Posttraumatic Stress Disorder: Nightmare After The Ordeal

Written by Michael G. Rayel, MD

Continued from page 1

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

What isrepparttar 126065 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 addressrepparttar 126066 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 expressrepparttar 126067 fear,repparttar 126068 frustration,repparttar 126069 guilt, andrepparttar 126070 blame in a secure and safe setting. Moreover,repparttar 126071 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 and

The Intermittent Explosive Narcissist

Written by Sam Vaknin

Continued from page 1

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 torepparttar here and now and ignorerepparttar 126064 future consequences of their actions. Recent events are judged more relevant and weighted more heavily than any earlier ones. Anger impairs cognition, includingrepparttar 126065 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 regardingrepparttar 126066 source of frustration (or, atrepparttar 126067 very least,repparttar 126068 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 withrepparttar 126069 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 towardsrepparttar 126070 victim ofrepparttar 126071 latest rage attack. Driven byrepparttar 126072 mortal fear of being abandoned or ignored,repparttar 126073 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 ofrepparttar 126074 time. It manifests itself only whenrepparttar 126075 narcissist's defenses are down, incapacitated, or adversely affected by circumstances, inner or external.

Pathological anger is neither coherent, not externally induced. It emanates fromrepparttar 126076 inside and it is diffuse, directed atrepparttar 126077 "world" and at "injustice" in general. The narcissist is capable of identifyingrepparttar 126078 IMMEDIATE cause of his fury. Still, upon closer scrutiny,repparttar 126079 cause is likely to be found lacking andrepparttar 126080 anger excessive, disproportionate, and incoherent.

It might be more accurate to say thatrepparttar 126081 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,repparttar 126082 alleged cause ofrepparttar 126083 eruption. The second layer, however, incorporatesrepparttar 126084 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) -repparttar 126085 narcissist sulks, givesrepparttar 126086 silent treatment, and is plotting how to punishrepparttar 126087 transgressor and put her in her proper place. These narcissists are vindictive and often become stalkers. They harass and hauntrepparttar 126088 objects of their frustration. They sabotage and damagerepparttar 126089 work and possessions of people whom they regard to berepparttar 126090 sources of their mounting wrath.

Sam Vaknin ( ) is the author of Malignant Self Love - Narcissism Revisited and After the Rain - How the West Lost the East. He served as a columnist for Central Europe Review, PopMatters, and eBookWeb , and Bellaonline, and as a United Press International (UPI) Senior Business Correspondent. He is the the editor of mental health and Central East Europe categories in The Open Directory and Suite101.

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