Eating Disorders and Personality Disorders (narcissism)

Written by Sam Vaknin


Do narcissists also suffer from eating disorders such as bulimia nervosa or anorexia nervosa?


Patients suffering from eating disorders either binge on food or refrain from eating and sometimes are both anorectic and bulimic. This is an impulsive behaviour as defined byrepparttar DSM and is sometimes comorbid with Cluster B personality disorder, particularly withrepparttar 126196 Borderline Personality Disorder.

Some patients develop eating disorders asrepparttar 126197 convergence and confluence of two pathological behaviours: self-mutilation and an impulsive (rather, obsessive-compulsive or ritualistic) behaviour.

The key to improvingrepparttar 126198 mental state of patients who have been diagnosed with both a personality disorder and an eating disorder lies in focusing at first upon their eating and sleeping disorders.

By controlling his eating disorder,repparttar 126199 patient reasserts control over his life. This newfound power is bound to reduce depression, or even eliminate it altogether as a constant feature of his mental life. It is also likely to ameliorate other facets of his personality disorder.

It is a chain reaction: controlling one's eating disorders leads to a better regulation of one's sense of self-worth, self-confidence, and self-esteem. Successfully coping with one challenge -repparttar 126200 eating disorder - generates a feeling of inner strength and results in better social functioning and an enhanced sense of well-being.

When a patient has a personality disorder and an eating disorder,repparttar 126201 therapist would do well to first tacklerepparttar 126202 eating disorder. Personality disorders are intricate and intractable. They are rarely curable (though certain aspects, like obsessive-compulsive behaviours, or depression can be ameliorated with medication or modified). The treatment of personality disorders requires enormous, persistent and continuous investment of resources of every kind by everyone involved.

Fromrepparttar 126203 patient's point of view,repparttar 126204 treatment of her personality disorder is not an efficient allocation of scarce mental resources. Neither are personality disordersrepparttar 126205 real threat. If one's personality disorder is cured but one's eating disorders are left untouched, one might die (though mentally healthy)…

An eating disorder is both a signal of distress ("I wish to die, I feel so bad, somebody help me") and a message: "I think I lost control. I am very afraid of losing control. I will control my food intake and discharge. This way I can control at least ONE aspect of my life."

This is where we can and should begin to helprepparttar 126206 patient - by letting her regain control of her life. The family or other supporting figures must think what they can do to makerepparttar 126207 patient feel that she is in control, that she is managing things her own way, that she is contributing, has her own schedules, her own agenda, and that she, her needs, preferences, and choices matter.

Eating disorders indicaterepparttar 126208 strong combined activity of an underlying sense of lack of personal autonomy and an underlying sense of lack of self-control. The patient feels inordinately, paralyzingly helpless and ineffective. His eating disorders are an effort to exert and reassert mastery over his own life.

Narcissism - Treatment Modalities and Therapies - Part II

Written by Sam Vaknin

The fourth edition ofrepparttar authoritative "Review of General Psychiatry" (London, Prentice-Hall International, 1995), says (p. 309):

"(People with personality disorders) ... cause resentment and possibly even alienation and burnout inrepparttar 126195 healthcare professionals who treat them ... (p. 318) Long-term psychoanalytic psychotherapy and psychoanalysis have been attempted with (narcissists), although their use has been controversial."

The reason narcissism is under-reported and healing over-stated is that therapists are being fooled by smart narcissists. Most narcissists are expert manipulators and consummate actors and they learn how to deceive their therapists.

Here are some hard facts:

There are gradations and shades of narcissism. The differences between two narcissists can be great. The existence of grandiosity and empathy or lack thereof are not minor variations. They are serious predictors of future psychodynamics. The prognosis is much better if they do exist. There are cases of spontaneous healing, Acquired Situational Narcissism, and of "short-term NPD" [see Gunderson's and Ronningstam work, 1996]. The prognosis for a classical narcissist (grandiosity, lack of empathy and all) is decidedly not good as far as long-term, lasting, and complete healing. Moreover, narcissists are intensely disliked by therapists. BUT…

Side effects, co-morbid disorders (such as Obsessive-Compulsive behaviors) and some aspects of NPD (the dysphorias,repparttar 126196 persecutory delusions,repparttar 126197 sense of entitlement,repparttar 126198 pathological lying) can be modified (using talk therapy and, depending onrepparttar 126199 problem, medication). These are not long-term or complete solutions – but some of them do have long-term effects. The DSM is a billing and administration oriented diagnostic tool. It is intended to "tidy" uprepparttar 126200 psychiatrist's desk. The Axis II Personality Disorders are ill demarcated. The differential diagnoses are vaguely defined. There are some cultural biases and judgements [seerepparttar 126201 diagnostic criteria ofrepparttar 126202 Schizotypal and Antisocial PDs]. The result is sizeable confusion and multiple diagnoses ("co-morbidity"). NPD was introduced torepparttar 126203 DSM in 1980 [DSM-III]. There isn't enough research to substantiate any view or hypothesis about NPD. Future DSM editions may abolish it altogether withinrepparttar 126204 framework of a cluster or a single "personality disorder" category. When we ask: "Can NPD be healed?" we need to realise that we don't know for sure what is NPD and what constitutes long-term healing inrepparttar 126205 case of an NPD. There are those who seriously claim that NPD is a cultural disease (culture-bound) with a societal determinant. Narcissists in Therapy

In therapy,repparttar 126206 general idea is to createrepparttar 126207 conditions forrepparttar 126208 True Self to resume its growth: safety, predictability, justice, love and acceptance - a mirroring, re-aprenting, and holding environment. Therapy is supposed to provide these conditions of nurturance and guidance (through transference, cognitive re-labelling or other methods). The narcissist must learn that his past experiences are not laws of nature, that not all adults are abusive, that relationships can be nurturing and supportive.

Most therapists try to co-optrepparttar 126209 narcissist's inflated ego (False Self) and defences. They complimentrepparttar 126210 narcissist, challenging him to prove his omnipotence by overcoming his disorder. They appeal to his quest for perfection, brilliance, and eternal love - and his paranoid tendencies - in an attempt to get rid of counterproductive, self-defeating, and dysfunctional behaviour patterns.

By strokingrepparttar 126211 narcissist's grandiosity, they hope to modify or counter cognitive deficits, thinking errors, andrepparttar 126212 narcissist's victim-stance. They contract withrepparttar 126213 narcissist to alter his conduct. Some even go torepparttar 126214 extent of medicalizingrepparttar 126215 disorder, attributing it to a hereditary or biochemical origin and thus "absolving"repparttar 126216 narcissist from his responsibility and freeing his mental resources to concentrate onrepparttar 126217 therapy.

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