Author: Victoria Ramirez

Categories
Sexual Disorders

Understanding Sexual Dysfunction

Sex has become a topic discussed with serious intent. While situations and cultures vary, contention surrounding sex has been voiced openly by all sides. Women and men are embracing their sexual identity and preferences with a renewed vigor. The dark side of sex has also been exposed, with the emergence of social movements representing communities who have been victims of sexual assault and unwanted sexual advances. Sex, in general, has become a constant conversation however, there are hardly any discussions concerning people who for various reasons, have trouble or difficulty with sex. Conversations involving sexual dysfunction often target men struggling with impotence, plights commonly turned into jokes driven by stigma and sensationalism. Ignorance hinders people from addressing topics that are important. Furthermore, a large population is excluded from the conversation frequently due to embarrassment.

Sexual dysfunction is referred to as “a problem occurring during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity,” (Cleveland Clinic, n.d., para. 1). The sexual response cycle has four stages: excitement, plateau, orgasm, and resolution (Cleveland Clinic, n.d.).  Excitement involves elevated heart rate, increased genital blood flow and secretion of a lubricating substance (MedicineNet, n.d.). Excitement is different for every person and can range from minutes to hours (MedicineNet, n.d.). Plateau suggests intensification of excitement stage characteristics, lasting seconds to minutes (SexInfo, n.d.). Orgasm, the shortest stage, usually lasts seconds (SexInfo, n.d.). Orgasm involves reproductive organ contractions and ejaculation of semen in men. Resolution, the final stage is commonly associated with fatigue and intimacy (SexInfo, n.d.). Resolution in men includes a refractory period preventing subsequent arousal lasting seconds to days increasing with age (SexInfo, n.d.).

Sexual dysfunction can be present at any age displaying a negative correlated with health, with people over 40 more likely to experience dysfunction (Cleveland Clinic, n.d.). Sexual dysfunction consists of four diagnostic categories: desire disorders, arousal disorders, orgasm disorders, and pain disorders (Cleveland Clinic, n.d.). Desire disorders deal with lack of desire or interest in sex. Arousal disorders imply inability to become excited or physically aroused during sexual activity. Orgasm disorders involve inability to climax or delay orgasm, whereas pain disorders suggest pain during intercourse.

Causes of sexual dysfunction vary. Physical causes include diabetes, hormonal imbalance, drug side effects and chronic disease (Cleveland Clinic, n.d.). Psychological causes include trauma, anxiety, depression, body image concerns and relationship problems (Cleveland Clinic, n.d.). Mood disorders, psychotic disorders, and anxiety are often comorbid with sexual dysfunction (Ciocca, Ochoa, & Jannini, 2018). Research suggests sexual dysfunction is common but insufficiently recorded (Ciocca et al., 2018), with) “43% of woman and 31% of men report some degree of sexual difficulty (Cleveland Clinic, n.d., para. 2). Mental health and sexual dysfunction are negatively correlated with higher rates of dysfunction exhibited in people with mental illness (Ciocca et al., 2018). Men experiencing psychological stress display higher prevalence of sexual dysfunction (Gürtler, Brunner, Dürsteler-MacFarland, & Weisbeck, 2019).

“Despite growing research investigating sexual desire disorders, little is known or understood about the impact on individuals, their partners, and relationship functioning” (Frost, & Donovan, 2019, para. 1). Sexual dysfunction may affect relationships and confidence but it’s important to acknowledge it’s common and often natural (SexInfo, n.d.). Sexual dysfunction can be managed by medication, psychoeducation, mechanical aids, behavioral treatments, psychotherapy and sex therapy (Cleveland Clinic, n.d.). Mindfully discussing sexual dysfunction will aid in others feeling more comfortable and inclined to seek treatment, no one should be judged or ridiculed for something they cannot control.

References

Cleveland Clinic. (n.d.). Sexual Dysfunction. Retrieved from https://my.clevelandclinic.org/health/diseases/9121-sexual-dysfunction

MedicineNet. (n.d.). Sexual Response Cycle (Phases of Sexual Response). Retrieved from https://www.medicinenet.com/sexual_response_cycle_phases_of_sexual_response/article.htm

SexInfo. (n.d.). The Sexual Response Cycle. Retrieved from http://www.soc.ucsb.edu/sexinfo/article/sexual-response-cycle

Jannini, E. A., & Siracusano, A. (2018). Epidemiology of sexual dysfunctions in persons suffering from psychiatric disorders. In Sexual dysfunctions in mentally ill patients (pp. 41-51). Cham, Switzerland: Springer.

Gürtler, M. A., Brunner, P., Dürsteler-MacFarland, K. M., & Weisbeck, G. A. (2019). Sexual dysfunction in primary health care [Abstract]. Praxis, 108(1), 23-30. doi:10.1024/1661-8157/a003172

Frost, R., & Donovan, C. (2019). A qualitative exploration of the distress experienced by long-term heterosexual couples when women have low sexual desire [Abstract]. Sexual and Relationship Therapy, 1-24. doi:10.1080/14681994.2018.1549360

Cleveland Clinic. (n.d.). Sexual Dysfunction: Management and Treatment. Retrieved from https://my.clevelandclinic.org/health/diseases/9121-sexual-dysfunction/management-and-treatment

Categories
Personality Disorders

Schizoid and Schizotypal Personality Disorder

Have you ever felt judged because of something that you could not change, for a flaw that you did not ask for, a trait woven deeply in your personality, for something that is just you and is there to remain? It does not feel too great, does it? There are policies for racism, sexism, and assault, but what about for unfair treatment towards mental illnesses? The right to have medical records not disclosed to an employer is protected under HIPAA, but what if your mental disorder is already known or you have been outed? Being a member of the workforce is already stressful, but now you are made to feel unworthy, irresponsible and unreliable all because of something that you cannot change. Sure, every person’s experience is different, but for people living with Schizoid Personality Disorder (PD) and Schizotypal PD, experiences at the workplace can be even more challenging.

It is a common mistake to connect schizoid PD and schizotypal PD to schizophrenia. Although these disorders do present with overlapping symptoms, they are in fact different. Regardless, many people are not aware of that and automatically attach the stigmas of schizophrenia to schizoid PD and schizotypal PD. For example, “schizo” a slang term derived from the word schizophrenia has now become synonymous with “crazy” in society. Therefore, when people hear that someone is living with schizophrenia, they often disregard the humanity of the person. Instead, they think of the negative connotations associated with this personality disorder and deem the individual as being “unpredictable or dangerous” (Whiteman, 2014). This type of mentality can lead to both subconscious and conscious biases and stereotypes. Such stereotypes not only hinder the day to day lives of individuals dealing with these personality disorders, but it also affects their ability to work. For example, only 8% of people living with schizophrenia are in the workplace in the UK (Evans, 2017). Additionally, not only do these general stereotypes affect people living with schizophrenia, but it also affects people living with schizoid PD and schizotypal PD because people believe that they are all the same. Not only do such individuals have to deal with the biases and stigmas of their own disorder, but now of another disorder with the close sounding name. That’s twice as much stigma and twice as many misunderstandings and stress.

While these disorders are co-morbid, as aforementioned they are indeed different. Schizoid PD and Schizotypal PD are defined as Cluster A disorders meaning that they are characterized as “odd, eccentric, or bizarre” (Burton, 2018) A person living with Schizoid Personality Disorder is usually defined as “detached and aloof and prone to introspection and fantasy” (Burton, 2018). Also, a person with Schizoid Personality Disorder may often display characteristics of “detachment from social relationships and a restricted range of emotional expression” (Kaurin et al, 2018). For this reason, others may assume that the person is cold or rude, which can negatively affect relationships, especially in environments where teamwork and cooperation are required. On the other hand, a person living with Schizotypal Personality Disorder is characterized by “oddities of appearance, behavior, and speech, unusual perceptual experiences, and anomalies of thinking similar to those seen in schizophrenia.”

These behaviors can also allow people to assume a negative perception which hinders relationships. Along with the usual stigmas of mental disorders, there also comes the stigma of mental disorders in the workplace. Usually, it falls along the lines of less efficiency, productivity losses and feelings of uncomfortableness. This type of thinking can lead to the ostracization of their coworkers and lower productivity. A study found that “initial reluctance to seek help may result in decreased productivity, which may lead to confirmation of stereotypes and additional stigma by co-workers resulting in further reluctance to seek help” (Knaak et al., 2017).

To combat this, there should be more awareness about mental health in the workplace in general. Workshops, where mental health disorders are taught and discussed to de-stigmatize and educate, should be mandated. Hopefully, in the future, there will be a type of legislation that will protect people living with mental illnesses from prejudice and discrimination in the workplace.

References

Evans, A. (2017, September 19). Metro News. Why are so few people with schizophrenia and schizoaffective disorder employed? Supporting mental health must begin in the workplace Retrieved from https://metro.co.uk/2017/09/19/why-are-so-few-people-with-schizophrenia-and-schizoaffective-disorder-employed-supporting-mental-health-must-begin-in-the-workplace-6937626

Kaurin, A., Funder, D., & Sauerberger, K. (2018). Associations between informant ratings of personality disorder traits, self‐reports of personality, and directly observed behavior. Journal of Personality, 86(6), 1078-1101. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/jopy.12376

Knaak, S., Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare management forum, 30(2), 111-116. doi:  10.1177/0840470416679413

Burton, N. (2018). The 10 Personality Disorders. Retrieved from https://www.psychologytoday.com/us/blog/hide-and-seek/201205/the-10-personality-disorders

Quide, Y., Cohen-Woods, S., O’Reilly, N., Carr, V., Elzinga, B., & Green, M. (2018). Childhood trauma is associated with social cognition and schizotypal personality traits in psychotic and healthy populations. (PDF). Retrieved from https://pdfs.semanticscholar.org/a831/9902945603d45387df8502fd085c80feb679.pdf

Whiteman, H. (2014, October 10). MedicalNewsToday. Schizophrenia: shattering the stigma. Retrieved from https://www.medicalnewstoday.com/articles/283776.php

Categories
Personality Disorders

Does Upbringing Influence the Development of Narcissism?

Every loving parent wants what’s best for their child. Whether that’s sending them to prestigious schools or making sure that the neighborhood is safe and supportive, every parent just wants their child on the best path possible. However, there is a myriad of factors that go into raising a child and that is typically what makes parenthood appear so intimidating and daunting. For many parents, deciphering the amount of praise they should give their child can be challenging. They want their children to have a high self-esteem but don’t want them to become arrogant. They want their children to feel beautiful without boasting, be smart without being snarky and be kind without feeling entitled for something in return.

Therefore, balancing the accolades becomes quite difficult. In some cases, the more praise parents give the better, but this type of upbringing can sometimes have adverse effects on a child.

In instances where a parent overvalues their child, the child can establish narcissistic traits which could possibly develop into Narcissistic Personality Disorder (NPD). The Mayo Clinic defines Narcissistic Personality Disorder as “… a mental condition in which people have an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others.” Narcissistic Personality Disorder is usually attributed to both genetic and environmental factors, with environmental factors heavily influencing the development of this disorder (Mayo Clinic, 2017). For example, environmental factors can include situations in which the child has a parent with NPD or some variation of the disorder.  

According to Dr. Elinor Greenberg, a renowned Gestalt therapy trainer with a specialization in NPD, there are 7 signs of a parent with NPD. These signs include: the need to be the center of attention, having low emotional empathy, devaluing others to get their way, maintaining selfish behavior, having an expectation for the child to be perfect, being moody and inappropriately intrusive (Greenberg, 2017)). The aforementioned list provides several scenarios that can foster an environment for a child to develop Narcissistic Personality Disorder. However, there are four common types of scenarios that enhance the likelihood of a child developing NPD. These situations typically arise in situations where the head of household has NPD.

The “Golden Child” scenario describes an environment where the parents, who have narcissistic traits, idolize their child excessively causing the child to only value themselves for being “perfect” (Greenberg, 2017). However, this scenario can cause the child to have stunted self-growth and an unhealthy fixation on their flaws (Greenberg, 2017). A study found that young adults with narcissism may be “predisposed to greater anxiety after failure, over-reliance on and false perceptions of social support, and experiences of guilt” which could result in lower self-esteem (Muratori et al., 2018). It is important to note the distinction between having a high self-esteem and narcissism. Self-esteem is the idea that you are worthy of who you are as a person while narcissism is the idea that other people are inferior to you and you are superior (Pogosyan, 2018).

The second scenario is the “Narcissistic Parental Values” scenario. This environment is described as very competitive and stressful because of external pressures. A common mentality would be the parent reprimanding the child mentioning that ”If you can’t be the best, why bother?” (Greenberg, 2017). This situation creates a highly competitive atmosphere that can cause stress and an obsession with being the absolute best (Greenberg, 2017). This type of environment doesn’t allow the child to feel adequately loved and can set in “motion a lifelong pattern of chasing success and confusing it with happiness” (Greenberg, 2017).

The “Devaluing Narcissistic Parent” is the third scenario. Quite self-explanatory, this scenario is characterized by a situation in which a parent devalues and belittles the child resulting in constant feelings of inadequacy, humiliation, and anger (Greenberg, 2017). To combat this, children may develop a “mask model”. The “mask model” is a defense mechanism whereby low self-esteem is masked by a grandiose and inflated sense of self to create an outer appearance of high, albeit fragile, self-esteem” (Derry et al., 2018). This scenario can also affect siblings where the parent may switch which sibling to praise and which to belittle, in a frequent and unpredictable manner (Greenberg, 2017).

The last scenario is the “Exhibitionists Nightmare”.  This scenario contains an exhibitionist parent that usually possesses the seven qualities discussed previously. This environment details where an exhibitionist, narcissistic parent teaches the child to serve and praise their parent while devaluing themselves (Greenberg, 2017). They are taught to not surpass their parent and as adults feel exposed and vulnerable (Greenberg, 2017). As said by Elinor Greenberg, “all their value in the family comes from acting as a support to the ego of the exhibitionist parent.”

It is important to remember that people living with Narcissistic Personality Disorder are in fact, people just living with a disorder. It’s important to not dehumanize individuals with Narcissistic Personality Disorder. More often than not, they were caught in the cycle of these 4 types of environments, where their childhoods may have related one or more of the four scenarios. Therefore, it is important to get help so that the cycle can stop and people can achieve their full potential and personal growth.

References

Derry, K. L., Bayliss, D. M., & Ohan, J. L. (2018). Measuring Grandiose and Vulnerable Narcissism in Children and Adolescents: The Narcissism Scale for Children. Assessment. Retrieved from https://doi.org/10.1177/1073191118773872

Greenberg, E. (2017). How Do Children Become Narcissists? (n.d.). Retrieved from https://www.psychologytoday.com/us/blog/understanding-narcissism/201705/how-do-children-become-narcissists

Greenberg, E. (13 July 2017). Is Your Mother an Exhibitionist Narcissist? Retrieved from https://www.psychologytoday.com/us/blog/understanding-narcissism/201707/is-your-mother-exhibitionist-narcissist

Mayo Clinic. Narcissistic personality disorder. (2017, November 18). Retrieved from https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662

Muratori, P., Milone, A., Brovedani, P., Levantini, V., Melli, G., Pisano, S., . . . Masi, G. (2018). Narcissistic traits and self-esteem in children: Results from a community and a clinical sample of patients with oppositional defiant disorder. Journal of Affective Disorders,241, 275-281. doi:10.1016/j.jad.2018.08.043

Pogosyan, M. (2018). Self-Esteem and Narcissism in Children. (n.d.). Retrieved from https://www.psychologytoday.com/us/blog/between-cultures/201809/self-esteem-and-narcissism-in-children

Categories
Personality Disorders

Borderline Personality Disorder Treatments

Imagine that you’ve just been diagnosed with Borderline Personality Disorder. Although you familiarize it with Bipolar Disorder, you’re corrected and told that they are indeed different disorders. As a kid, you were diagnosed with Conduct Disorder and now as an adult, you have Borderline Personality Disorder. Among the research that you do, treatments are the main objective that you focus on. There are so many options, but which one is the best for you?

Borderline Personality Disorder (BPD) is a cluster B disorder. It is described as “an extreme sensitivity to perceived interpersonal slights, an unstable sense of self, intense and volatile emotions and impulsive behaviours” (Gunderson et al., 2018). BPD is fairly prevalent in society, but more so in the psychiatric community and it can be difficult to diagnose (Bryne et al., 2018). Borderline Personality Disorder is commonly developed during childhood and proceeds into adulthood. There are four categories of symptoms of Borderline Personality Disorder: interpersonal instability, behavioral dysregulation, cognitive and affective. Interpersonal instability is described as an individual having profoundly unstable relationships as well as avoidance behaviors pertaining to abandonment (Gunderson et al., 2018). Behavioral dysregulation as described by Gunderson and colleagues is characterized by an individual being impulsive and susceptible to harm (2018). Cognitive symptoms are described as the individual being paranoid or having identity disturbance, and affective symptoms are described as the individual having feelings of anger, emptiness, or instability of mood (Gunderson et al., 2018). In each sub-category of Borderline Personality Disorder, the symptoms are usually extreme and are harmful to the individual.

There are many treatments for Borderline Personality Disorder. Most treatments align with Cognitive therapy due to the fact that Borderline Personality Disorder is a pattern of thoughts and behavior. One of these treatments is Schema Therapy, which is characterized as the integration of “elements from cognitive behavioral therapy, attachment theory, and a number of other approaches, [to explore] emotions, maladaptive coping methods, and the origin of mental health concerns” (Santangelo et al., 2017). The basis of Schema Therapy is to target events and thoughts that cause the individual to perform harmful actions and to replace them with good thoughts and actions. The role of the therapist is to be an almost parental-like figure and to provide emotional stability and validation. Schema therapy can include imagery, chair work, flash-cards and diaries. The effectiveness of Schema therapy is thought to be well supported and is backed by several articles. One study lasted 30 weeks and out of the 16 participants in the experimental group, 15 reached Borderline Personality Disorder remission compared to the 75% of participants in the control group. Another study comparing Transference Focused Psychotherapy (TFP) and Schema Therapy concluded that Schema therapy worked better with an average of 29% more participants in remission.

Mentalization-based therapy (MBT) is another treatment. It is based on the attachment theory, which suggests that there is a critical time period in an individual’s life to make attachments and if not made, it can negatively affect that individual’s life and development such as by reducing intelligence and increasing anger.  MBT focuses on creating diverse meaningful perspectives along with the individual’s own perspectives to create a coherent self that is reimagined through these techniques (Bryne et al., 2018). A study found that MBT compared to general treatments was effective in improving depression and anxiety, and decreasing self harm in individuals.

Lastly, there is no way to automatically know which treatment will work best, rather it operates on a case-by-case basis, but knowing available options tends to ease the obscurity of an unknown future for those with Borderline Personality Disorder.

References

Byrne, G. & Egan, J. (2018) Clinical Social Work Journal, 46, 174. https://doi.org/10.1007/s10615-018-0652-y

Gunderson, J. G., Herpertz, S. C., Skodol, A. E., Torgersen, S., & Zanarini, M. C. (2018, May 24). Borderline personality disorder. Retrieved from https://www.nature.com/articles/nrdp201829#management

McLeod, S. A. (2017, Feb 05). Attachment theory. Retrieved from https://www.simplypsychology.org/attachment.html

Santangelo, P.S., Koenig, J., Funke, V. Parzar, P., Resch, F., Ebner-Priemer, U., & Kaess, M. (2017). Journal of Abnormal Child Psychology, 45, 1429. https://doi.org/10.1007/s10802-016-0249-2

 

Categories
Personality Disorders

An Overview of Avoidant Personality Disorder: The Unnoted Anxiety Disorder

Avoidant Personality Disorder (APD/AvPD) is a lesser-known anxiety disorder that is more commonly known for being related to Social Phobia. There are debates on whether it is a subgroup of Social Phobia or belongs in its own category. Avoidant Personality Disorder is “characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and a hypersensitivity to negative evaluation” (DSM-5).  Social Phobia is a condition of “a person with social anxiety disorder [who] feels symptoms of anxiety or fear in certain or all social situations. He or she may be afraid of being humiliated, judged, and rejected” (Social). Since their definitions are very similar, it is easy to see why those debates are happening. They both deal with being uncomfortable in social situations, feeling an intense fear of rejection, and desire interactions. Although people living with Social Phobia may want social interactions, they don’t yearn for it to the extent that people with Avoidant Personality Disorder do. However, as much as people with AvPD desire it, they also reject it. Since there is a lot of overlap between these two disorders and anxiety disorders in general, we will dive into what AvPD is.

There are many causes of Avoidant Personality Disorder, with a few studies attempting to pin causes down to heritability. There was a study done with female Norwegian twins to determine whether environment and heritability were factors in their Dependent Personality Disorder (DPD) and Avoidant Personality Disorder. The results for the experiment was that environmental effects weren’t as significant as heritability was. APD got .64 for the heritability results and DPD has .66(Gjerde et al., 2012).  These results suggest that there is the statistical significance of heritability being a cause of Avoidant Personality Disorder more so than environmental factors. Another potential cause of Avoidant Personality Disorder is a negative childhood and, more specifically, childhood neglect. There was a study on childhood neglect and the significance it had on Social Phobia and Avoidant Personality Disorder. The results were that childhood neglect affected “that the experiences of physical and emotional neglect in childhood are risk factors for adult AvPD and SP, most pronounced for AvPD though”(Turner et al., 1986).

The most successful and used treatment for Avoidant Personality Disorder is psychotherapy and, more specifically, cognitive therapy. Since APD is a result of engrained repeated behaviors and ways of thinking, it is a bit tricky to treat. The therapy that would be done, described by the Cleveland Clinic, as focuses on overcoming fears, changing thought processes and behaviors, and helping the person better cope with social situations. The Cleveland Clinic also advises that medication may help as well for the anxiety aspect, but the best treatment is a mix of both medication and psychotherapy.

Untreated AvPD can truly inhibit a person’s life and, in some cases, may even be fatal. By avoiding social interactions, it becomes very difficult to excel in relationships and work environments. Because of this, it also likely that a person with Avoidant Personality Disorder is not able to reach their full potential. In the case of violence and more specifically domestic abuse, a study found that 12% of domestic abuse survivors had comorbid AvPD. Even more alarming, the researchers also found that 35% of wife batterers scored above a statistical range for APD (Lynn et al., 2002).

It is important that people with Avoidant Personality Disorder receive help, as it is highly devitalizing to live with. It is also important to distinguish between Social Phobia and Avoidant Personality Disorder, as arduous as that may be. Avoidant Personality Disorder has different causes and can lead to a much more hindered life. This stems from an intense fear of rejection but yearning for interaction. By receiving treatment, someone living with AvPD might be able to reach their full potential and live the lives that they deserve.

References:

Examples Of Personality Disorders With Distorted Thinking Patterns. (n.d.). Retrieved from https://www.mentalhelp.net/articles/examples-of-personality-disorders-with-distorted-thinking-patterns/

DSM-5 The Ten Personality Disorders: Cluster C. (n.d.). Retrieved from https://www.mentalhelp.net/articles/dsm-5-the-ten-personality-disorders-cluster-c/

Social Anxiety Disorder: More Than Just Shyness. Retrieved from http://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml#pub2

Lynn E. Alden, Judith M. Laposa, Charles T. Taylor, Andrew G. Ryder, (2002). Avoidant Personality Disorder: Current Status and Future Directions. Journal of Personality Disorders: Vol. 16, No. 1, pp. 1-29. https://doi.org/10.1521/pedi.16.1.1.22558

Gjerde, L. C., Czajkowski, N., Røysamb, E., Ørstavik, R. E., Knudsen, G. P., Østby, K., … Reichborn-Kjennerud, T. (2012). The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire. Acta Psychiatrica Scandinavica, 126(6), 448–457. http://doi.org/10.1111/j.1600-0447.2012.01862.x

Avoidant Personality Disorder Management and Treatment | Cleveland Clinic. (n.d.). Retrieved October 1, 2018, from https://my.clevelandclinic.org/health/diseases/9761-avoidant-personality-disorder/management-and-treatment

Turner, S. M., Beidel, D. C., Dancu, C. V., & Keys, D. J. (1986). Psychopathology of social phobia and comparison to avoidant personality disorder. Journal of Abnormal Psychology,95(4), 389-394. http://doi:10.1037//0021-843x.95.4.389

Categories
Personality Disorders

Narcissistic Personality Disorder

Narcissism is a term that has often been used colloquially in society. Not only has it rooted itself in society, but also in mainstream culture such as the shows that individuals watch, the music that is listened to and social media. Most of the time when someone is called a narcissist, it’s because they are deemed to be rude, mean or self-centered. But for people with Narcissistic Personality Disorder (NPD), it isn’t just a synonym for being a dislikable person.

The Mayo Clinic defines Narcissistic Personality Disorder as “… a mental condition in which people have an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others”. This  definition is quite broad. Therefore, many people may be able to compare themselves and find certain personality traits of theirs that are listed in the definition of NPD. However, this form of comparison makes it difficult for many to understand the depth of this personality disorder and causes people to undervalue Narcissistic Personality Disorder. This lack of understanding and the vague definition also makes it difficult to do clinical research and empirical trials. A study by  Aaron L. Pincus and Mark R. Lukowitsky  found that approximately less than 1% of outpatient samples are people with NPD. This coupled with the fact that “most of the literature regarding patients suffering with narcissistic personality disorder is based on clinical experience and theoretical formulations, rather than on empirical evidence” leads to a larger stigma and misunderstanding of the disorder itself and the people who have it (Pincus, 2010).

The ignorance and stigma behind the name of the disorder itself does not reflect the real dangers that occur with people who have NPD. The Mayo Clinic refers to the psychological impacts of having NPD as being a mask of extreme confidence that lies behind a fragile self-esteem which is vulnerable to the slightest criticism This means that people with NPD are very susceptible to harmful risks that most people are not. Although there are not a substantial amount of studies conducted about Narcissistic Personality Disorder, there was a study that researched how different disorders were related to suicidal behaviors and the act of suicide. Suicidal behaviors can have varying meanings for people with NPD. The study defined suicidal behavior as “including an attempt to raise self-esteem through a sense of mastery; an attempt to protect themselves against anticipated narcissistic threats—‘death before dishonor’; a vengeful act against a narcissistic trauma; the false belief of indestructibility; and a wish to destroy or attack an imperfect self” (Links, 2003). The study concluded that people with Narcissistic Personality Disorder are more likely to have suicidal behaviors than people without NPD. Among the deceased belonging to the population group of the study , researchers found that people with NPD had a nine percent increase in suicide rate compared to the people without NPD. According to the 15-year follow-up, patients with narcissistic personality disorder or traits were significantly more likely to have their cause of death be suicide, compared with patients who did not have narcissistic personality disorder or traits (14% vs 5%; P < 0.02) (Links, 2003).

Unfortunately, people with Narcissistic Personality Disorder are also risk at having a “Richard Corey suicide” (Links, 2003). The “Richard Corey suicide” is from a poem named aptly “Richard Cory” by Edwin Arlington Robinson. Summarized, the poem is about a man named Richard Cory who seems to have everything anybody could ever want. The town is jealous of him, but they respect him because he is the star man of the town. However, by the end of the poem it is revealed that he takes his life. That being said, the study found that people with NPD even when not clinically depressed and seemingly happy, are also at risk.

Lastly, due to limited research and disconnect in clinical practice, Narcissistic Personality Disorder is not taken as seriously as it should be. To reduce stigma and spread awareness, revisions of the definition and criteria of NPD should be sufficiently considered.

References:

Duke, J., & Robinson, E. A. (1948). Four poems by Edward [sic] Arlington Robinson. New York: C. Fischer.

Links, P. S., Gould, B., & Ratnayake, R. (2003). Assessing Suicidal Youth with Antisocial, Borderline, or Narcissistic Personality Disorder. The Canadian Journal of Psychiatry, 48(5), 301-310. doi:10.1177/070674370304800505

Narcissistic personality disorder. (2017, November 18). Retrieved from https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662

Pincus, A. L., & Lukowitsky, M. R. (n.d.). Pathological Narcissism and Narcissistic Personality Disorder | Annual Review of Clinical Psychology. Retrieved from https://www.annualreviews.org/doi/full/10.1146/annurev.clinpsy.121208.131215#abstractSection