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INDEX
1. Introduction
2. Codependence
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5
6
7
11
11
12
13
14
14
15
19
28
32
37
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41
53
70
75
76
86
95
101
110
116
118
122
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129
132
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1. INTRODUCTION
Most of the personality disorders described in this publication are part of
the Cluster B Personality Disorders. Disorders in this cluster are of a
dramatic, emotional and / or erratic nature. This implies that people
suffering from these disorders have problems with impulse control and
emotional regulation
Cluster B includes:
5.
6.
7.
8.
When this is the case, Conduct Disorder (a juvenile form of Antisocial Personality
Disorder) may be an appropriate diagnosis. Conduct Disorder is often considered
the precursor to an Antisocial Personality Disorder.
People with this disorder are often quite flirtatious or seductive, and like to
dress in a manner that draws attention to them.
They can be flamboyant and theatrical, exhibiting an exaggerated degree
of emotional expression.
Yet simultaneously, their emotional expression is vague, shallow, and
lacking in detail. This gives them the appearance of being disingenuous
and insincere.
Moreover, the drama and exaggerated emotional expression often
embarrasses friends and acquaintances as they may embrace even casual
acquaintances with excessive ardor, or may sob uncontrollably over some
minor sentimentality.
People with Histrionic Personality Disorder can appear flighty and fickle.
Their behavioural style often gets in the way of truly intimate relationships,
but it is also the case that they are uncomfortable being alone.
They tend to feel depressed when they are not the centre of attention.
When they are in relationships, they often imagine relationships to be more
intimate in nature than they actually are.
People with Histrionic Personality Disorder tend to be suggestible; that is,
they are easily influenced by other people's suggestions and opinions.
These people can get so caught up in their fantasies that they don't put
any effort into their daily life and don't direct their energies toward
accomplishing their goals.
They may believe that they are special and deserve special treatment, and
may display an attitude that is arrogant and haughty.
This can create a lot of conflict with other people who feel exploited and
who dislike being treated in a condescending fashion.
People with Narcissistic Personality Disorder often feel devastated when
they realize that they have normal, average human limitations; that they
are not as special as they think, or that others don't admire them as much
as they would like.
These realizations are often accompanied by feelings of intense anger or
shame that they sometimes take out on other people.
Their need to be powerful, and admired, coupled with a lack of empathy for
others, makes for conflictual relationships that are often superficial and
devoid of real intimacy and caring.
Status is very important to people with Narcissistic Personality Disorder.
Associating with famous and special people provides them a sense of
importance. These individuals can quickly shift from over-idealizing others
to devaluing them.
However, the same is true of their self-judgments. They tend to vacillate
between feeling like they have unlimited abilities, and then feeling
deflated, worthless, and devastated when they encounter their normal,
average human limitations. Despite their bravado, people with Narcissistic
Personality Disorder require a lot of admiration from other people in order
to bolster their own fragile self-esteem.
They can be quite manipulative in extracting the necessary attention from
those people around them.
BPD may say that they feel as if they are on an emotional roller coaster, with
very quick shifts in mood (for example, going from feeling OK to feeling
extremely down or blue within a few minutes).
BPD is associated with a tendency to engage in risky behaviours, such as going
on shopping sprees, drinking excessive amounts of alcohol or abusing drugs,
engaging in promiscuous sex, binge eating, or self-harming.
Borderline Personality Disorder is one of the most widely studied personality
disorders. People with Borderline Personality Disorder tend to experience intense
and unstable emotions and moods that can shift fairly quickly. They generally
have a hard time calming down once they have become upset. As a result, they
frequently have angry outbursts and engage in impulsive behaviours such as
substance abuse, risky sexual liaisons, self-injury, overspending, or binge eating.
These behaviours often function to sooth them in the short-term, but harm them
in the longer term.
disorders. Richer, more detailed descriptions of these disorders are found in the
section describing the four core features of personality disorders.
These four core features are common to all personality disorders. Before a
diagnosis is made, a person must demonstrate significant and enduring
difficulties in at least two of those four areas: Furthermore, personality disorders
are not usually diagnosed in children because of the requirement that personality
disorders represent enduring problems across time. These four key features
combine in various ways to form ten specific personality disorders identified in
DSM-5 (APA, 2013). Each disorder lists asset of criteria reflecting observable
characteristics associated with that disorder. In order to be diagnosed with a
specific personality disorder, a person must meet the minimum number of criteria
established for that disorder. Furthermore, to meet the diagnostic requirements
for a psychiatric disorder, the symptoms must cause functional impairment
and/or subjective distress. This means the symptoms are distressing to the
person with the disorder and/or the symptoms make it difficult for them to
function well in society.
Furthermore, the ten different personality disorders can be grouped into three
clusters based on descriptive similarities within each cluster. These clusters are:
Cluster A (the "odd, eccentric" cluster)
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
P.M. : Cluster B (the "dramatic, emotional, erratic" cluster)
Antisocial personality disorder
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
Cluster C (the "anxious, fearful" cluster)
Avoidant personality disorder
Dependent personality disorder
Obsessive-compulsive personality disorder
Oftentimes, a person can be diagnosed with more than just one personality
disorder. Research has shown that there is a tendency for personality disorders
within the same cluster to co-occur (Skodol, 2005). Later, this issue of cooccurrence will be discussed in greater detail. The alternative model of
personality disorder, proposed for further study in DSM-5 (APA, 2013), hopes to
reduce this overlap by using a dimensional approach versus the present
categorical one. These different models are discussed in another section.
Now let's look at how all four core features merge to create specific patterns
called personality disorders.
Cluster A: Paranoid, Schizoid, and Schizotypal Personality Disorders
Cluster A is called the odd, eccentric cluster. It includes Paranoid Personality
Disorder, Schizoid Personality Disorder, and Schizotypal Personality Disorders.
The common features of the personality disorders in this cluster are social
awkwardness and social withdrawal. These disorders are dominated by distorted
thinking.
The Paranoid Personality Disorder is
characterized by a pervasive distrust and
suspiciousness of other people. People
with this disorder assume that others are
out to harm them, take advantage of
them, or humiliate them in some way.
They put a lot of effort into protecting
themselves and keeping their distance
from others. They are known to preemptively attack others whom they feel
threatened by. They tend to hold grudges, are litigious, and display pathological
jealously. Distorted thinking is evident. Their perception of the environment
includes reading malevolent intentions into genuinely harmless, innocuous
comments or behaviour, and dwelling on past slights. For these reasons, they do
not confide in others and do not allow themselves to develop close relationships.
Their emotional life tends to be
dominated by distrust and hostility.
The Schizoid Personality Disorder is
characterized by a pervasive pattern of
social detachment and a restricted
range of emotional expression. For
these reasons, people with this disorder
tend to be socially isolated. They don't
seem to seek out or enjoy close
relationships. They almost always chose
11
13
They likely come across as stiff and restricted. All this will likely interfere with
their ability to make friends, or to move ahead professionally.
The core feature of the Dependent Personality Disorder is a strong need to be
taken care of by other people. This
need to be taken care of, and the
associated fear of losing the support
of others, often leads people with
Dependent Personality Disorder to
behave in a "clingy" manner; to
submit to the desires of other people.
In order to avoid conflict, they may
have great difficulty standing up for
themselves. The intense fear of losing
a relationship makes them vulnerable
to manipulation and abuse. They find
it difficult to express disagreement or
make independent decisions, and are
challenged to begin a task when nobody is available to assist them. Being alone is
extremely hard for them. When someone with Dependent Personality Disorder
finds that a relationship they depend on has ended, they will immediately seek
another source of support.
Persons with Obsessive-Compulsive Personality Disorder are preoccupied
with
rules,
regulations,
and
orderliness. This preoccupation with
perfectionism and control is at the
expense of flexibility, openness, and
efficiency. They are great makers of
lists and schedules, and are often
devoted to work to such an extent
that they often neglect social
relationships. They have perfectionist
tendencies, and are so driven in their
work to "get it right" that they
become unable to complete projects
or specific tasks because they get
lost in the details, and fail to see the "forest for the trees." Persons with
Obsessive-Compulsive Personality Disorder tend to be rigid and inflexible in their
approach to things. It simply isn't an option for them to do a "sub-standard" job
just to get something done. Often, they are unable to delegate tasks for fear that
another person will not "get it right." Sometimes people with this disorder adopt
a miserly style with both themselves and others. Money is regarded as something
that must be rigidly controlled in order to ward off future catastrophe. People
with this disorder are often experienced as rigid, controlling, and stubborn.
Note:
It is important to remember that everyone can exhibit some of these personality
traits from time to time. To meet the diagnostic requirement of a personality
disorder, these traits must be inflexible; i.e., they can be repeatedly observed
without regard to time, place, or circumstance. Furthermore, these traits must
cause functional impairment and/or subjective distress. The above list only briefly
summarizes these individual Cluster A personality disorders. Richer, more
detailed descriptions of these disorders are found in the section describing the
four core features of personality disorders.
Personality disorder not otherwise specified
Personality disorder not otherwise specified, also referred to as personality
disorder NOS, is a diagnostic category in the Diagnostic and Statistical Manual of
Mental Disorders, fourth edition (DSM-IV-TR).
In current clinical practice, recognized mental health conditions and disorders are
grouped by a general category then by specific clinical diagnosis.
Under Mood Disorders for example, we have Major Depression, Dysthymia,
Bipolar Disorder (several types), Cyclothymia, and even Mood Disorder NOS.
Personality Disorders is one of the general categories. This category is often
given to individuals who have a long history of personality, behaviour, emotional,
and relationship difficulties. This group is said to have a personality disorder
an enduring pattern of inner experience (mood, attitude, beliefs, values, etc.) and
behaviour (aggressiveness, instability, etc.) that is significantly different from
those in their family or culture.
These dysfunctional patterns are inflexible and intrusive into almost every aspect
of the individuals life. These patterns create significant problems in personal and
emotional functioning and are often so severe that they lead to distress or
impairment in all areas of functioning. (Source: DSM-IV.)
In my observation, Personality Disorders often have core personalities of selfpreoccupation, insensitivity to others, a refusal to accept personal responsibility
(its always someone elses fault), and a tremendous sense of entitlement.
If a person has been diagnosed with a mood disorder, e.g. Bipolar l (Mixed) and a
Personality Disorder NOS, than this is a way of saying that while that person
requires treatment for Bipolar Disorder, the clinician suspects that he may have
long-standing personality features that may complicate the treatment and/or
recovery.
The NOS diagnostic category is reserved for a clinically significant problem in
personality functioning that does not fit into any of the other existing personality
15
Sources:
The Ten Personality Disorders: Cluster B by Authors: Simone Hoermann, Ph.D.,
Corinne E. Zupanick, Psy.D., & Mark Dombeck, Ph.D. - EDITOR: MATTHEW S.
GOODMAN, M.A., BCB
https://www.mentalhelp.net/articles/dsm-5-the-ten-personalitydisorders-cluster-b/
American Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders DSM-IV-TR Fourth Edition. American Psychiatric Association: 2000.
http://bpd.about.com/od/relatedconditions/a/clusterB.htm
DSM-5: The Ten Personality Disorders: SIMONE HOERMANN, PH.D., CORINNE E.
ZUPANICK, PSY.D. & MARK DOMBECK, PH.D. DEC 6, 2013
https://www.mentalhelp.net/articles/dsm-5-the-ten-personalitydisorders-cluster-a/
https://www.mentalhelp.net/articles/dsm-5-the-ten-personalitydisorders-cluster-b/
https://www.mentalhelp.net/articles/dsm-5-the-ten-personalitydisorders-cluster-c/
Recently Diagnosed Personality Disorder NOS. What Does That Mean?
Dr Joseph M Carver, PhD
http://bpd.about.com/od/doihavebpd/f/Personality-Disorder-NotOtherwise-Specified.htm
CODEPENDENCE
A compilation of Public Domain
Publications about CODEPENCE.
More compilations by Dean Amory
are available at:
http://www.lulu.com/spotlight/Jaimelavie
AUTHORS :
Dr. Irene Matiatos Ph.D.
Daniel Ploskin, MD
Royane Real
Melody Beattie
Patty E. Fleener M.S.W.
Wikipedia Encyclopedy
17
2. Codependence
By Dr. Irene Matiatos Ph.D.
Source: http://www.soulselfhelp.on.ca/codependencea.html
Some of the nicest people I know are codependent.
They always smile, never refuse to do a favor. They are happy and
bubbly all the time. They understand others and have the ability to make
people feel good. People like them!
So, what is wrong with this?
Nothing, really, unless the giving is
one-sided and so excessive that it
hurts the giver. Then, the giver is
showing the signs of codependence.
Partners who go out of their way
for
each
other
are
interdependent.
Only relatively healthy people are
capable
of
interdependent
relationships, which involve give and
take.
It is not unhealthy to
unilaterally give during a time when
your partner is having difficulty. You
know your partner will reciprocate
should
the
tables
turn.
Interdependency also implies that
you do not have to give until it hurts.
By comparison, in a codependent
relationship, one partner does almost
all the giving, while the other does
almost all the taking, almost all of the
time.
By giving, codependent people avoid the discomfort of entitlement.
Giving allows them to feel useful and justifies their existence. Rather than simply
approving of themselves, codependent people meet their need for self-esteem, by
winning their partner's approval. Also, because they lack self-esteem,
codependent people have great difficulty accepting from others. One must feel
deserving and entitled in order to accept what is offered.
Codependent behaviour is not easy. It requires a lot of work.
It hurts. These individuals typically suffer with low self-esteem, depression,
anxiety, and especially guilt, as well as other painful thoughts and feelings. They
judge themselves using far stricter criteria than they use to measure the
performance of others. While they are brutally critical of their own misbehaviour,
they are very good at justifying and excusing the misbehaviour of others.
19
person's demeaning behaviour toward them. But, how can stop disrespect when
misbehaviour is not perceived as disrespectful or abusive? Disrespect is normal.
An unfortunate side effect of the codependent person's willingness to
ignore, excuse, or otherwise allow the
partner's abuse or disrespect, enables
the misbehaviour directed at them to
continue and intensify.
Implicit or explicit permission to continue
misbehaving
is
granted
since
the
codependent partner "understands."
Because
codependent
individuals
are
approval-driven, they cannot stand it when
others are angry at or disappointed with
them.
As such, they unwittingly place themselves in
a position to be taken advantage of. The
more approval is needed, the less likely is
the individual to realize the extent of their
self-sacrifice in favor of tending to the needs
of the other. This hurts ("Ouchhh!"), and
creates or maintains depression and low selfesteem, in a vicious, downward spiral.
21
Why Be Codependent?
Why would anybody spend time and energy to control outcomes, while
actively neglecting the inner self? How can they do this and not realize
they are selling themselves short?
The Why: they know no other way;
The How: they received very good training early in life.
Any dysfunction in the family predisposes a child to codependent
behaviour.
Children are biologically programmed
to seek love and approval. They have
to be cared for or they will die.
When a parent or family member is
dysfunctional, the child tends to focus
on this person--rather than on
enjoying a carefree and joyful kid
existence. The child has to worry: if
the caretaker does not care take, the
child dies. For example, in an alcoholic
home, little Sally has to worry about
whether she can bring friends home because daddy may be in a bad mood
and embarrass her.
Such events are training her in
codependent thinking, the art of
anticipating the other person.
If mom is physically ill, Teddy has to worry about exerting her. Who would care
for him if anything happened to her? If daddy is angry and controlling, Timmy
needs to worry about pleasing him to avoid punishment and humiliation - and to
get his conditional love and approval.
Children are naturally egocentric.
That means that they see the world
revolving around them. If mom and
dad fight, children feel that it is
somehow their fault. Julie may try to
make her parents happy by getting
straight As in school in an attempt to
keep the parental marriage together.
Another child may have an abusive,
or simply overactive older sibling.
Since the parents cannot be there at
all times to police the situation, the
younger
sibling
may
learn
to
anticipate the sib's moods and to
behave in ways that might increase
the probability of "safety." Or,
perhaps daddy is depressed. Jennifer
may tiptoe around him wondering if he is unhappy because she is not good
enough. And so on.
23
Examples of codependency
Health professionals first identified codependence in the wives of alcoholic men.
Through family treatment, they discovered that spouses and family members
were codependent, or also had addictive tendencies. Co-addiction occurs when
more than one person, usually a couple, has a relationship that is responsible for
maintaining addictive behaviour in at least one of the persons.
For example, co-addicted people might believe that, at some level, getting a
partner or family member to become sober or drug-free might seem like the one
goal which, if achieved, would bring them happiness. But on another level, they
might realize they are behaving in a way that enables the addict with whom they
live to maintain their addictions.
For instance, they might never confront the addict about her behaviour. Or they
might become her caretaker, spending limitless time worrying about her. They
might assume its their responsibility to clean up after and apologize for their
loved ones behaviour. They might even help her continue to use alcohol or drugs
by giving her money, food or even drugs and alcohol, for fear of what would
happen to her if they did things differently. Many codependents come to believe
25
You must learn to get your life back and as the author Melodie Beattie says
"lovingly detaching." You are not on this earth to take care of your partner or
your daughter or your cousin, etc. Let me repeat that. You are not on this earth
to take care of your partner or your daughter or your cousin, etc.
That may be a part of your life and a very important part of your life. But that is
not the only reason you are on this earth and that is not the only thing that
defines you. You must find out who you are and become that person once again.
You must be that person you were before you knew "that person" and have that
person in your life as well.
What does it feel like if you have been around someone strongly
codependent?
I felt violated. My boundaries were crossed. I felt extremely angry and upset. I
felt manipulated and power was taken away from me that belonged to me.
I had always heard that 50% of chemically dependent people are codependent.
My husband who attends AA says the joke there is that it is 100%. So I do not
know what the exact figures are.
27
Do you feel like you give and give in your relationships but you get very
little back? Are you always trying to save somebody or rescue somebody
that doesnt have their life together? You may be co-dependent. Take
this quiz and find out.
label
people
who
are
A person who is co-dependent will tend to have relationships with people who
have a lot of problems emotional, social, familial and financial. The codependent person may spend much of their own time, money, and energy
helping other people who have problems, while ignoring the problems in their
own life.
When is it healthy to put the needs of other people first, and when is it
unhealthy?
There arent really any hard and fast lines between the two.
Here are some questions you can ask yourself to see whether your
"helping" behaviour may actually be co-dependency:
- Do you have a hard time saying no to others, even when you are very busy,
financially broke, or completely exhausted?
- Are you always sacrificing your own needs for everyone else?
- Do you feel more worthy as a human being because you have taken on a
helping role?
- If you stopped helping your friends, would you feel guilty or worthless?
- Would you know how to be in a friendship that doesnt revolve around you
being the "helper"?
- If your friends eventually didnt need your help, would you still be friends with
them? Or would you look around for someone else to help?
- Do you feel resentful when others are not grateful enough to you for your
efforts at rescuing them or fixing their lives?
- Do you sometimes feel like more of a social worker than a friend in your
relationships?
- Do you feel uncomfortable receiving help from other people? Is the role of
helping others a much more natural role for you to play in your relationships?
- Does it seem as if many of your friends have particularly chaotic lives, with one
crisis after another?
- Did you grow up in a family that had a lot of emotional chaos or addiction
29
problems?
- Are many of your friends addicts, or do they have serious emotional and social
problems?
- As you were growing up, did you think it was up to you to keep the family
functioning?
- As an adult, is it important for you to be thought of as the "dependable one"?
- Do you feel responsible for other people--their feelings, thoughts, actions,
choices, wants, needs, well-being and destiny?
- Do you feel compelled to help people solve their problems or by trying to take
care of their feelings?
- Do you find it easier to feel and express anger about injustices done to others
than about injustices done to you?
- Do you feel safest and most comfortable when you are giving to others?
- Do you feel insecure and guilty when someone gives to you?
- Do you feel empty, bored and worthless if you don't have someone else to take
care of, a problem to solve, or a crisis to deal with?
- Are you often unable to stop talking, thinking and worrying about other people
and their problems?
- Do you lose interest in your own life when you are in love?
- Do you stay in relationships that don't work and tolerate abuse in order to keep
people loving you?
- Do you leave bad relationships only to form new ones that don't work, either?
If you answered "yes" to a lot of these questions, you may indeed have a
problem with co-dependency.
This does not mean that you are a flawed person. It means that you are spending
a lot of energy on other people and very little on yourself.
If it seems that a lot of your friendships are based on co-dependent rescuing
behaviours, rather than on mutual liking and respect between equals, you may
wish to step back and rethink your role in relationships.
If you suspect that your helping behaviour is a form of co-dependency, a good
therapist or counselor can help you gain perspective on your actions and learn a
more balanced way of relating to others.
Characteristics of Codependency
1. My good feelings about who I am stem from being liked by you
2. My good feelings about who I am stem from receiving approval from you
3. Your struggle affects my serenity. My mental attention focuses on solving your
problems/relieving your pain
4. My mental attention is focused on you
5. My mental attention is focused on protecting you
6. My mental attention is focused on manipulating you to do it my way
7. My self-esteem is bolstered by solving your problems
8. My self-esteem is bolstered by relieving your pain
9. My own hobbies/interests are put to one side. My time is spent sharing your
hobbies/interests
10. Your clothing and personal appearance are dictated by my desires and I feel
you are a reflection of me
11. Your behaviour is dictated by my desires and I feel you are a reflection of me
12. I am not aware of how I feel. I am aware of how you feel.
13. I am not aware of what I want - I ask what you want. I am not aware - I
assume
14. The dreams I have for my future are linked to you
15. My fear of rejection determines what I say or do
16. My fear of your anger determines what I say or do
17. I use giving as a way of feeling safe in our relationship
18. My social circle diminishes as I involve myself with you
19. I put my values aside in order to connect with you
20. I value your opinion and way of doing things more than my own
21. The quality of my life is in relation to the quality of yours
Melody Beattie, author of Codependent No More developed this check list:
*********************************************************
Website Links for Codependents: http://alcoholism.about.com/cs/coda/
*********************************************************
31
That's another pattern of codependency - only letting that one person get close
and not letting others get close to you.
Even if someone were to show me, I still didn't see at all how I was codependent
on Anna. It is very much a process of discovering on my own the kind of lifestyle
I was living.
I am a stubborn person too. I didn't quite want to give her friendship up, as
unhealthy as it was. I knew I had a problem, but I didn't want to break
from this friendship because I was scared of the unknown.
All I knew was what I was comfortable with and I didn't want to separate myself
from that comfort. I wanted to change my life but it took months and months
before I could take the necessary steps, which made me realize just how
unhealthy my relationship had been.
What are some key questions that would help someone realize if
they are in a codependent relationship?
How much time am I spending with this friend? That determines a lot right
there.
Am I neglecting other friends?
Do I think this relationship is healthy? What do others in my life who care
about me think about this relationship?
Are there questions about the past that I need to answer for myself?
Have I forgiven people in my past that have hurt me, and moved on?
33
We started hanging out 2-3 times a week, but I started calling her more and
more.
By the second year of our friendship we hung out every night and were
communicating thoroughly every day.
We became inseparable to the point that people thought we were sisters.
Neither of us had been in an unhealthy friendship before and because we shared
a deeper dimension of life in our friendship (faith and spirituality), we never
thought our attachment to each other was unhealthy.
But, over time, I started becoming more manipulative over her and placed
higher and higher expectations on her. I figured that if she knew me best she
should know how to treat me perfectly.
She was the one that I thought had to give me what I needed and I would get
upset if I didn't get it. I demanded a lot from her and she complied most of
the time with what I needed.
35
What steps did you have to take to get back out of this
codependent relationship?
Through mentorship and reading books I learned that our friendship was
unhealthy. About 5 months ago she took an important step and asked to take
time away from our friendship. Since then, we haven't communicated or talked.
It was the best thing we've ever done.
37
Spouse
Begin a dialogue about childhood and
messages your spouses might have
received from his parents that could have
caused shame. You might want to share
your own experiences of shame and how
they affected you. If you are recovering
from an addiction, it might be useful to
discuss how most spouses are affected by
their partners addiction and what might
be helpful to him (Al-Anon Meetings,
Codependence
Anonymous
Meetings).
Attending therapy with a spouse or buying
a book on codependence and reading it
together are other ways to begin to help.
Friend
You might want to get a friend to open up to you by sharing your
own insights with him. You can offer to go to a Codependents
Anonymous Meeting with him or buy him a book to read about
codependence. You also could offer him a place to stay (if he is
living with an addict and could benefit from time apart) or a
referral to a mental health professional. Sometimes making the
first phone call for help can be the first step toward empowering
the person to get well.
Child
Helping a child, unless its an adult child, might not be
appropriate since codependency as dysfunctional behaviour
is hard to distinguish from normal dependency when a child
is still young. If you are the parent of an adult son or
daughter who is now in a codependent relationship, you
could help by telling your child how much you love her and
that getting well is possible. Remind your child of the
strengths and positive qualities that sustained her through
other difficult times. Offer a place to stay or to go to a 12-Step meeting with her.
Parent
Helping a parent often is like helping adult children. Parents may resist taking
advice from their children. But if, together, you can go to a 12-step meeting, go
to therapy or read a book on codependence, you may begin to stir up a desire for
recovery.
Co-worker
Helping a coworker might include sharing information over lunch or inviting her
over for coffee after work. If you are aware of a codependence problem with a
coworker, chances are she already has entrusted you with some intimate
information. However, work might not be the best place to discuss a topic as
personal as codependence. Often, you can help just by offering to listen outside
work or to be an escort to a 12-step meeting.
Therapy
Treatment may consist of individual
therapy, group therapy and, eventually,
couples and family therapy. A clinical
social worker, psychologist or psychiatrist
with experience treating codependents
and families of addicts can help you
identify and discuss the feelings, thoughts
and behaviours that you and others find
troubling.
Twelve-step groups
Many advocates of the codependency theory view codependency as a type of
addiction. Therefore, they maintain that codependents can overcome their
symptoms with a 12-step process similar to that used by Alcoholics Anonymous.
Twelve-step recovery programs bring codependents together as a group to talk
about their struggles and share hope and experiences. The 12-step recovery
process involves spirituality and is nondenominational. Codependents Anonymous
meetings can provide participants with a great source of emotional and practical
support. Program recovery involves admitting your life has become
unmanageable because of your codependence. It requires expressing your
feelings, doing what you can to get better and letting go of things you cant
control. Familiar 12-step affirmations include One Day at a Time, Easy Does
It, Let Go and Let God (a higher power).
39
If you are interested in going to a meeting, contact your local mental health
center and ask where you can find a Codependents Anonymous meeting in your
area.
Medication
If you are confronting codependence issues as well as mental illness such as a
depression or anxiety disorder [Link to articles on Depression and Anxiety
Disorder], you might want to see your primary care doctor or a psychiatrist. He
can determine whether medication such as an antidepressant might help you.
Often those who take medication and attend therapy and 12-step sessions find
this combination to be the fastest and easiest way to get well.
Healing shame
The key to healing a wounded self is to change
the distorted, negative perspectives and reactions
to our human emotions that result from having
grown up in a dysfunctional, emotionally
repressive and spiritually hostile environment.
Most therapists agree that part of this healing
process must involve grief. Grieving for the pain
that caused the codependence and for the
difficulties you suffered is a difficult but rewarding
process. Learning to love yourself requires
acknowledging your shame, disowning it, grieving
the emotional damage you have sustained and
healing the emotional wounds.
http://psychcentral.com/lib/2007/what-is-codependence/
41
Meeting Process
One
of
the
most
widely-recognized
characteristics of twelve-step groups is the
requirement that members focus on the
admission that they "have a problem". In this
spirit, many members open their address to
the group along the lines of, "Hi, I'm Pam and
I'm an alcoholic" a catchphrase now widely
identified with support groups.
Attendees at group meetings share their
experiences,
challenges,
successes
and
failures, and provide peer support for each
other. Many people who have joined these
groups report they found success that
previously eluded them, while others
including some ex-members criticize their
efficacy or universal applicability. This varied
success rate, along with the fact that twelvestep programs have been associated with the
belief in a higher power -- a belief often
associated with religion -- has caused some
controversy.
Sponsorship
In twelve-step programs, a sponsor is a more experienced person in recovery
who guides the less-experienced aspirant ("sponsee") through the process of the
steps as a program of personal recovery. One of the first suggestions newcomers
to 12-step meetings are offered is to secure a relationship with a sponsor. A vast
array of publications from various fellowhips emphasize that sponsorship is a
"one on one" relationship of shared experiences focused on working the 12 steps
Many forms of sponsorship exist. Sponsors and sponsees participate in activities
that lead to spiritual growth as defined by the twelve-step process. These may
include practices such as literature discussion and study, meditation, and writing.
Part of the final of the twelve steps is often interpreted to imply becoming a
sponsor to newcomers in recovery. "Sponsorship, with its continuing interest in
43
another alcoholic, often develops when the second person is willing to be helped,
admits having a drinking problem, and decides to seek a way out of the trap."
"Sponsors share their
experience, strength,
and hope with their
sponsees...
A
sponsors role is not
that
of
a
legal
adviser, a banker, a
parent, a marriage
counselor, or a social
worker. Nor is a
sponsor a therapist
offering some sort of
professional advice. A
sponsor
is
simply
another
addict
in
recovery
who
is
willing to share his or
her journey through
the Twelve Steps."
from NA's Sponsorship: Revised
Sponsees typically do their Fifth Step with their sponsor. The Fifth Step, as well
as the Ninth Step, have been compared to confession and penitence. Many, such
as Michel Foucault, noted such practices "produces intrinsic modifications in the
person" and exonerates, redeems, purifies them; it unburdens them of their
wrongs, liberates them and promises their salvation.
The personal nature of the behavioural issues that lead to seeking help in 12-step
fellowships results in a strong relationship between sponsee and sponsor. As the
relationship is based on spiritual principles, it is unique and not generally
characterized as "friendship." Fundamentally, the sponsor has the single purpose
of helping the sponsee recover from the behavioural problem that brought the
sufferer into 12-step work[18], which reflexively helps the sponsor recover.
Literature studied in
most 12-step groups
is limited to their own
publications, as these
groups
claim
no
outside affiliation. The
members of 12-step
groups
make
the
distinction that the
groups are spiritual,
and
not
religious.
Some members of 12step groups are also
members of a wide
variety of religious
bodies. Nearly every
meeting begins with
the Serenity Prayer, a prayer addressed to "God." Some critics also question the
idea of giving up on self-reliance, which, they argue, results in a form of idealized
despair. Others acknowledge a debt to the twelve-steps movement but do not
have a culture of belief in God.
45
47
49
Twelve-step program
From Wikipedia, the free encyclopedia
A Twelve-step program is a set of guiding principles for recovery from
addictive, compulsive, or other behavioural problems, originally developed by the
fellowship of Alcoholics Anonymous ("A.A.") to guide recovery from alcoholism.
The twelve steps were first published in the text Alcoholics Anonymous ("The Big
Book"). This method has been adapted as the foundation of other twelve-step
programs such as Narcotics Anonymous, Overeaters Anonymous, Marijuana
Anonymous, Crystal Meth Anonymous, Co-Dependents Anonymous and Emotions
Anonymous. Mandated court involvement with 12-step fellowships is a
controversial practice of some governments; as stated in the Twelve Traditions,
Twelve-step fellowships have no opinion as a group on issues other than personal
recovery. As summarized by the American Psychological Association, working the
Twelve Steps involves the following.
Overview of
Twelve-Step
Programs
The way of life outlined
in the 12-steps has
been adapted widely.
The effects of A.A.
recovery
within
the
family unit providing
improved quality of life
resulted in fellowships
like
Al-Anon;
substance-dependent
people who did not
relate to the specifics of alcohol dependency started meeting together as
Narcotics Anonymous[3]; similar groups were formed for sufferers of cocaine
addiction, crystal meth addiction and many other behavioural problems.
Behavioural issues such as compulsion and/or addiction with sex, food, and
gambling were found to be solved for some people with the daily application of
the 12-steps in such fellowships as Sexual Compulsives Anonymous, Overeaters
Anonymous and Emotions Anonymous. Other groups addressing problems with
51
History
The first such program was Alcoholics Anonymous (A.A.), which was begun in
1935 by Bill Wilson and Dr. Bob Smith, known to A.A. members as "Bill W." and
"Dr. Bob", in Akron, Ohio. They established the tradition within the "anonymous"
Twelve-step programs of using only first names. The Twelve Steps were originally
written by Wilson and represented Wilson's incorporation of the teachings of Rev.
Sam Shoemaker about the Oxford Group's life-changing program.
As Alcoholics Anonymous was growing in the 1930s and 1940s and definite
guiding principles began to emerge as the 12 traditions, a singleness of purpose
emerged as tradition five: "Each group has but one primary purpose to carry its
message to the alcoholic who still suffers." [9] Consequently, drug addicts who do
not suffer from the specifics of alcoholism involved in Alcoholics Anonymous
hoping for recovery technically are not welcome in 'closed' meetings for alcoholics
only[10]. The reason for such emphasis on alcoholism as the problem is to
overcome denial and distraction[11]. Thus the principles of Alcoholics Anonymous
have been used to form many numbers of other fellowships for those recovering
from various pathologies, each of which in term emphasizes recovery from the
specific malady which brought the sufferer into the fellowship.
Recovery Steps
Relief of symptoms is
only the first step in
treating depression or
bipolar
disorder.
Wellness, or recovery,
is a return to a life that
you
care
about.
Recovery happens when
your
illness
stops
getting in the way of
your life.
What is Recovery?
SAMSHA
(the
Substance Abuse and
Mental Health Services
Administration / Center
for Mental Health Services) defines recovery as:
Mental health recovery is a journey of healing and transformation enabling a
person with a mental health problem to live a meaningful life in a community of
his or her choice while striving to achieve his or her full potential.
53
You have the right to recover according to your needs and goals. Talk to your
health care provider (HCP) about what you need from treatment to reach your
recovery. Your HCP can provide the
treatment(s) and/or medication(s) that
work best for you. Along the way, you
have a right to ask questions about the
treatments you are getting and choose
the treatments you want.
It can also be helpful to work with a
therapist, family member, friend and
peer supporters to help define your
recovery. Your definition of a meaning
life may change at different times in
life. At times, depression and bipolar
disorder might make it seem difficult to
set a goal for yourself.
Sometimes it might feel almost
impossible to think about the things
that you hope for or care about. But goal setting is an important part of
wellness, no matter where you are on your path to recovery. Work on what you
can when you can.
Setting Goals
Identifying life goals is the heart of the recovery process. When we see a future
for ourselves, we begin to become motivated to do all we can to reach that
future. Goals can be big or small, depending on where you are in your recovery
journey.
Ask yourself:
What do I want?
What are some things I can do that might help me feel better?
Know the difference between your symptoms
and your true self. Your HCPs can help you
separate your true identity from your symptoms
by helping you see how your illness affects your
behaviour. Be open about behaviours you want
to change and set goals for making those
changes.
Educate your family and involve them in
treatment when possible. They can help you
spot symptoms, track behaviours and gain
perspective. They can also give encouraging
feedback and help you make a plan to cope with
any future crises.
Work on healthy lifestyle choices. Recovery is also about a healthy lifestyle,
which includes regular sleep, healthy eating, and the avoidance of alcohol, drugs,
and risky behaviour.
Find the treatment that works for you. Talk to your HCP about your
medications' effects on you, especially the side effects that bother
you. Remember to chart these effects so that you can discuss them fully with
your HCP. You might need to take a lower dosage, a higher dosage, or a
different medication. You might need to switch your medication time from
morning to evening or take medication on a full stomach. There are many
options for you and your HCP to try. Side effects can be reduced or eliminated.
It is very important to talk to your HCP first before you make any changes to
your medication or schedule.
Talk with your HCP first if you feel like changing your dosage or stopping your
medication. Explain what you want to change and why you think it will help you.
55
Talk Therapy
There are many types of talk therapy that can help
you address issues in your life and learn new ways to
cope with your illness. Goal setting is an important
part of talk therapy. Talk therapy can also help you
to:
Understand your illness
Overcome fears or insecurities
Cope with stress
Make sense of past traumatic experiences
Separate your true personality from the mood
swings caused by your illness
Identify triggers that may worsen your symptoms
Improve relationships with family and friends
Establish a stable, dependable routine
Develop a plan for coping with crises
Understand why things bother you and what you can do about them
End destructive habits such as drinking, using drugs, overspending or risky
sex
Address symptoms like changes in eating or sleeping habits, anger,
anxiety, irritability or unpleasant feelings
Peer Support
Support from people who understand is another
important part of recovery. There are many ways to
get this support. DBSA offers a variety of ways to
interact with your peers, such as support groups,
discussion forums, and an interactive chat room.
Find a support group
DBSA's discussion board
Interactive chat room
Lifestyle
A healthy lifestyle is always important. Even if
symptoms of depression or bipolar disorder make
things like physical activity, healthy eating or
regular sleep difficult, you can improve your
moods by improving your health. Take advantage
of the good days you have. On these days, do
something healthy for yourself. It might be as
simple as taking a short walk, eating a fresh
vegetable or fruit, or writing in a journal. A talk
about lifestyle changes should be a part of your
goal setting with your HCPs.
You have the power to change. You are the most
important part of your wellness plan. Your
treatment plan will be unique to you. It will follow
some basic principles and paths, but you and your
HCPs can adapt it to fit you. A healthy lifestyle
and support from people who have been there can
help you work with your HCP and find a way to
real and lasting wellness.
57
59
Tell them they have the ability to get well with time and patience. Instill
hope by focusing on their strengths.
Work to separate the symptoms of the illness from the persons true
personality. Help the person rebuild a positive self-image.
Recognize when your loved one is having symptoms and realize that
communication may be more difficult during these times. Know that
symptoms such as social withdrawal come from the illness and are
probably not a reaction to you.
Do your best not to rush, pressure, hover or nag.
Symptoms of depression and bipolar disorder may cause a hopeless, whats the
point? attitude. This is also a symptom of the illness. With treatment, people
can and will improve. To help loved ones move forward in recovery, help them
identify negative things they are dissatisfied with and want to change, or positive
things they would like to do. Help them work toward achieving these things.
4. Commitment to Change
Exploring possibilities and challenging the disabling power of the illness.
Depression and bipolar disorder are powerful illnesses, but they
do not have to keep people from living fulfilling lives. At this
stage, people experience a change in attitude. They become
more aware of the possibilities in their lives and the choices
that are open to them. They work to avoid feeling held back or
defined by their illness. They actively work on the strategies
they have identified to keep themselves well. It is helpful to
focus on their strengths and the skills, resources and support
they need.
61
The key is to take small steps. Many small steps will add up to big positive
changes. Find small ways for them to get involved in things they care about.
These can be activities they enjoy, or things they want to change, in their own
lives or in the world.
Avoid saying:
Its all in your head.
We all go through times like this.
Youll be fine. Stop worrying.
Look on the bright side.
You have so much to live for why do you want to die?
I cant do anything about your situation.
Just snap out of it.
Stop acting crazy.
Whats wrong with you?
Shouldnt you be better by now?
63
doctor
Have any symptom of mania or depression that significantly interferes with
life
Voluntary hospitalization takes place when a person willingly signs forms agreeing
to be treated in the hospital. A person who signs in voluntarily may also ask to
leave. This request should be made in writing. The hospital must release people
who make requests within a period of time (two to seven days, depending on
state laws), unless they are a danger to themselves or others.
Most psychiatric hospital stays are from five to ten days. There are also longer
residential rehabilitation programs for alcohol or substance abuse, eating
disorders or other issues that require long-term treatment.
Involuntary hospitalization is a last resort when someones symptoms have
become so severe that they will not listen to others or accept help. You may need
to involve your loved ones doctor, the police or lawyers. It is better to talk with
your loved one before a crisis and determine the best treatment options together.
Work with your loved one in advance to write down ways to cope and what to do
65
if symptoms become severe. Having a plan can ease the stress on you and your
loved one, and ensure that the appropriate care is given.
Crisis Planning:
Some people find it helpful to write down mania prevention and suicide
prevention plans, and give copies to trusted friends and relatives. These plans
should include:
A list of symptoms that might be signs the person is becoming manic or
suicidal.
Things you or others can do to help when you see these symptoms.
A list of helpful phone numbers, including health care providers, family
members, friends and a suicide crisis line such as 1-800-273-TALK.
A promise from your friend or family member that he or she will call you,
other trusted friends or relatives, one of his or her doctors, a crisis line or a
hospital when manic or depressive symptoms become severe.
Encouraging words such as My life is valuable and worthwhile, even if it
doesnt feel that way right now. Reality checks such as, I should not make
major life decisions when my thoughts are racing and Im feeling on top of
the world. I need to stop and take time to discuss these things with others
before going through with them. How can an advance directive or a medical
power of attorney help?
An advance directive and a medical power of attorney are written documents that
give others authority to act on a persons behalf when that person is ill. Your
loved one can specify what decisions should be made and when. It is best to
consult a qualified attorney to help with an advance directive or a medical power
of attorney. These documents work differently in different states.
67
69
Second, the unconscious does not hear or process negative words. Traditionally,
affirmations state what you dont want, plus what you do want. For example, you
may say, Im not going to eat ice cream every day, because I dont want to get
fat so Ill choose more fruits and vegetables. Your unconscious hears, Im going
to eat ice cream, Im going to get fat, Im going to choose more fruits and
vegetables. These messages are usually enhanced mentally with pictures of ice
cream and being fat instead of eating healthy vegetables and a healthy body.
71
There is hope:
As a friend or family member of
someone who is coping with bipolar
disorder or depression, your support is
an important part of working toward
wellness. Dont give up hope. Treatment
for mood disorders does work, and the
majority of people with mood disorders
can return to stable and productive
lives. Keep working with your loved one
and his or her health care providers to
find treatments that work, and keep reminding your loved one that you are there
for support.
Check http://www.lulu.com/spotlight/Jaimelavie
for more publications like this, about: coaching, family therapy, borderline personality
disorder, crisis counseling, empowerment, mental imagery, mind reading, communication,
influencing, manipulation, interpersonal relationships etc...
73
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Although some features of narcissistic personality disorder may seem like having
confidence or strong self-esteem, it's not the same. Narcissistic personality disorder
crosses the border of healthy confidence and self-esteem into thinking so highly of
yourself that you put yourself on a pedestal. In contrast, people who have healthy
confidence and self-esteem don't value themselves more than they value others.
When you have narcissistic personality disorder, you may come across as conceited,
boastful or pretentious. You often monopolize conversations. You may belittle or look
down on people you perceive as inferior. You may have a sense of entitlement. And
when you don't receive the special treatment to which you feel entitled, you may
become very impatient or angry. You may insist on having "the best" of everything
the best car, athletic club, medical care or social circles, for instance.
But underneath all this behaviour often lies a fragile self-esteem. You have trouble
handling anything that may be perceived as criticism. You may have a sense of
secret shame and humiliation. And in order to make yourself feel better, you may
react with rage or contempt and efforts to belittle the other person to make yourself
appear better.
77
When you have narcissistic personality disorder, you may not want to think that
anything could be wrong doing so wouldn't fit with your self-image of power and
perfection. But by definition, a narcissistic personality disorder causes problems in
many areas of your life, such as relationships, work, school or your financial affairs.
You may be generally unhappy and confused by a mix of seemingly contradictory
emotions. Others may not enjoy being around you, and you may find your
relationships unfulfilling.
If you notice any of these problems in your life, consider reaching out to a trusted
doctor or mental health provider. Getting the right treatment can help make your life
more rewarding and enjoyable.
Causes
It's not known what causes narcissistic personality disorder. As with other mental
disorders, the cause is likely complex. The cause may be linked to a dysfunctional
childhood, such as excessive pampering, extremely high expectations, abuse or
neglect. It's also possible that genetics or psychobiology the connection between
the brain and behaviour and thinking plays a role in the development of narcissistic
personality disorder.
79
Prevention
Because the cause of narcissistic personality disorder is unknown, there's no known
way to prevent the condition with any certainty. Getting treatment as soon as possible
for childhood mental health problems may help. Family therapy may help families
learn healthy ways to communicate or to cope with conflicts or emotional distress.
Parents with personality disorders may benefit from parenting classes and guidance
from therapists or social workers.
Risk factors
Narcissistic personality disorder is rare. It affects more
men than women. Narcissistic personality disorder often
begins in early adulthood. Although some adolescents
may seem to have traits of narcissism, this may simply
be typical of the age and doesn't mean they'll go on to
develop narcissistic personality disorder.
Although the cause of narcissistic personality disorder
isn't known, some researchers think that extreme
parenting behaviours, such as neglect or excessive
indulgent praise, may be partially responsible.
Complications
Complications of narcissistic personality
disorder can include:
Substance abuse
Alcohol abuse
Depression
Suicidal thoughts or behaviour
Relationship difficulties
Problems at work or school
Write down any symptoms you're experiencing and for how long. It will
help the mental health provider to know what kinds of events are likely to make
you feel angry or defeated.
Write down key personal information, including traumatic events in your
past and any current, major stressors.
Make a list of your medical information, including other physical or mental
health conditions with which you've been diagnosed. Also write down the
names of any medications or supplements you're taking.
Take a family member or friend along, if possible. Someone who has
known you for a long time may be able to ask questions or share information
with the mental health provider that you don't mention.
Write down questions to ask your mental health provider in advance so
that you can make the most of your appointment.
81
In addition to the questions that you've prepared to ask your mental health provider,
don't hesitate to ask any additional questions that may come up during your
appointment.
How would you describe your childhood, including your relationship with your
parents?
How would you say your symptoms are affecting your life, including school,
work and personal relationships?
Have any of your close relatives been diagnosed with a mental health problem,
including a personality disorder?
Have you been treated for any other mental health problems? If yes, what
treatments were most effective?
Do you use alcohol or illegal drugs? How often?
Are you currently being treated for any other medical conditions?
Family therapy. Family therapy typically brings the whole family together in
therapy sessions. You and your family explore conflicts, communication and
problem solving to help cope with relationship problems.
Group therapy. Group therapy, in which you meet with a group of people with
similar conditions, may be helpful by teaching you to relate better with others.
This may be a good way to learn about truly listening to others, learning about
their feelings and offering support.
Because personality traits can be difficult to change, therapy may take several years.
The short-term goal of psychotherapy for narcissistic personality disorder is to
address such issues as substance abuse, depression, low self-esteem or shame. The
long-term goal is to reshape your personality, at least to some degree, so that you
can change patterns of thinking that distort your self-image and create a realistic selfimage.
Psychotherapy can also help you learn to relate better with others so that your
relationships are more intimate, enjoyable and rewarding. It can help you understand
the causes of your emotions and what drives you to compete, to distrust others, and
perhaps to despise yourself and others.
Get
treatment
for
substance abuse or other
mental
health
problems. Your addictions,
depression, anxiety and
stress can feed off each
other, leading to a cycle of
emotional
pain
and
unhealthy behaviour.
Learn relaxation and stress management. Try such stress-reduction
techniques as meditation, yoga or tai chi. These can be soothing and calming.
Stay focused on your goal. Recovery from narcissistic personality disorder
can take time. Keep motivated by keeping your recovery goals in mind and
reminding yourself that you can work to repair damaged relationships and
become happier with your life.
85
Narcissistic Relationships
Narcissistic Relationships bring with them
huge risks to the partner of the narcissist
because their behaviour is a manifestation of
an excessive ego and self absorption at the
cost of everyone around them. Over the years,
if this behaviour doesn't change, it generally
results in a codependent, emotionally draining
and
abusive
relationship.
Narcissistic Relationships will require lots of
energy and work, because narcissists are in
constant need for outside support and
approval. Once these needs are fulfilled they
feel powerful, but many times this need will be
very hard to be satisfied and the self image
and the peace of the partner may be dramatically impacted.
Narcissistic Relationships test the mental limits of their partners patience, and
individuals in a relationship with a narcissist feel something is not 'quite right', feel a
lack of emotional connection and most eventually realize it's wise to seek answers to
the unsettling experience of their day to day contact with a narcissist.
However, it's important for you to
know that you do not have to be the
victim of narcissism forever. You don't
have to lose your confidence, self
image, hope and passion for life
because you are in a relationship with
a narcissist. You can learn the skills to
move beyond the downside effects of
your narcissistic relationship and
move on to a more normal
relationship.
87
Verbal Abuse:
Verbal abuse is hurtful and usually attacks the nature and abilities of the partner.
Over time, the partner may begin to believe that there is something wrong with her /
her abilities. She may come to feel that she is the problem, rather than her partner.
Verbal abuse is often insidious. The partner's self-esteem gradually diminishes,
usually without her realizing it's happening. She may consciously or unconsciously try
to change her behaviour so as not to upset the abuser.
Sexual Abuse:
Normally a narcissist stays within the law,
but may break the rules of morality of a
society. Narcissist are careful about it
because, even if they do not feel guilty,
they want to avoid the shame of
discovery.
The sexual relationship with the narcissist
is peculiar. Narcissists are exhibitionists
and sex is just one further means of being
admired to her or him. True intimacy
doesn't and you will frequently feel used.
The narcissist will demand that you
subdue yourself to their wishes.
Physical Abuse:
Narcissistic individuals do not tend to be
physically abusive although there are
some out there that are. Their worst
weapon is their mouth. With their mouth
they spit verbal negations and dispense
emotional abuse. Their vocal cords are
their method of attempting to control
others.
89
of person - if in any way you depend on them, they will blackmail you to make you
give in to their desires.
Don't let yourself be infuriated by their lack of empathy or understanding - they are not
capable of it. Showing them their incapacity will do nothing - they will blame you for
everything that it doesn't work.
Narcissists will be attached to those that satisfy their needs but will never treat them
as partners but as followers. They have the need to lead and be in control constantly they do not need equals but disciples or pleasers. The worst thing that can happen is
when one narcissist meets someone with low self-esteem - it will be the perfect victim
and toy for them.
Finally, you need to decide when enough is enough. A relationship with a narcissist
can take you places where you do not want to be, can make you behave in ways you
do not recognize yourself . It can undermine your self esteem and will rob you of the
attention you need to give to yourself trying to meet all their needs.
Experts Recommend:
All the experienced experts in preventing narcissistic abuse make two vital
recommendations:
1) If at all possible, walk away (leave) your narcissistic abuser.
2) If that's not possible due to constraints of your employment, wider family, children
or love, you must, repeat must, take advantage of the support and resources
available to learn how to deal with a narcissist, and in doing so discover how to
protect yourself from ongoing emotional, mental and sometimes physical harm.
Please take action TODAY to protect yourself!
Give up on your relationship with the narcissist and maintain a no contact policy.
If you choose to stay with him either give him a taste of his own medicine by reflecting
his misbehaviour or provide him with narcissistic supply (attention and adulation).
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No one should feel responsible for the narcissist's predicament. To him, others hardly
exist so enmeshed he is in himself and in the resulting misery of this very selfpreoccupation. Others are objects on which he projects his wrath, rage, suppressed
and mutating aggression and, finally, ill disguised violence. How should his closest,
nearest and dearest cope with his eccentric vagaries?
The short answer is by abandoning him.
Alternatively, you can
try by threatening to
abandon him.
The threat to abandon
need not be explicit or
conditional ("If you don't
do something or if you do
it I will ditch you"). In
some cases it may be
sufficient to confront the
narcissist, to completely
ignore him, to insist on
respect
for
one's
boundaries and wishes, or
to shout back at him. The
narcissist takes these
signs
of
personal
autonomy to be harbinger
of impending separation
and reacts with anxiety.
The narcissist might be tamed by the very same weapons that he uses to subjugate
others. The spectre of being abandoned looms large over everything else. In the
narcissist's mind, every discordant note presages solitude and the resulting
confrontation with his self.
The narcissist is a person who is irreparably traumatized by the behaviour of the most
important people in his life: his parents, role models, or peers. By being capricious,
arbitrary, and sadistically judgmental, they moulded him into an adult, who fervently
and obsessively tries to recreate the trauma in order to, this time around, resolve it
(repetition complex).
Thus, on the one hand, the narcissist feels that his freedom depends upon reenacting these early experiences. On the other hand, he is terrified by this prospect.
Realizing that he is doomed to go through the same traumas over and over again, the
narcissist distances himself by using his aggression to alienate, to humiliate and in
general, to be emotionally absent.
This behaviour brings about the very consequence that the narcissist so fears abandonment. But, this way, at least, the narcissist is able to tell himself (and others)
that HE was the one who
fostered the separation,
that it was fully his choice
and that he was not
surprised.
The truth is that, governed
by his internal demons,
the narcissist has no real
choice. The dismal future
of his relationships is
preordained.
The narcissist is a binary
person: the carrot is the
stick in his case. If he gets
too close to someone
emotionally,
he
fears
ultimate and inevitable
abandonment. He, thus,
distances himself, acts
cruelly and brings about
the very abandonment
that he feared in the first
place.
In this paradox lies the key to coping with
the narcissist. If, for instance, he is
having a rage attack rage back. This
will provoke in him fears of being
abandoned and the resulting calm will be
so total that it might seem eerie.
Narcissists are known for these sudden
tectonic shifts in mood and in behaviour.
Mirror the narcissists actions and
repeat his words.
If he threatens threaten back and
credibly try to use the same language
and content. If he leaves the house
leave it as well, disappear on him. If he is
suspicious act suspicious. Be critical,
denigrating, humiliating, go down to his
level because that's the only way to
penetrate his thick defences. Faced with
his mirror image the narcissist always
recoils.
93
Source: http://samvak.tripod.com/copenarcissist.html
This article appears in my book, "Malignant Self-love: Narcissism Revisited"
We must not forget that the narcissist behaves the way he does in order to engender
and encourage abandonment. When mirrored, the narcissist dreads imminent and
impending desertion, which is the inevitable result of his actions and words. This
prospect so terrifies him that it induces in him an incredible alteration of conduct.
He instantly succumbs and obsequiously tries to make amends, moving from one
(cold and bitter, cynical and misanthropic, cruel and sadistic) pole to another (warm,
even loving, fuzzy, engulfing, emotional, maudlin, and saccharine).
The other coping strategy is to give up on him.
Dump him and go about reconstructing your own life. Very few people deserve the
kind of investment that is an absolute prerequisite to life with a narcissist. To cope
with a narcissist is a full time, energy and emotion-draining job, which reduces people
around him to insecure
nervous wrecks. Who
deserves
such
a
sacrifice?
No one, to my mind, not
even the most brilliant,
charming, breathtaking,
suave narcissist. The
glamour and trickery
wear
thin
and
underneath them a
monster lurks which
irreversibly
and
adversely
influences
the lives of those
around it for the worse.
Narcissists
are
incorrigibly
and
notoriously difficult to
change. Thus, trying to
"modify"
them
is
doomed to failure. You
should either accept
them as they are or avoid them altogether. If one accepts the narcissist as he is one
should cater to his needs. His needs are part of what he is. Would you have ignored a
physical handicap? Would you not have assisted a quadriplegic? The narcissist is an
emotional cripple. He needs constant adulation. He cannot help it. So, if one chooses
to accept him it is a package deal, all his needs included.
95
Defence Strategy: Learn about projection. Don't take the bait when he blames you.
He made the mess, let him clean it up.
6. THE VIOLENT NARCISSIST is a wife-Beater, Murderer, Serial Killer, Stalker,
Terrorist. Has a 'chip-on-his-shoulder' attitude. He lashes out and destroys or uses
others (particularly women and children) as scapegoats for his aggression or
revenge. He has poor impulse control. Fearless and guiltless, he shows bad
judgement. He anticipates betrayal, humiliation
or punishment, imagines rejection and will
reject first to 'get it over with'. He will harass
and push to make you pay attention to him and
get a reaction. He will try to make you look out
of control. Can become dangerous and
unpredictable. Has no remorse or regard for
the rights of others.
Defence Strategy: Don't antagonize or tip your
hand you're leaving. Ask for help from the
police and shelters.
7. THE CONTROLLER/MANIPULATOR pits
people against each other. Keeps his allies
and targets separated. Is verbally skilful at
twisting words and actions. Is charismatic and
usually gets his way. Often undermines our
support network and discourages us from
seeing our family and friends. Money is often
his objective. Other people's money is even
better. He is ruthless, demanding and cruel. This control-freak bully wants you
pregnant, isolated and financially dependent on him. Appears pitiful, confused and in
need of help. We rush in to help him with our finances, assets, and talents. We may
be used as his proxy interacting with others on his behalf as he sets us up to take the
fall or enjoys the performance he is directing.
Defence Strategy: Know the 'nature of the beast'. Facing his failure and
consequences will be his best lesson. Be suspicious of his motives, and avoid
involvement. Don't bail him out.
8. THE SUBSTANCE ABUSER Alcohol, drugs, you name it, this N does it. We see
his over-indulgence in food, exercise or sex and his need for instant gratification. Will
want you to do likewise.
Defence Strategy: Don't sink to his level. Say No.
9. OUR "SOUL MATE" is cunning and knows who to select and who to avoid. He will
come on strong, sweep us off our feet. He seems to have the same values, interests,
goals, philosophies, tastes, habits. He admires our intellect, ambition, honesty and
sincerity. He wants to marry us quickly. He fakes integrity, appears helpful,
comforting, generous in his 'idealization' of us phase. It never lasts. Eventually Jekyll
turns into Hyde. His discarded victims suffer emotional and financial devastation. He
will very much enjoy the double-dipping attention he gets by cheating. We end the
relationship and salvage what we can, or we are discarded quickly as he attaches to
Defence Strategy: Give him no reason to be suspicious of you. Let some things slide.
Protect yourself if you anticipate violence.
16. THE IMAGE MAKER will flaunt his 'toys', his children, his wife, his credentials and
accomplishments. Admiration, attention, even glances from others, our envy or our
fear are his objective. He is never satisfied. We see his arrogance and haughty strut
as he demands centre stage. He will alter his mask at will to appear pitiful, inept,
solicitous, concerned, or haughty and superior. Appears the the perfect father,
husband, friend - to those outside his home.
Defence Strategy: Ignore his childlike behaviours. Know his payoff is getting attention,
deceiving or abusing others. Provide him with 'supply' to avert problems.
17. THE EMOTIONAL VACUUM is the cruellest blow of all. We learn his lack of
empathy. He has deceived us by his cunning ability to mimic human emotions. We
are left numbed by the realization. It is incomprehensible and painful. We now
remember times we saw his cold vacant eyes and when he showed odd reactions.
Those closest to him become objectified and expendable.
Defence Strategy: Face the reality. They can deceive trained professionals.
18. THE SAINTLY NARCISSIST proclaims high moral standing. Accuses others of
immorality. "Hang 'em high" he says about the murderer on the 6:00 news. This
hypocrite lies, cheats, schemes, corrupts, abuses, deceives, controls, manipulates
and torments while portraying himself of high morals.
Defence Strategy: Learn the red flags of behaviour. Be suspicious of people claiming
high morals. Can be spotted at a church near you.
19. THE CALLING-CARD NARCISSIST forewarns his targets. Early in the
relationship he may 'slip up' revealing his nature saying "You need to protect yourself
around me" or "Watch out, you never know what I'm up to." We laugh along with him
and misinterpret his words. Years later, coping with the devastation left behind, his
victims recall the chilling warning.
Defence Strategy: Know the red flags and be suspicious of the intentions of others.
20. THE PENITENT NARCISSIST says "I've behaved horribly, I'll change, I love you,
I'll go for therapy." Appears to 'come clean' admitting past abuse and asking
forgiveness. Claims we are at fault and need to change too. The sincerity of his words
and actions appear convincing. We learn his words are verbal hooks. He knows our
vulnerabilities and what buttons to push. We question our judgement about his
disorder. We can disregard "Fool me once..." We hope for change and minimize past
abuse. With a successful retargeting attempt, this N will enjoy his second reign of
terror even more if we allow him back in our lives.
Defence Strategy: Expect this. Self-impose a "No Contact" rule. Focus on the reality
of his disorder. Journal past abusive behaviour to remind yourself. Join our support
group.
Sources
http://www.mayoclinic.com
http://www.squidoo.com/narcissistic-relationships
Check http://www.lulu.com/spotlight/Jaimelavie
for more publications like this, about: coaching, family therapy, borderline personality
disorder, crisis counseling, empowerment, mental imagery, mind reading, communication,
influencing, manipulation, interpersonal relationships etc...
99
101
Introduction
Psychotherapy
Hospitalization
Medications
Self-Help
Introduction
Borderline personality disorder is a disturbance of certain brain functions that
causes four types of behavioural disturbances:
1.
2.
3.
4.
Psychotherapy
Like with all personality disorders, psychotherapy
is the treatment of choice in helping people
overcome this problem. While medications can
usually help some symptoms of the disorder, they
cannot help the patient learn new coping skills,
emotion regulation, or any of the other important
changes in a persons life.
An initially important aspect of psychotherapy is
usually contracting with the person to ensure that
they do not commit suicide. Suicidality should be carefully assessed and
monitored throughout the entire course of treatment. If suicidal feelings
are severe, medication and hospitalization should be seriously considered.
The most successful and effective psychotherapeutic approach to date has been
Marsha Linehans Dialectical Behaviour Therapy. Research conducted on
this treatment have shown it to be more effective than most other
psychotherapeutic and medical approaches to helping a person to better cope
with this disorder. It seeks to teach the client how to learn to better take control
of their lives, their emotions, and themselves through self-knowledge, emotion
regulation, and cognitive restructuring. It is a comprehensive approach that is
most often conducted within a group setting. Because the skill set learned is new
103
and complex, it is not an appropriate therapy for those who may have difficulty
learning new concepts.
Like all personality disorders, borderline personality disorder is intrinsically
difficult to treat. Personality disorders, by definition, are long-standing ways of
coping with the world, social and personal relationships, handling stress and
emotions, etc. that often do not work, especially when a person is under
increased stress or performance demands in their lives. Treatment, therefore, is
also likely to be somewhat lengthy in duration, typically lasting at least a year for
most.
Other psychological treatments which
have been used, to lesser effectiveness, to
treat this disorder include those which
focus on social learning theory and conflict
resolution. These types of solutionfocused therapies, though, often neglect
the core problem of people who suffer
from this disorder difficulty in
expressing appropriate emotions (and
emotional attachments) to significant
people in their lives due to faulty
cognitions.
Providing a structured therapeutic setting
is important no matter which therapy type
is undertaken. Because people with this
disorder often try and test the limits of
the therapist or professional when in treatment, proper and well-defined
boundaries of your relationship with the client need to be carefully explained at
the onset of therapy. Clinicians need to be especially aware of their own feelings
toward the patient, when the client may display behaviour which is deemed
inappropriate. Individuals with borderline personality disorder are often unfairly
discriminated against within the broad
range of mental health professionals
because they are seen as troublemakers. While they may indeed need
more care than many other patients, their
behaviour is caused by their disorder.
Phillip W. Long, M.D. also notes that:
The therapeutic alliance should form
within the patients real experiences with
the therapist and with the treatment. The
therapist must be able to tolerate
repeated episodes of primitive rage,
distrust, and fear. Uncovering is to be
avoided in favor of bolstering of ego defences, in order to eventually allow the
patient to be less anxious about potential fragmentation and loss. The goals of
therapy should be in terms of life gains toward independent functioning, and not
complete restructuring of the personality.
Hospitalization
Hospitalization is often a concern with people
who suffer from borderline personality disorder
because they so often visit hospital emergency
rooms and are sometimes seen on inpatient
units because of severe depression.
People with this disorder often present in crisis
at their local community mental health center,
to their therapist, or at the hospital emergency
room. While an emergency room is an
immediate source of crisis intervention for the
patient, it is a costly treatment and regular
visits to the E.R. should be discouraged.
Instead, patients should be encouraged to find
additional social support within their community (including self-help support
groups), contact a crisis hotline, or contact their therapist or treating physician
directly.
Emergency room personnel should be careful not to treat the person with
borderline personality disorder in blind conjunction with another set of therapists
or doctors who are treating the patient for the same problem at another facility.
Every attempt should be made to contact the clients attending physician or
primary therapist as soon as possible, even before the administration of
medication which may be contraindicated by the primary treatment provider.
Crisis management of the immediate problem is usually the key component to
effective treatment of this disorder when it presents in a hospital emergency
room, with discharge to the patients usual care provider.
Inpatient treatment often takes the form of medication in conjunction with
psychotherapy sessions in groups or individually. This is an appropriate treatment
option if the person is experiencing extreme difficulties in living and daily
functioning. It is, however, relatively rare to be hospitalized in the U.S. for this
disorder. Long-term care of the person suffering from borderline personality
disorder within a hospital setting is nearly never appropriate. The typical inpatient
stay for someone with borderline personality disorder in the U.S. is about 3 to 4
weeks, depending upon the persons insurance. Since this treatment is so
expensive, it is getting more difficult to obtain. Results of such treatment are also
mixed. While it is an excellent way of helping stabilize the client, it is usually too
short a time to attain significant changes within the individuals personality
makeup.
Good inpatient care facilities for this disorder should be highly structured
environments which seek to expand the individuals independence. Phillip W.
Long, M.D., adds that the goals of such a treatment modality, include decreasing
acting out, clearly identifying and working with inappropriate behaviours and
feelings, accepting with the patient the magnitude of the therapeutic task,
fostering more effective interpersonal relationships, and working with both real
and transference relationships within the hospital.
105
Partial hospitalization or a day treatment program is often all thats needed for
people who suffer from borderline personality disorder. This allows the individual
to gain support and structure from a safe environment for a short time, or during
the day, and returning home in the evening. In times of increased stress or
difficulty coping with specific situations, this type of treatment is more
appropriate and more healthy for most people than full inpatient hospitalization.
Medications
Phillip W. Long, M.D. has noted:
Medications play three very important roles in the
treatment of most patients with borderline disorder.
They are effective in reducing the four major groups
of symptoms of the disorder. They thereby enhance
the rate and quality of improvement derived from
psychotherapy. Finally, medications are effective in
treating other emotional disorders that frequently
are associated with borderline disorder, for example,
depression, anxiety/panic attacks, and ADHD, and
physical disorders such as migraine headaches.
During brief reactive psychoses, low doses of
antipsychotic drugs may be useful, but they are
usually not essential adjuncts to the treatment
regimen, since such episodes are most often self-limiting and of short duration.
It is, however, clear that low doses of high potency neuroleptics (e.g.,
haloperidol) may be helpful for disorganized thinking and some psychotic
symptoms. Depression in some cases is amenable
to neuroleptics. Neuroleptics are particularly
recommended
for
the
psychotic
symptoms
mentioned above, and for patients who show anger
which must be controlled. Dosages should
generally be low and the medication should never
be
given
without
adequate
psychosocial
intervention.
Antidepressant and anti-anxiety agents may be
appropriate during particular times in the patients
treatment, as appropriate. For example, if a client
presents with severe suicidal ideation and intent,
the clinician may want to seriously consider the
prescription of an appropriate antidepressant
medication to help combat the ideation. Medication
of this type should be avoided for long-term use,
though, since most anxiety and depression is
directly related to short-term, situational factors
that will quickly come and go in the individuals life.
effectiveness of different
in people with borderline
people without borderline
initial treatment strategies
107
Self-Help
Self-help methods for the treatment of this disorder are often overlooked by the
medical profession because very few professionals are involved in them.
Encouraging the individual with borderline personality disorder to gain additional
social support, however, is an important aspect of treatment. Many support
groups exist within communities throughout the world which are devoted to
helping individuals with this disorder share their commons experiences and
feelings.
Patients can be encouraged to try out new coping skills and emotion regulation
with people they meet within support groups. They can be an important part of
expanding the individuals skill set and develop new, healthier social
relationships.
Family Connections
The
family
education
program,
Family
Connections (FC), is available in multiple
locations throughout the US, and at several
locations in Canada, Europe and the UK. It
operates under the auspices of NEA-BPD with
research funding from the National Institute of
Mental Health. Experienced family members colead the 12-week manualized series of sessions
for other families. These sessions provide
participants with the most current information
and research about borderline disorder, teach
DBT and family coping skills, and provide an opportunity to develop a support
network.
Research documents a reduction in family member depression, burden, and grief
and an increase in coping skills. No registration fee is required, but in some
locations a donation to cover costs of the course materials is suggested.
Family-to-Family
The National Alliance on Mental Illness (NAMI) has recently designated borderline
disorder as a priority population. In doing so, NAMI has now extended its
popular 12 week Family Education Program to include this disorder. The course is
taught by trained NAMI volunteers in every state in the country. It provides a
broad range of information essential to those caring for loved ones with
borderline and other serious mental disorders.
Support Groups
In some communities, groups of people with borderline disorder and family
members meet on a regular basis, without a therapist or trained and skilled
group leader, to help one another. Such support groups typically do not charge
members a fee and can be very beneficial for the reasons cited above for
therapist-assisted group therapy.
109
111
Identity disturbance.
There are sudden and dramatic shifts in self-image, characterized by shifting
goals, values and vocational aspirations. There may be suddent changes in
opinions and plans about career, sexual identity, values and types of friends.
These individuals may suddenly change from the role of a needy supplicant for
help to a righteous avenger of past mistreatment. Although they usually have a
self-image that is based on being bad or evil, individuals with borderline
personality disorder may at times have feelings that they do not exist at all. Such
experiences usually occur in situations in which the individual feels a lack of a
meaningful relationship, nurturing and support. These individuals may show
worse performance in unstructured work or school situations.
113
Prevalence
The prevalence of Borderline Personality Disorder is estimated to be about 2% of
the general population, about 10% among individuals seen in outpatient mental
health clinics, and about 20% among psychiatric inpatients. In ranges from 30%
to 60% among clinical populations with Personality Disorders.
Course
There is considerable variability in the course of Borderline Personality Disorder.
The most common pattern is one of chronic instability in early adulthood, with
episodes of serious affective and impulsive dyscontrol and high levels of use of
health and mental health resources. The impairment from the disorder and the
risk of suicide are greatest in the young-adult years and gradually wane with
advancing age. During their 30s and 40s, the majority of individuals with this
disorder attain greater stability in their relationships and vocational functioning.
Familial Pattern
Borderline Personality Disorder
degree biological relatives of
population. There is also an
Disorders, Antisocial Personality
is about five times more common among firstthose with the disorder than in the general
increased familial risk for Substance-Related
Disorder, and Mood Disorders.
Differential Diagnosis
Borderline Personality Disorder often co-occurs with Mood Disorders, and when
criteria for both are met, both may be diagnosed. Because the cross-sectional
presentation of Borderline Personality Disorder can be mimicked by an episode of
Mood Disorder, the clinician should avoid giving an additional diagnosis of
Borderline Personality Disorder based only on cross-sectional presentation
without having documented that the pattern of behaviour has an early onset and
a long-standing course.
Look-alikes
Other Personality Disorders may be confused with Borderline Personality Disorder
because they have certain features in common. It is, therefore, important to
distinguish among these disorders based on differences in their characteristic
features. However, if an individual has personality features that meet criteria for
one or more Personality Disorders in addition to Borderline Personality Disorder,
all can be diagnosed. Although Histrionic Personality Disorder can also be
characterized by attention seeking, manipulative behaviour, and rapidly shifting
emotions, Borderline Personality Disorder is distinguished by self-destructiveness,
angry disruptions in close
relationships, and chronic feelings of deep emptiness and loneliness. Paranoid
ideas or illusions may be present in both Borderline Personality Disorder and
Schizotypal Personality Disorder, but these symptoms are more transient,
interpersonally reactive, and responsive to external structuring in Borderline
Personality Disorder.
Although Paranoid Personality Disorder and Narcissistic Personality Disorder may
also be characterized by an angry reaction to minor
stimuli, the relative stability of self-image as well as
the relative lack of self-destructiveness, impulsivity,
and abandonment concerns distinguish these disorders
from Borderline Personality Disorder. Although
Antisocial
Personality
Disorder
and
Borderline
Personality Disorder are both characterized by
manipulative behaviour, individuals with Antisocial
Personality Disorder are manipulative to gain profit,
power, or some other material gratification, whereas
the goal in Borderline Personality Disorder is directed
more toward gaining the concern of caretakers. Both
Dependent Personality Disorder and Borderline Personality Disorder are
characterized by fear of abandonment, however, the individual with Borderline
Personality Disorder reacts to abandonment with feelings of emotional emptiness,
rage, and demands, whereas the individual with Dependent Personality Disorder
reacts with increasing appeasement and submissiveness and urgently seeks a
replacement relationship to provide caregiving and support. Borderline
Personality Disorder can further be distinguished from Dependent Personality
Disorder by the typical pattern of unstable and intense relationships.
Borderline Personality Disorder must be distinguished from Personality Change
Due to a General Medical Condition, in which the traits emerge due to the direct
115
effects of a general medical condition on the central nervous system. It must also
be distinguished from symptoms that may develop in association with chronic
substance use (e.g., Cocaine-Related Disorder Not Otherwise Specified).
Borderline Personality Disorder should be distinguished from Identity
Problem...which is reserved for identity concerns related to a developmental
phase (e.g., adolescence) and does not qualify as a mental disorder."
Stop Walking on Eggshells: Taking Your Life Back When Someone You Care
about Has Borderline Personality Disorder by Paul T. Mason and Randi
Kreger
117
angry retorts when the limits of normal patience have been exceeded. Therefore,
most loved ones of individuals with borderline disorder are quite relieved to learn
that effective treatment is available for the disorder, and that there are ways they
can help as well.
Two significant advances in the area of borderline disorder have been the recent
research on the effectiveness of different educational and therapeutic experiences
for families, and the development of consumer and family organizations focused
on the disorder.
119
future. Such a plan is best developed with the help of the patients primary
clinician.
Experience has shown that responding positively to appropriate behaviours is also
very important in encouraging change to new and more successful ways of
handling stressful situations. Doing so also reduces the incidence of inappropriate
behaviours that then cause additional problems. Issuing spontaneous ultimatums
should be avoided.
9. Remember:
the Person with Borderline Disorder Must Take Charge
Remember that it is primarily
the responsibility of the person
with borderline disorder to take
charge of her or his behaviour
and life. Although difficult at
times, it is important for you to
provide the opportunity for
your family member with
borderline disorder to take
reasonable risks in order to try
new behaviours. It is also
important that you help her or
him to be accountable for the
consequences
of
old,
destructive
behaviours.
Excessive dependency on family and friends is not helpful in the long run. Beware
of the tendency of people with borderline disorder to act at the extremes. For
example, the proper alternative to excessive dependency is not immediate, total
independency. The more appropriate responses are to remain engaged and to
gradually help move to a more balanced, mature relationship level of mutual
interdependency.
121
THE WORLD
NEEDS PEOPLE...
who cannot be bought;
whose word is their bond;
who put character above wealth;
who possess opinions and a will;
who are larger than their vocations;
who do not hesitate to take chances;
who will not lose their individuality in a crowd;
who will be as honest in small things as in great things;
who will make no compromise with wrong;
whose ambitions are not confined to their own selfish
desires;
who will not say they do it" because everybody else does
it";
who are true to their friends through good report and evil
report,
in adversity as well as in prosperity;
who do not believe that shrewdness, cunning, and
hardheadedness are the best qualities for winning
success;
who are not ashamed or afraid to stand for the truth
when it is unpopular;
who can say "no" with emphasis, although all the rest of
the world says "yes." - Charles Swindoll.
ONLINE TEST
The following "test" may help you to evaluate the possibility
that you or a loved one has borderline disorder. It is simply
a check list of the nine criteria of borderline disorder as
defined by the American Psychiatric Association in their
diagnostic manual, DSM-IV-TR. However, it is reworded so
that you may readily apply the criteria to your situation.
Please note that you should not use the results of the test to
arrive at any fixed conclusion, but rather to provide you with
an estimation of the possibility that this disorder, or its
traits, may exist.
How to Use the Borderline Disorder Test
First, read carefully about the symptoms of borderline disorder provided on this
website, or as they are described in more detail in my book, Borderline
Personality Disorder Demystified.
Next, print this page and place a check mark next to those symptoms or
behaviours listed below that you believe accurately describe your condition. If
you are in doubt, leave the item blank.
___
___
___
___
5) Now, or in the past, when upset, I have engaged in recurrent suicidal behaviours,
gestures, threats, or self-injurious behaviour such as cutting, burning or hitting
myself.
___
___
7) I have very suspicious ideas, and am even paranoid (falsely believe that others are
plotting to cause me harm) at times; or I experience episodes under stress when I
feel that I, other people or the situation is somewhat unreal.
___
___
123
How
to
Score
the
Borderline
Disorder
Test
in many different ways. Therefore, in most cases, effective treatment plans are
more complex than can be accomplished by a single type of treatment.
Immediate Help: You should establish how the provider handles those times
when you may need immediate help, for example who will respond to your
telephone calls and under what
circumstances. Also, should you require
brief hospitalization, what hospital will
be utilized, and who will direct your
care when you are in the hospital.
Communication: If you will have more
than one clinician working with you, it
is important to establish the degree to
which they will work with you and with
your family or partner, and with each
other. It is important that the team
communicate openly. Under most
circumstances, it is essential that those
people who are very important in your
life are included in your treatment. The types and frequency of involvement
required are best discussed prior to the onset of treatment.
Finding the Right Fit: Ultimately, you are looking for clinicians who appear to
be good fits for you and your special needs. To some degree this is a subjective
quality, and cannot be easily defined further, but patients often sense when they
have found the right professionals with whom to work.
Credentials: It is very appropriate to ask about the potential providers specific
credentials: in what mental health specialty do they have their degree; are they
certified properly, for example., for psychiatrists, by the American Board of
Psychiatry and Neurology; are they licensed to practice in their specific clinical
area; and what degree of training and experience do they have with borderline
disorder.
Payment Information: Finally, you should obtain their fee schedule and method
of payment for different services, for example medication checks, and individual
and group psychotherapy sessions. Many clinicians accept insurance with copayments, while some require self payment.
At the outset of care, remember that your doctor may not be able to determine
precisely the most effective treatments for you. Therefore, it seems to me most
reasonable to find a psychiatrist, and other clinicians when necessary, who know
the relevant medical literature, that have open minds regarding different
diagnostic possibilities and treatment approaches, and who communicate well
with you and your family. Given our current level of knowledge about borderline
disorder, it is likely that such professionals will give you the best help available,
now and in the future.
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More than 80 percent of people with borderline disorder suffer from episodes of
major depression. Treatment for depression is vital in these individuals. There are
two categories of major depressive episodes, those associated with bipolar I and
II disorder-depressed*, and those referred to as major depressive disorder.
Therefore, if you have borderline disorder, it is important that you know and
recognize the symptoms of these disorders. If they occur, you should alert your
physician so that you may receive prompt treatment for depression.
Bipolar II Disorder-Depressed*
In bipolar disorder-depressed, the symptoms
of a major depressive episode listed above
are often characterized by:
increased appetite or weight gain
increased sleep and napping
marked decrease in mental and
physical activity
marked fatigue and loss of energy
Substance
Abuse
Treatment
in
Patients with Borderline Disorder
by Robert O. Friedel, MD
127
Substance Dependence
A pattern of substance use that leads to significant impairment or distress in
three (or more) of the following ways:
Self-Injurious
Behaviours
and
Suicidality in Borderline Disorder
by Robert O. Friedel, MD
Self-Injurious Behaviours
In addition to cutting and burning themselves, and taking small drug overdoses,
people with borderline disorder hit themselves, pull out their hair, scratch their
skin to the point they open wounds, and injure themselves in other ways. Most
people with the disorder who injure themselves report that they do so mainly to
decrease the intense emotional pain they experience. Remarkably, they also
often report that the first time they engaged in cutting and other self injurious
behaviours, the idea just came to them. Finally, they report that these acts
usually do result in brief emotional relief.
It is important that family and other loved ones understand that this is the main
motive of self injurious behaviours, not primarily to manipulate the situation or
the people around them, though this is often a secondary motive.
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co-occurring disorders
antisocial personality disorder (higher in
males)
major depression
substance abuse*
personality characteristics
impulsive aggression
poor emotional control
hopelessness
history and severity of childhood sexual abuse
age over 30 years
number of prior self-injurious behaviours and suicide attempts
no prior treatment, or extensive and unsuccessful treatment history
Management
of
Self-Injurious
Behaviours and Suicidality
General Treatment Interventions for
Injurious Behaviours and Suicidality:
careful evaluation
determine the level of intent and risk of
self-injurious behaviours and suicide overt and unstated
directly involve the patient and family in
the process
treat at the least restrictive level of care
for the shortest period of time indicated
aggressively treat all co-occurring disorders
modify the treatment to accommodate the significant increase in severity
of borderline disorder symptoms
highly structure the environment
identify and promptly address precipitating events
assure involvement and coordination of the entire treatment team,
including the family
continue to balance risk vs. reward
Self-
therapy-DBT;
Purposes
reduce self-injurious behaviours and
suicidality
decrease
the
hospitalizations
frequency
of
Substance Abuse
A pattern of substance use that leads
to significant impairment or distress
in one (or more) of the following
ways:
a failure to fulfill major role
obligations at work, school, or
home
recurrent substance use in situations in which it is physically hazardous
recurrent substance-related legal problems
continued substance use despite having persistent or recurrent social or
interpersonal problems caused or worsened by the effects of the substance
131
Have you or a loved one been diagnosed with borderline disorder and are
suffering from anxiety and panic attack symptoms? Read the following
article and learn more about these symptoms and how they are treated.
Anxiety and panic attack symptoms are common in people with borderline
disorder. Anxiety disorders occur in almost 90% of people with the disorder. If
you have borderline disorder, you may experience heightened levels of anxiety
and panic attack symptoms, especially at times of stress. For example, this may
occur when you feel you are personally criticized and rejected, or during periods
of separation from people who are very important to you. Moderate to severe
anxiety may also lead to physical symptoms, such as migraine headaches,
abdominal pain and irritable bowel syndrome.
Panic Attacks
A panic attack is an acute and severe form of anxiety that occurs in about 50% of
people with borderline disorder. Panic attacks are characterized by a discrete
period of intense fear in which four or more of the following symptoms develop
abruptly and reach a peak within 10 minutes:
palpitations,
pounding
heart,
or
increased heart rate
sweating
trembling or shaking
sensations of shortness of breath or
smothering
feeling of choking
chest pain or discomfort
nausea or abdominal distress
feeling dizzy, unsteady, lightheaded, or
faint
feelings of unreality or being detached
from oneself
fear of losing control or going crazy
fear of dying
numbness or tingling sensations
chills or hot flushes
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Background
Attention deficit hyperactivity disorder (ADHD) occurs in about 25% of people
with borderline disorder; 5 times more often than it does in the general
population. The symptoms of ADHD include decreased attention and
concentration, easy distractibility, difficulty in the completion of tasks, and poor
management of time and the space area that you use. These symptoms of ADHD
result in significantly impaired school, work and social performance, and are
described in detail below.
ADHD is estimated to occur in about 5% of school age children. It is more
common in boys than in girls. There are subtypes associated with hyperactivity
and normal activity levels. The hyperactive subtype is much more common in
boys, while the inattentive subtype (the subtype with normal activity levels) is
somewhat more evenly distributed among boys and girls. The symptoms of ADHD
are now known to persist into adulthood in many people, and to require
continued treatment. There is often a strong family history of ADHD.
Hyperactivity
Impulsivity
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