An examination of whether narcissists, and those with Narcissistic Personality Disorder, are really responsible for their criminal behavior.

• Watch the video on Is the Narcissist Legally Insane? 

Narcissists are not prone to "irresistible impulses" and dissociation (blanking out certain stressful events and actions). They more or less fully control their behavior and acts at all times. But exerting control over one's conduct requires the investment of resources, both mental and physical. Narcissists regard this as a waste of their precious time, or a humiliating chore. Lacking empathy, they don't care about other people's feelings, needs, priorities, wishes, preferences, and boundaries. As a result, narcissists are awkward, tactless, painful, taciturn, abrasive and insensitive.

The narcissist often has rage attacks and grandiose fantasies. Most narcissists are also mildly obsessive-compulsive. Yet, all narcissists should be held accountable to the vast and overwhelming majority of their actions.

At all times, even during the worst explosive episode, the narcissist can tell right from wrong and reign in their impulses. The narcissist's impulse control is unimpaired, though he may pretend otherwise in order to terrorize, manipulate and coerce his human environment into compliance.

The only things the narcissist cannot "control" are his grandiose fantasies. All the same, he knows that lying and confabulating are morally wrong and can choose to refrain from doing so.

The narcissist is perfectly capable of anticipating the consequences of his actions and their influence on others. Actually, narcissists are "X-ray" machines: they are very perceptive and sensitive to the subtlest nuances. But the narcissist does not care. For him, humans are dispensable, rechargeable, reusable. They are there to fulfil a function: to supply him with Narcissistic Supply (adoration, admiration, approval, affirmation, etc.) They do not have an existence apart from carrying out their "duties".

Still, it is far from a clear-cut case.

 

Some scholars note, correctly, that many narcissists have no criminal intent ("mens rea") even when they commit criminal acts ("acti rei"). The narcissist may victimize, plunder, intimidate and abuse others - but not in the cold, calculating manner of the psychopath. The narcissist hurts people offhandedly, carelessly, and absentmindedly. The narcissist is more like a force of nature or a beast of prey - dangerous but not purposeful or evil.

Moreover, many narcissists don't feel responsible for their actions. They believe that they are victims of injustice, bias, prejudice, and discrimination. This is because they are shape-shifters and actors. The narcissist is not one person - but two. The True Self is as good as dead and buried. The False Self changes so often in reaction to life's circumstances that the narcissist has no sense of personal continuity.

From my book "Malignant Self Love - Narcissism Revisited":

"The narcissist's perception of his life and his existence is discontinuous. The narcissist is a walking compilation of "personalities", each with its own personal history. The narcissist does not feel that he is, in any way, related to his former "selves". He, therefore, does not understand why he has to be punished for "someone else's" actions or inaction. This "injustice" surprises, hurts, and enrages him."

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

 

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next: The Syphilitic Narcissist

Are personality disorders true mental illnesses and  should a person with a personality disorder be entitled to  use the insanity defense after committing a crime?

"It is an ill thing to knock against a deaf-mute, an imbecile, or a minor. He that wounds them is culpable, but if they wound him they are not culpable." (Mishna, Babylonian Talmud)

Some personality disorders are culture-bound. Critics charge that these "mental illnesses" mostly serve as an organizing social principle and are tools for societal control and coercion. But if personality disorders are not objective clinical entities - what should we make of the insanity defense (NGRI- Not Guilty by Reason of Insanity)?

The insanity defense (when a person is held not responsible for his criminal actions) rests on two pillars of evidence:

1. That the accused was unable to tell right from wrong ("lacked substantial capacity either to appreciate the criminality (wrongfulness) of his conduct" - diminished capacity).

2. That the accused did not intend to act the way he did (absent "mens rea") and/or could not control his behavior ("irresistible impulse"). These handicaps are often associated with "mental disease or defect" or "mental retardation".

Still, the "guilty but mentally ill" verdict appears to be a contradiction in terms. All "mentally-ill" people operate within a (usually coherent) worldview, with consistent internal logic, and rules of right and wrong (ethics). The problem is that these private constructs rarely conform to the way most people perceive the world. The mentally-ill, therefore, cannot be guilty because s/he has a tenuous grasp on reality. Mental health professionals prefer to talk about an impairment of a "person's perception or understanding of reality".

Reality, however, is a lot more shaded and complex that the rules that purport to apply to it. Some criminals are undoubtedly mentally ill but still maintain a perfect grasp on reality ("reality test"). They are, thus, held criminally responsible (Jeffrey Dahmer comes to mind). The "perception and understanding of reality", in other words, can and does co-exist even with the severest forms of mental illness. It is, therefore, not very helpful in distinguishing the criminally insane from the merely insane.

This makes it even more difficult to comprehend what is meant by "mental disease". If some mentally ill patients maintain a grasp on reality, know right from wrong, and can anticipate the outcomes of their actions, are not subject to irresistible impulses (the tests set forth by the American Psychiatric Association) - in what way do they differ from us, "normal" folks? Are personality disorders mental illnesses? Can someone with the Narcissistic Personality Disorder (a narcissist) successfully claim the insanity defense? Are narcissists insane?

This is the topic of our next article.

Click on these links to learn more:

The Myth of Mental Illness

The Insanity Defense

Crime and the Never repenting Narcissist

Serial Killers

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

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next: Is the Narcissist Legally Insane?

Excellent description of the masochist and signs, symptoms and characteristics of Masochistic Personality Disorder.

Disclaimer

The Masochistic personality disorder was included in the DSM III-TR but removed from the DSM IV and from its text revision, the DSM IV-TR. This move was criticized by some scholars, notably Theodore Millon.

Notes of first therapy session with Sam, male, 46, diagnosed with Masochistic Personality Disorder

Sam is an advertising executive. He keeps sending letters with damaging and incriminating information about himself to various online, print, and electronic media. He knows that it is an extreme form of self-destructive and self-defeating behavior, but "it feels good afterwards, like I am cleansed." Does he enjoy it? He recoils: "Enjoy is a strong word." What things and pastimes does he find pleasurable? He likes classical music. When was the last time he has been to a concert? He can't remember.

Sam is gregarious and somewhat narcissistic. He likes being the center of attention. Still, he is a virtual hermit. He rarely exits his home and spends all his time in solitary activities. Why does he abstain from social contact? He tends to make a fool of himself: he often gets drunk and then loses control of what he says and does. "And that is not fun!" - he concludes sadly.

Sam is homosexual. He craves a stable and long-term relationship but keeps finding himself involved with unsuitable partners. These brief and stormy liaisons invariably end in heartbreak and financial ruin. Why didn't he seek help before? "I don't need help" - he sounds resentful - "I need advice." OK, then why didn't he seek advice before? He murmurs something inaudibly but refuses to share it with me. When I insist, Sam confesses that he has been to therapy a few years ago.

"She gave me all the wrong advice."- he complains and proceeds to list his former therapist's suggestions. I inform him that he is likely to receive very similar guidance from me and offer to assist him to assimilate these lessons, gain insights, and act of them. "That's more than I had bargained for when I came here." - he frowns - "Therapy is not exactly my idea of intimacy or companionships." I am not offering either, I tell him, merely support and some knowledge regarding the workings of the human mind.

But he is still on edge: "I understand that you practice brief therapy." Yes, that's true. "This means that we can see results in one or two sessions?" Sometimes. "Sounds more like brainwashing to me!" - he declares - "I don't like people tinkering with my mind like that." People always tinker with other people's minds. This is what fields like advertising and political campaigning and, yes, psychotherapy, are all about. "Cut you down to size." - he sneers - "Conform or die!"

Sam feels constantly manipulated by people who pretend to care about him. "Love" is a code word for subjugation on the one hand and obsequiousness on the other hand. Only weak people develop such dependence. He is shocked by the fact that I fully concur: "Love and dependence are mutually-exclusive."

At work, Sam is much loved and admired. He is known for his willingness to help others with their tasks. He dedicates time and attention and puts lots of efforts into these altruistic excursions while neglecting to attend to his own clients and thus jeopardising his standing in the firm and his career.

The only time Sam had a row with his superior was when he was promoted. "I didn't want the new job, though I admit that it far better suited my qualifications and experience." - he explains. He remembers the incident because that night he had a near-fatal accident. "Saved by the wheel" - he laughs disingenuously - "Someone else got the job while I languished at the hospital."

"What do you think of my story?" - asks Sam - "Am I not a pathetic piece of work?" When I ignore the bait, he proceeds to taunt and provoke me: "What's the matter, Doc? As a therapist, aren't you supposed to answer truthfully? Am I not the most screwed up, hopeless, miserable imitation of a person you ever came across in your practice?"

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

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next: The Negativistic (Passive-Agressive) Patient ~ back to: Case Studies: Table of Contents

Learn what role sex plays in people with different personality disorders -  including Paranoid, Schizoid, Histrionic, Narcissistic, Borderline and Dependent personality disorders.

Our sexual behavior expresses not only our psychosexual makeup but also the entirety of our personality. Sex is the one realm of conduct which involves the full gamut of emotions, cognitions, socialization, traits, heredity, and learned and acquired behaviors. By observing one's sexual predilections and acts, the trained psychotherapist and diagnostician can learn a lot about the patient.

Inevitably, the sexuality of patients with personality disorders is thwarted and stunted. In the Paranoid Personality Disorder, sex is depersonalized and the sexual partner is dehumanized. The paranoid is besieged by persecutory delusions and equates intimacy with life-threatening vulnerability, a "breach in the defenses" as it were. the paranoid uses sex to reassure himself that he is still in control and to quell is anxiety.

The patient with Schizoid Personality Disorder is asexual. The schizoid is not interested in maintaining any kind of relationship and avoids interactions with others - including sexual encounters. He prefers solitude and solitary activities to any excitement sex can offer. The Schizotypal Personality Disorder and the Avoidant Personality Disorder have a similar effect on the patient but for different reasons: the schizotypal is acutely discomfited by intimacy and avoids close relationships in which his oddness and eccentricity will be revealed and, inevitably, derided or decried. The Avoidant remains aloof and a recluse in order to conceal her self-perceived shortcomings and flaws. The avoidant mortally fears rejection and criticism. The schizoid's asexuality is a result of indifference - the schizotypal's and avoidant's, the outcome of social anxiety.

Patients with the Histrionic Personality Disorder (mostly women) leverage their body, appearance, sex appeal, and sexuality to gain narcissistic supply (attention) and to secure attachment, however fleeting. Sex is used by histrionics to prop up their self-esteem and to regulate their labile sense of self-worth. Histrionics are, therefore, "inappropriately seductive" and have multiple sexual liaisons and partners.

The sexual behavior of histrionics is virtually indistinguishable from that of the somatic narcissist (patient with Narcissistic Personality Disorder) and the psychopath (patient with Antisocial Personality Disorder). But while the histrionic is overly-emotional, invested in intimacy, and self-dramatizing ("drama queen"), the somatic narcissist and the psychopath are cold and calculating.

The Somatic narcissist and the psychopath use their partners' bodies to masturbate with and their sexual conquests serve merely to prop up their wavering self-confidence (somatic narcissist) or to satisfy a physiological need (psychopath). The somatic narcissist and psychopath have no sexual playmates - only sexual playthings. Having conquered the target, they discard it, withdraw and move on heartlessly.

The cerebral narcissist is indistinguishable from the schizoid: he is asexual and prefers activities and interactions which emphasize his intelligence or intellectual achievements. Many cerebral narcissists are celibate even when married.

Patients with the Borderline Personality Disorder and the Dependent Personality Disorder both suffer from abandonment and separation anxieties and are clinging, demanding, and emotionally labile - but their sexual behavior is distinguishable. The borderline uses her sexuality to reward or punish her mate. The dependent uses it to "enslave" and condition her lover or spouse. The borderline withholds sex or offers it in accordance with the ups and downs of her tumultuous and vicissitudinal relationships. The codependent tries to make her mate addicted to her particular brand of sexuality: submissive, faintly masochistic, and experimental.

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

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next: Personality Disorders as an Insanity Defense

Explanation of the differences between the dependent, co-dependent and counterdependent person.

• Codependents
• Typology de Codependents
• Counterdependents
•  Watch the video on Co-dependent, Counter-dependent, Straight-forward Dependent

There is great confusion regarding the terms co-dependent, counter-dependent, and dependent. Before we proceed to study the Dependent Personality Disorder in our next article, we would do well to clarify these terms.

Codependents

Like dependents (people with the Dependent Personality Disorder), codependents depend on other people for their emotional gratification and the performance of both inconsequential and crucial daily and psychological functions.

Codependents are needy, demanding, and submissive. They suffer from abandonment anxiety and, to avoid being overwhelmed by it, they cling to others and act immaturely. These behaviors are intended to elicit protective responses and to safeguard the "relationship" with their companion or mate upon whom they depend. Codependents appear to be impervious to abuse. No matter how badly mistreated, they remain committed.

This is where the "co" in "co-dependence" comes into play. By accepting the role of victims, codependents seek to control their abusers and manipulate them. It is a danse macabre in which both members of the dyad collaborate.

Typology of Codependents

Codependence is a complex, multi-faceted, and multi-dimensional defence against the codependent's fears and needs. There are four categories of codependence, stemming from their respective aetiologies:

(i) Codependence that aims to fend of anxieties related to abandonment. These codependents are clingy, smothering, prone to panic, are plagued with ideas of reference, and display self-negating submissiveness. Their main concern is to prevent their victims (friends, spouses, family members) from deserting them or from attaining true autonomy and independence.

 

(ii) Codependence that is geared to cope with the codependent's fear of losing control. By feigning helplessness and neediness such codependents coerce their environment into ceaselessly catering to their needs, wishes, and requirements. These codependents are "drama queens" and their life is a kaleidoscope of instability and chaos. They refuse to grow up and force their nearest and dearest to treat them as emotional and/or physical invalids. They deploy their self-imputed deficiencies and disabilities as weapons.

Both these types of codependents use emotional blackmail and, when necessary, threats to secure the presence and blind compliance of their "suppliers".

(iii) Vicarious codependents live through others. They "sacrifice" themselves in order to glory in the accomplishments of their chosen targets. They subsist on reflected light, on second-hand applause, and on derivative achievements. They have no personal history, having suspended their wishes, preferences, and dreams in favour of another's.

From my book "Malignant Self Love - Narcissism Revisited":

"Inverted Narcissist

Also called "covert narcissist", this is a co-dependent who depends exclusively on narcissists (narcissist-co-dependent). If you are living with a narcissist, have a relationship with one, if you are married to one, if you are working with a narcissist, etc. - it does NOT mean that you are an inverted narcissist.

To "qualify" as an inverted narcissist, you must CRAVE to be in a relationship with a narcissist, regardless of any abuse inflicted on you by him/her. You must ACTIVELY seek relationships with narcissists and ONLY with narcissists, no matter what your (bitter and traumatic) past experience has been. You must feel EMPTY and UNHAPPY in relationships with ANY OTHER kind of person. Only then, and if you satisfy the other diagnostic criteria of a Dependent Personality Disorder, can you be safely labelled an 'inverted narcissist'."

(iv) Finally, there is another form of dependence that is so subtle that it eluded detection until very recently.

Counterdependents

Counterdependents reject and despise authority and often clash with authority figures (parents, boss, the Law). Their sense of self-worth and their very self-identity are premised on and derived from (in other words, are dependent on) these acts of bravura and defiance. Counterdependents are fiercely independent, controlling, self-cantered, and aggressive. Many of them are antisocial and use Projective Identification (i.e. force people to behave in ways that buttresses and affirm the counterdependent's view of the world and his expectations).

These behavior patterns are often the result of a deep-seated fear of intimacy. In an intimate relationship, the counterdependent feels enslaved, ensnared, and captive. Counterdependents are locked into "approach-avoidance repetition complex" cycles. Hesitant approach is followed by avoidance of commitment. They are "lone wolves" and bad team players.

 

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From my book "Malignant Self Love - Narcissism Revisited":

"Counterdependence is a reaction formation. The counterdependent dreads his own weaknesses. He seeks to overcome them by projecting an image of omnipotence, omniscience, success, self-sufficiency, and superiority.

Most "classical" (overt) narcissists are counterdependent. Their emotions and needs are buried under "scar tissue" which had formed, coalesced, and hardened during years of one form of abuse or another. Grandiosity, a sense of entitlement, a lack of empathy, and overweening haughtiness usually hide gnawing insecurity and a fluctuating sense of self-worth."

The Dependent Personality Disorder is a much disputed mental health diagnosis.

We are all dependent to some degree. We all like to be taken care of. When is this need judged to be pathological, compulsive, pervasive, and excessive? Clinicians who contributed to the study of this disorder use words such as "craving", "clinging", "stifling" (both the dependent and her partner), and "humiliating", or "submissive". But these are all subjective terms, open to disagreement and differences of opinion.

Moreover, virtually all cultures encourage dependency to varying degrees. Even in developed countries, many women, the very old, the very young, the sick, the criminal, and the mentally-handicapped are denied personal autonomy and are legally and economically dependent on others (or on the authorities). Thus, the Dependent Personality Disorder is diagnosed only when such behavior does not conform with social or cultural norms.

Codependents, as they are sometimes known, are possessed with fantastic worries and concerns and are paralyzed by their abandonment anxiety and fear of separation. This inner turmoil renders them indecisive. Even the simplest everyday decision becomes an excruciating ordeal. This is why codependents rarely initiate projects or do things on their own.

Dependents typically go around eliciting constant and repeated reassurances and advice from a myriad sources. This recurrent solicitation of succour is proof that the codependent seeks to transfer responsibility for his or her life to others, whether they have agreed to assume it or not.

This recoil and studious avoidance of challenges may give the wrong impression that the Dependent is indolent or insipid. Yet, most Dependents are neither. They are often fired by repressed ambition, energy, and imagination. It is their lack self-confidence that holds them back. They don't trust their own abilities and judgment.

Absent an inner compass and a realistic assessment of their positive qualities on the one hand and limitations on the other hand, Dependents are forced to rely on crucial input from the outside. Realizing this, their behavior becomes self-negating: they never disagree with meaningful others or criticizes them. They are afraid to lose their support and emotional nurturance.

Consequently, as I have written in the Open Site Encyclopedia entry on this disorder:

"The codependent molds himself/herself and bends over backward to cater to the needs of his nearest and dearest and satisfy their every whim, wish, expectation, and demand. Nothing is too unpleasant or unacceptable if it serves to secure the uninterrupted presence of the codependent's family and friends and the emotional sustenance s/he can extract (or extort) from them.

The codependent does not feel fully alive when alone. S/he feels helpless, threatened, ill-at-ease, and child-like. This acute discomfort drives the codependent to hop from one relationship to another. The sources of nurturance are interchangeable. To the codependent, being with someone, with anyone, no matter whom - is always preferable to solitude."

Read Notes from the therapy of a Dependent (Codependent) Patient

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

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next: Paranoid Personality Disorder

Why do abuse victims frequently get short-changed by the system? Usually, it's because the victim of abuse doesn't understand how to play the game.

• Watch the video on Abuse Victims: Befriending the System

In the process of mediation, marital therapy, or evaluation, counselors frequently propose various techniques to ameliorate the abuse or bring it under control. Woe betides the party that dares object or turn these "recommendations" down. Thus, an abuse victim who declines to have any further contact with her batterer - is bound to be chastised by her therapist for obstinately refusing to constructively communicate with her violent spouse.

Better to play ball and adopt the sleek mannerisms of your abuser. Sadly, sometimes the only way to convince your therapist that it is not all in your head and that you are a victim - is by being insincere and by staging a well-calibrated performance, replete with the correct vocabulary. Therapists have Pavlovian reactions to certain phrases and theories and to certain "presenting signs and symptoms" (behaviors during the first few sessions). Learn these - and use them to your advantage. It is your only chance.

 

I described in "The Guilt of the Abused - Pathologizing the Victim" how the system is biased and titled against the victim.

Regrettably, mental health professionals and practitioners - marital and couple therapists, counselors - are conditioned, by years of indoctrinating and dogmatic education, to respond favorably to specific verbal cues.

The paradigm is that abuse is rarely one sided - in other words, that it is invariably "triggered" either by the victim or by the mental health problems of the abuser. Another common lie is that all mental health problems can be successfully treated one way (talk therapy) or another (medication).

This shifts the responsibility from the offender to his prey. The abused must have done something to bring about their own maltreatment - or simply were emotionally "unavailable" to help the abuser with his problems. Healing is guaranteed if only the victim were willing to participate in a treatment plan and communicate with the abuser. So goes the orthodoxy.

Refusal to do so - in other words, refusal to risk further abuse - is harshly judged by the therapist. The victim is labeled uncooperative, resistant, or even abusive!

The key is, therefore, feigned acquiescence and collaboration with the therapist's scheme, acceptance of his/her interpretation of the events, and the use of key phrases such as: "I wish to communicate/work with (the abuser)", "trauma", "relationship", "healing process", "inner child", "the good of the children", "the importance of fathering", "significant other" and other psycho-babble. Learn the jargon, use it intelligently and you are bound to win the therapist's sympathy.

Above all - do not be assertive, or aggressive and do not overtly criticize the therapist or disagree with him/her.

I make the therapist sound like yet another potential abuser - because in many cases, he/she becomes one as they inadvertently collude with the abuser, invalidate the abuse experiences, and pathologize the victim.

Phrases to Use

• "For the children's sake ..."
• "I want to maintain constructive communications with my husband/wife..."
• "The children need the ongoing presence of (the other parent) ..."
• "I wish to communicate/work with (the abuser) on our issues"
• "I wish to understand our relationship, help both sides achieve closure and get on with their lives/my life"
• "Healing process"

 

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Things to Do

• Attend every session diligently. Never be late. Try not to cancel or reschedule meetings.
• Pay attention to your attire and makeup. Project a solid, conservative image. Do not make a disheveled and disjointed appearance.
• Never argue with the counselor or the evaluator or criticize them openly. If you have to disagree with him or her - do so elliptically and dispassionately.
• Agree to participate in a long-term treatment plan.
• Communicate with your abuser politely and reasonably. Do not let yourself get provoked! Do not throw temper tantrums or threaten anyone, not even indirectly! Restrain your hostility. Talk calmly and articulately. Count to ten or take a break, if you must.
• Repeatedly emphasize that the welfare and well-being of your children is uppermost in your mind - over and above any other (selfish) desire or consideration.

Maintain Your Boundaries

• • Be sure to maintain as much contact with your abuser as the courts, counselors, mediators, guardians, or law enforcement officials mandate.
  • Do NOT contravene the decisions of the system. Work from the inside to change judgments, evaluations, or rulings - but NEVER rebel against them or ignore them. You will only turn the system against you and your interests.
  • But with the exception of the minimum mandated by the courts - decline any and all gratuitous contact with the narcissist.
  • Do not respond to his pleading, romantic, nostalgic, flattering, or threatening e-mail messages.
  • Return all gifts he sends you.
  • Refuse him entry to your premises. Do not even respond to the intercom.
  • Do not talk to him on the phone. Hang up the minute you hear his voice while making clear to him, in a single, polite but firm, sentence, that you are determined not to talk to him.
  • Do not answer his letters.
  • Do not visit him on special occasions, or in emergencies.
  • Do not respond to questions, requests, or pleas forwarded to you through third parties.
  • Disconnect from third parties whom you know are spying on you at his behest.
  • Do not discuss him with your children.
  • Do not gossip about him.
  • Do not ask him for anything, even if you are in dire need.
  • When you are forced to meet him, do not discuss your personal affairs - or his.
  • Relegate any inevitable contact with him - when and where possible - to professionals: your lawyer, or your accountant.

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This - working with professionals to extricate yourself and your loved ones from the quagmire of an abusive relationship - is the topic of our next article.

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next: Working with Professionals

Each personality disorder seemingly comes with its own body language which perfectly fits the personality disorder. Here are some examples.

Patients with personality disorders have a body language specific to their disorder. It comprises an unequivocal series of subtle presenting signs. The patient's body language usually reflects the underlying mental health problem. For instance: people with Avoidant Personality Disorder and patients with its diametrical opposite, the Narcissistic Personality Disorder, comport themselves differently.

A few examples:

The Narcissist's body language- from my book "Malignant Self Love - Narcissism Revisited":

"Haughty" body language - The narcissist adopts a physical posture which implies and exudes an air of superiority, seniority, hidden powers, mysteriousness, amused indifference, etc. Though the narcissist usually maintains sustained and piercing eye contact, he often refrains from physical proximity (he maintains his personal territory)."

The psychopath is likely to be expansive (dominate and invade other people's personal territory), swaggering, and vaguely menacing. His manifest equanimity is bound to be mixed with an underlying streak of agitation, violent impatience, and hypervigilance. The general impression is of a wound time bomb, about to explode.

The Avoidant is reticent and maintains a clearly demarcated personal turf to which she often withdraws (for instance, by folding her legs underneath her). Her body posture is tense and defensive: shoulders stooped, arms folded, legs crossed. She avoids eye contact.

The Borderline is "all over the place". Her body seems to not be fully under her control. She is irritated, fidgety, manic, and alternates between displaying empathic warmth and a demanding, sulking or even threatening position.

The Schizoid is robotic, slow, and deliberate. He moves reluctantly, maintains great distance from the therapist, and is passive (but not aggressive) throughout the encounter.

The Schizotypal is hypervigilant but friendly and warm. He does not hesitate to gesture his emotions; affection, anger, or fear. Similar to the Obsessive-Compulsive, the Schizotypal has small, private rituals which he uses to reduce his level of anxiety.

The Paranoid is cold and defensive, hypervigilant and has a startle reaction. His eyes dart, he fidgets, and sometimes sweats and has difficulties breathing (Panic Attacks). His speech is likely to be idiosyncratic and he maintains eye contact only when trying to prove a point and to gauge his interlocutor's reaction.

In itself, body language cannot and should not be used as a diagnostic tool. But, in conjunction with psychiatric interviews and psychological tests, it can provide an additional layer of diagnostic certainty.

How To Recognize a Narcissist

The Abuser's Body Language

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

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next: Sex and Personality Disorders

Excellent description of a passive-aggressive person. Get insight into what it's like living with Negativistic (Passive-Aggressive) Personality Disorder.

Disclaimer

The Negativistic (Passive-Aggressive) Personality Disorder appears in Appendix B of the Diagnostic and Statistical Manual (DSM), titled "Criteria Sets and Axes Provided for Further Study."

Notes of first therapy session with Mike, male, 52, diagnosed with Negativistic (Passive-Aggressive) Personality Disorder

Mike is attending therapy at the request of his wife. She complains that he is "emotionally absent" and aloof. Mike shrugs: "We used to have a great marriage, but good things don't last. You can't sustain the same levels of passion and interest throughout the relationship." Isn't his family worth the effort? Another shrug: "It doesn't pay to be a good husband or a good father. Look what my loving wife did to me. In any case, at my age the future is behind me. Carpe Diem is my motto."

Does he consider his wife's demands to be unreasonable? He flares: "With all due respect, that's between me and my spouse." Then why is he wasting his time and mine? "I didn't ask to be here." Did he prepare a list of things he would like to see improved in his family life? He forgot. Can he compile it for our next meeting? Only if nothing more urgent pops up. It would be difficult to continue to work together if he doesn't keep his promises. He understands and he will see what he can do about it (without great conviction).

The problem is, he says, that he regards psychotherapy as a form of con-artistry: "psychotherapists are snake oil salesmen, latter-day witch doctors, only less efficient." He hates to feel cheated or deceived. Does he often feel that way? He laughs dismissively: he is too clever for run-of-the-mill crooks. He is often underestimated by them.

Do other people besides crooks underestimate him? He admits to being unappreciated and underpaid at work. It bothers him. He deserves more than that. Obsequious intellectual midgets rise to the top in every organization, he observes with virulent envy. How does he cope with this discrepancy between the way he perceives himself and the way others, evidently, evaluate him? He ignores such fools. How can one ignore one's co-workers and one's superiors? He doesn't talk to them. In other words, he sulks?

Not always. He sometimes tries to "enlighten and educate" people he deems "worthy". It often gets him into arguments and he has acquired a reputation as a cantankerous curmudgeon but he doesn't care. Is he an impatient or irritable person? "What do you think?" - he counters - "During this session did I ever lose my cool?" Frequently. He half rises from his chair then thinks better of it and settles down. "Do your thing" - he says sullenly and contemptuously - "Let's get it over with."

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

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next: The Dependent Patient ~ back to: Case Studies: Table of Contents

Many times, abuse victims choose the wrong divorce attorney or other professional and feel  abused again. Learn how to make good choices.

Selecting the right professional is crucial. In the hands of an incompetent service provider, you may end up feeling abused all over again.

Go through the following check list before you settle on a divorce attorney, a financial consultant, a tax planner, a security adviser, or an accountant. Don't be ashamed to demand full disclosure - you have a right to do so. If you are met with impatience, arrogance, or a patronizing attitude - leave. This is not the right choice.

Make additional enquiries. Join online support groups and ask the members for recommendations. Visit directories on the Web - they are usually arranged by city, state, region, and country. Compare notes with others who have had similar experiences. Ask friends, neighbors, and family members to do the same. Scan the media for mentions of experts and mavens. Seek advice and referrals - the more the better.

Suggested Check List

Is the professional certified in your state/country? Can he himself fully represent you?

Will you be served by the expert himself - or by his staff? Don't end up being represented by someone you never even met! Make the professional's personal services an explicit condition in any written and verbal arrangement you make.

Obtain a complete financial offer, all fees and charges included, before you hire the services. Make sure you are aware of the full monetary implications of your decisions. Finding yourself financially stranded midway through is bad policy. If you can afford it - don't compromise and go for the best. But if you don't have the pecuniary means - don't overshoot.

What is the professional's track record? Does he have a long, varied, and successful experience in cases similar to yours? Don't hesitate to ask him or her for recommendations and referrals, testimonials and media clips.

What are the likely outcomes of the decisions you make, based on the specialist's recommendations? A true pro will never provide you with an iron-clad guarantee but neither will he dodge the question. Your expert should be able to give you a reasonably safe assessment of risks, rewards, potential and probable outcomes, and future developments.

Always enquire about different courses of action and substitute measures. Ask your professional why he prefers one method or approach to another and what is wrong with the alternatives. Don't accept his authority as the sole arbiter. Don't hesitate to argue with him and seek a second opinion if you are still not convinced.

Make the terms of your agreement crystal-clear, get it in writing, and in advance. Don't leave anything to chance or verbal understanding. Cover all grounds: the scope of activities, the fees, the termination clauses. Hiring a consultant is like getting married - you should also contemplate a possible divorce.

Relegate any inevitable contact with your abusive ex - when and where possible - to professionals: your lawyer, or your accountant. Work with professionals to extricate yourself and your loved ones from the quagmire of an abusive relationship.

This is the topic of our next article.

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next: Interacting with Your Abuser

Definition and comprehensive explanation of Oppositional Defiant Disorder (ODD). Includes personality traits of Oppositional Defiant Disorder.

• Watch the video on Oppositional Defiant Disorder 

If you are a rebellious child or teenager and you have not been diagnosed with Conduct Disorder, you are still at risk of being labelled and pathologized. The DSM informs us that "The essential feature of Oppositional Defiant Disorder is a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior towards authority figures that persists for at least 6 months.

Unbelievable as this Orwellian, Big Brother text is - it gets worse. If you are under 18 years old and you lose your temper, argue with adults, actively "defy or refuse to comply with the requests or rules of adults", deliberately do things that annoy said adults, blame others for your mistakes or misbehavior - then unquestionably you are a sick little puppy. And who is to make these value judgements? An adult psychologist or psychiatrist or social worker or therapist. And what if you disagree with these authorities? They get annoyed and this is proof positive that you are afflicted with Oppositional Defiant Disorder (ODD). Did anyone mention catch-22?

And the charade continues, masquerading as "science". If you are touchy or get easily annoyed (for instance by the half-baked diagnoses rendered by certain mental health practitioners), you are ODD (i.e., you suffer from Oppositional Defiant Disorder).You are allowed to be touchy when you are an adult - it is then called assertiveness. You are allowed to get pissed off when you are above the crucial (though utterly arbitrary) age limit. Then it is called "expressing your emotions", which is by and large a good thing.So tell us the charlatans that call themselves mental health 'professionals' (as though psychology is an exact science, not merely an elaborate literary exercise).

The DSM, this manual of the Potemkin science known as clinical psychology, continues to enlighten us:

If you are habitually angry and resentful, spiteful or vindictive and these traits impair your "normal" social, academic, or occupational functioning (whatever "normal" means in today's pluralistic and anomic culture), beware: you may be harbouring Oppositional Defiant Disorder (ODD). It is not clear what the DSM means by 'occupational' when Oppositional Defiant Disorder typically applies to primary school age children. Perhaps we will find out in the DSM V.

 

"The behaviors must occur more frequently than is typically observed in individuals of comparable age and developmental level." - the DSM helpfully elaborates. If the child is psychotic or suffers from a mood disorder, Oppositional Defiant Disorder should not be diagnosed.

Why am I bothering you with this tripe? Because the DSM is ominously clear:

"The diagnosis is not made if ... criteria are met for Conduct Disorder or Antisocial Personality Disorder (in an individual above the age of 18)."

Get this straight: if you are above the age of 18 and you are stubborn, resistant to directions, "unwilling to compromise, give in, or negotiate with adults and peers", ignore orders, argue, fail to accept blame for misdeeds, and deliberately annoy others - you stand a good chance of being "diagnosed" as a psychopath.

Let us hope that the "scholars" of the DSM V Committee have the good sense to remove this blatant tool of social control from the Diagnostic and Statistical Manual. But don't count on it and don't argue with them if they don't. They may diagnose you with something.

Conduct Disorder

Read The Myth of Mental Illness

Is Psychoanalysis a science?

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

 

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next: The Hateful Patient - Difficult Patients in Psychotherapy