Do you LIVE or WORK with a NARCISSIST?

It’s not just be­ing vain — it’s a de­bil­i­tat­ing men­tal ill­ness. And, as the Mail’s Mind Doc­tor MAX PEM­BER­TON re­veals in this com­pelling se­ries, it’s far more com­mon than you think

Irish Daily Mail - - Good Health - by Dr MAX PEM­BER­TON

CAN you imag­ine the re­ac­tion if one per­son in ten was af­fected by a dis­ease that could de­stroy their life, yet was miss­ing out on treat­ment — of­ten be­cause they were seen as ‘at­ten­tion­seek­ing’ or time-wast­ing?

That’s what hap­pens to many peo­ple with per­son­al­ity dis­or­der.

There is still a lot of stigma around men­tal health con­di­tions, par­tic­u­larly per­son­al­ity dis­or­der. Few peo­ple un­der­stand it and con­se­quently many are left to suf­fer in si­lence, un­aware there is help avail­able.

Those who do seek help of­ten de­scribe be­ing dis­missed by health pro­fes­sion­als as ‘dif­fi­cult’ and are treated in a cruel or un­sym­pa­thetic way.

I’ve seen this my­self when pa­tients with bor­der­line (or emo­tion­ally un­sta­ble) per­son­al­ity dis­or­der have come into A&E af­ter they’ve self-harmed, with staff fail­ing to un­der­stand this is a sign they are at rock bot­tom.

And rather than be­ing shown the un­der­stand­ing they de­serve, these pa­tients are of­ten con­sid­ered an­noy­ing and self­ish be­cause they’ve ‘done this to them­selves’.

There are even sto­ries of pa­tients be­ing stitched without ad­e­quate anaes­thetic to ‘teach them a les­son’.

The tragic truth is that these pa­tients of­ten have a his­tory of trauma and this treat­ment only con­trib­utes to it.

The stigma around per­son­al­ity dis­or­der means we don’t talk about it, but it’s noth­ing to be ashamed of and cer­tainly not the per­son’s fault they have it.

Part of the prob­lem is that peo­ple think per­son­al­ity dis­or­der means ‘dan­ger­ous ‘psy­chopath’, which is wrong and only adds to the stigma.

In fact, there are ten dif­fer­ent types and the chances are you have a col­league, friend or even part­ner af­fected by one of these without them re­al­is­ing it, yet suf­fer­ing real dis­tress as a re­sult.

In the past, it was thought that peo­ple with a per­son­al­ity dis­or­der had it for life and it was as­sumed lit­tle could be done.

But thanks to ad­vances in brain scan­ning, we now know our brains

can change — to an ex­tra­or­di­nary de­gree — over the course of our lives.

Large stud­ies have shown that per­son­al­ity char­ac­ter­is­tics can change, too.

The good news is that with the right treat­ment, peo­ple with per­son­al­ity dis­or­der do get bet­ter, and their symp­toms can im­prove.

As I ex­plained last week, lots of peo­ple have as­pects of a per­son­al­ity dis­or­der.

But un­less it is caus­ing se­ri­ous prob­lems, it is of­ten said that they have ‘traits’ of a per­son­al­ity dis­or­der, but not the full-blown ver­sion where the symp­toms are a con­stant fea­ture that ham­pers their life.

Some­times the dis­or­der emerges only later in life, per­haps be­cause they’ve been in a re­la­tion­ship that helped to con­tain the most dif­fi­cult as­pects.

Money prob­lems and stress­ful sit­u­a­tions, or im­por­tant events, can also trig­ger it.

AL­WAYS NEEDS TO BE AD­MIRED

A FEW years ago, I worked pri­vately for a short while, and among my pa­tients were sev­eral for­mer pop stars. One in par­tic­u­lar had been quite fa­mous sev­eral decades ago, but the spot­light had dimmed and he now ex­hib­ited clear nar­cis­sis­tic per­son­al­ity dis­or­der traits.

There are three broad types of per­son­al­ity dis­or­der, known as clus­ters, based on the type of emo­tional prob­lem un­der­ly­ing them. Nar­cis­sism be­longs to the Clus­ter B group, char­ac­terised as dra­matic, emo­tional or er­ratic. Last week we looked at three of the four types in this group: an­ti­so­cial (psy­cho­pathic), histri­onic and bor­der­line (or emo­tion­ally un­sta­ble).

The fourth type, nar­cis­sis­tic per­son­al­ity dis­or­der, of­ten gen­er­ates a lot of in­ter­est be­cause peo­ple be­lieve they can see it in those around them. In fact, we are all a lit­tle self-ob­sessed at times, and this is per­fectly nor­mal.

Of course, some of us are more self-ob­sessed than oth­ers but this is dif­fer­ent from nar­cis­sis­tic per­son­al­ity dis­or­der, where there is an over­rid­ing feel­ing of self­im­por­tance com­bined with a dis­re­gard for oth­ers’ feel­ings and an ex­ces­sive need for adoration.

The for­mer pop star was crest­fallen, then an­gry, when I con­fessed I hadn’t heard of him. It was clear his suc­cess as a pop star was of great im­por­tance to him.

He was very grandiose and self­im­por­tant and spoke bit­terly of his con­tem­po­raries who were still suc­cess­ful. In­ter­est­ingly, nar­cis­sis­tic traits are com­mon in celebri­ties and very suc­cess­ful peo­ple: they helped them re­main fo­cused on get­ting what they want from life.

While they are suc­cess­ful and rid­ing high, things are usu­ally rel­a­tively sta­ble. They might seem very full of them­selves but their ego re­mains sat­is­fied be­cause, ob­jec­tively, they are suc­cess­ful and peo­ple adore them.

How­ever, when there is a fall from grace — when they lose their jobs, fail to gain pro­mo­tion or, as in the case of my for­mer pop star pa­tients, when the spot­light dims — things start col­laps­ing and the symp­toms of the per­son­al­ity dis­or­der come to the fore and start caus­ing se­ri­ous prob­lems.

They can be­come very de­pressed and even sui­ci­dal — the for­mer pop star had come to see me be­cause of prob­lems with al­co­hol, which is a com­mon way for peo­ple to try to numb emo­tional pain.

AR­RO­GANT AND HY­PER-CRIT­I­CAL

TO HAVE per­son­al­ity dis­or­der di­ag­nosed, some­one needs to demon­strate three or four of the char­ac­ter­is­tics. The fol­low­ing is a check­list for nar­cis­sis­tic per­son­al­ity dis­or­der. Does the per­son:

BE­LIEVE there are spe­cial rea­sons mak­ing them dif­fer­ent, bet­ter or more de­serv­ing than oth­ers?

HAVE frag­ile self-es­teem, re­ly­ing on oth­ers to recog­nise their worth and needs?

FEEL up­set if oth­ers ig­nore them and don’t give them what they feel they de­serve?

RE­SENT the suc­cesses of other peo­ple?

PUT their own needs above those of oth­ers, and de­mand that those oth­ers do the same? TAKE ad­van­tage of oth­ers? Nar­cis­sists can be very dif­fi­cult to be around, not least be­cause they of­ten don’t think they have a prob­lem. They have a strong sense of su­pe­ri­or­ity and seem ar­ro­gant.

The flip side is they need con­stant ad­mi­ra­tion to feel ful­filled. De­spite their ap­par­ent ar­ro­gance, they of­ten have very frag­ile egos.

To feel bet­ter about them­selves they will of­ten be­lit­tle or crit­i­cise those around them. If chal­lenged on this, they may be dis­mis­sive or sug­gest the other per­son is be­ing

weak. In the ex­treme, they can be con­trol­ling, blam­ing and self­ab­sorbed. It’s not just cock­i­ness: they typ­i­cally be­lieve they are more im­por­tant, more wor­thy and their needs should take pri­or­ity, re­gard­less of their ac­tual sta­tus.

About 1% of the pop­u­la­tion has this per­son­al­ity dis­or­der at some point.

LONELY BUT LONGS FOR COM­PANY

NERVY and anx­ious peo­ple can of­ten be mis­di­ag­nosed with an anx­i­ety dis­or­der when in fact their anx­i­ety is part of a big­ger is­sue to do with a per­son­al­ity dis­or­der.

The group of per­son­al­ity dis­or­ders char­ac­terised by anx­i­ety and fear­ful­ness can be very de­bil­i­tat­ing and iso­lat­ing. And there can be a real sad­ness — for in­stance, one of the dis­or­ders in this group, avoidant per­son­al­ity dis­or­der, is strongly as­so­ci­ated with ne­glect or re­jec­tion in child­hood: those af­fected some­times de­scribe be­ing dis­liked by one par­ent. The fol­low­ing are char­ac­ter­is­tics of this dis­or­der: Do they:

AVOID work or so­cial ac­tiv­i­ties which in­volve be­ing with oth­ers?

EX­PECT dis­ap­proval and crit­i­cism and are very sen­si­tive to it?

WORRY con­stantly about be­ing ‘found out’ and re­jected? FEEL in­se­cure or in­fe­rior? WORRY about be­ing ridiculed or shamed by oth­ers?

AVOID re­la­tion­ships, friend­ships and in­ti­macy be­cause they fear re­jec­tion? FEEL lonely and iso­lated? AVOID try­ing new ac­tiv­i­ties in case they em­bar­rass them­selves?

FEEL a des­per­ate need to be liked and ac­cepted?

Peo­ple like this will of­ten be bowed down with feel­ings of in­fe­ri­or­ity, and their main cop­ing strat­egy is avoid­ance. They also strug­gle in so­cial sit­u­a­tions.

Yet, de­spite this, they will feel lonely and long for com­pany. They are self-crit­i­cal and have a strong fear of be­ing re­jected, em­bar­rassed or hu­mil­i­ated in so­cial set­tings.

As a re­sult, they of­ten choose jobs where they can work alone.

NEEDY AND CAN’T MAKE DE­CI­SIONS

THE med­i­cal term for this per­son­al­ity dis­or­der is de­pen­dent — those af­fected are very re­liant on oth­ers and strug­gle to at­tain in­de­pen­dence: they have a need to be taken care of and for oth­ers to make de­ci­sions for them. They are some­times de­scribed as ‘clingy’.

They of­ten have a strong sense of self-doubt and will of­ten re­fer to them­selves as stupid or in­ept and be­lit­tle their own abil­i­ties.

They tend to seek re­la­tion­ships with dom­i­nant or over­pro­tec­tive part­ners and avoid po­si­tions of re­spon­si­bil­ity; their so­cial life also tends to be lim­ited to this per­son or a small group of peo­ple on whom they are de­pen­dent.

This per­son­al­ity dis­or­der is as­so­ci­ated with sep­a­ra­tion and chronic phys­i­cal ill­ness when grow­ing up. Signs to look for — do they: FEEL needy, weak and un­able to make de­ci­sions or func­tion prop­erly without help or sup­port?

AL­LOW oth­ers to as­sume re­spon­si­bil­ity for many ar­eas of their lives?

FEEL afraid of be­ing left to fend for them­selves? HAVE low self-con­fi­dence? FEEL eas­ily aban­doned or de­serted by peo­ple?

FEEL hope­less and in­com­pe­tent, and see oth­ers as be­ing much more ca­pa­ble than they are?

AP­PEAR to oth­ers to be much too sub­mis­sive and pas­sive?

EN­RAGED BY OTHER DRIV­ERS

ODD, ec­cen­tric, loner — these are the words typ­i­cally used to de­scribe the third group of per­son­al­ity dis­or­ders.

Typ­i­cally, these peo­ple are also the hard­est to treat be­cause they are sus­pi­cious and wary, or strug­gle to ex­press their emo­tions so they don’t seek help; this is of­ten left to fam­ily to do in­stead. Per­haps one of the bet­ter known types in this group is para­noid per­son­al­ity dis­or­der.

This in­volves much more than the cliche of think­ing ‘every­one is out to get them’. To be di­ag­nosed with a per­son­al­ity dis­or­der in­volves hav­ing three or four of the char­ac­ter­is­tics; these are a con­stant fea­ture that ham­pers their life. Signs to look for — do they: FIND it hard to con­fide in peo­ple, even friends, and very dif­fi­cult to trust other peo­ple?

OF­TEN sus­pect that oth­ers will use or take ad­van­tage of them?

WATCH oth­ers closely, look­ing for signs of be­trayal or hos­til­ity? BEAR grudges? READ threats and dan­ger that oth­ers don’t see into ev­ery­day sit­u­a­tions?

FIND it dif­fi­cult to brush off things that oth­ers say or do, and dwell on them and get an­gry?

These peo­ple are of­ten very sus­pi­cious of oth­ers and take of­fence eas­ily — they are of­ten in­volved in le­gal dis­putes and write lots of com­plaint let­ters.

They can be very hard to work with be­cause they as­sume that the usual mis­takes every­one makes are de­lib­er­ately di­rected at them. They fall out with lots of peo­ple and tend to hold grudges: they of­ten get over-an­gry if, for ex­am­ple, some­one oc­cu­pies their car park­ing space or un­in­ten­tion­ally cuts in on them while driv­ing.

They of­ten have fre­quent sus­pi­cions about a part­ner’s fi­delity. About 2% of the pop­u­la­tion have this dis­or­der.

HAS NO REAL IN­TER­EST IN SEX

PEO­PLE with schizoid per­son­al­ity dis­or­der of­ten come across as aloof or un­in­ter­ested in oth­ers. They don’t pay much at­ten­tion to so­cial norms, so their be­hav­iour may seem strange. They are not re­ally in­ter­ested in form­ing re­la­tion­ships and are of­ten lon­ers. Signs to look for — do they: AP­PEAR emo­tion­ally ‘cold’? NOT like mix­ing with oth­ers and pre­fer their own com­pany?

HAVE a very de­tailed fan­tasy life they of­ten re­treat into, spend­ing a lot of time day­dream­ing?

HAVE no real in­ter­est in sex — in­ti­macy is an en­croach­ment into their per­sonal space?

NOT get an­gry or hos­tile, even when pro­voked?

FIND it hard to ex­press feel­ings?

BE­LIEVES THEY MAY BE PSY­CHIC

PEO­PLE with schizo­ty­pal per­son­al­ity dis­or­der are the odd, ec­cen­tric types you might come across around your neigh­bour­hood. But al­though they may seem alarm­ing at first, over time you re­alise they are harm­less — their be­hav­iour is just who they are. This per­son­al­ity dis­or­der oc­curs in ap­prox­i­mately 3% of the pop­u­la­tion and is more com­mon in men. Signs to look for — do they: FIND mak­ing close re­la­tion­ships in­cred­i­bly dif­fi­cult? BE­HAVE in an ec­cen­tric way? BE­LIEVE they have spe­cial pow­ers, are psy­chic or have a sixth sense?

GET anx­ious and para­noid in so­cial sit­u­a­tions?

SOME­TIMES hear voices or talk to them­selves?

USE odd or un­usual words or phrases?

STRUG­GLE to ex­pe­ri­ence nor­mal emo­tions?

FOR fur­ther in­for­ma­tion, visit men­tal­healthire­land.ie and stpatricks.ie The Sa­mar­i­tans helpline: 116 123.

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