Histrionic, Somatic Personality Disorders - Excerpts Part 4

Excerpts from the Archives of the Narcissism List Part 4

1. HPD (Histrionic Personality Disorder) and Somatic NPD
2. Narcissists and Depression
3. Narcissistic Self-Absorption
4. Narcissists as Friends
5. PDs and Self-Mourning
6. DID and NPD
7. NPD and ADHD
8. Psychodynamic Therapies
9. Self-Pity and Grief
10. Should We Licence Parents?
11. BPD, NPD and Other Cluster B PDs

1. HPD (Histrionic Personality Disorder) and Somatic NPD

I "invented" another category between NPD and HPD which I call "somatic narcissists". These are narcissists who acquire their Narcissistic Supply by making use of their bodies, of sex, of physical of physiological achievements, traits, or relationships.

Click here to read the DSM IV-TR definition of the Histrionic Personality Disorder.

2. Narcissists and Depression

If by "depression" we also mean "numbness" then most narcissists are simply numb, emotionally absent, non-existent. Their emotions are not accessible, not "available" to them. So, they inhabit a grey emotional twilight zone. They regard the world through a glass opaquely. It all looks false, fake, invented, contrived, in hues of wrong. But they do not have a sense of living in prison. I have been to prison. Once in it, you remember there's an "outside" and you know there's a way out. Not so in narcissism. The outside has long faded into oblivion, if it ever existed. And there's no way out.

3. Narcissistic Self-Absorption

Narcissists are so abnormally self absorbed because:

1. They are constantly in pursuit of narcissistic supply (fishing for compliments, for instance).
2. They feel bad, sad, distraught most of the time. As opposed to common (and even wrong professional) opinion, narcissists are ego-dystonic (don't "live well" with their personality, the effect they have on others and what I call their Grandiosity Gap - the abyss between their grandiose and fantastic self-perception and the much less fantastic reality).

4. Narcissists as Friends

If your friend is a narcissist - you can never get to really know him, to be friends with him, and ESPECIALLY to be in a loving relationship with him. Narcissists are addicts. They are no different to drug addicts. They are in pursuit of gratification through the drug known as Narcissistic Supply. Everything and EVERYONE around them is an object, a potential source (to be idealised) or not (and, then to be cruelly discarded).

Narcissists home in on potential supplies like cruise missiles with the most toxic load. They are excellent at imitating emotions, exhibiting the right behaviours, and manipulating.

There is an abyss between knowing and feeling and between feeling and healing. Otherwise I - who knows so much about narcissism - would have been healthy by now (and I am NOT). So, it does not matter what you think - it matters how you feel and behave.

5. PDs and Self-Mourning

An integral part of every personality disorder is the all-pervasive feelings of loss, sadness, helplessness, and the resulting rage. It is almost as if people with PDs grieve, mourn themselves, or rather the selves that could have been theirs. This perpetual state of bereavement is oft confused with depression or existential angst.

6. DID and NPD

Is the False Self an alter? In other words: is the True Self of a narcissist the equivalent of a host personality in a DID (Dissociative Identity Disorder) - and the False Self one of the fragmented personalities, also known as "alters"?

My personal opinion is that the False Self is a construct, not a self in the full sense. It is the locus of the fantasies of grandiosity, the feelings of entitlements, omnipotence, magical thinking, omniscience and magical immunity of the narcissist. It lacks so many elements that it can hardly be called a "self". Moreover, it has no "cut-off" date. DID alters have a date of inception, as a reaction to trauma or abuse. The False Self is a process, not an entity, it is a reactive pattern and a reactive formation. All taken into account, the choice of words was poor. The False Self is not a Self, nor is it False. It is very real, more real to the narcissist than his True Self. A better choice would have been "abuse reactive self" or something to that effect.

7. NPD and ADHD

NPD has been associated lately with Attention Deficit / Hyperactivity Disorder (ADHD or ADD). The rationale is that children suffering from ADHD are unlikely to develop the attachment necessary to prevent a narcissistic regression (Freud) or adaptation (Jung). Bonding and object relations ought to be affected by ADHD. Research which supports this conjecture has yet to be made available. Still, many psychotherapists and psychiatrists use it as a working hypothesis.

8. Psychodynamic Therapies

Dynamic psychotherapy (or psychodynamic therapy, psychoanalytic psychotherapy, psychoanalytically psychotherapy):

Let us start with what it is NOT. As opposed to (wrong) common opinion it is NOT psychoanalysis. It is an intensive psychotherapy BASED on psychoanalytic theory WITHOUT the (very important) element of free association. This is not to say that free association is not used - only that it is not a pillar and the technique of choice in dynamic therapies. Dynamic therapies are usually applied to patients not considered "suitable" for psychoanalysis (such as PDs, except the Avoidant PD). Usually, different modes of interpretation are employed and other techniques borrowed from other treatments. But the material interpreted is not necessarily the result of free association or dreams and the psychotherapist is a lot more active than the psychoanalyst.

These treatments are open ended. At the commencement of the therapy the therapist (or analyst) makes an agreement (a "pact") with the analysand (AKA patient or client). The pact states that the patient undertakes to explore his problems no matter how long it takes (and how expensive it becomes). The patient is made to feel guilty if he breaks the pact. I never heard of a more brilliant marketing technique. This is a prime demonstration of the "captive market" concept. On the other hand, this makes the therapeutic environment much more relaxed because the patient knows that the analyst is at his/her disposal no matter how many meetings would be required in order to broach painful subject matter.

Sometimes, these therapies are divided to expressive versus supportive.

Expressive therapies uncover (=make conscious) the patient's conflicts but study his/her defences and resistances. The analyst interprets the conflict in view of the new knowledge thus gained and the happy ending, the resolution of the conflict, is at hand. the conflict, in other words, is "interpreted away" through insight and the change in the patient motivated by his/her insights.

Supportive therapies seek to strengthen the ego. Their premise is that a strong ego can cope better (and later on, alone) with external (situational) or internal (instincts, drives) pressures. notice that this is DIAMETRICALLY opposed to expressive therapies. Supportive therapies seek to increase the patient's ability to SUPPRESS conflicts (rather than bring them to the surface of consciousness). As painful conflict is suppressed - so are all manner of dysphorias and symptoms. This is somewhat reminiscent of behaviourism (the main aim is to change behaviour and to relieve symptoms). It usually makes no use of insight or interpretation (though there are exceptions).

9. Self-Pity and Grief

I think that grieving is an emotional process intended to overcome the clear and irrevocable loss of a loved object (including one's self). It is a coherent, all-consuming, all-pervasive, highly focused emotion. As a result it is short lived (has an "expiry date") and highly efficient and functional in that it allows for the removal / suppression / repression of the representation of the loved object and its transformation into a memory.

Self pity seems to me to be a diffuse, general, though also all-pervasive, emotion. It has no clear emotional aim. It is non-coherent. It is long lived, inefficient and dysfunctional (disturbs proper functioning).

10. Should We Licence Parents?

When we want to drive a car, to become a bank teller, or a dental assistant - we need to study and to be licensed.

Only if we want to become parents - it is a free for all. I honestly do not understand why. Parenting is by far the most complicated human vocation (or avocation) in existence. It involves the exercise of the highest possible mental and physical faculties in combination. A parent deals constantly with the most fragile, vulnerable, susceptible thing on earth (children). You need a licence to educate or care for someone else's children - but not for yours. This is insane. Every future parent must go through a course and learn basic parenting skills before obtaining a licence to procreate. As opposed to well-ingrained common opinion, parenthood is NOT a natural gift. It is learnt and usually from the wrong role models.

Should the mentally disabled be prevented from getting such a license? Should schizophrenics have children? what about MPDs? Other PDs? NPDs like me? OCDs? AsPDs? Where should the line be drawn and by whom on whose authority?

I don't have children because I think I will propagate my PD through them and to them. I don't want to reproduce myself because I conceive of myself as a defective product. But do I have the right NOT to give life to my children? I don't know.

11. BPD, NPD and Other Cluster B PDs

If NPD and BPD have a common source (pathological narcissism) this could be very meaningful. It could open up new vistas of understanding, coping and treatment.

All PDs are interrelated, in my view, at least phenomenologically. True, there is no Grand Unifying Theory of Psychopathology. No one knows whether there are - and what are - the mechanisms underlying mental disorders. At best, mental health professionals register symptoms (as reported by the patient) and signs (as observed by them in a therapeutic setting). Then, they group them into syndromes and, more specifically, into disorders. This is descriptive, not explanatory science. Sure, there are a few theories around (psychoanalysis, to mention the most famous) but they all failed miserably at providing a coherent, consistent theoretical framework with predictive powers.

Still, observations are a powerful tool, if properly used. People suffering from personality disorders have many things in common:

1. Most of them are insistent (except those suffering from the schizoid or the avoidant personality disorders). They demand treatment on a preferential and privileged basis. They complain about numerous symptoms. They never obey the physician or his treatment recommendations and instructions.

1. They regard themselves as unique, display a streak of grandiosity and a diminished capacity for empathy (the ability to appreciate and respect the needs and wishes of other people). They regard the physician as inferior to them, alienate him using umpteen techniques and bore him with their never-ending self-preoccupation.
2. They are manipulative and exploitative because they trust no one and usually cannot love or share. They are socially maladaptive and emotionally unstable.
3. Most personality disorders start out as problems in personal development which peak during adolescence and then become personality disorders. They stay on as enduring qualities of the individual. Personality disorders are stable and all-pervasive - not episodic. They affect most of the areas of functioning of the patient: his career, his interpersonal relationships, his social functioning.
4. The person suffering a PD is not happy, to use an understatement. He is depressed, suffers from auxiliary mood and anxiety disorders. He does not like himself, his character, his (deficient) functioning, or his (crippling) influence on others. But his defences are so strong, that he is aware only of the distress - and not of the reasons to it.
5. The patient with a personality disorder is vulnerable to and prone to suffer from a host of other psychiatric disturbances. It is as though his psychological immunological system has been disabled by the personality disorder and he is left prey to other variants of mental sickness. So much energy is consumed by the disorder and by its corollaries (example: by obsessions-compulsions), that the patient is rendered defenceless.
6. Patients with personality disorders are alloplastic in their defences. In other words: they would tend to blame the external world for their mishaps. In stressful situations, they will try to preempt a (real or imaginary) threat, change the rules of the game, introduce new variables, or otherwise influence the external world to conform to their needs. This is as opposed to autoplastic defences exhibited, for instance, by neurotics (who change their internal psychological processes in stressful situations).
7. The character problems, behavioural deficits and emotional deficiencies and instability encountered by the patient with personality disorders are, mostly, ego-syntonic. This means that the patient does not find his personality traits or behaviour objectionable, unacceptable, disagreeable, or alien to his self. As opposed to that, neurotics are ego-dystonic: they do not like what they are and how they behave on a constant basis.
8. The personality-disordered are not psychotic. They have no hallucinations, delusions or thought disorders (except those who suffer from a Borderline Personality Disorder and who experience brief psychotic "microepisodes", mostly during treatment).

They are also fully oriented, with clear senses (sensorium), good memory and general fund of knowledge and in all-important respects "normal".

The bible of the psychiatric profession is the Diagnostics and Statistics Manual (DSM) - IV-TR (2000). It defines "personality" as:

"...enduring patterns of perceiving, relating to, and thinking about the environment and oneself... exhibited in a wide range of important social and personal contexts."

Click here to read its definition of personality disorders

next: Excerpts from the Archives of the Narcissism List Part 5