it makes me sad and mad. You also say very critical things about me and this also makes me sad and mad at you. So sometimes I just don't feel like answering at all because I am sad and mad at you. Period. I don't want to discuss it."  Her reply was "ok". Then several days later she sends another message saying "Made it home. Your sister and the children are well. Give a hug to the boys for me." 

These previous examples illustrate her inability to understand how someone else might be feeling in any given situation. In example 1, she plainly states she did not understand. I think a stranger could have shown more understanding. I had a co-worker I did not know very well reach out and offer to talk about it if I needed to. In example 2, she showed a total inability to empathize with my sister and what my sister was feeling in this very difficult time and even went so far as to make it into something about her and it was difficult for HER. In example 3 she fails to acknowledge my feelings in anyway and then follows up with a non-chalant text as though nothing was wrong at all. This has been her pattern my whole life. Whenever I brought up any way in which I as hurt by something she said or did, there was never any acknowledgement of it at all. She simply cannot understand how I am feeling and has no ability to care that I have been hurt. 
Also as you may have noticed that some of her behaviors may have seemed appropriate and empathetic such as going to help my sister after her divorce, but it is important to keep in mind that those with NPD can also fake some degree of empathy. But there is no actual understanding behind the actions. It is all show to look good in front of others. 

I hope these examples have helped to illustrate how a lack of empathy may manifest itself in everyday situations.

Ice Plant at Carpinteria Beach, California

Monday, July 27, 2015

Criteria for diagnosing NPD

As promised from last week's blog, here is a more in-depth look at the diagnostic criteria for Narcissistic Personality Disorder (NPD). I have included both the most recent criteria from the Diagnostic and Statistical Manual of Mental Disorders Fourth edition and Fifth Edition from the American Psychiatric Association for reference as completeness. The 5th Edition was published in 2013 and seems to be a bit more difficult to follow and so I though including the 4th Edition will help with overall understanding because it seems to me a bit more straight forward.


DSM-4
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:

(1) has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements) 
(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
(3) 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)
(4) requires excessive admiration
(5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
(6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
(7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
(8) is often envious of others or believes that others are envious of him or her
(9) shows arrogant, haughty behaviors or attitudes




DSM-5 

A. Significant impairments in personality functioning manifested by:
1. Impairments in self functioning (a or b):
a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.
b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.
AND
2. Impairments in interpersonal functioning (a or b):
a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.
b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others' experiences and predominance of a need for personal gain
B. Pathological personality traits in the following domain:
  1. Antagonism, characterized by:
a. Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others.
b. Attention Seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.
C. The impairments in personality functioning and the individual's personality trait expression are relatively stable :across time and consistent across situations.
D. The impairments in personality functioning and the individual's personality trait expression are not better understood as normative for the individual's developmental stage or socio-cultural environment.
E. The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Lake Tahoe

Monday, July 20, 2015

Introduction

I am the daughter of a narcissistic personality disordered (NPD) mother and an enabling father. I am also a practicing physician, wife, mother, landlord and writer.  Having an NPD mother is really something that I have only recently realized after a particularly crazy making encounter with my mother a few years ago. I was on the phone with a friend describing this horrible encounter where my mother out of the blue and with no evidence to to support her, claimed my husband was abusing our son. 
After much discussion with my friend, a fellow physician, he encouraged me to "Dust off your psychiatry books and re-read the Cluster B personality disorders. I think your mother may have one."
I was shocked at his suggestion. I had always suspected an underlying depression or anxiety but never a cluster B personality disorder. But out of desperation to find answers to her strange behavior and accusations I "dusted off" my old psychiatry books and reread the Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition (DSM-IV) published by the American Psychiatric Association (www.psychiatry.org) criteria for cluster B personality disorders. The American Psychiatric Association  (APA) has since printed a 5th edition published in 2013 that places personalities disorders in the same category as other mental illness rather than its own axis as in DSM IV. The APA defines personality disorders as a "class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual's culture. These patterns develop early, are inflexible, and are associated with significant distress or disability."
The following is a list of the Cluster B personality disorders which are known as the dramatic, emotional or erratic disorders:
  • Antisocial personality disorder: a pervasive pattern of disregard for and violation of the rights of others, lack of empathy, bloated self-image, manipulative and impulsive behavior.
  • Borderline personality disorder: pervasive pattern of instability in relationships, self-image, identity, behavior and affects often leading to self-harm and impulsivity.
  • Histrionic personality disorder: pervasive pattern of attention-seeking behavior and excessive emotions.
  • Narcissistic Personality Disorder: a pervasive pattern of grandiosity, need for admiration, and a lack of empathy.
I write this blog in the hope that my stories of my past and present struggles and how I have worked and continue to work to overcome them can help people suffering from the same issues to heal and lead happy lives.

I will note that in order to maintain the privacy of my family and friends, I have changed names and in some cases details though the content will remain the same. 

Up next will be more detailed diagnostic criteria for NPD

Kona