If untreated, some individuals develop emotional difficulties such as depression associated with inability to concentrate, sleep, and eat. Occasionally, they also become hopeless to point that they want to die.

What is treatment for PTSD?

The combination of individual psychotherapy and medications is known to help. Antidepressants especially SSRIs have been tried with some success. Other medications have been helpful to address associated symptoms. Anxiety and agitation can be treated with benzodiazepines. The latter should be restricted to short-term use because of their addiction potential. Insomnia can be treated by a small dose of Trazodone.

Psychotherapy or “talk therapy” is an important part of treatment and recovery. The individual should be able to express fear, frustration, guilt, and blame in a secure and safe setting. Moreover, therapist should provide ample support and empathy.

Copyright © 2005. Dr. Michael G. Rayel – author (First Aid to Mental Illness–Finalist, Reader’s Preference Choice Award 2002) psychiatrist, and inventor of Oikos Game: An Emotional Intelligence or EQ Game. For more information, visit www.oikosgame.com and www.soardime.com.

Still, all manner of angry people - narcissists or not - suffer from a cognitive deficit and are worried and anxious. They are unable to conceptualize, to design effective strategies, and to execute them. They dedicate all their attention to here and now and ignore future consequences of their actions. Recent events are judged more relevant and weighted more heavily than any earlier ones. Anger impairs cognition, including proper perception of time and space.

In all people, narcissists and normal, anger is associated with a suspension of empathy. Irritated people cannot empathise. Actually, "counter-empathy" develops in a state of aggravated anger. The faculties of judgment and risk evaluation are also altered by anger. Later provocative acts are judged to be more serious than earlier ones – just by "virtue" of their chronological position.

Yet, normal anger results in taking some action regarding source of frustration (or, at very least, planning or contemplation of such action). In contrast, pathological rage is mostly directed at oneself, displaced, or even lacks a target altogether.

Narcissists often vent their anger at "insignificant" people. They yell at a waitress, berate a taxi driver, or publicly chide an underling. Alternatively, they sulk, feel anhedonic or pathologically bored, drink, or do drugs – all forms of self-directed aggression.

From time to time, no longer able to pretend and to suppress their rage, they have it out with real source of their anger. Then they lose all vestiges of self-control and rave like lunatics. They shout incoherently, make absurd accusations, distort facts, and air long-suppressed grievances, allegations and suspicions.

These episodes are followed by periods of saccharine sentimentality and excessive flattering and submissiveness towards victim of latest rage attack. Driven by mortal fear of being abandoned or ignored, narcissist repulsively debases and demeans himself.

Most narcissists are prone to be angry. Their anger is always sudden, raging, frightening and without an apparent provocation by an outside agent. It would seem that narcissists are in a CONSTANT state of rage, which is effectively controlled most of time. It manifests itself only when narcissist's defenses are down, incapacitated, or adversely affected by circumstances, inner or external.

Pathological anger is neither coherent, not externally induced. It emanates from inside and it is diffuse, directed at "world" and at "injustice" in general. The narcissist is capable of identifying IMMEDIATE cause of his fury. Still, upon closer scrutiny, cause is likely to be found lacking and anger excessive, disproportionate, and incoherent.

It might be more accurate to say that narcissist is expressing (and experiencing) TWO layers of anger, simultaneously and always. The first layer, of superficial ire, is indeed directed at an identified target, alleged cause of eruption. The second layer, however, incorporates narcissist's self-aimed wrath.

Narcissistic rage has two forms: I. Explosive - The narcissist flares up, attacks everyone in his immediate vicinity, causes damage to objects or people, and is verbally and psychologically abusive. II. Pernicious or Passive-Aggressive (P/A) - narcissist sulks, gives silent treatment, and is plotting how to punish transgressor and put her in her proper place. These narcissists are vindictive and often become stalkers. They harass and haunt objects of their frustration. They sabotage and damage work and possessions of people whom they regard to be sources of their mounting wrath.