Sanctuary for the Abused
Saturday, August 22, 2020
Misdiagnosing Narcissism (BiPolar I)
Bipolar patients in the manic phase exhibit many of the signs and symptoms of pathological narcissism - hyperactivity, self-centeredness, lack of empathy, and control freakery. During this recurring chapter of the disease, the patient is euphoric, has grandiose fantasies, spins unrealistic schemes, and has frequent rage attacks (is irritable) if her or his wishes and plans are (inevitably) frustrated.
The manic phases of the Bipolar Disorder, however, are limited in time - NPD is not. Furthermore, the mania is followed by - usually protracted - depressive episodes. The narcissist is also frequently dysphoric. But whereas the Bipolar sinks into deep self-deprecation, self-devaluation, unbounded pessimism, all-pervasive guilt and anhedonia - the narcissist, even when depressed, never forgoes his narcissism: his grandiosity, sense of entitlement, haughtiness, and lack of empathy.
Narcissistic dysphorias are much shorter and reactive - they constitute a response to the grandiosity gap. In plain words, the narcissist is dejected when confronted with the abyss between his inflated self-image and grandiose fantasies - and the drab reality of his life: his failures, lack of accomplishments, disintegrating interpersonal relationships, and low status. Yet, one dose of narcissistic supply is enough to elevate the narcissists from the depth of misery to the heights of manic euphoria.
Not so with the Bipolar. The source of her or his mood swings is assumed to be brain biochemistry - not the availability of narcissistic supply. Whereas the narcissist is in full control of his faculties, even when maximally agitated, the Bipolar often feels that s/he has lost control of his/her brain ("flight of ideas"), his/her speech, his/her attention span (distractibility), and his/her motor functions.
The Bipolar is prone to reckless behaviors and substance abuse only during the manic phase. The narcissist does drugs, drinks, gambles, shops on credit, indulges in unsafe sex or in other compulsive behaviors both when elated and when deflated.
As a rule, the Bipolar's manic phase interferes with his/her social and occupational functioning. Many narcissists, in contrast, reach the highest rungs of their community, church, firm, or voluntary organization. Most of the time, they function flawlessly - though the inevitable blowups and the grating extortion of narcissistic supply usually put an end to the narcissist's career and social liaisons.
The manic phase of Bipolar sometimes requires hospitalization and - more frequently than admitted - involves psychotic features. Narcissists are never hospitalized as the risk for self-harm is minute. Moreover, psychotic microepisodes in narcissism are decompensatory in nature and appear only under unendurable stress (e.g., in intensive therapy).
The Bipolar's mania provokes discomfort in both strangers and in the patient's nearest and dearest. His/her constant cheer and compulsive insistence on interpersonal, sexual, and occupational, or professional interactions engenders unease and repulsion. Her/his lability of mood - rapid shifts between uncontrollable rage and unnatural good spirits - is downright intimidating. The narcissist's gregariousness, by comparison, is calculated, "cold", controlled, and goal-orientated (the extraction of narcissistic supply). His cycles of mood and affect are far less pronounced and less rapid.
The Bipolar's swollen self-esteem, overstated self-confidence, obvious grandiosity, and delusional fantasies are akin to the narcissist's and are the source of the diagnostic confusion. Both types of patients purport to give advice, carry out an assignment, accomplish a mission, or embark on an enterprise for which they are uniquely unqualified and lack the talents, skills, knowledge, or experience required.
But the Bipolar's bombast is far more delusional than the narcissist's. Ideas of reference and magical thinking are common and, in this sense, the Bipolar is closer to the Schizotypal than to the Narcissistic.
There are other differentiating symptoms:
Sleep disorders - notably acute insomnia - are common in the manic phase of Bipolar and uncommon in narcissism. So is "Manic speech" - pressured, uninterruptible, loud, rapid, dramatic (includes singing and humorous asides), sometimes incomprehensible, incoherent, chaotic, and lasts for hours. It reflects the Bipolar's inner turmoil and his/her inability to control his/her racing and kaleidoscopic thoughts.
As opposed to narcissists, Bipolar in the manic phase are often distracted by the slightest stimuli, are unable to focus on relevant data, or to maintain the thread of conversation. They are "all over the place" - simultaneously initiating numerous business ventures, joining a myriad organization, writing umpteen letters, contacting hundreds of friends and perfect strangers, acting in a domineering, demanding, and intrusive manner, totally disregarding the needs and emotions of the unfortunate recipients of their unwanted attentions. They rarely follow up on their projects.
The transformation is so marked that the Bipolar is often described by his/her closest as "not himself/herself". Indeed, some Bipolars relocate, change name and appearance, and lose contact with their "former life". Antisocial or even criminal behavior is not uncommon and aggression is marked, directed at both others (assault) and oneself (suicide). Some Bipolars describe an acuteness of the senses, akin to experiences recounted by drug users: smells, sounds, and sights are accentuated and attain an unearthly quality.
As opposed to narcissists, Bipolars regret their misdeeds following the manic phase and try to atone for their actions. They realize and accept that "something is wrong with them" and seek help. During the depressive phase they are ego-dystonic and their defenses are autoplastic (they blame themselves for their defeats, failures, and mishaps).
Finally, pathological narcissism is already discernible in early adolescence. The full-fledged Bipolar Disorder - including a manic phase - rarely occurs before the age of 20. The narcissist is consistent in his pathology - not so the Bipolar. The onset of the manic episode is fast and furious and results in a conspicuous metamorphosis of the patient.
More about this topic here:
Stormberg, D., Roningstam, E., Gunderson, J., & Tohen, M. (1998) Pathological Narcissism in Bipolar Disorder Patients. Journal of Personality Disorders, 12, 179-185
Roningstam, E. (1996), Pathological Narcissism and Narcissistic Personality Disorder in Axis I Disorders. Harvard Review of Psychiatry, 3, 326-340
Labels: bipolar, cold, compulsivity, cycling, mental disorder, mood swings, narcissism
Wednesday, July 25, 2018
Sex & Porn Addiction
What you are looking for is a "sex addiction therapist" from any of the mental health healing disciplines who has a good track record in treating this problem & personal values that are reasonably congruent with the patient's values. Suggestions will be given shortly on how to find such a therapist.
In addition to having a competent, qualified sex addiction therapist, the patient will also need to attend regularly - (90% of the time) for two years or longer - weekly meetings of Sexaholics Anonymous (or other similar 12-step support group). These groups (free of charge) meet in nearly every fair sized city in America & their address & location can be found in the business pages of the phone book or by contacting Alcoholics Anonymous, who can give directions to the caller on location & time of meetings of the sexaholic group. It will be at these meetings that patients can inquire of fellow members or attendees the names of competent therapists they are individually meeting with & have found helpful & competent in receiving their own treatment. Another source of referrals is to call the National Council of Sexual Addiction & Compulsivity, who have a register of most therapists in the U.S. doing treatment in this area: 770-989-9754.
In my experience of 25 years in treating approximately 350 of these patients I find, if married, nearly universally the wives are traumatized by the husbands lies, deceptions, and-out-of-bounds sex behavior, and need treatment, too.
If the wife decides to stay in the marriage for a while longer, I engage her in joint treatment with her husband. I have found that if I successfully heal the husband of his addiction but have an angry, hostile, wounded wife who can never trust or forgive her husband even though she remains in the marriage, it greatly increases the risk of relapse in the husband as he attempts unsuccessfully to placate & deal with major marital turmoil. The wife's wounding has to be addressed as well as have both parties participate in marital therapy. Thus I nearly always attempt to have the wife join with the husband in our therapy sessions. This usually predicts a successful outcome if both stay in the healing program. This program works & is successful if both parties stay with it.
Sometimes the husband will find himself with years of sobriety & feel he's all "cured" & doesn't need to still attend his group meetings or therapy sessions anymore. Why waste time & money when he's doing so well? This can be very risky. And it greatly increases the chances for relapse. What I do when patients start experiencing long-term sobriety is gradually lengthen the time interval between therapy sessions. So eventually we may be meeting once every month, or six to eight weeks or longer.
The specifics of treatment by the therapist will not be presented in detail here other than to mention that we do marital therapy, put the couple in marital communication workshops (such as Marriage Enrichment), do a lot of work with relapse prevention, identify the triggers to acting out & develop strategies to protect them from the triggers, fortify them to deal with the "wave," and help them reduce & eliminate masturbation to pornography, since this increases the power of their addictive illness over them & is the royal road to acquiring new sexual addictions or paraphilias which might be acted out. We also strongly emphasize a "no secrets" rule, and how vital this is to healing.
We treat concomitantly any other addictions which they might have. All have to be treated together, otherwise the patient just shifts back & forth between addictions with no real long-term healing. We teach them the three-second rule to manage & control intrusive thoughts & imagery. We give them a lot of reading to do in the sex addiction area (like the Carnes' books, and the "white book," created by S.A. & filled with successful recovery biographies, plus monographs on many other related topics). We want them to be "world experts" on the nature of sex addiction, its genesis, its course, and helpful treatment procedures.
We also find it most important that they have hope & assured knowledge that the illness is treatable & they can get their free agency back again & have rational control over their previously driven irrational behavior. They see how this is possible as they attend S.A. & see & hear the testimonies of other people who now have long-term sobriety. These were people who were in much worse shape than they when entering treatment.
We deal with spiritual issues in therapy when this is appropriate to the unique circumstances & values of the client. We also deal with deep woundedness arising out of early life traumas which now make them vulnerable to seeking out quick-fix sexual acting out as a solution, which really doesn't work in the long-term. I also give a lot of verbal praise & genuine appreciation in response to even their smallest gains & good behavior. I never criticize or put them down when there are relapses. I just say, "This is exactly why we meet in therapy - to strengthen you & develop new strategies to deal with temptation. Now if this situation were to occur again, what might be a more powerful way to deal with it? To resist it? To remain sober? …etc.,"
Male teenage patients can be quite challenging. Many deny that it is a problem & consistently lie about the details of their involvement with it. Their motivation to change may be nonexistent. They are usually brought in for treatment by an angry and/or sorrowful parent & often tend to be uncooperative & passive/aggressive in dealing with the problem. It may be helpful to consider family therapy & be therapeutically confrontive in dealing with the issues that arise. Fairly drastic limitations on home computer/Internet use may be necessary. If 17 or older, I put them into a regular S.A. group with, possibly, the father also attending to be a support to the son & be someone he can talk with about the various issues as they arise.
Permission to reprint granted by Mark B. Kastelman. Excerpt taken from "The Drug of the New Millennium, The Science of How Internet Pornography Radically Alters the Human Brain & Body" Chapter 30, pages 308-311. Click the articles to the right to view more writings on sex & porn addiction topics from Mark Kastelman.
Labels: abuse, acting out, anxiety, compulsivity, denial, narcissists, porn, secrets, sex addiction, sociopaths
Thursday, May 31, 2018
Centerfold Syndrome & Men
The Centerfold Syndrome
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Psychologist Dr. Gary R. Brooks, in his book, The Centerfold Syndrome: How Men Can Overcome Objectification and Achieve Intimacy with Women*, has identified four symptoms of the "centerfold syndrome." As the result of a steady diet of soft-core pornography, men may display one or more of the following symptoms:
Voyeurism-an obsession with visual stimulation that trivializes all other features of a healthy relationship
Objectification-obsessive fetishes over body parts and the rating of women by size and shape
Trophyism-treatment of women as collectibles and property
Fear of intimacy-inability to get beyond glossy, centerfold images of women to have a real relationship
Pornography subtly communicates that the value of a woman is determined by her body, shape, and size. Only those women with a perfect physical appearance are valuable and worthy of being admired, desired, and loved. This can have detrimental effects on how women and girls view themselves.
I often wonder how many young girls who struggle with anorexia, bulimia, and other eating disorders are unknowingly struggling to measure up to the perfect "10" image projected by the airbrushed centerfold.
I also wonder how many teenage boys, consciously or unconsciously, measure the value of their girlfriends against the "bunny" image.
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Pornography's Progressive Pattern of Addiction
Dr. Victor Cline, a clinical psychologist at the University of Utah and a specialist in the area of sexual addictions, has observed a four-step syndrome common to almost all of his clients who have been involved with pornography.
Step 1-Addiction.
Once consumers of pornography get hooked, they keep coming back for more and more. The sexually graphic material provides the viewer with an aphrodisiac effect, followed by sexual release, most often through masturbation. Pornography gives the viewer powerful imagery that can be recalled and elaborated on with the person's fantasy life. Despite negative consequences, most addicts are unable to rid themselves of their dependence on pornography. Their addiction rules their lives.
Step 2-Escalation.
Cline describes the second phase as an escalation-effect. The pornography consumer, similar to the drug user, requires more and more stimulation to reach his or her "highs." In fact some viewers prefer the powerful sexual imagery planted in their minds by exposure to pornography to sexual intercourse itself. This nearly always diminishes the viewer's capacity to love and express appropriate intimacy within relationships.
Step 3-Desensitization.
In this phase, material that was originally perceived as unthinkable, shocking, illegal, repulsive, or immoral is now viewed as acceptable and commonplace by the viewer of pornography. Regardless of the deviancy expressed, the viewer perceives the pornography and his or her use of it as legitimate.
Step 4-Acting out sexually.
This last step describes an increased tendency to act out sexually the behaviors viewed in pornography, including things such as: promiscuity, visiting escorts, voyeurism, exhibitionism, group sex, affairs, rape, sadomasochism, cybersex, phone sex, child molestation, and more.
Clearly, this progressive pattern demonstrates how reality and fantasy become blurred for those who are entangled with pornography or when viewing is no longer enough. Early emotional wounding is almost always a factor in pornography addiction.
In regard to the compulsive or addictive nature of pornography, Dr. Cline shares the following: "In over 26 years, I have treated approximately 350 males afflicted with sexual addictions (or sometimes referred to as sexual compulsions). In about 94 percent of the cases I have found that pornography was a contributor, facilitator, or direct causal agent in the acquiring of these sexual illnesses." ii
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iCline, Pornography's Effects, 3-5.
iiVictor B. Cline, "Pornography and Sexual Addictions," Christian Counseling Today 4, no.4 (1996): 58.
Labels: abuse, centerfold syndrome, compulsivity, denial, objectification, pornography, sex addiction
Sunday, April 22, 2018
Compulsive Liars
Compulsive Liars often feel the need to lie about almost anything. They often lie about little things such as what they ate for lunch and they also lie about big important things. When compulsive liars lie it becomes a very bad habit. It is very difficult to break and it almost feels like that they can not stop lying due to it being almost automatic. It almost becomes so automatic within themselves that lying becomes a part of them. They often can lie and sound very convincing.
People who are compulsive liars often lie so much that it is almost like a script. Once an individual memorizes a series of scripts that are lies then they can say the scripts sounding very convincing to other individuals. At times there is flaws in the individual stories that they lie about or other lies that they tell. Compulsive liars often have big stories in order to cover up a certain area of their past which the person is afraid to let other people know. They are often afraid of being judged. Compulsive liars often have extreme self esteem issues and often lie to portray themselves as someone else that they aren't really.
Compulsive liars may stop lying and come clean about the truth when they are caught. The lies that compulsive liars do tell will eventually catch up to them. People around them will begin to notice gaps in their stories and the other lies that they tell people. Compulsive liars can only be so convincing only so long until someone notices that it is mostly lies. Compulsive liars will often tell another story full of lies if they don't want the truth to be known when they are caught in other lies.
One thing to remember about compulsive liars is you often can not tell the difference between a truth and lie. After so many stories have been told and so many lies that have been told then it is difficult to people around them to figure out exactly which is false and which is true.People can not always tell lies about everything about themselves since it is impossible to hide everything about themselves completely. Compulsive liars can not always lie about everything little thing about themselves or other things.
Compulsive liars often lie to the family and friends. Compulsive liars will also lie to the person that they love romantically. Be careful with some compulsive liars since some of them don't have any guilt about the lies. Some of them never come clean about the truth unless they reach a point of where they want to stop lying.
How does a compulsive liar stop?
A compulsive liar has to make the decision to stop lying. A person won't stop lying unless he or she wants to do so. A compulsive liar can't begin to stop lying until he or she decides to start to tell the truth about everything in the past and present and future. Or just selective truth. Someone who is a compulsive liar will sometimes fall back into the mode of lying again. Compulsive lying is much deeper than just self esteem issues.
Michelle Knudson is a Freelance Writer. She's happily married and resides in the USA. She loves making a positive difference in the lives of people. She enjoys reading, writing, her gold fish, and computers.
Labels: compulsivity, liars, lies, self esteem, thought stopping
Friday, January 12, 2018
Adults Shamed as Children
The following is quoted from Shame & Guilt: Masters of Disguise by Jane Middelton-Moz, Ph.D.
1. Adults shamed as children are afraid of vulnerability and fear exposure of self.
2. Adults shamed as children may suffer extreme shyness, embarrassment and feelings of being inferior to others. They don't believe they make mistakes. Instead they believe they are mistakes.
3. Adults shamed as children fear intimacy and tend to avoid real commitment in relationships. These adults frequently express the feeling that one foot is out of the door, prepared to run.
4. Adults shamed as children may appear either grandiose and self-centered or seem selfless.
5. Adults shamed as children feel that, “No matter what I do, it won't make a difference; I am and always will be worthless and unlovable.”
6. Adults shamed as children frequently feel defensive when even minor negative feedback is given. They suffer feelings of severe humiliation if forced to look at mistakes or imperfections.
7. Adults shamed as children frequently blame others before they can be blamed.
8. Adults shamed as children may suffer from debilitating guilt. These individuals apologize constantly. They assume responsibility for the behavior of those around them.
9. Adults shamed as children feel like outsiders. They feel a pervasive sense of loneliness throughout their lives, even when surrounded with those who love and care.
10. Adults shamed as children project their beliefs about themselves onto others. They engage in mind-reading that is not in their favor, consistently feeling judged by others.
11. Adults shamed as children often feel angry and judgmental towards the qualities in others that they feel ashamed of in themselves. This can lead to shaming others.
12. Adults shamed as children often feel ugly, flawed and imperfect. These feelings regarding self may lead to focus on clothing and makeup in an attempt to hide flaws in personal appearance and self.
13. Adults shamed as children often feel controlled from the outside as well as from within. Normal spontaneous expression is blocked.
14. Adults shamed as children feel they must do things perfectly or not at all. This internalized belief frequently leads to performance anxiety and procrastination.
15. Adults shamed as children experience depression.
16. Adults shamed as children lie to themselves and others.
17. Adults shamed as children block their feelings of shame through compulsive behaviors like workaholism, eating disorders, shopping, sexual addiction, substance abuse, list-making or gambling.
18. Adults shamed as children often have caseloads rather than friendships.
19. Adults shamed as children often involve themselves in compulsive processing of past interactions and events and intellectualization as a defense against pain.
20. Adults shamed as children are stuck in dependency or counter-dependency.
21. Adults shamed as children have little sense of emotional boundaries. They feel constantly violated by others. They frequently build false boundaries through walls, rage, pleasing or isolation.
Labels: adult children of narcissists, boundaries, childhood abuse, compulsivity, guilt, rage, shame, victims
