Narcissistic personality disorder

 

Overview

Narcissistic personality disorder is a mental health condition in which people have an unreasonably high sense of their own importance. They need and seek too much attention and want people to admire them. People with this disorder may lack the ability to understand or care about the feelings of others. But behind this mask of extreme confidence, they are not sure of their self-worth and are easily upset by the slightest criticism.

A narcissistic personality disorder causes problems in many areas of life, such as relationships, work, school or financial matters. People with narcissistic personality disorder may be generally unhappy and disappointed when they're not given the special favors or admiration that they believe they deserve. They may find their relationships troubled and unfulfilling, and other people may not enjoy being around them.

Treatment for narcissistic personality disorder centers around talk therapy, also called psychotherapy.

Narcissistic personality disorder affects more males than females, and it often begins in the teens or early adulthood. Some children may show traits of narcissism, but this is often typical for their age and doesn't mean they'll go on to develop narcissistic personality disorder.

Symptoms

Symptoms of narcissistic personality disorder and how severe they are can vary. People with the disorder can:

• Have an unreasonably high sense of self-importance and require constant, excessive admiration.
• Feel that they deserve privileges and special treatment.
• Expect to be recognized as superior even without achievements.
• Make achievements and talents seem bigger than they are.
• Be preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate.
• Believe they are superior to others and can only spend time with or be understood by equally special people.
• Be critical of and look down on people they feel are not important.
• Expect special favors and expect other people to do what they want without questioning them.
• Take advantage of others to get what they want.
• Have an inability or unwillingness to recognize the needs and feelings of others.
• Be envious of others and believe others envy them.
• Behave in an arrogant way, brag a lot and come across as conceited.
• Insist on having the best of everything — for instance, the best car or office.

At the same time, people with narcissistic personality disorder have trouble handling anything they view as criticism. They can:

• Become impatient or angry when they don't receive special recognition or treatment.
• Have major problems interacting with others and easily feel slighted.
• React with rage or contempt and try to belittle other people to make themselves appear superior.
• Have difficulty managing their emotions and behavior.
• Experience major problems dealing with stress and adapting to change.
• Withdraw from or avoid situations in which they might fail.
• Feel depressed and moody because they fall short of perfection.
• Have secret feelings of insecurity, shame, humiliation and fear of being exposed as a failure.

depression

 Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychotherapy or both.

Symptoms

Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in most or all normal activities, such as hobbies or sports
• Sleep disturbances, including insomnia or sleeping too much
• Tiredness and lack of energy, so even small tasks take extra effort
• Reduced appetite and weight loss or increased cravings for food and weight gain
• Anxiety, agitation or restlessness
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past failures or self-blame
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
• Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Depression symptoms in children and teens

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

• In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.
• In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

ocd

 Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions). To get rid of the thoughts, they feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing/cleaning, checking on things, and mental acts like (counting) or other activities, can significantly interfere with a person’s daily activities and social interactions.

Many people without OCD have distressing thoughts or repetitive behaviors. However, these do not typically disrupt daily life. For people with OCD, thoughts are persistent and intrusive, and behaviors are rigid. Not performing the behaviors commonly causes great distress, often attached to a specific fear of dire consequences (to self or loved ones) if the behaviors are not completed. Many people with OCD know or suspect their obsessional thoughts are not realistic; others may think they could be true. Even if they know their intrusive thoughts are not realistic, people with OCD have difficulty disengaging from the obsessive thoughts or stopping the compulsive actions.

A diagnosis of OCD requires the presence of obsessional thoughts and/or compulsions that are time-consuming (more than one hour a day), cause significant distress, and impair work or social functioning. OCD affects 2-3% of people in the United States, and among adults, slightly more women than men are affected. OCD often begins in childhood, adolescence, or early adulthood. Some people may have some symptoms of OCD but not meet full criteria for this disorder.

Obsessions

Obsessions are recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety, fear or disgust. Many people with OCD recognize that these are a product of their mind and that they are excessive or unreasonable. However, the distress caused by these intrusive thoughts cannot be resolved by logic or reasoning. Most people with OCD try to ease the distress of the obsessional thinking, or to undo the perceived threats, by using compulsions. They may also try to ignore or suppress the obsessions or distract themselves with other activities.

Examples of common content of obsessional thoughts:

• Fear of contamination by people or the environment
• Disturbing sexual thoughts or images
• Religious, often blasphemous, thoughts or fears
• Fear of perpetrating aggression or being harmed (self or loved ones)
• Extreme worry something is not complete
• Extreme concern with order, symmetry, or precision
• Fear of losing or discarding something important
• Can also be seemingly meaningless thoughts, images, sounds, words or music

Compulsions

Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. The behaviors typically prevent or reduce a person's distress related to an obsession temporarily, and they are then more likely to do the same in the future. Compulsions may be excessive responses that are directly related to an obsession (such as excessive hand washing due to the fear of contamination) or actions that are completely unrelated to the obsession. In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible.

Examples of compulsions:

• Excessive or ritualized hand washing, showering, brushing teeth, or toileting
• Repeated cleaning of household objects
• Ordering or arranging things in a particular way
• Repeatedly checking locks, switches, appliances, doors, etc.
• Constantly seeking approval or reassurance
• Rituals related to numbers, such as counting, repeating, excessively preferencing or avoiding certain numbers
• People with OCD may also avoid certain people, places, or situations that cause them distress and trigger obsessions and/or compulsions. Avoiding these things may further impair their ability to function in life and may be detrimental to other areas of mental or physical health.

Treatment

Patients with OCD who receive appropriate treatment commonly experience increased quality of life and improved functioning. Treatment may improve an individual's ability to function at school and work, develop and enjoy relationships, and pursue leisure activities.

Cognitive Behavioral Therapy

One effective treatment is a type of cognitive-behavioral therapy (CBT) known as exposure and response prevention (ERP). During treatment sessions, patients are exposed to feared situations or images that focus on their obsessions. Although it is standard to start with those that only lead to mild or moderate symptoms, initially the treatment often causes increased anxiety. Patients are instructed to avoid performing their usual compulsive behaviors (known as response prevention). By staying in a feared situation without anything terrible happening, patients learn that their fearful thoughts are just thoughts. People learn that they can cope with their thoughts without relying on ritualistic behaviors, and their anxiety decreases over time. Using evidence-based guidelines, therapists and patients typically collaborate to develop an exposure plan that gradually moves from lower anxiety situations to higher anxiety situations. Exposures are performed both in treatment sessions and at home. Some people with OCD may not agree to participate in CBT because of the initial anxiety it evokes, but it is the most powerful tool available for treating many types of OCD.

Medication

A class of medications known as selective serotonin reuptake inhibitors (SSRIs), typically used to treat depression, can also be effective in the treatment of OCD. The SSRI dosage used to treat OCD is often higher than that used to treat depression. Patients who do not respond to one SSRI medication sometimes respond to another. The maximum benefit usually takes six to twelve weeks or longer to be fully visible. Patients with mild to moderate OCD symptoms are typically treated with either CBT or medication depending on patient preference, the patient’s cognitive abilities and level of insight, the presence or absence of associated psychiatric conditions, and treatment availability. The best treatment of OCD is a combination of CBT and SSRIs, especially if OCD symptoms are severe. 

Neurosurgical treatment 

Some newer studies show that gamma ventral capsulotomy, a surgical procedure, can be very effective for patients who do not respond to typical treatments and are very impaired, but it is underused due to historical prejudice and its invasiveness. Deep brain stimulation, which involves an implanted device in the brain, has data to support efficacy and does not permanently destroy brain tissue as done in a capsulotomy. However, it is still highly invasive and complex to manage, and there are limited providers and hospital systems trained to offer this treatment and, able to provide the long-term support needed by DBS patients.

How to Support a Loved One Struggling with OCD

In people with OCD who live with family, friends, or caregivers, enlisting their support to help with exposure practice at home is recommended. In fact, the participation of family and friends is a predictor of treatment success.

Self-care

Maintaining a healthy lifestyle can help in coping with OCD. Getting enough good quality sleep, eating healthy food, exercising, and spending time with others can help with overall mental health. Also, using basic relaxation techniques (when not doing exposure exercises) such as meditation, yoga, visualization, and massage can help ease the stress and anxiety.

anxiety

 Having occasional feelings of anxiety is a normal part of life, but people with anxiety disorders experience frequent and excessive anxiety, fear, terror and panic in everyday situations. These feelings are unhealthy if they affect your quality of life and prevent you from functioning normally.

Common symptoms of anxiety disorders include:

• Feeling nervous
• Feeling helpless
• A sense of impending panic, danger or doom
• Increased heart rate
• Hyperventilation
• Sweating
• Trembling
• Obsessively thinking about the panic trigger

These feelings of anxiety and panic can interfere with daily activities and be difficult to control. They are out of proportion to the actual danger and can cause you to avoid places or situations.

You should see your health care provider if your anxiety is affecting your life and relationships. Your provider can help rule out any underlying physical health issue before seeing a mental health professional.

While most people with anxiety disorders need psychotherapy or medications to get anxiety under control, lifestyle changes and coping strategies also can make a difference.

Here are 11 tips for coping with an anxiety disorder:

1. Keep physically active.
   Develop a routine so that you're physically active most days of the week. Exercise is a powerful stress reducer. It can improve your mood and help you stay healthy. Start out slowly, and gradually increase the amount and intensity of your activities.
2. Avoid alcohol and recreational drugs.
   These substances can cause or worsen anxiety. If you can't quit on your own, see your health care provider or find a support group to help you.
3. Quit smoking, and cut back or quit drinking caffeinated beverages.
   Nicotine and caffeine can worsen anxiety.
4. Use stress management and relaxation techniques.
   Visualization techniques, meditation and yoga are examples of relaxation techniques that can ease anxiety.
5. Make sleep a priority.
   Do what you can to make sure you're getting enough sleep to feel rested. If you aren't sleeping well, talk with your health care provider.
6. Eat healthy foods.
   A healthy diet that incorporates vegetables, fruits, whole grains and fish may be linked to reduced anxiety, but more research is needed.
7. Learn about your disorder.
   Talk to your health care provider to find out what might be causing your specific condition and what treatments might be best for you. Involve your family and friends, and ask for their support.
8. Stick to your treatment plan.
   Take medications as directed. Keep therapy appointments and complete any assignments your therapist gives. Consistency can make a big difference, especially when it comes to taking your medication.
9. Identify triggers.
   Learn what situations or actions cause you stress or increase your anxiety. Practice the strategies you developed with your mental health provider so you're ready to deal with anxious feelings in these situations.
10. Keep a journal.
    Keeping track of your personal life can help you and your mental health provider identify what's causing you stress and what seems to help you feel better.
11. Socialize.
    Don't let worries isolate you from loved ones or activities.

Your worries may not go away on their own, and they may worsen over time if you don't seek help. See your health care provider or a mental health provider before your anxiety worsens. It's easier to treat if you get help early.

Introduction to psychology

 Psychology is the scientific study of mind and behavior. The word “psychology” comes from the Greek words “psyche,” meaning life, and “logos,” meaning explanation. Psychology is a popular major for students, a popular topic in the public media, and a part of our everyday lives. Television shows such as Dr. Phil feature psychologists who provide personal advice to those with personal or family difficulties. Crime dramas such as CSI, Lie to Me, and others feature the work of forensic psychologists who use psychological principles to help solve crimes. And many people have direct knowledge about psychology because they have visited psychologists, for instance, school counselors, family therapists, and religious, marriage, or bereavement counselors.

Because we are frequently exposed to the work of psychologists in our everyday lives, we all have an idea about what psychology is and what psychologists do. In many ways I am sure that your conceptions are correct. Psychologists do work in forensic fields, and they do provide counseling and therapy for people in distress. But there are hundreds of thousands of psychologists in the world, and most of them work in other places, doing work that you are probably not aware of.

Most psychologists work in research laboratories, hospitals, and other field settings where they study the behavior of humans and animals. For instance, my colleagues in the Psychology Department at the University of Maryland study such diverse topics as anxiety in children, the interpretation of dreams, the effects of caffeine on thinking, how birds recognize each other, how praying mantises hear, how people from different cultures react differently in negotiation, and the factors that lead people to engage in terrorism. Other psychologists study such topics as alcohol and drug addiction, memory, emotion, hypnosis, love, what makes people aggressive or helpful, and the psychologies of politics, prejudice, culture, and religion. Psychologists also work in schools and businesses, and they use a variety of methods, including observation, questionnaires, interviews, and laboratory studies, to help them understand behavior.

This chapter provides an introduction to the broad field of psychology and the many approaches that psychologists take to understanding human behavior. We will consider how psychologists conduct scientific research, with an overview of some of the most important approaches used and topics studied by psychologists, and also consider the variety of fields in which psychologists work and the careers that are available to people with psychology degrees. I expect that you may find that at least some of your preconceptions about psychology will be challenged and changed, and you will learn that psychology is a field that will provide you with new ways of thinking about your own thoughts, feelings, and actions.