DID/MPD: Working Within the Multiple System

DID/MPD: Dissociative Identity Disorder, Multiple Personality Disorder. How to get your alters to work together. Multiplicity, dissociation transcript.

Anne Pratt, Ph.D.

Our guest, Anne Pratt, Ph.D., is a clinical psychologist at the Traumatic Stress Institute. Her expertise centers around psychological trauma and Dissociative Identity Disorder (Multiple Personality Disorder). The discussion focuses on getting your alters to work together.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.


David: Good evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com.

Our topic tonight is "DID/MPD: Working Within the Multiple System". Our guest is therapist, Anne Pratt, Ph.D., a clinical psychologist at the Traumatic Stress Institute, a private mental health organization devoted to research, treatment, and training of other professionals in the area of psychological trauma. Dr. Pratt has worked in the field for fifteen years, and has extensive experience with Dissociative Identity Disorder. If you are unfamiliar with DID, MPD, here's a link for a further explanation of dissociative identity disorder (a.k.a. Multiple Personality Disorder).

Good evening, Dr. Pratt, and welcome to HealthyPlace.com. We appreciate you being our guest tonight. I can imagine that having several alters within can become very disrupting, making it difficult to live a "normal" life. Because everyone in the audience tonight may not be DID/MPD, but may be just friends or family members, can you give us a description of what it's like living in a fragmented way?

Dr. Pratt: Good evening. I will try! People with Dissociative Identity Disorder differ considerably from each other, so this description won't fit everyone with DID. People with DID who do not have what is called co-consciousness (awareness of what is happening when other alters are out) experience significant disruption in their lives, through amnesia, and through finding out that they have behaved in ways that they don't usually behave.

David: And the result of this is what?

Dr. Pratt: Sometimes a person with DID is called a liar because people accuse them of doing things that they deny doing. Sometimes they are viewed as weird or flaky because their behavior is so variable. Their internal experience is that the world is kind of unpredictable, difficult to navigate at times.

David: Tonight, we want to discuss getting your alters working together towards a common goal, whether it be healing or just everyday living. Is that even possible or reasonable to expect that to happen?

Dr. Pratt: Oh, yes. It sure is. When people can get their alters to agree on things, life gets much easier and less disrupted. It's a difficult goal for many to reach, but not impossible. Alters were created because there were things that were too hard for one person to accept what happened to them. So, the barriers between alters, barriers between knowing what one or another is thinking or doing, are there for a reason. When the barriers get in the way, though, and disrupt one's life, it is more helpful to have openness within the system.

David: Is this something that can only be accomplished in a therapeutic setting?

Dr. Pratt: I don't think it can only be accomplished in therapy, but if the therapist is experienced in dealing with dissociation, it sure does help. I expect that many people accomplish this outside of therapy, but we therapists, just don't know that much about it because we only see people in therapy.

David: A moment ago, you used the term "openness within the system". What does that mean?

Dr. Pratt: By that, I mean "internal communication," or communication among alters. Internal communication is the first step toward cooperation.

David: How does one accomplish internal communication amongst the alters?

Dr. Pratt: For many people with multiplicity, it is a difficult task. This is because, as I said earlier, the barriers between alters are there for a good reason, self-protection. But for others, it is relatively easy. If the person wants to establish communication, but can't "hear" others inside, they might start by writing to each other in a journal.

I'd like to add, that if you contemplate doing this, please check it out with your own doctor. This isn't a good idea for everybody at different stages of treatment.

Others, who can hear each other, might start trying to have conversations about their different needs and wishes. It's a little like getting any group of people to work together. You find ways to get the word out, and then you take care to listen carefully to each other.

David: As you can imagine, we have a lot of audience questions. Let's get to a few and then we'll continue with our conversation:

Dr. Pratt: Sure.

saharagirl: How can one get alters to work together when they have different loyalties?

Dr. Pratt: Saharagirl, that's a good and important question. I think that different loyalties are one of the primary reasons why this doesn't happen quickly or overnight. Alters (and the "host") need to respect each others' loyalties, needs, and wishes. Like any group of people who experience conflict, this is not easy. But if those who are trying to accomplish internal communication and cooperation keep emphasizing respect for everyone's point of view, it will help. Even those alters who have seemingly self-destructive points of view have them for a reason. If their reasons are understood and respected, it will build a bridge to working together toward mutual goals.


Chandra: I have a seven-year-old alter that cuts me after I do anything that she perceives is not safe. How do I deal with that?

Dr. Pratt: Chandra, you bring up another common problem and one which makes working together really difficult. Obviously, it's really important to help this little one feel safe, to help her define what she needs to feel safe, and to assist her in getting that safety. It's not an easy or a short-term problem, but when she starts to feel safer, she will be more able to relax and let older ones make decisions. Even if they feel a little risky to her. I guess the short answer is, negotiate (easier said than done, I know).

David: I know that this is sort of controversial, but just so we know and understand where you are coming from Dr. Pratt, is "healing" to you the same as "integration" of the personalities, or is it getting the alters to work and exist together?

Dr. Pratt: I think that everyone needs to define healing for themselves. I cannot dictate my idea of what healing is to another person. I personally believe that doctors have made too much of the idea of integration. Many multiples, if they are able to cooperate internally and are not losing time or missing what is going on when others are out, can live completely satisfactory lives without trying to integrate. If someone chooses to work toward integration, that is certainly their option. If they choose not to, I would support that decision too.

asilencedangel: I have a very angry alter in the system who is both mentally and physically disruptive and violent. I have been trying to contract with her, or reach her in some way, but have been unable to. Do you have any suggestions in obtaining a contract or communication with her?

Dr. Pratt: Asilencedangel, you are describing one of the most difficult problems to address. I would make the same suggestion, though, with perhaps the added encouragement to persist, and keep on persisting.

The way to open communication with alters who seem opposed to the goals of the rest of you, is to discover his/her goal (like the goal of Chandra's 7 year old alter was safety, even though she was doing something that some would define as unsafe) and try to make suggestions about how to reach that goal that both of you can agree with.

It's not easy and I won't pretend it is. However, the key is definitely, "I disagree with your method, but I think we may have something we do agree about." It's usually keeping safe, not getting too close to others, not remembering. That's what "destructive" alters are usually after.

David: If one can't consciously watch over the other alters, how can you work with them?

Dr. Pratt: This is where the help of a therapist sure comes in handy. A therapist experienced with DID and dissociation can help the person's alters begin to feel some trust, and begin to come out to the therapist. As that happens in the very beginning, sometimes the therapist is the conduit for communication between alters. That's not a good way for treatment to proceed, however, and the goal should be to help alters communicate with each other through written, or ideally, internal words. As soon as possible.

Falcon2: How do you teach alters to do specific things when you are not co-conscious?

Dr. Pratt: Falcon2, I guess the answer is, you try to communicate and really try to listen. What do the others need or want? What do you want of them? If internal communication isn't happening yet, you keep trying, and in the meantime, get help from a therapist or a written journal to try to communicate that way. I don't know if you can teach alters to do specific things. But you might be able to ask them to do "x" for you if you can do "y" for them. For example, they will refrain from drinking, if you can give them some time for recreation for themselves.

David: Here are a few audience comments on what's been said, so far, tonight. Then we'll continue on.

katmax: I am co-conscious and it has taken long time and lots of good therapy. I have seven alters.

Sonja: The alters I have can't agree on anything!

cherokee_cryingwind: I am a survivor of incest with six alters, one of which, used to be very destructive.

David: Besides the journaling, what other ways are there to establish a workable system of existence with your alters?

Dr. Pratt: I think that the help of a therapist is really useful in helping people develop internal communication and cooperation. Sometimes the therapist is the one who can most easily recognize the common goals, from alters who seem to have very different goals indeed.

David, as is so often the case, there is lots of expertise in the room, and it certainly isn't all mine! These comments illustrate how much good information multiples can get from each other.

David: I agree :)

We B 100: I've found, that allowing alters to have their times, they tend to work better together and communicate more to the others.

Dr. Pratt: I would have to underscore what We B 100 said, that giving alters their own time to do their own thing is a very positive step. Sometimes the trouble increases in a multiple's system because different parts' needs aren't being met. Everyone, multiple or not, has different needs, and in a multiple, meeting the needs of alters is one way to keep everyone settled down and willing to work together.

David: Regarding "meeting your alters needs," here's an audience comment, then we'll go to more questions:

toomany: Just like outside children, you give them a little and it goes a long way.

Dr. Pratt: :)


David: One of the common questions we are getting, Dr. Pratt, is how long should it take to obtain a peaceful coexistence with your alters?

Dr. Pratt: I wish I could answer this to everyone's satisfaction. I'm not sure I can. I think, if the person has alters who are doing highly destructive, scary things (like intensely suicidal or self-injurious behavior, severe addictions or eating disorders, to name a few, it may take a few years to get it all settled down. Sometimes more than a few. If, however, the individual's life is only mildly disrupted by the multiplicity, treatment can help things settle down dramatically in maybe six to eighteen months. Not everyone with multiplicity experiences these very difficult adaptations. There's a lot of differences among multiples.

milo: Does gaining cooperation and communication with your alters, whether through therapy or simply journaling, always have to involve rehashing the past?

Dr. Pratt: Oh, Milo, what a good question. The short answer is, No. But I'm not good at short answers! The goal of internal communication and cooperation might be accomplished with almost NO rehashing of the past. But the reasons why alters do various things, and the reasons why one has alters to begin with, will probably mean some thinking about and talking about the past. That's as short as I can do it!

Kimby: Where is the Traumatic Stress Institute located and do they work with SRA/DID individuals?

Dr. Pratt: TSI is in South Windsor, Connecticut. The psychologists at TSI do work with these folks.

jewlsplus38: The 'core' has recently had to feel intense grief for the first time and has buried herself again. We are at a loss as to what to do to try get her back. Our job, up until now, has been to teach her how to live, and we feel very alone. Did we give her too much?

Dr. Pratt: Jewlsplus38, I think you are most likely doing a great job. I would guess that, if all her life she has dissociated strong feelings, the process of learning to feel them for the first time is going to be on-again/ off-again. Offer support when she reappears, and keep her life in order while she is away. I can't say for sure, but you sound very caring and careful, and I think you are probably on the right track.

oak: How does one work with alters who refuse to be drawn out to talk with either the therapist or other alters?

Dr. Pratt: Oak, that's a tough question. It reminds me of my first question tonight and the answer is very similar: Make sure that there is safety for those alters. If you (or anyone inside) has an idea about what those alters might need in order to feel safe, then I would try to create that safety. And make sure that it is communicated to them that it is up to them. They can come out when it feels right to them.

JoMarie_etal: Prior to about six years ago, we were at least communicating and cooperating to some extent. Then something terrible happened to us and it totally destroyed all trust inside and out. I have been trying to reestablish some communication and cooperation, but everybody went into their own protective shells and there is extreme resistance to any kind of cooperation. In fact, there is a lot of energy going into disrupting day-to-day living. Is there any way of reestablishing communication and getting everyone to work together again?

Dr. Pratt: JoMarie_etal, you are also describing one of the hardest situations to deal with. A new trauma on top of all the old has to be one of the hardest things for all of your alters to cope with. They were partially convinced that cooperating and communicating (breaking down the barriers among them) was a good idea, and then something awful happened and they went back to what they know best.

It comes back to safety again, and perhaps, a strong dose of not blaming. I wouldn't blame any of them for what happened or for pulling back. Try to make it safe to be out again, safe to be talking together again, and stress that everyone has the same goal: keeping safe and not letting bad stuff happen. Then try to focus on ways that everyone can agree to accomplish that goal. Best of luck.

Wind: How do you feel about locking away a destructive alter for a period of time in order to gain co-consciousness?

Dr. Pratt: Wind, I'm not sure I understand. I do know someone who has had some success with locking away destructive alters, but I have never suggested it, or witnessed it myself. If there is a place where the destructive alter can wait safely, apart from others, I guess that's the direction I would go in. But again, without knowing you and the particular circumstances, I'm in the dark, so it's kind of guessing on my part. Talk with someone you have confidence in and who knows your situation well.

David: An audience member says she talks with a DID friend by phone almost nightly. Her friend switches a lot and she wants to know how she can contact the core/main person to continue the conversation?

Dr. Pratt: If possible, that is something she should talk over with her friend. If it is okay with her friend, she might try saying something like: "I was talking to "X" about "Y." I am happy to talk to you later on (if that's true), but right now I'd like to finish what "X" and I were talking about. Is that okay with you?"

You have to be cautious because traumatized people are sensitive (and most DID people have a history of severe trauma). They will perceive rejection in the smallest comments. So, I'd first recommend talking it over with the friend and asking for her suggestions. And perhaps talking it over with the alters and asking them for their suggestions so that, the conversation can be more fluid and less switchy for the caller.


Grace67: What do you suggest for people on the "low end" of Dissociative Identity Disorder who have such a hard time believing themselves and what is happening in their lives? I am thirty-three and recently diagnosed. My alters do not have the depth of other's alters, yet are each their own. I struggle daily with believing myself (we are co-conscious, although there is little dialogue, there is no amnesia).

Dr. Pratt: Grace, the tendency to disbelieve one's own experience is not limited to people like you describe yourself, who are at the "low end." Disbelief is rampant in society and rampant in the consciousness of every survivor of interpersonal trauma. Just like society, survivors and those who work with them, do not want to believe that it could be true. And DID-like symptoms, or Dissociative Identity Disorder, are part of the picture that we don't want to believe is true.

In some ways, one's disbelief protects one from having to believe it too much, all at once. So stay calm, know that you will probably move from believing in your experience to disbelieving, to being unsure, to believing again. It's part of the experience of surviving interpersonal trauma.

David: Grace, so you know that you are not alone, here are a few audience responses to your comment:

jewlsplus38: I have over eighty alters, and I still go through small amounts of time where I wonder if I made it all up.

JoMarie_etal: We call that disbelief a form of denial and to make it not feel so terrible. Joking about floating down the Nile in Egypt helps to realize that it is a common thing.

engberg: I am in total denial of my DID and don't even want to discuss it with my therapist because I don't want to admit it. I want to lead a normal life now and I feel like if I get into things, I will be too overwhelmed and won't be able to handle it.

Dr. Pratt: Denial is a necessary part of living with a history of trauma.

David:Thank you, Dr. Pratt, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful.

Dr. Pratt: I have really enjoyed this chance to listen and talk with everyone.

David: Thank you again, Dr. Pratt and everyone in the audience. I hope you have a pleasant rest of the evening.


Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.


 

APA Reference
Gluck, S. (2007, April 18). DID/MPD: Working Within the Multiple System, HealthyPlace. Retrieved on 2024, December 29 from https://www.healthyplace.com/abuse/transcripts/didmpd-working-within-the-multiple-system

Last Updated: May 10, 2019

Narcissistic Personality Disorder

online conference transcript

Transcript on narcissism, narcissistic personality disorder, NPD, narcissists and victims of narcissists. Sam Vaknin, author of Malignant Self Love.

Dr. Sam Vaknin

Dr. Sam Vaknin: is our guest. He has a Ph.D. in philosophy and is the author of the book Malignant Self Love - Narcissism Revisited. We talked about Narcissist Personality Disorder (NPD), victims of a narcissist, inverted narcissists, and other narcissism topics.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.


David: Good afternoon. I'm David Roberts. I'm the moderator for today's conference. I want to welcome everyone to HealthyPlace.com.

Our topic today is "Narcissistic Personality Disorder". Our guest is Sam Vaknin, who has a Ph.D. in philosophy. Dr. Vaknin is author of the book: "Malignant Self Love - Narcissism Revisited". The book gives an in-depth look at Narcissistic Personality Disorder, NPD. Dr. Vaknin, a self-professed narcissist, calls the book a "documentation of a road of self-discovery".

And, in the end, although he documented everything and realized he has NPD, he's not any healthier for it. "My disorder is here to stay, the prognosis is poor and alarming." You can read more about Dr. Vaknin here. His site, Malignant Self Love, is in the HealthyPlace.com Personality Disorders Community.

I know you are overseas, in Macedonia. Good Evening, Dr. Vaknin, and welcome to HealthyPlace.com. We appreciate you being our guest today. So that everyone knows what we're talking about, can you please define Narcissistic Personality Disorder, NPD, for us and how it differs from someone who may have narcissistic episodes or tendencies?

Dr. Vaknin: Everyone is a narcissist, to varying degrees. Narcissism is a healthy phenomenon. It helps survival. The difference between healthy and pathological narcissism is, indeed, in measure.

Pathological narcissism and its extreme form, NPD, is characterized by extreme lack of empathy. The narcissist regards and treats other people as objects to be exploited. He uses them to obtain narcissistic supply. He believes that he is entitled to special treatment because he harbours these grandiose fantasies about himself. The narcissist is NOT self-aware. His cognition and emotions are distorted.

David: In your book and other writings, you paint a very undesirable picture of a narcissist as someone who lacks empathy, uses others to fulfill their own ego needs, a pathological liar. What kinds of problems does this create for the narcissist and can they be treated at all?

Dr. Vaknin: Narcissism cannot be treated. The side-effects and by-products of narcissism, such as depressive episodes or obsessive-compulsive behaviors can. Psychodynamic therapies have very limited success in treating NPD and cognitive behavioral therapy (CBT) doesn't fare much better. Medication can be used to treat the side-effects I mentioned. The narcissist is the prime and first victim of his own mental constitution. His disorder prevents him from materializing his potential, from having mature, adult relationships and from enjoying life. The narcissist is universally hated or despised, prosecuted and cast out. He pays dearly for what, in essence, is beyond his full control.

David: From an outsider's point of view, the negatives of being a narcissist, the inability to have mature relationships and enjoy life, may sound bad. But does the narcissist him/herself feel bad about that?

Dr. Vaknin: Recent research shows that he does (he is ego-dystonic). He interprets away his destiny (=bad feelings), he invents complex narratives and employs a myriad of defense mechanisms such as intellectualization and rationalization. In short, he lies to himself and to others, projecting "untouchability", emotional immunity and invincibility. However, this is all a facade which cracks when the narcissist is faced with a real-life crisis, as I did.

David: I read through most of your faqs on your site and one of the things that struck me was, it seems the narcissist only suffers relatively short episodes of feeling bad whenever a "life-crisis" comes up, but then recovers relatively quickly. Is that true?

Dr. Vaknin: Yes, absolutely. This is why it is near impossible to have a long-term treatment plan and therapeutic alliance or contract with the narcissist. He simply doesn't stay put long enough. He "recovers" the functioning of his defenses very quickly and devalues the therapist.

Narcissism is a resilient and pernicious phenomenon, deeply ingrained in the psyche of the narcissist, or as they say in DSM land: "all-pervasive". The reason is that narcissism is not merely an agglomeration of defense mechanisms. It is a way of life, a religion, an ideology, a catechism all rolled into one. It is very akin to drug addiction in its psychological dimensions and, indeed, dual diagnoses (narcissism and substance abuse) are very common as is co-morbidity (narcissism with another mental health disorder). Narcissism is also at the root of a few other mental health disorders. This makes it very intractable.

David: Can the narcissist have a meaningful life?

Dr. Vaknin: Frequently Asked Question Number 1... LOL. The narcissist feels that his life is meaningful as long as his self-deception holds. But when a narcissistic injury occurs (following the loss of a major source of narcissistic supply, for instance), the narcissist is faced with the void that is his life: the empty, dark, all consuming black hole that is at the core of his emotional apparatus. Life without emotions is artificial intelligence. No wonder the narcissist compares himself constantly to computers and other automata.

David: We have some audience questions and then we'll continue with our conversation:

Dr. Vaknin: My pleasure.

SAGUI: Have you ever done any kind of psychotherapy?

Dr. Vaknin: Yes, twice. Once as an adolescent and once in jail. Oops! Forgot a third time, after I broke up with my first girlfriend. None of them went anywhere. I co-opted (bribed, bought off) and then devalued one of the three, discussed psychiatry with another (hence "Malignant Self Love") and became the therapist of the third ... LOL.

Very few therapists know the first thing about pathological narcissism and NPD. The disorder has been classified as a separate mental health category only as late as 1980 (DSM III). Freud did some groundbreaking work and so did Kohut and, later Millon and Kernberg. But these were "lab" types and didn't filter down to practitioners. Additionally, the boundary between NPD and other personality disorders (such as Borderline Personality Disorder, Histrionic Personality Disorder, or Antisocial Personality Disorder) all in the infamous Cluster B - is very blurred.

David: How long were you in therapy (total time) and did you get anything positive from it?

Dr. Vaknin: Well, as I said, no. I didn't derive any discernible benefits, except that I was able to label myself, finally. All therapies were short (the longest was six months) and rather erratic. But labeling myself has helped me get to know myself and, so, maybe it wasn't all in vain. One should not confuse, though, self-knowledge with healing. To heal, one must experience insight and it's emotional correlates. KNOWING is not FEELING and there is no healing (transformation) without the latter.

David: Is there a difference between male and female narcissists?

Dr. Vaknin: Not really. This is why I keep using the politically incorrect male voice ("he", "him", etc.). Still, 75% of all diagnosed NPDs (1% of the population) are MALES. Females tend more to Histrionic Personality Disorder (which, in my book, is another form of NPD where the narcissistic supply is sex and the physical).

David: Here are some more audience questions.

Forgetful: What would be the best way to relate to someone with NPD?

Dr. Vaknin: What do you want to achieve? Who is the narcissist? A boss, a lover, your kid, the neighborhood bully?

Forgetful: A friend and a co-worker.

Dr. Vaknin: If you wish to preserve and maintain the relationship, do not criticize or disagree with the narcissist. Provide him or her with ample and recurrent narcissistic supply (adulation, admiration, attention, affirmation, applause). Never give advice unless explicitly asked to and, even then, make it seem like the narcissist found it by himself. Never remind him that he is weak, sick, unknowledgeable, in need of help, or otherwise beholden to someone or something. Do not threaten to abandon him, do not pose conditions, or impose. Do not intrude, or micromanage his life. Stay away until summoned. Be there only when requested. Do not have a full-fledged existence, being, needs, or wishes of your own.

David: How does one recognize a narcissist (and I'm talking about someone who has an untrained eye)?

Dr. Vaknin: FAQ #58 is dedicated to that, and it is a long one. The narcissist is a master of disguise. He is a charmer, a talented actor, a magician and a director of both himself and his milieu. It is very difficult to expose him as such in the first encounter. But here are a few signs:

  1. displays haughty behaviour
  2. has a tendency to humiliate, criticize and belittle others
  3. has a tendency to exaggerate, small, unnecessary lies
  4. has a tendency to fantasize about unlimited success
  5. brags incessantly, to ignore you, not to listen
  6. has a tendency to idealize you much beyond the call of courtship
  7. makes promises which are incommensurate either with the event, or with his ability to fulfill them
  8. has haughty body language

David: But there are also people, as you describe, who are "genuine" in nature. So, I'm assuming that by the time one finds out they are involved with a narcissist, it may be too late to dodge the hurt, if it comes.

Dr. Vaknin: I don't know what you mean by "genuine". Anyone who is "genuinely" like I described is a genuine narcissist. Invariably, you feel something wrong on your first encounter with a narcissist. There is something fake, cheap, not authentic, two dimensional in his behaviour, even in his looks. Everything is bigger than life. If he is polite, then he is aggressively so. His romantic nature will tend to schmaltz. His promises outlandish, his criticism violent and ominous, his generosity inane. Something doesn't fit. But we all want to find the right one, prince charming, the savior. It is sad. It is the fear of our loneliness which drives us into a hell much worse than any solitude.

David: I was referring to the "talented and charming" part of the person. Here's an audience comment and then we have a question someone emailed in.

rainmaker: Sam, I spoke to you over two years ago about my NPD fiance and after evaluating the situation, you advised me to immediately throw in the towel and move on. It took me two years to heed your advice and escape the long shadow of the NPD. You were totally right. NPDs can't change as their emotional wiring harness cannot be accessed by mortals. Your advice is so sound: "Just work on changing yourself and trying to understand why you are drawn to a person with Narcissistic Personality Disorder in the first place." You gave great advice.

Dr. Vaknin: Thank you. I am glad I could be of help.

David: This is an email question from C.G., who says "I am 'in love' with someone that I think may be narcissistic. I want to know what these type of men look for in a mate. I guess I am willing to lose myself in order to have him fall in love with me. I get no feedback whatsoever, even though I know that he does care (I have at least gotten that much out of him verbally) as much as he is capable of. I basically am a 'pleaser' and put the other person first in any type of relationship. I find this to be natural, wanting to make others happy. Does this mean I am an 'Inverted Narcissist'? If so, do we just feed off of each other? And if that is the case, couldn't this actually fulfill both of our wants and needs?"

Dr. Vaknin: Not every pleaser is an inverted narcissist. To "qualify" as an inverted narcissist, one must be willing to self-sacrifice. The inverted narcissist forgoes her own needs and wishes and subjugates them to those of her narcissist. She learns the art of "UN-being". She collapses into a shadow, a marionette, skillfully at the mercy of the whims and pleasures of her puppet master. If you wish to hold on to your narcissist, become his "pusher", his drug dealer. He is addicted to a drug called "narcissistic supply." Give it to him, but remember: drug dealers are interchangeable. Someone may come along with a purer, crystalline version.

vielen: When a narcissist abandons someone, can he erase them totally out of his memory? And does he want to?

Dr. Vaknin: Yes, I did that with my ex-wife. Actually, there are two typical reactions:

  1. One is, to totally erase and delete every shred of a remnant of a shadow of a memory of her and the common life (the more common reaction).
  2. Or as vindictive narcissists do - to stalk, pursue, invade, control, threaten and manipulate the ex.

See the relevant FAQ about "Vindictive Narcissists".

David: Is there a common characteristic, common personality trait, among the victims of narcissists?

Dr. Vaknin: Yes, their submissiveness and eagerness to please. This is because the narcissist becomes their drug, their addiction. Without him, it is a world of black and white. With him, it is a Technicolor show, complete with drama, thrills and frills. So, the inverted narcissist and the victims of narcissists (not all of them inverted narcissists), are attracted to excitement, to the violation of routine, to life itself. They live vicariously, by proxy, through their narcissist.

David: Dr. Vaknin's extensive list of frequently asked questions is here.

luke1116: HELP! Any advice on how to cope with my NPD ex-husband, with whom I share joint custody? He belittles and berates me daily in writing and I'm afraid that he's doing it during his visitation with our daughter.

Dr. Vaknin: He most probably is. But then, this behaviour is not necessarily limited to narcissists ...:o(( Narcissists are paranoids and cowards. If you were to find a way to show him that you are strong and are willing to use your strength, the harassment might stop. Leave it to his imagination what you might do to him. But make clear that you are going to do something about it.

But I must add that narcissists rarely go where they experience frequent or recurrent narcissistic injuries. Ask yourself what have you been doing to provide him with narcissistic supply. Your fear and humiliation give him the feeling of omnipotence. Are you ambivalent about your separation? Are you in pain? Can he see this pain? Are you sorry he left? Can he see that you still love him? Make his encounters with you a source of humiliation and narcissistic injury for HIM!

Jacqui B: What are the lasting effects on adult children of narcissists? Is there any hope for them to break free from their upbringing?

Dr. Vaknin: Yes, of course there is. Only a very small fraction of children of narcissists become narcissists themselves. What rarely goes away, is the pain and the agony of being treated like an object, of being subjected to psychological torture and nefarious mental abuse. This is part of the psychological baggage of every child of every narcissistic parent. Therapy sometimes helps and ameliorates. But the problem is that it is impossible to obtain closure with an narcissistic parent. He, or she, simply will not admit that they did anything wrong. They will deny, rationalize, intellectualize. Project anything, just to accept the bare facts and confront them in a constructive manner together with the hurting child.

Rena: I allowed my father much control over my life. I'm thirty-eight now and realize his narcissism. How do I limit his control without disowning him? Is it too late?

Dr. Vaknin: It is never too late to set oneself free. But liberty always has a price. Sometimes you can make peace with your oppressors, sometimes you can't, and YOU have to let go. It is a tango - you are BOTH engaged in this macabre dance. Stop the music. Set boundaries. Declare independence. Legislate. Fight for your rights. And if he persists, say goodbye.

David: Here's another email question. This is from Jill. Can you please explain how to reason and negotiate with a narcissist, whether it be a serious subject or everyday conversation?

Dr. Vaknin: That's a tough one. The narcissist is autistic. He inhabits in his own universe. In this universe, a unique logic prevails. You have to learn the language and then the meta language and then exercise some. To be more helpful: you offer to him narcissistic supply and he will give you whatever you want. It is that simple. Make it look like all the initiative is his, all the ideas are his, all the control is his, all the decisions are his. His, him, he - the three keywords. Not you, HE. Manipulate him. Example: if you want him to learn something new (of which he has no idea), ask him to explain it to you (put him in the position of the teacher, the guru). If you want him to attend marital counseling, tell him you need help and you need HIM to help you.

campbet: When dealing with a person with Narcissistic Personality Disorder, what tactics can be used to make this person take responsibility for their actions?

Dr. Vaknin: The narcissist has alloplastic defenses. What this means is that he tends to blame others, inanimate objects and people, for his behaviour. "You made me do it" is a common sentence or, "What could I do? I couldn't help it under the circumstances." He is superstitious to some extent and paranoid ("The world/luck is against me").

Again, the key is simple: the narcissist is a vending machine. Input the coins of narcissistic supply and press the right button ("responsibility"). Example: the narcissist made a mistake. You want him to acknowledge his responsibility. Make the mistake GRAND, unprecedented, unique, amazing, stunning, and the narcissist will immediately "adopt" it. Narcissistic supply can be both negative or positive. To write the masterpiece of all time is the exact emotional equivalent of writing the flop of all time. To be a Hitler is identical to being Jesus. The narcissist has no moral or emotional preference between these two. He just wants to be considered the unique-st.

David: What you're saying is, much like a child, any attention, positive or negative, is good for the narcissist.

Dr. Vaknin: Yes, precisely. The narcissist's personality has frozen in time in his early childhood or early adolescence. He is an emotional fossil. Unable to grow, unable to interact, caught in the amber of his own delusions and rage.

Pollyanna: Dr. Vaknin, in your opinion, is it possible for a Somatic/physical narcissist to ever be monogamous?

Dr. Vaknin: A somatic narcissist derives his narcissistic supply from his body, its functioning, his health, his looks, but above all, from continuous sexual interactions (in which he manifests sexual prowess). It is no good to limit one's sexual interactions to one person. One person is not a representative sample and the narcissist is on a constant polling mission. He collects the opinions of his sexual partners and creates a composite from which he derives supply. Somatic narcissists are very unlikely to be monogamous, although they are very likely to maintain emotional attachment to one preferred woman (man) and regard all other sexual partners as objects. The somatic narcissist is a misogynist. He regards women as tools. The female somatic narcissist (more commonly known as Histrionic) is a man hater. The narcissist maintains a dichotomous picture of "holy-whore". The significant other is holy (and, therefore, should not be contaminated by sexual intercourse). All other women are whores and sex with them tends to acquire sado-maso hues.

David: Judging from the questions, I would say many of the people in the audience are "victims" of narcissists. So, I think here, it's important to point out that getting help for yourself is important.

Dr. Vaknin: Professional help is essential! You do not have to stay in an abusive relationship or a relationship that is harmful to you psychologically or physically. Victims of narcissists often suffer from Post Traumatic Stress Disorder. PTSD is treatable successfully and as David said, stay out of abusive relationships.

David: Here's an audience comment, then another question:

Pris: My NPD husband has been forced to grow because he lost his toy when we discovered my Dissociative Identity Disorder and ritual abuse history.

David: This email question comes from Herb Janssen. "People that I know have narcissistic traits that include lack of empathy, need for excessive personal attention, use of lies to exaggerate their accomplishments, inability to appreciate the needs of others, etc. These run counter to the teachings of most major religions. Based on this, I question the ability of the narcissistic individual to really accept the religious teachings they profess. Is there any information in the literature on the topic of narcissism and religion? Do these people use religion as an escape (I'm okay, I'm a religious person.) or do they really strive to meet the religious teachings?

Dr. Vaknin: Narcissists use anything they can lay their hands on in the pursuit of narcissistic supply. If God, creed, church, faith, institutionalized religion can provide them with narcissistic supply, they will become devout. They will abandon religion if it can't. They abuse religion as they abuse everything else: political office, positions of authority (there's a FAQ dedicated to this) their life circumstances, access to information, other people. They are predatory because they need the supply, not because they are malevolent (most of them are not). They are not evil (as Scott Peck would have it). They are addicts, simple. And religion, as Marx taught us, is a great source of opium. Unfortunately, there are no published texts I am aware of regarding narcissism and religion (with the exception of texts about religious cults and sects).

David: What causes someone to be a narcissist, have Narcissistic Personality Disorder. It is a learned behavior or genetic in nature?

Dr. Vaknin: Dr. Anthony Benis believes that it is of genetic origin. Being the hardware that we are, it is both possible and plausible. It is a fact that not all abused children become narcissists. Also, recent research has demonstrated the incredible plasticity of the brain. But there is insufficient data to support this theory. There are mountain ridges of data regarding the connection between childhood abuse, or bad parenting, or abuse by peers, and the development of narcissism. Pathological narcissism is an escapist reaction to the unpleasant facts of life. It is adaptive. It aids survival. It works. That is why it is difficult to get rid of it. It was functional in a critical period of one's development. I dedicated many FAQs to these questions (especially 64 and 15).

David: Here's a related question on the "passing on of narcissism."

lglritr: Dr. Vaknin, I'm in the process of a divorce from a narcissist who is the product of two extreme narcissist parents (one of which recently passed away). How do you protect an eleven year old child from their influence? I'm worried that I'm beginning to see an onset of some of the traits.

Dr. Vaknin: Nothing to do except serve as a counter-example. Show your kid that there is an alternative. That not all people are so self-centered and merciless in their pursuit of gratification. Be the kind of person you want him to be. Give him a choice. But do not choose for him because this is what narcissists do ..:o)

BlackAngel: My last relationship was with a narcissist. He was manipulating and controlling, often times without words, just a glance. Is this characteristic of NPDs? It is taking me a long time to regain my sense of self, and nature back. I feel that he drained me dry of everything good in me. Is this a natural feeling to have?

Dr. Vaknin: Yes and yes. Narcissists manipulate because they are control freaks and they are control freaks because they lost control early in life with devastating consequences. They manipulate verbally and behaviourally, and body language is an important weapon in their arsenal of communication. And, yes, your reaction is absolutely normal. You are sad (depressed?). You have gone through the trauma of being a Prisoner Of War. It was war, you know, not a relationship. You were fighting for your life and identity. For your sanity and his. For your relationship as you wanted it to be. So, now you have depression and PTSD. Get help. These two things are treatable, unlike narcissism.

David: I'm wondering how many people in the audience are repeat "victims" of narcissists? I bring this up because we held a conference about sexual abuse dealing with how sexually abused people leave themselves open to further abuse if they don't get professional help. I'm guessing, Dr. Vaknin, that also holds true for victims of narcissists.

Dr. Vaknin: Most victims I know have spent all their life interacting with one narcissist after another. Abused people seem to unconsciously choose abuse in the hope of solving old conflicts and salving old wounds.

SAGUI: Is there any report of a narcissist who, after a life crisis, cured completely?

Dr. Vaknin: Yes, a few in the literature. It was even suggested (1996) that there are two forms of narcissism: transient and permanent. I also think that we should distinguish between: reactive narcissism, narcissistic episode, NPD and narcissistic traits (or overlay).

David: Did the awareness of your Narcissistic Personality Disorder change anything about your "real self"?

Dr. Vaknin: No, I have no access to my real self. I know as much as anyone about narcissism and it helped me none. To heal one must undergo an emotional transformation, to reach the point of the "unbearable being", to want to change fervently. I have only my brain. This is one thing it is not good at: healing. In this sense, I am only a quarter human, an emotional quadriplegic. I had high hopes. I really wanted my brain to conquer my disorder. I studied. I wrote. I read. I fought with the only weapons I had and the only way I knew how. But it was the wrong war. I never got to meet the enemy.

David: It's been a fast two hours. Thank you, Dr. Vaknin for coming and staying so long to answer questions. We appreciate it. And thank you to everyone in the audience for coming and participating. I hope you found it helpful.

Jacqui B: Please, thank Sam on my behalf for his valuable time and care in answering all our questions. Thanks!

vielen: Just wanted to thank you, David and Dr. Vaknin for a very enlightening discussion.

Dr. Vaknin: I want to thank all you for allowing me to talk about this disorder. Thanks for the compliments, the questions - and to the hosts!

SAGUI: It was a pleasure being your Narcissistic supply!!

Dr. Vaknin: LOL

David: Have a good day everyone.

Dr. Vaknin: And from me!

David: Here's the link to the HealthyPlace.com Personality Disorders Community.

You can visit Dr. Vaknin's site, Malignant Self Love and you can purchase his book: Malignant Self Love - Narcissism Revisited.


Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

APA Reference
Vaknin, S. (2007, April 18). Narcissistic Personality Disorder, HealthyPlace. Retrieved on 2024, December 29 from https://www.healthyplace.com/personality-disorders/transcripts/narcissistic-personality-disorder

Last Updated: July 9, 2019

Narcissism in the Workplace

Online Conference Transcript

About narcissism in the workplace, including how to recognize a narcissist, what personality types can work with a narcissist and how to cope with a narcissistic employer.

Dr. Sam Vaknin

Our guest, Dr. Sam Vaknin, has a Ph.D. in philosophy and is the author of the book Malignant Self Love - Narcissism Revisited. We discussed various aspects of narcissism in the workplace, including how to recognize a narcissist, what personality types can work with a narcissist and how to cope with a narcissistic employer.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.


David: Good Evening. I hope your day went well. Welcome to HealthyPlace.com and our chat conference on "Narcissism in the Workplace." I'm David Roberts, the moderator of tonight's chat. Some of the topics we'll be discussing include: How to cope with a narcissistic boss, co-worker, supplier, colleague, partner, competitor, manager, or employee. And when is it time to toss in the towel and leave that troublesome job?

Our guest is Dr. Sam Vaknin, author of Malignant Self Love: Narcissism Revisited and an authority on the subject of narcissism. You can read more about Dr. Vaknin by clicking on the link.

Just to clarify, Dr. Vaknin is not a therapist or medical doctor of any sort. However, he is an expert on the subject of narcissism and a self-proclaimed narcissist. Good Evening Dr. Vaknin and welcome to HealthyPlace.com. Just so we are all clear on the subject, can you give us a brief overview of what narcissism is?

Dr. Vaknin: Great to be here again. Thank you for having me and for the kind words. Hello, everyone.

Narcissists are driven by the need to uphold and maintain a false self. They use the False Self to garner narcissistic supply which is any kind of attention adulation, admiration, or even notoriety and infamy.

David: How does one recognize a narcissist?

Dr. Vaknin: It is close to impossible and that is the secret of their astounding success. Narcissists are good actors. They are adept at charming others, persuading them, manipulating them, or otherwise influencing them to do their bidding. The narcissist's sense of self-worth is unstable (labile) so, the narcissist relies on input from other people to regulate his self-esteem and self-confidence. He focuses on potential sources of supply and engulfs them with focused attention and simulated deep emotions. Only in a later encounter, as time passes and the number of interactions grows, is it possible to tell that someone is a narcissist. Narcissists are preoccupied with grandiose fantasies unrealistic plans. They are poor judges of reality. They are bullies and often resort to verbal and emotional abuse. They exploit people and then discard them. They have no empathy and regard their co-workers as mere instruments objects, tools, and sources of adulation, affirmation, or potential benefits.

David: So, in the beginning, you are saying they will get on your good side by charming you and pretending to be interested in you and what you're doing. Later, what kind of behaviors should a person expect from the: (1) narcissistic boss and (2) colleague? And I'm assuming here that the behaviors for the two might be different.

Dr. Vaknin: Workplace narcissists seethe with anger and resentment. The gap between reality and their grandiose flights of fancy (the "grandiosity gap") is so great that they develop persecutory delusions, resentment, and rage. They are also extremely and pathologically envious, seeking to destroy what they perceive to be the sources of their constant frustration: a popular co-worker, a successful boss, a qualified or skilled employee. Narcissists at work crave constant attention and will go to great lengths to secure it - including by "engineering" situations that place them at the center. They are immature, constantly nagging and complaining, finding fault with everyone and everything, Cassandras who constantly predict impending doom. They are intrusive and invasive. They firmly believe in their own omnipotence and omniscience. They feel entitled to special treatment and are convinced that they are above Man-made laws, including the rules of their place of employment. They are very disruptive, poor team members, can rarely collaborate with others without being cantankerous and quarrelsome. They are control freaks and feel the compulsive and irresistible urge to interfere in everything to micromanage and overrule others. All in all, a highly unpleasant experience.

David: If you work with or under a narcissist, it sounds like your work life might be a living hell.

Dr. Vaknin: You would never forget it. It is traumatic and very likely to end in actual bullying and stalking behaviors. Many workers end up with PTSD - Post Traumatic Stress Syndrome. Others quit, or even relocate.

David: What kind of individual, personality-wise, is best suited to work with a narcissist co-worker or boss?

Dr. Vaknin: Certain pathological personalities - for instance, someone with a Dependent Personality Disorder - or an Inverted Narcissist may get along just fine. A submissive person whose expectations are limited, moods are subdued and willingness to absorb abuse is extended would survive with a narcissist, or even thrive in such an environment. But the vast majority of workers are likely to suffer ill-health effects, clash with the narcissist, or end up being sacked, reassigned, relocated, or demoted. The narcissistic bully very often gets his way: He gets promoted, the ideas he "adopted" become corporate policy, his misdeeds are overlooked, his misbehavior tolerated. This is partly because, as I said earlier, narcissists are excellent liars with considerable thespian skills - and partly because no one wants to mess around with a thug, even if his thuggery is limited to words and gestures.

David: We have a lot of audience questions, Dr. Vaknin. Let's get to a few and then I have a few more questions to ask you. Here's the first one:

AMichael: How common is narcissism within the population?

Dr. Vaknin: According to orthodoxy, between 0.7%-1% of the adult population suffer from Narcissistic Personality Disorder. This figure is an underestimate. Pathological narcissism is under-reported because, by definition, few narcissists admit that anything is wrong with them and that they may be the source of the constant problem in their life and the lives of their nearest or dearest. Narcissists resort to therapy only in the wake of a harrowing life crisis. They have alloplastic defenses - they tend to blame the world, their boss, society, God, their spouse for their misfortune and failures. Last, but not least, psychotherapists regard narcissists as "difficult" patients with a "severe" personality disorder - or, put plainly, lots of work with little reward. Narcissists, Paranoiacs and Psychotherapists Narcissistic Personality Disorder (NPD) At a Glance.

Doria57: Is there any way to get along with these type of people at work?

Dr. Vaknin: Here are a few useful guidelines:

  1. Never disagree with the narcissist or contradict him.
  2. Never offer him any intimacy. You are not his equal and an offer of intimacy insultingly implies that you are.
  3. Look awed by whatever attribute matters to him (for instance: by his professional achievements or by his good looks, or by his success with women and so on).
  4. Never remind him of life outside his bubble and if you do, connect it somehow to his sense of grandiosity. Do not make any comment, which might directly or indirectly impinge on his self-image, omnipotence, judgment, omniscience, skills, capabilities, professional record, or even omnipresence.
  5. Bad sentences start with: "I think you overlooked & made a mistake here & you don't know & do you know & you were not here yesterday so & you cannot & you should, etc. These are perceived as a rude imposition. Narcissists react very badly to restrictions placed on their freedom.

Linda3003: My husband is employed by a very large university, in spite of "outstanding" appraisals, many stolen ideas, marked increase in customer satisfaction and being very professional, he was recently fired. His boss did not like the accolades my husband was receiving, etc. How does one combat the defamation?

Dr. Vaknin: Depends on your resources and your ability to accept recurrent interim defeats. Narcissistic bosses are very tenacious and resourceful. They are pillars of the community, usually widely respected and believed. They have at their disposal the entire wherewithal of the organization. People say "where there's fire, there's smoke". "If he was fired, there must have been a good reason for it", "Why couldn't he simply get along? He must be egocentric, a bad team player." And so on. It is an uphill battle. My advice to you is to team up with an anti-bullying group or to have an attorney look into wrongful dismissal charges.

freedom03: I would like to know if the narcissist is aware of what they are doing?

Dr. Vaknin: Aware, cunning, premeditated, and, sometimes, even enjoying every bit of it. But it is not malice that drives them. They believe in their own destiny, superiority, entitlement, exemption from laws promulgated by mere mortals. The narcissist regards himself as one would an expensive present, a gift to his company, to his family, to his neighbours, to his colleagues, to his country. Resistance calls for strenuous measures. Disagreement with the narcissist is bound to be the outcome of ignorance or obstructionism. Criticism is malevolent and ill-founded. The narcissist trusts that he has the full moral justification to battle his foes. To his mind, the world is a hostile place, full of Lilliputians who seek to shackle his genius, foresight, and natural advantages. They aim to harness and castrate - and they deserve his ire and the ensuing punishment he metes out to them in his infinite wisdom. It is a crusade against the injustice of not recognizing the narcissist's true place in this world - at the pinnacle.

David: Dr. Vaknin, earlier you mention that the narcissist would act empathetic to draw in his prey, so to speak. In light of that, here's the next question:

martha j: Can this person genuinely develop authentic empathy skills?

Dr. Vaknin: No, he cannot. Narcissists lack the basic machinery of putting themselves in other people's shoes. They react with fury and denial when confronted with the fact that persons in their environments are individual entities with their own idiosyncratic and specific needs, preferences, choices, fears, hopes, and expectations. This, the refusal to grant autonomy, is at the core of abuse, whether on the domestic front or at the workplace. To the narcissist, others are mere extensions, instruments of gratification, sources of narcissistic supply. And nothing more than that.

delaware1974: With so many people afflicted with this - why are we making it sound like a death sentence? All of us still need to move on with our lives ...are we supposed to give up and accept because it's hard? We spend a lot of time talking about the negative or "escaping" the narcissist, "surviving" the narcissist, what about those of us that want to help them and NOT give up on them? Are there LIVE face-to-face help groups? Hope?

Dr. Vaknin: It is possible to live with the narcissist, as I made clear earlier. It requires certain behavioral modifications and a willingness to accept the narcissist largely as he is. These may be of interest:

David: For many people, Dr. Vaknin, if you are in a situation working with a narcissist or under a narcissist, they can't just pick up and leave their job. What is the best way for them to cope without "kissing" up to this person and being always vigilant about what you say and how you say it? or is that the only way to survive?

Dr. Vaknin: It depends whether the narcissistic bully represents the corporate culture of the workplace - or is an isolated case attributable to a quirky nature or a personality disorder. Alas, very often, abusive behaviors in one's office or shop floor are merely the epitome of all-pervasive wrongdoing which permeates the entire hierarchy, from top management to the bottom rung of employment. Bullies rarely dare to express their tendencies in isolation and in defiance of the prevailing ethos. Or, if they do run against the grain of their place of employment, they lose their jobs. Typically, narcissists join already narcissistic firms and mesh well with a toxic workplace, a poisonous atmosphere, and abusive management. If one is not willing to succumb to the mores and (lack of) ethics of the workplace, there is little one can do. Surprisingly few countries (Sweden, the United Kingdom, to some extent) outlaw workplace abuse specifically. Whistleblowers and "troublemakers" are frowned upon and are not protected by any institutions. It is a dismal landscape. The victim would do well to simply resign and move on, sad as this may be. As awareness of the phenomenon increases and laws take effect, hopefully, this will change and bullied and abused workers will find effective ways to cope with mistreatment.

TimeToFly: What typically happens to a narcissist when they lose their position of authority or their job. How do they react to that? My narcissist ex-husband recently lost his job. He will not say what happened exactly, typical. But since then he has been on a rampage to destroy me. It was right after the loss of his previous job that he left me and our children 4 years ago. He had been the manager of engineering and was first demoted, and then finally left the company. I never did get the story. He has just remarried, but his new life somehow has not distracted him from his obsession with destroying mine.

Dr. Vaknin: Being demoted or losing one's job is a narcissistic injury (or wound). The entire edifice of the Narcissistic Personality Disorder is an elaborate and multi-layered reaction to past narcissistic injuries. A gap opens between the way the narcissistic imagines himself to be (grandiosity) and reality (unemployed, humiliated, discarded, unneeded). The narcissist strives to bridge the grandiosity gap but sometimes it is simply to abysmal to deny or ignore. So, some narcissists go through decompensation - their defense mechanisms crumble. They may even experience brief psychotic episodes. They become dysfunctional. The narcissists redouble their efforts to obtain narcissistic supply by any means - sex, exercise, attention-seeking behaviors. Yet others withdraw altogether to "lick their wounds" (schizoid posture). What is common to all these narcissists is the ominous feeling that they are losing control (and maybe even losing it). In a desparate effort to re-exert control, the narcissist becomes abusive. Sometimes abuse is about controlling the victim. Others seek "easy targets" - lonely women to "conquer" or simple tasks to accomplish, or no-brainers, or to compete against weak opponents with a guaranteed result.

For more on these behaviors:

David: If you are interested in purchasing Dr. Vaknin's excellent and very thorough book on narcissism, Malignant Self Love: Narcissism Revisited, click on the link.

jenmosaic: What causes NPD?

Dr. Vaknin: No one knows. The accepted wisdom is that NPD is tan adaptative reaction to early childhood or early adolescence trauma and abuse. There are many forms of abuse. The more familiar ones - verbal, emotional, psychological, physical, sexual - of course yield psychopathologies. But are far more subtle and more insidious forms of mistreatment. Doting, smothering, ignoring personal boundaries, treating someone as an extension or a wish-fulfillment machine, spoiling, emotional blackmail, an ambience of paranoia or intimidation ("gaslighting") - have as long lasting effects as the "classic" varieties of abuse. Still, there is always the possibility of a hereditary component More about the roots of narcissism here

David: Here are a couple of audience comments about what's been said tonight:

Doria57: No one ever wants to form an anti-bullying group, they are afraid.

martha j: The descriptions of the narcissistic boss --Isn't this the unfortunate all American definition of the "successful" boss?

Dr. Vaknin: I'd like to respond to that last comment. Mental health disorders - and especially personality disorders - are not divorced from the twin contexts of culture and society. Western society and culture are narcissistic. Disparate scholars and thinkers - Christopher Lasch on the one hand and Theodore Millon on the other hand - have concluded as much. Narcissistic behaviors - now labeled "misconduct" - have long been normative. The basically narcissistic traits of individualism competitiveness, unbridled ambition - are the founding stones of certain versions of capitalism. Thus, certain forms of abuse and bullying actually constitute an integral part of the folklore of corporate America. Narcissistic bosses were idolized. As long as this is the case, workplace abuse would be hard to overcome. More here:

David: Thank you, Dr. Vaknin, for being our guest this evening and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com


Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

APA Reference
Vaknin, S. (2007, April 18). Narcissism in the Workplace, HealthyPlace. Retrieved on 2024, December 29 from https://www.healthyplace.com/personality-disorders/transcripts/narcissism-in-the-workplace

Last Updated: July 9, 2019

The Development and Treatment of Personality Disorders

Online Conference Transcript

Dr. Joni Mihura

What is a personality disorder? How are different personality disorders diagnosed and what does the treatment of personality disorders consist of?

Our guest, Dr. Joni Mihura, a licensed psychologist and an assistant professor of psychology joined us to discuss why they develop, common traits among people who have personality disorders (awful time adjusting, self-esteem, and depressive problems, feeling of rejection and abandonment, unstable sense of themselves, unstable feelings, unstable identity, distorted perceptions of what is happening, feel abandoned, relationships may be poor, acting out behaviors), symptoms of various personality disorders (audience members had a lot of questions about Borderline Personality Disorder, BPD), general treatment guidelines and the big question: When it comes to the treatment of people with personality disorders, what are the chances of significant improvement?

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.


David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "The Development and Treatment of Personality Disorders." Our guest is Dr. Joni Mihura, a licensed psychologist and an assistant professor at the University of Toledo, where she teaches psychology courses.

Her post-doc training consisted of specializing in women's trauma and psychological assessment. Dr. Mihura's current specialties are psychodynamic therapy and personality assessment. Besides teaching, she has a part-time private practice and she just received an award as a national American Psychoanalytic Association Fellow.

Good evening, Dr. Mihura, and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Just so everyone knows where you are coming from, can you please explain "psychodynamic therapy" to us in layman's terms?

Dr. Mihura: Good evening to you too, David. I'm glad to be here tonight. You could say that psychodynamic therapy addresses the fears and maladaptive coping that people have in response to their needs.

David: Thank you. Now onto our topic. What is a personality disorder?

Dr. Mihura: By the DSM-IV (the diagnostic manual), a personality disorder is an inflexible, persistent pattern of inner experience or behavior that leads to significant distress or dysfunction. The 'significant distress or dysfunction' is what makes it a 'disorder.'

David: When you say "inner experience or behavior," what does that mean?

Dr. Mihura: Basically, thoughts and feelings make up the inner experience. The thoughts can include words or images.

David: So, you're saying these problems really create a problem in allowing the person to function "normally"?

Dr. Mihura: Yes, you're right. In allowing the person to function adaptively and to have good well-being.

David: What causes someone to develop a personality disorder?

Dr. Mihura: There are many ideas on that, but they basically could be summarized as contributions from genetics and environment. There is evidence that personality is somewhat genetically related. And our environment--our interactions with other people, trauma, the general adaptiveness and type of our environment growing up. So it is both genetics and environment.

That is a global answer, the particulars also depend on the disorder. We need an environment, too, that is adaptive for our human needs like safety and attachment to caregivers.

David: - Here are all the different types of personality disorders: Personality Disorders includes: Antisocial Personality Disorder, Avoidant Personality Disorder, Borderline Personality Disorder (BPD), Dependent Personality Disorder, Histrionic Personality Disorder, Narcissistic Personality Disorder, Obsessive-Compulsive Personality Disorder, Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypal Personality Disorder.

I know that each personality disorder has its own particular traits, but are there common traits among people who have personality disorders?

Dr. Mihura: That's a good question. Mainly, there are commonalities between clusters of personality disorders. The basic commonality they share is the general description that I gave. Concerning the commonalities between groups of personality disorders, for example, schizoid, schizotypal, and paranoid are considered in the 'odd or eccentric' group. They often don't have close relationships, and may not want them.

David: How about when it comes to taking responsibility for their own lives and feelings? Is that another commonality?

Dr. Mihura: Yes, there is something very related to that concerning the way that they see their problems. The types of behaviors they show are usually not what they consider to be the problem. They may, however, take responsibility for their lives in many other ways. Like, the obsessive-compulsive may work a lot and be hyper-concerned with responsibility, but this person's relationships may be poor because they do not take responsibility for the lack of emotional closeness that they may show.

David: How do you evaluate a person for a personality disorder?

Dr. Mihura: Evaluating a person for a personality disorder is often more difficult than other disorders, like depression, and this is very related to the fact that they do not usually see their behaviors as being the problem, so they may not report the behaviors a psychologist considers to be part of their personality disorder to be 'the problem.'

Largely, a clinician will use the criteria in the DSM-IV manual, as they would for any other disorder, but often you will have to ask them more directly about these things. And you may need to observe over time or get information from other respondents. For example, someone with an antisocial personality is not that likely to want to tell you about their criminal activity.

David: That I can understand :) On the subject of diagnosis, here's an audience question, Dr. Mihura:

moonNstars: Is this a disorder that can be diagnosed with a single visit to a doctor?

Dr. Mihura: Sometimes, yes, it can be. Often, clinicians will have enough information to diagnose on the first visit, but not always. I'm sorry to give the 'it depends' answer, but I wanted to say that it can be diagnosed in one visit. Just not always.

David: What about treatment of personality disorders? I have heard that most people with personality disorders of any type have a poor prognosis; a poor chance of getting significantly better, even with therapy. Is that true?

Dr. Mihura: That is a good question, and you are right about the difficulty with treatment, but the amount of difficulty also does depend on the disorder. For example, many people with borderline personality disorder can get much better with treatment, but it takes a long time. The good news is that it can get better, which has been shown by research.

David: In general, what types of treatments are available?

Dr. Mihura: People often use an eclectic approach to treatment, which means several different methods are used. For example, cognitive-behavioral components can help people monitor their thoughts and notice when they are starting to get very angry. Social skills training can be used for those people who have significant interpersonal problems, and is used for problems like borderline or avoidant personality disorder. Often, people will use what is called a 'psychodynamically informed' approach, where you try to understand why the person might be feeling and acting as they are now, and what to do about it. Often, a person will have a difficult time with dynamic therapy initially if they have a personality disorder, but it can inform treatment throughout.

David: And when you say "a long time" to get better with treatment, are you saying 3-6 months or years of constant, intensive therapy?

Dr. Mihura: I am saying that it may be as long as two years. However, this depends on what your goal is. If it is to significantly change the personality, it is that long or longer. To address crises or for supportive therapy, it can be much shorter until the person stabilizes. For example, a person with narcissistic personality disorder may suffer a loss and have an awful time adjusting, with self-esteem and depressive problems. Therapy can be focused on supporting the person through their loss in an empathic manner that will help the person's self-esteem recover, and help them grieve their loss without major depressive problems.

David: We have many audience questions, let's get to them:

ladyofthelake: Why is it that different members of the same family living with similar genetics and heredity develop different disorders?

Dr. Mihura: It is the same reason that people with the same genetics also don't look exactly like each other. There are many combinations of genes that can result. Also, there are environmental factors, like how the person is raised and the events that happen in their lives.

lostsoul2: The feeling of rejection and abandonment is really hurting me and I can't get over those negative feelings. Can you tell me how I can "stop" this or if it can be stopped?

Dr. Mihura: Often people can use a cognitive behavioral approach for this, which asks you what are the underlying beliefs and what evidence do you have for them. For example, sometimes people believe that they are not lovable or not loving people, and this is what makes them feel so bad and like it will last forever. But, if that is your belief, you need to challenge it.

ladyw5horses: My 16 year old daughter has been diagnosed as BPD (borderline personality disorder). I am not sure of how to handle her. We talk, she tells me how she feels... I'm not sure about what BPD means.

Dr. Mihura: It does sound like you will need outside assistance with a professional. It can be very difficult. It sounds like you are trying. People with BPD have a very unstable sense of themselves, unstable feelings, unstable identity. Often their emotions overwhelm their ability to take perspective, and they feel caught up in any one moment. They may have distorted perceptions of what is happening and may easily feel abandoned, like they are being attacked, and/or being cruelly rejected. It is a painful experience. At any one time, it is difficult for them to see the whole person, the whole situation, especially in close emotional relationships. But this disorder has been shown to be responsive to treatment. It can take some time, (so can finding a professional she can make a good alliance with) but it can be helped by treatment.

ladyw5horses: Some of my daughter's problems are similar but are compounded by problems in school, relationships with peers, etc. How can I help my daughter? A psychiatrist told me that I could not affect her, just offer suggestions when she asked me my opinion.

Dr. Mihura: I don't know if you 'could not affect her,' but perhaps she or he was saying that you cannot completely change the situation. You just need to be there, open for her emotionally, letting her know you aren't intruding but are there as a strong emotional source.

David: ladyw5horses, we have an excellent site on Borderline Personality Disorder in the HealthyPlace.com Personality Disorders Community. It's called "Life at the Border."

If you haven't been on the main HealthyPlace.com site yet, I invite you to take a look. There's over 9000 pages of content.

Here's the link to the HealthyPlace.com Personality Disorders Community. You can click on this link and sign up for the mail list at the side of the page, so you can keep up with events like this.

Here's the next question:

SuzyR: Is it at all possible for a person with a personality disorder to 'just decide' to get better?

Dr. Mihura: I'm not completely sure of your question. If you are asking if one can 'just decide' to get better and everything will markedly change, that is not likely. But 'just deciding to get better,' could be rephrased by saying that one could decide 'to change.' And then one can make progress towards that change by identifying the problems and the methods and ways to address them.

terriej: How much success have you had with treatment of PPD (Paranoid Personality Disorder)? If they are suspicious of everything and will not accept blame or dismiss the idea of having the slightest problem, it seems that the efforts would be in vain

Dr. Mihura: You are very right in the sense that PPD is a very difficult problem to treat. Part of the initial problem is that the person is not likely to be present for therapy on their own accord, because they have such a lack of trust and expect malevolent intent and actions from others. And therapists are 'others.' I have treated PPD in an inpatient setting, but not in an outpatient basis. You are right, it is very difficult. In treating PPD, it takes a long time to build trust and address the anger.

mj679: Do you find that behavioral methods or medications are more successful in treating personality disorders, or is some combination of both best?

Dr. Mihura: Those methods have been effective with certain disorders and symptoms of the disorder. For example, people with Schizotypal Personality Disorder can sometimes be helped with a low-dose anti-psychotic. For people with borderline personality disorder, sometimes different combinations of medications are used to address the problematic symptoms, like labile mood or transient psychotic symptoms. The issue is that the personality disorders are treated by different methods depending on the disorder, and also, that some people within personality disorders may use some therapies better or have different types of predominant symptoms to address.

David: Here's the next audience question:

C.U.: Is it rare for me to see my acting out behaviors as a problem for others but not for myself?

Dr. Mihura: To not see one's acting out behaviors as a problem for themselves is common. I'm not sure whether you mean 'a problem for others' as in 'that is their problem' or you are concerned that it might be a problem for others. That is a complicated question, either way because sometimes people who have acting out problems may see it not as a problem for others at the time, but at other times, they can see that it was a problem for others. Often people with acting out problems may think that it is someone else's problem, not theirs, as they can't see the problems that arise from their behavior, yet someone is telling them that there are problems. So it must be 'their problem.'

seeking peace: Please advise me on where to go for help. My therapist and several clinics have refused to help. I am bipolar with psychosis. I had therapy for years and was recently diagnosed with BPD and have no more services.

Dr. Mihura: It depends on the specifics of why they refuse to help. I am certainly not familiar with that happening. If it is because of financial problems, community mental health centers should be able to help because they will treat those people with severe disorders, and bipolar with psychosis would fit this category.

ladyofthelake: How difficult is it to get a person with a personality disorder to realize they have a disorder and that they may need help?

Dr. Mihura: It often takes a meaningful event in their lives to bring them to therapy. And the 'distress or dysfunction' part of the disorder is key here. Often, it is something negative that happened that is very meaningful in their lives, like a relationship or their job, and either it was a highly significant thing, and/or it has happened over and over again. The events must hold significance to the person, and/or the distress has gotten to where the person feels they have tried everything possible and nothing has helped.

I am speaking, by the way, about someone who is having difficulty acknowledging a problem and seeking treatment. Some people more easily will seek therapy, but for most people, it is still a difficult decision. Sometimes people will seek treatment to relieve distress, and often that will bring them to therapy, but for those who have trouble trusting, that is a challenge.

moonNstars: When you have two disorders that are somewhat similar, for example Bipolar and BPD, which one is treated first, or can they be treated together?

Dr. Mihura: They can be treated together, but are treated with different methods (although one may also help the other). For bipolar disorder, it is the general consensus and based on research, that this needs to be treated with bipolar medications, and the person needs to stay on that medication so they will not relapse. The BPD can be helped with medication, but it is recommended the person seek psychotherapy also. Additionally, treating bipolar disorder will help the BPD symptoms not be as unstable (mood swings, for example).

Any approach that helps the person address their stress/anxiety points, whether internal or external sources, can help reduce the occurrence of the symptoms of a disorder. So, the psychotherapy could also help the person learn how to notice when their mood is shifting and how to modulate it, and when to increase their meds, but the bipolar part does need the medication. So, yes, they can be treated at the same time in one's life.

David: For those in the audience, you can read more about Bipolar Disorder and Borderline Personality Disorder, as well as all psychological disorders, here.

cathygo: Dr. Mihura, I have a very close friend who I know has BPD, but his Dr's will not recognize it. He uses prescription drugs, is a cutter, and he has a little boy who is being exposed to this behavior and a wife who thinks he's just a drug addict. What can I do to help him?

Dr. Mihura: That sounds like a very tough situation for you to be in. I am not sure exactly what you mean by his doctor will not recognize it. If your friend recognizes the problems, he can tell his doctor what the problems are. He will need to tell his doctor what his symptoms are, the ones you refer to as BPD. If the doctor still will not address them, then he should seek out the help of someone else. I would be sure that it is the doctor that is not recognizing them first and that your friend has talked about these problems.

It sounds like you care very much about your friend. As a note, I can only give feedback based on little information here, but I would try not to feel too much responsibility. Sometimes, one can feel very caught up in a person's life and problems when they have borderline features. Sometimes a spouse, for example, can describe these behaviors to a doctor but it is up to the patient what they want to do. Good luck in whatever you do, and to your friend and his family.

David: I have one question. Can personality disorders be diagnosed in young children and adolescents?

Dr. Mihura: Yes, they can, although this is less common. The patterns of behavior and problems need to be problematic and enduring, however. For example, sometimes adolescents may have what look like borderline features, in problems with identity and some anger control, but it may change over time with maturation. Sometimes, as in adults too, the symptoms may be more confined to an 'Axis I' disorder, like emerging bipolar in an adolescent that looks like the anger, depression, liability of a borderline personality, but it is due to an 'episodic' disorder, not a long-lasting pattern as in a personality disorder.

David: Thank you, Dr. Mihura, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com. You will always find people in the chatrooms and interacting with various sites. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com/

Thank you again, Dr. Mihura, for coming tonight and for staying late to answer everyone's questions. You were an excellent guest and we appreciate your coming here.

Dr. Mihura: You're very welcome, David. And thank you for having me here. I enjoyed talking to the participants, and I wish all of them luck in the problems they posted, and also for those who didn't post.

David: Good night everyone and I hope you have a pleasant weekend.


Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

APA Reference
Staff, H. (2007, April 18). The Development and Treatment of Personality Disorders, HealthyPlace. Retrieved on 2024, December 29 from https://www.healthyplace.com/personality-disorders/transcripts/the-development-and-treatment-of-personality-disorders

Last Updated: July 9, 2019

Living Day-to-Day with DID/MPD

Recovery from Dissociative Identity Disorder, DID, MPD. Includes coping with flashbacks, switching, losing time, getting your alters to work together.

Online Conference Transcript

What's it like living day-to-day with DID/MPD (Dissociative Identity Disorder, Multiple Personality Disorder)? There are many issues for DID patients.

Randy Noblitt, Ph.DPsychologist, Randy Noblitt, Ph.D. specializes in the treatment of DID patients. He says because of the experience of abuse in childhood (child abuse), many are suffering from disturbing flashbacks, dissociative switching (switching alters), and losing time. Then there's the depression and mood swings, thoughts of suicide, and loneliness that accompanies many serious mental illnesses.

Along with the above subjects, we discussed managing dissociation and getting your alters to work together, treatment for DID and integration (integrate your alters), what is life like after integration, hypnosis and EMDR treatment for DID, how to get your partner to understand MPD and how a significant other can help their DID partner.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.


David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Living Day-to-Day with DID, MPD (Dissociative Identity Disorder, Multiple Personality Disorder)." Our guest is Randy Noblitt, Ph.D. In private practice in Dallas, Texas USA, Dr. Noblitt specializes in the treatment of individuals who suffer from the psychological aftermath of childhood trauma with a special interest in dissociative disorders, PTSD, and reports of ritual abuse.

Over the past 15 years, Dr. Noblitt has evaluated, treated or supervised the treatment of more than 400 MPD/DID patients. He also co-authored the book Recovery from Dissociative Identity Disorder, a consumer's manual for finding and obtaining competent therapy, social services, and legal assistance.

Dr. Noblitt lectures widely on the existence of ritual cults and mind-control techniques and has served as an expert witness in a number of child abuse cases. He is also a founding member of The Society for the Investigation, Treatment and Prevention of Ritual and Cult Abuse.

Good evening, Dr. Noblitt, and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Is it difficult for people with DID to find competent treatment for their disorder?

Dr. Noblitt: Hello, David. Thanks for inviting me. Yes, it is difficult and getting more so all the time.

David: Why is that?

Dr. Noblitt: Managed care is increasingly limiting funding for adequate treatment. Additionally, the very real threat of litigation has caused many excellent therapists to leave this field.

David: I'm also wondering if there is an abundance of skilled therapists to treat Dissociative Identity Disorder or are there relatively few?

Dr. Noblitt: There are fewer therapists than needed. As you probably know, there is a prejudice in the mental health field regarding DID (MPD) so fewer people are going into this area. This is extremely unfortunate since individuals with DID have significant needs. They are often known to fall between the cracks not only in the realm of mental health but in the social services arena as well.

David: In my introduction, I had mentioned that you have treated, or supervised the treatment of, some 400 DID (MPD) patients. In your experience, what are the most difficult issues for DID patients to cope with on a day-to-day basis?

Dr. Noblitt: The difficulties experienced by DID/MPD patients vary. One significant problem is suicidal and self-destructive impulses. Many individuals with DID/MPD also experience clinical depression, mood swings, and disability causing unemployment and poverty which further restricts their quality of life.

David: The depression and the mood swings are very difficult to cope with. What are your suggestions for dealing with that?

Dr. Noblitt: Individuals with depression often rely on psychoactive medications, although a high percentage with Dissociative Identity Disorder (Multiple Personality Disorder) do not get adequate relief from medications alone. The development of caring and supportive relationships and psychotherapy is often helpful.

David: Many with DID, and this is from email that I receive, live a pretty lonely life, in that they find it difficult to share their DID with others.

Dr. Noblitt: Yes, this is common. Isolation tends to increase a sense of hopelessness and depression. Taking the risk to develop caring relationships can go a long way in reducing one's depression and sense of isolation.

The reason that many DID patients experience loneliness and isolation stems from their experience of abuse in childhood by family members or other trusted individuals. This early betrayal of trust is devastating.


David: We have a lot of audience questions, Dr. Noblitt. Let's get to a few and then I want to talk about coping with flashbacks and other day-to-day issues.

teesee: Why the prejudice within the mental health field?

Dr. Noblitt: This prejudice goes back to a time even before mental health was considered an independent profession and has to do with the prejudices associated with trance states and other states of mind that resemble "possession." Additionally, there has been prejudice against dealing with child abuse and even now, I would say that the greatest part of our society is in denial about the magnitude of this problem.

David: We have a lot of questions regarding treatment for DID and integration:

lovey: Is it important to integrate your alters, in your opinion?

Dr. Noblitt: Not all individuals with DID/MPD are motivated to achieve complete integration. I believe the patient has the right to make this decision without coercion on the part of the therapist. If the patient asks me, "is it healthy to integrate?" I would say yes.

More important than integration is improving the level of functioning and the quality of life.

David: Why would you say "it's healthy to integrate?"

Dr. Noblitt: I view integration as a process with many levels and steps to it. Before the alternates "go away," the individual with DID learns to integrate experience and behavior, reducing inner conflict and becoming more functional.

colbe: Do you still think the number 1 treatment for MPD is hypnosis?

Dr. Noblitt: Let me qualify my response by saying that I think it is important to work in trance states and hypnotherapy may be a good way to accomplish this. Hypnotherapy in the traditional sense may not always work with this diagnosis.

maranatha: I just found out in January that I have DID. My alters fight and tease each other all the time. There is much confusion and mistrust among them. My doctor wants me to try to get them to talk to each other, but I can't even get them in the same "room," so to speak, or to sit with everyone. Any suggestions on how to start building that trust and communication between them? I can't hold a job down 'cause of so much confusion in them. Is it still possible to integrate them?

Dr. Noblitt: There are a variety of ways to increase communication: journaling, music therapy, art therapy, hypnotherapy. Why not ask your therapist what he or she recommends since he or she knows you? Integration is definitely possible and is a realistic goal. Not all individuals with DID achieve this goal.

David: Also Maranatha, we had an excellent conference on getting your alters to work together. I hope you'll take a look at the transcript.

Maera: Can you touch on how to break the self-destructiveness or alters inside who will not cooperate and only sabotage?

Dr. Noblitt: Increase inner communication and learn why the self-destructive motives are there. Usually, these self-destructive motives are related to traumatic experiences that need resolution through therapy.

7claire7: Why do you like to use trance and hypnosis?

Dr. Noblitt: Dissociative Identity Disorder is a trance disorder. Unlike the other various diagnoses, DID involves trance states. I have observed that patients who do not work in trance states in therapy are often more unaware of the functioning of their entire dissociative system. Developing this awareness is healthy and increases the patient's control over the disorder.

David: There are two things I wanted to address tonight and both deal with memory. Because DID is the result of trauma or abuse, many with DID suffer from flashbacks on a fairly frequent basis. How does one cope with them and then reduce the number and frequency?

Dr. Noblitt: This is a complex question. Ultimately, flashbacks reduce over time after the trauma associated with the flashback has been worked through in therapy or independently. However, before that time, many individuals want to reduce these flashbacks and are able to do so by learning to "shut down" the system.

I encourage my own patients to "open up" when they are in therapy and "shut down" when they are not in therapy. Also, some medications can help with the frequency and intensity of flashbacks. Anti-psychotics tend to reduce some particularly disturbing flashbacks and some anti-anxiety medications will reduce the anxiety that accompanies them. This varies from person to person. As I mentioned before, people with DID sometimes have unusual reactions to medications.

David: When you say "shut down" the system, what do you mean by that and how is that accomplished?

Dr. Noblitt: Individuals with DID sometimes experience trance states that may be spontaneous or triggered by particular stimuli. When this happens, there is likely to be more dissociative "switching" and "losing time." Shutting down is like the reverse of being in such a trance state. This can be accomplished in different ways by different individuals with DID. Sometimes it takes trial and error to find what works with a particular individual. Some individuals respond to "self-talk" and particular cues that may cause them to shut down. For some individuals, particular pieces of music may serve this function.


David: The other memory question I had was how to deal with "losing time" caused by switching alters or dissociating. This can be very frustrating and confusing for those with DID. Do you have any suggestions for helping with that?

Dr. Noblitt: Improving inner communication and increasing the degree of integration tends to reduce the loss of time. Further, when the various alternates are working well together, they can contract to prevent or reduce loss of time.

David: By the way, Dr. Noblitt, where can one purchase your book?

Dr. Noblitt: Initially, my assistant, Pam and I put this together for the benefit of my patients who were experiencing problems obtaining appropriate services. I would be happy to make a copy available over the internet if individuals are interested and can receive attachments.

David: We will post more info on that in the transcript when it goes up on Friday evening. A few site notes, then we'll go right to the audience questions:

Here's the link to the HealthyPlace.com Personality Disorders Community. You can sign up for the mail list and receive our newsletter, so you can keep up with events like this.

Here's the next audience question:

asilencedangel: When you have a protector who is extremely angry and has been recently betrayed by a spouse, how would you suggest she learn to trust again?

Dr. Noblitt: It may be necessary to resolve the betrayal of trust in a joint therapy session with the spouse and that particular alternate present.

Hannah Cohen: Dr Noblitt, what do you do when the spinning starts and the motion carries the time wild and you cannot stop to see one thing to grab on to and stop yourself? You stand still the best you can and say strong and loud for the circle of spinning to stop so you can walk away from the noise! Dr Noblitt, I'm having difficulty getting away from the noise. Any suggestions would be appreciated. Thanks.

Dr. Noblitt: When spinning occurs, the individual may be in great distress and often is motivated to learn how to stop the spinning. This may be accomplished in several ways. The most permanent solution is to work through the trauma associated with the spinning. A more temporary solution is to learn how to trigger a "shut down" response. Some individuals are able to reduce the effects of these experiences with medication. Many individuals spin as a consequence of "telling the secrets." However, telling the secrets eventually wears down the spinning response.

AngelaPalmer27: How much luck have you had dealing with alters that self-injure other alters?

Dr. Noblitt: This varies from individual to individual. Self-injury is more common early in therapy and less common later in therapy when the individual has worked through the various issues around experiences of trauma.

Some individuals can learn through imagery to stop or block self-injurious behaviors. In response to your question, I have had some patients who can learn to stop this experience and others who do not learn to until they have worked through the trauma.

Bucs: I was recently diagnosed with MPD. My alters don't talk to me or talk out loud, as other peoples alters do. I have noticed that my handwriting styles change day to day, and I still have what I refer to as "mood swings." Will they ever talk to me? And should I even worry about it if they don't?

Dr. Noblitt: This is a common experience, particularly in the early stages of therapy. As you work on opening up your system in therapy and increase inner communication, this will become less of a problem for you.

sryope77: My question is this (and I will try to be appropriate and not offend)... I lead a BDSM alternative lifestyle and I was wondering how to keep the babies and kids and others who don't want/need to be involved out of it. Please don't judge me, this is a common lifestyle among many DID survivors and a lot of us led this life LONG before the net, but we are having trouble keeping it "healthy" for all of us.

Dr. Noblitt: I know that this is a common experience among individuals with DID and I do not judge anyone's sexual lifestyle. But, I recommend that individuals who have been abused not participate in any activities that may be interpreted as retraumatization by the alternates. This is not because this particular lifestyle is "bad," but for many, it resembles too much the original trauma.

sryope77: I hope I can get some help with this. My former therapist "dropped" me because she says she is a Christian and we are not to discuss that, but how can we heal or get better if we are "censored" in therapy?????

David: Sryope, I want to add here that if you are not finding your therapist helpful, then it's time to get another therapist. 

Dr. Noblitt: David is right. You need to find a therapist who is willing to work with you and your needs, not have you conform to hers.

sryope77: That's what my former therapist says, but we use our lifestyle sometimes to work THROUGH the past traumas and it is about the only way we ever get any "GOOD" touches like hugging and holding.

Dr. Noblitt: This is exactly how a traumatized child feels.

David: Here's the next question:

Snowmane: Have you heard of using energy work along with containment exercises to control and clear memories?

Dr. Noblitt: Yes, I have heard of it, but I don't know of anyone who is having success with this approach. Some have claimed that this can be effective, but whenever I have investigated this further, I have not found it to be helpful.

Containment exercises are very helpful but one can never "clear" past experiences. The best one can do is desensitize them and reduce inner conflict and keep self-sabotage to a minimum. As a word of clarification, I should state that I am not from the "energy" school and may be biased against it.


lovey: How long is the treatment of Multiple Personality Disorder, Dissociative Identity Disorder?

Dr. Noblitt: Unfortunately, DID/MPD requires lengthy treatment. The briefest case I had took six months. Most individuals, however, are in therapy for years. It should be pointed out, however, that many individuals will develop some skills in managing dissociation within the first few months of treatment. Others may have the symptoms of depression and PTSD (Post-Traumatic Stress Disorder) reduce sometime later in therapy.

Treatment for DID seems to progress in steps and stages. Individuals with more severe symptoms usually take longer than individuals with milder symptoms.

wlaura: In your treatment of DID patients, what is their life like after integration? Are there residual problems related to the abuse?

Dr. Noblitt: Some individuals are disabled prior to treatment and periodically hospitalized to address their disabling condition. Many of these individuals are able to obtain employment and experience significant improvements in their functioning such that they no longer require hospitalization. However, in my experience, patients who have successfully completed treatment still have some residual problems. Treatment for DID does not completely wipe clean the effects of trauma.

luckysurvivor:I suffer from DID and bipolar disorder and work and manage to survive, although I am suicidal a lot. My biggest emotional pain is an alter that is destroying relationships I have with people. Now I have no friends. I don't know how to reason with her anymore. Any suggestions?

Dr. Noblitt: It would be helpful to understand the alter's motivation. Some alters destroy relationships because they fear closeness with others, sometimes because they were betrayed in a close relationship. That particular alter will need to work in therapy to resolve her fear of vulnerability and to develop better interpersonal skills.

jjjamms: I am highly functional when it comes to working - it's the interpersonal relationships that are hard. How does one reach out with DID? It's very isolating.

Dr. Noblitt: There is no easy answer to this dilemma. It takes much effort and work to overcome. I would encourage you to bring this up with your therapist. Together, you may be able to formulate a specific plan for expanding your social life.

Different approaches seem to work for different people. Some individuals develop a sense of closeness with others in a support group (although this does not work for everyone). Some people can make social contacts through a church or synagogue. Sometimes it is possible to develop social relationships at work.

This is a very important goal and I wish you luck in achieving it. Most individuals with DID who expand their social network soon notice improvements in their mood and quality of life. It is difficult to change one's lifestyle when one has been living like a recluse for years, but I have known people who have succeeded through their perseverance.

eveinaustralia:I live in Australia and I have been refused talk therapy because I stopped taking the Psychiatrist's drugs (my significant other and I thought they were making me worse). Do you believe that MPD people have to take drugs and that it's okay to refuse therapy without them? Also, why are the drugs so important to MPD people?

Dr. Noblitt: I believe in the patient's right to choose aspects of therapy that are helpful and reject those that they feel are not helpful. I do not think that therapists should require that their patients take medications unless such medications treat a life-threatening condition (such as HIV).

I believe no patient, DID or otherwise, should be forced to take psychoactive medications without their consent.

David: If you haven't been on the main HealthyPlace.com site yet, I invite you to take a look. There are over 9000 pages of content. http://www.healthyplace.com

HealthyPlace.com is broken down into different communities. And so some of the questions about depression, for instance, can be answered by the reading through the sites and "conf. transcripts" in the Depression Community.

We also have a very large self-injury community.

Between the sites and the "conf. transcripts," you will find a lot of information on almost every mental health topic.

We have a few more questions, then we'll call it a night.

katerinathepoet: Hello Dr. Noblitt, I have had Multiple Personality Disorder most of my life. I was wondering how I can get my husband to understand MPD. He is not comfortable with me and doesn't understand it all. We do not have enough money for therapy, so any suggestions on how to get him to understand my MPD?

Dr. Noblitt: You might consider contacting the Sidran Foundation for literature that can explain your condition to him. You might also want to explore the possibilities of obtaining Medicaid, Medicare, or some other form of subsidized funding for treatment. You can also consider pastoral counseling with a therapist skilled in DID issues.

sherry09: What do you do when the children are screaming in your head because they are still in the past?

Dr. Noblitt: This problem falls within the realm of developing self-soothing and grounding skills. Sometimes self-talk can be helpful, reminding them that they are not in any danger at the present time, letting them observe their present environment. Other soothing and calming strategies can be helpful as well.


David: Here's the flip side to katherinathepoet's question about getting her SO to understand her DID:

Temper: I am a SO (significant other), and on one of my support lists we have been talking about the role of a SO. What role do you see a SO having in therapy and outside? What can a significant other do to help their DID partner (specifically, they were talking about messing with internal politics, rescuing alters, and instigating system changes)?

Dr. Noblitt: The role of the significant other is probably the primary social support for the individual with DID. The most important thing about this role is maintaining a healthy relationship where the individual with DID can learn to trust and to give and accept unconditional love.

The significant other can help the individual with DID by being supportive and responsive. He or she should never take advantage of the relationship or use the DID's vulnerability to jockey for a power position. There should be boundaries established in the relationship to distinguish between a healthy partnership and a therapeutic relationship.

Maera: What do you think about EMDR treatment for DID?

Dr. Noblitt: I believe that EMDR methods effectively access dissociated mental states, for some individuals, not all. I think we should learn more about how and why EMDR causes these particular effects. Hopefully, all of us are interested in the effectiveness of the method, not the particular theory behind it.

MomofPhive: Why don't all individuals with DID achieve the goal of integration? Is it that some aren't able to or choose to and why not?

Dr. Noblitt: I don't think that anyone really knows the answer to this question. Many therapists assume that the individual has not been able to heal the effects of trauma or that the individual does not want to say goodbye to their alternates.

SoulWind: Is it possible to recover and function in a normal way without dealing with ALL of the repressed memories and the accompanying flashbacks?

Dr. Noblitt: Again, I don't think anyone knows for sure. However, I assume that patients need to deal with the flashbacks but do not necessarily have to deal with every memory that may be hidden from their conscious awareness. Individuals with DID need to have enough insight into these memories, however, to understand the gist of what happened to them, why they have alternates, and why their alternates behave and feel as they do.

David: Thank you, Dr. Noblitt, for being our guest tonight and for sharing this information with us. We especially appreciate that you stayed late to answer many of the audience questions. And to those in the audience, thank you for coming and participating. I hope you found it helpful. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Thanks again, Dr. Noblitt.

Dr. Noblitt: My pleasure, David.

David: Good night everyone.


Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

APA Reference
Gluck, S. (2007, April 18). Living Day-to-Day with DID/MPD, HealthyPlace. Retrieved on 2024, December 29 from https://www.healthyplace.com/abuse/transcripts/living-day-to-day-with-didmpd

Last Updated: May 10, 2019

Relationships With Abusive Narcissists

Online Conference Transcript

The abusive narcissist and behaviour of narcissists. Types of abuse narcissists inflict upon their victims and the life a victim of the narcissist lives.

Dr. Sam Vaknin

Dr. Sam Vaknin: is our guest. He is a narcissist and is the author of the book Malignant Self Love - Narcissism Revisited.

Dr. Vaknin defined the abusive narcissist, the criteria of NPD, and explained the behaviour of narcissists. We also discussed the types of abuse narcissists inflict upon their victims, the types of people who are attracted to the narcissist, the life a victim of the narcissist can look forward to, and what it takes to get out of a relationship with a narcissist.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.


David: Welcome to HealthyPlace.com and our chat conference on "Relationships with Abusive Narcissists." For those of you who may be new to the subject, here is the definition of narcissism.

Our guest is Dr. Sam Vaknin. Dr. Vaknin has Ph.D. in philosophy and is the author of Malignant Self Love - Narcissism Revisited. He also hosts a very extensive site on Narcissism and Narcissistic Personality Disorder (NPD) in the HealthyPlace.com Personality Disorders Community. Almost everything you would want to know about Narcissism is included there and in his book. Dr. Vaknin, himself, is an admitted narcissist.

Good evening, Dr. Vaknin and welcome to HealthyPlace.com. I'm wondering, when we speak of "abusive narcissists," is this a special sub-class of narcissists or is being abusive a part of narcissism itself?

Dr. Vaknin: Good evening, David, everyone. The DSM IV-TR, the bible of mental health disorders, does not regard abusive behaviours as one of the criteria of NPD. It does, however, mention the precursors of abuse: exploitativeness, an exaggerated sense of entitlement and, above all, a lack of empathy. So, I think it is safe to say that abuse does characterise the behaviour of narcissists. Narcissists are terrified of intimacy because they are afraid of being exposed as frauds (the False Self) or of being hurt (especially the borderline narcissists). So, they cope either by exerting minute control over their nearest and dearest - or by being emotionally absent. There are numerous abuse strategies and they are detailed here.

David: Many of the visitors to HealthyPlace.com are, unfortunately, very familiar with "abuse." Sexual abuse - rape and incest and physical abuse, including domestic violence. Are these the types of acts you're referring to when you use the term "abusive narcissist?"

Dr. Vaknin: Sexual and psychological abuse are subsumed by narcissistic abuse. The narcissist abuses his spouse, children, friends, colleagues, and just about everyone else in whichever way possible. There are three important categories of abuse:

  1. Overt Abuse - The open and explicit abuse of another person.
  2. Covert or Controlling Abuse
  3. Abuse in response to perceived loss of control

There are many types of abuse: Unpredictability, Disproportional Reactions, Dehumanization and Objectification, Abuse of Information, Impossible Situations, Control by Proxy, Ambient Abuse.

David: What, then, can the other person in this relationship expect from the narcissist?

Dr. Vaknin: The narcissist regards the "significant other" as one would regard an instrument or implement. It is the source of his narcissistic supply, his extension, a mirror, an echo chamber, the symbiont. In short, the narcissist is never complete without his spouse or mate.

David: I'm assuming that there is something the narcissist looks for personality-wise in his/her victims. Can you go into that a bit please?

Dr. Vaknin: The narcissist is a drug addict. The name of the drug is Narcissistic Supply (NS). The spouse (or mate, or love, or friend, or child, or colleague) of the narcissist is supposed to supply the narcissist with his drug by adoring him, admiring him, paying attention to him, providing him with adulation, or affirmation and so on. This often requires self-denial as well as a denial of reality. It is a dance macabre in which both parties collaborate in a kind of mass psychosis. The narcissist's partner is also expected to accumulate past narcissistic supply by serving as a passive and fawning witness to the narcissist's (often imaginary) achievements.

David: So, if you are the victim of the narcissist, what kind of life can you look forward to?

Dr. Vaknin: You will be required to deny your self: your hopes, your dreams, your fears, your aspirations, your sexual needs, your emotional needs, and sometimes your material needs. You will be asked to deny reality and ignore it. It is very disorientating. Most victims feel that they are going crazy or that they are guilty of something obscure, opaque, and ominous. It is Kafkaesque: an endless, on-going trial without clear laws, known procedures, and identified judges. It is nightmarish.

David: Here's an audience comment on what life is like with an abusive narcissist:

bunnie-41: miserable and very unrewarding.

David: Before we get to some audience questions, what is it in the victim's personality that they find themselves attracted to the narcissist?

Dr. Vaknin: It is a very complicated situation. Generally speaking, there are two broad categories of partners of narcissists. One category consists of healthy people, with a stable sense of self worth, with self-esteem, professional and emotional independence, and a life, even without the narcissist. The second category consists of co-dependendents of a specific type, which I call "Inverted Narcissists" (FAQ 66). These are people who derive their sense of self worth from the narcissist, vicariously, by proxy as it were. They maintain a symbiotic relationship with the narcissist and mirror him by negation - by being submissive, sacrificial, caring, empathic, dependent, available, self-negation (in order to aggrandize him)

David: Here's the first audience question, Dr. Vaknin.

marymia916: How can you help someone who is with a narcissist and is not strong enough to leave?

Dr. Vaknin: It depends what is the source of the weakness. If it is objective - money matters, for instance - it is relatively easy to solve. But if the dependence is emotional, it is very difficult because the relationship with the narcissist caters to very deep-set, imprinted, emotional needs and landscape of the partner. The partner perceives the relationship as gratifying, colourful, fascinating, unique, promising. It is a combination of adrenaline-rush and Land of Oz fantasy. It is very difficult to beat. Only professional intervention can tackle real co-dependence. Having said that, the most important thing is to provide an emotional alternative by being a real friend: understanding, supportive, insightful, and non-addictive (i.e., do not encourage co-dependence on you instead of on the narcissist). It is a long, arduous process with uncertain outcomes.

David: Your answer then brings us to this question:

kodibear: If the abuser is a narcissist, how do we get away permanently?

Dr. Vaknin: Please clarify the question. Do you mean how do YOU get away or how do you get rid of the narcissist's unwelcome attentions?

kodibear: Both.

Dr. Vaknin: You get away by getting away. Get up, pack, hire a lawyer and go. It is far more difficult to get rid of the narcissist. There are two types: the vindictive narcissist and the unstable narcissist. The vindictive narcissist regards you as an extension of himself. Your express wish to leave is a major narcissistic injury. Such narcissists at first devalue the sources of their pain ("sour grapes" syndrome) - "She is no good, anyhow. I wanted to get rid of her. Now I can do what I really wanted and be who I really am, and so on. But then the vindictive narcissist "flip-flops". If you are such defective merchandise - how do you dare desert him? Your devalued image now reflects on him! So, he sets out to "fix" the situation but trying to "amend" the relationship (often by stalking, harrassing) or by trying to "punish" you for having humiliated him (thus restoring his sense of omnipotence).

The second type, the unstable narcissist, is much more benign. He simply moves on once he is convinced that you will never provide him with narcissistic supply. He "deletes" you and hops on to the next relationship. My advice: be firm, unequivocal, unambiguous. Most of the problems with narcissists arise from a message that is neither here nor there (having sex just one last time, letting him visit and sleep over, keeping his stuff for him, talking and corresponding with him, helping him with his new relationships, remaining his best friend).

David: What you're saying, Dr. Vaknin, is that to get rid of the abusive or vindictive narcissist, a simple "no" or "our relationship is over" is usually not enough.

Dr. Vaknin: No, it is not enough. The vindictive narcissist must eliminate the source of his frustration either by subsuming it (re-establishing the relationship) or by punishing and humilating it and thus establishing an imaginary symmetry and restoring the narcissist's sense of omnipotence. Vindictive narcissists are addicted to power and fear as sources of narcissistic supply. Unstable ("normal") narcissists are addicted to attention and their sources of supply are interchangeable.

David: For those asking, here the link to purchase Dr. Vaknin's book: Malignant Self-Love: Narcissism Revisited. And I'm not hawking the book, but if you are interested in the subject of narcissism, it's a great read and almost everything you would want to know about narcissism is in there.

Dr. Vaknin: Why, thank you. I may decide to finally read it myself ..:o). My turn to compliment. It is a must.

David: Thank you, Dr. Vaknin. This Saturday night, we'll be talking about Bipolar Disorder and ECT, electroshock therapy. About 4000 people listen to the show through our site. I hope you'll join us and become a regular listener.

One thing I'd like to touch on and then we'll continue with audience questions -- are there female abusive narcissists?

Dr. Vaknin: Over 75% of all narcissists (i.e., people diagnosed as suffering from the Narcissistic Personality Disorder as a primary Axis II diagnosis) are male. But, of course, there are female narcissists.

David: Are the behaviors exhibited by females the same or similar to those of male narcissists?

Dr. Vaknin: Largely, yes. The behaviours are identical - the targets are different. Women narcissists will tend to abuse "outside the family" (neighbours, friends, colleagues, employees). Male narcissists tend to abuse "inside the family" (mainly their spouse) and at work. But this is a very weak distinction. Narcissism is such an all-pervasive personality disorder that it characterizes the narcissist more than his gender, race, ethnic affiliation, socio-economic stratum, sexual orientation, or any other single determinant does.

David: Here are some audience comments about what's been said so far and then we'll get to the next question:

coping: I never knew that narcissim was a personality disorder until I read your writing and after I dated my last boyfriend. The relationship ended 6 months ago and I still feel hurt.

Dr. Vaknin: The aftermath of a relationship with a narcissist is often characterized by Post Traumatic Stress Disorder (PTSD).

garwen2: Hello, Dr. I am 53 and living with my elderly NPD mother...with my saint of a husband also. I have just learned, this last year, of her problem through your website and now reading your book. The main advice I saw for dealing with her is avoidance. And for almost a year, I have been more like a maid-in-waiting with not much social contact. The response I have recieved from this non-action is that she does not even notice. It is like OUtta sight, outta mind. This is really strange to me.

bunnie-41: A narcissist regards the person he is with as a source to accomplish his goals. I know, I was involved with one. They do not know how to feel real love or compassion.

kodibear: I am in intensive therapy for lack of self-worth from the abuse which started when I was a baby and I still am controlled by him, sorry to say. It makes it a little easier to understand what is going on and why he won't leave me alone after listening to you.

Neevis: My husband is totally lacking in empathy. I married a narcissist and the worse he is to me, the more I seem to want to be with him. What does that say about me?

KKQ: I have found that narcissists believe that they are GOD and all must bow to their desires or be punished.

LdyBIu: I have been married to a narcissist for 26 years and we are separated now.

David: Here's the next question:

kchurch: If a narcissist needs his spouse, what has to happen in order for the narcissist to leave a mate?

Dr. Vaknin: Before I respond, I wish to re-iterate what I said before: Living with a narcissist is a total experience. The narcissist takes over the partner, objectifies her (turns her to an object) and uses (and abuses) her. The result is Post Traumatic Stress Disorder (PTSD) - a shock mixed with breavement.

To the question: If the spouse is an outstanding source of narcissistic supply (very rich, very beautiful, very admiring very accepting, etc.) - the narcissist will do everything in his power to stick around. The only way to get rid of the narcissist is to make him realize that it is over. That no matter what he does or does not do to receive narcissistic supply, he is unlikely ever again to receive it from this source. But such a message must be incisive (though not hurtful or humilating). It must be clear, unequivocal, unambiguous, and consistent. Once he digests the message and internalizes it - the narcissist vanishes. To the narcissist, all sources of narcissistic supply are the same, interchangeable, and indistinguishable.

Checky: Hi, Dr. Vaknin. You're up late! What is your opinion on this: Can an abusive narcissist ever become a tolerable narcissist while in a marriage and when the abuse has taken place over many years?

David: I'll add to that question. Can the narcissist ever make a "real" change in his abusive behavior or is this ingrained in his personality?

Dr. Vaknin: Whether the narcissist is tolerable or not is up to the spouse or partner to decide. If you are asking whther the narcissist can ameliorate, tone down, be mollified, reduce his intensity, refrain from abuse and modify his behaviour - sure, he can. It depends what is in it for him. Narcissists are the consummate and ultimate actors. They maintain emotional resonance tables. They monitor other people's reactions and behaviour - and they are mimetic (imitators). But it is not a real and profound change. It is merely behaviour modification and it is reversible. I hasten to say that certain schools of psychotherapy claim success in treating pathological narcissism, notably the Cognitive-Behavioral Therapies and psychodynamic therapies - as well as more exotic, Eastern, therapies.

David: A few audience reaction comments here:

garwen2: So you respond by not having reactions? I call it emotional divorce...and it works

dolly: Oh! The ole "I treat you like you treat me" syndrome.

mcbarber: Dr. Vaknin, after being married to and abandoned by my narcissistic husband three times I am so angry, but deep down I somehow still crave him. How do I get over it?

Dr. Vaknin: You should talk to yourself. Ask yourself, in this dialog, why are you so atttracted to him? He probably fulfills very deep emotional (or maybe sexual or financial) needs. Prioritize your inner life. What is most important to you and what is the price you are willing to pay for it. Life is a trade off. Living with a narcissist - even with an abusive narcissist - is wrong only if it bothers you, hurts you, and prevents you from functioning properly. If you thrive in his company and take his abuse in stride - I say, why not?

moyadusha: Does the narcissist have a conscience?

Dr. Vaknin: No. Conscience is predicated on empathy. One puts oneself in other people's "shoes" and feels the way they do. Without empathy, there can be no love or conscience. Indeed, the narcissist has neither. To him, people are sillhuettes, penumbral projections on the walls of his inflated sense of self, figments of his fantasies. How can one regret anything if one is a solipsist (i.e., recognizes only his reality and no one else's)?

pkindheart: I was involved with a woman who is a narcissist. Her narcissistic supply was sex. She got a real high from it both during and especially afterwards. This high was intoxicating and addictive to me as well. Is this a common thing to happen with a woman who is a narcissist? I have had a very hard time dealing with the loss of this.

Dr. Vaknin: Pathological narcissism (rather NPD) is a clinical condition. Only a qualified mental health diagnostician can determine whether someone suffers from NPD and this, following lengthy tests and personal interviews. But there is something called addiction to sex. Like every addiction, it is connected to predominant narcissistic traits in the addict's personality.

David: You mentioned earlier that victims of abusive narrcissists "deny reality." Here's a followup question:

Mari438: Please give me an example of being asked to deny reality.

Dr. Vaknin: The partner is asked to accept, unconditionally and uncritically that she is inferior to the narcissist, that he is superior to her and to all others, that he is accomplished (even when he is not), that he is victimized (if he is somewhat paranoid) and so on. The partner replaces her judgement and critical faculties with those of the narcissist. This is suspended individuality. The partner is further destablized by the narcissist's tendency to idealize and, very rapidly, devalue; to change his mind often; to act unpredictably and capriciously; to form and abandon plans and so on. This disorientation leads to an overpowering and surrealistic sense of unreality.

David: Here are some more audience comments on what's being said tonight:

estrella: I was able to dump my narcissist after I began to develop traits within myself that I thought he had and thought I lacked.

bboop13: I can so relate to suspended individuality. I am finally divorced and am back to myself.

kodibear: I know as a victim for many years, as a child, I denied reality because he made me believe it was what I wanted from him.

garwen2: It really helps to understand this "no conscience, no love". It lets you know where you stand and gives you the strength to break away.

Checky: I tried to get my husband to change the abuse but he decided to seduce another supply.

jlc7197: My NPD husband never apologized once in 25 years. Not once!

Mari438: My husband was the most sensitive caring, considerate man I ever met. Actually too sensitive. Almost seemed to be child-like.

bunnie-41: I was married to a narcissist for 4 years and as long as I gave him all my attention, told him everyday how wonderful and handsome he was, gave him every material thing he wanted, did everything he wanted to do, ask him no questions or confronted him about anything, he was happy. When I started saying "no" is when he would sulk and get upset. Then I found out that he was already married when he married me. I could write a book of the abuse I have experienced with him.

Zette: Are narcissits usually big liars?

Dr. Vaknin: Narcissists are pathological liars (except I...:o)) This means that they lie even when they do not have to, when they achieve nothing by lying and when telling the truth would have achieved the same (or better) result. Pathological narcissism is the development of a FALSE self based on fantasies, grandiosity, and deceit. So, the very foundation of the narcissist is falsehood. Narcissists lie for two reasons: Either to obtain narcissistic supply or secure it Or because they prefer fantasy (or eternal love, brilliance, wealth, might) to (drab and disappointing) reality. Their propensity to fantasize often deteriorates to outright lying.

bboop13: They are the biggest liars and sooo good at it.

Neevis: I can answer that they are the biggest and best liars.

David: Just so everyone knows, you can sign up for our mail list so you can be notified of other events going on at HealthyPlace.com. A few more audience comments:

femfree: May I suggest that some victims wish to be deluded because their reality is just "too hard."

marymia916: I just want to thank you for changing my life Dr. Vaknin.

KKQ: I can sniff out a narcissist a mile away and no longer will put myself in that kind of a sick role.

kodibear: Having PTSD because of this, I can tell you I have no desire to delude myself, just survive.

jlc7197: My children were damaged severely by his abuse.

David: Dr. Vaknin, we have a few similar audience questions of a personal nature referring to you being an admitted narcissist.

Dr. Vaknin: Yes?

Neevis: Dr. Vaknin, you know that you are a narcissist. Do most narcissists have the same self-realization or do they think that something is wrong with everyone else but themselves?

Dr. Vaknin: Exceedingly few narcissists are self-aware. Actually, you might say that self-awareness is the antonym of narcissism. Most narcissists go through life convinced that something is wrong with everyone; that they are victimized, misunderstood, underestimated by intellectual midgets, abused (yes, abused!) by envious others and so on. In essence, the narcissist projects his own emotional barren and vitriolic landscape onto his environment. He sometimes forces people around him to behave in a way that justifies his expectations of them. This is called Projective Identification.

merelybecky: You do not seem to be like any Narcissist I know.

Dr. Vaknin: I am not sure if that's a compliment (laughing).

marymia916: Do you feel satisfied with your life?

Dr. Vaknin: Not at all. I suffer from a "grandiosity gap". It is the abyss between the narcissist's inflated, fantastic and grandiose image of himself - and reality. My self image, my expectations from myself and from people around me (for instance, my sense of entitlement). My unrealistic appraisal of my talents and skills (totally incommensurate with my rather mediocre achievements) - this hurts and transforms life into a frenetic, obsessed, sick, and sickening search of affirmation from the outside. Narcissistic supply is a drug and I am a drug addict.

David: Here's an audience comment:

dolly: If I heard my narcissist husband talk like this, I would pass out.

Zette: Hey, don't you know - the narcissist is ALWAYS right! Given that mindset, their lives must be almost as miserable as those they feed off of.

mldavi5: When I first read your site, you said that you had had no healing. However, you seem mellower and SEEM to show compassion. So has there now been some improvement for you in your condition?

David: Please respond to that.

Dr. Vaknin: I thought this chat was about relationships with abusive narcissists - but I will not evade the question...:o) There has been a marked deterioration in my condition in the last few years. As the narcissist ages, the grandiosity gap expands. He is no longer young, healthy, fit, agile, competitive. The narcissist feels "eroded," without an "edge," rusting away, wasted. The narcissist then reacts in one of three ways. He becomes

  1. paranoid (suspects a conspiracy of the whole world against him) or;
  2. schizoid (retreats from the world, mainly in order to avoid nacissistic injury), or;
  3. psychotic (renounces reality altogether and lives in fantasyland ever after).

Most narcissists - myself included - react with a blend of all three to the painful decline in their prowess, clout, faculties, abilities, skills, and charm. But I am mostly schizoid and paranoid.

David: It is about 4:40 a.m. in Macedonia, where Dr. Vaknin is located. We appreciate you being here tonight, Dr. Vaknin, and for staying up so late and sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com. You will always find people interacting with various sites. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Dr Vaknin: I want to thank all of you, moderator and audience alike, for being here and for your kind words. Be strong and do the right thing! Sam

David: Here's the link to the HealthyPlace.com Personality Disorders Community. Sign up for the newsletter mail list to keep up on events and happenings here at HealthyPlace.com.

Thanks again, Dr. Vaknin and good night everyone.


Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

APA Reference
Vaknin, S. (2007, April 18). Relationships With Abusive Narcissists, HealthyPlace. Retrieved on 2024, December 29 from https://www.healthyplace.com/personality-disorders/transcripts/relationships-with-abusive-narcissists

Last Updated: July 9, 2019

Personality Disorders Conference Transcripts Table of Contents

APA Reference
Staff, H. (2007, April 18). Personality Disorders Conference Transcripts Table of Contents, HealthyPlace. Retrieved on 2024, December 29 from https://www.healthyplace.com/personality-disorders/transcripts/personality-disorders-conference-transcripts-toc

Last Updated: October 19, 2015

Treating Self-Injury

Treatment of self-injury, self-harm discussion covering the difficulty of stopping self-injurious behavior and standard for treating self-injury.

Michelle Seliner on Treating Disorder

Michelle Seliner LCSW, Chief Operating Officer for S.A.F.E. Alternatives, discusses the treatment of self-injury, self-harm, including:

  • how to determine whether one needs professional help or not when it comes to self-abuse.
  • the difficulty in stopping repetitive self-injurious behavior.
  • the recognized standard for treating self-injury.
  • the S.A.F.E Alternatives (Self-Abuse Finally Ends) method of treatment.
  • can self-injury really be stopped altogether or just really managed?

Self-Injury Chat Transcript

Natalie: is the HealthyPlace.com moderator.

The people in blue are audience members.


Natalie: Good evening. I'm Natalie, your moderator for tonight's "Treating Self-Injury chat conference. I want to welcome everyone to HealthyPlace.com.

Tonight's conference topic is "Treating Self-Injury."

We receive a dozen or more emails every month from people inquiring about self-injury/self-mutilation and when you get to the bottom line, they all have one question in common:

How do I quit hurting myself?

Our guest tonight is Michelle Seliner LCSW, Chief Operating Officer for S.A.F.E. Alternatives, the nationally recognized treatment approach for self-injurious behavior.

S.A.F.E. Alternatives' (Self-Abuse Finally Ends) approach is designed to help people end self-injurious behavior. The website for S.A.F.E is www.selfinjury.com. The phone number 1-800-DONTCUT (1-800-366-8288).

To be clear, self-injury is not a psychiatric disorder, but rather it's a symptom of a more serious psychiatric problem; a personality disorder, a mood disorder like bipolar or depression, or possibly OCD (obsessive-compulsive disorder).

Good evening, Michelle, and thank you for joining us tonight. How does one determine whether they need professional help or not when it comes to self-abuse?

Michelle Seliner: Thank you for inviting me.

It is our opinion at S.A.F.E. that anyone who is injuring could benefit from a professional evaluation. Research shows that even those who have injured only once have a higher level of emotional distress. A professional can help the client to identify the source of that stress and learn to cope in healthier ways. It is our belief that self-injury doesn't "work" for healthy people: That is, rather than providing a sense of relief, it merely hurts.

Natalie: How difficult is it for someone to stop repetitive self-injurious behavior? And why?

Michelle Seliner: Although people can and do get better on their own, many find it incredibly difficult to stop the behavior as it provides an immediate sense of relief. In addition, self-injury is not the actual problem, but rather an attempt to soothe uncomfortable emotional states that underlie the behavior.

Natalie: What is the recognized standard for treating self-injury?

Michelle Seliner: The standard treatment for self-injury involves focusing on emotional regulation through skills training. Clients are taught to pay attention to the irrational thoughts that might serve to fuel intensive feeling states. They are also taught to focus on the present rather than the past.

Natalie: So there's therapy. Are there medications that can help?

Michelle Seliner: Yes, there are medications used to treat the psychiatric diagnosis that accompany the symptoms of self injury.

Natalie: So for instance, if you suffer from bipolar or depression, you might be on an antipsychotic or antidepressant. Do these medications also relieve self-injury behaviors or the urge to commit self-harm?

Michelle Seliner: No, there is no medication used to treat self-injury.

Natalie: Besides the recognized standard, are there any other alternative methods of treatment?

Michelle Seliner: Yes, for example, while the S.A.F.E. Alternatives model also focuses on irrational thinking, we do look at early childhood experiences as well as family systems and relational difficulties.


Natalie: Michelle, when you speak of "treating" self-harm, are you talking about "curing" it, ending it forever? Or is it more like an addiction or many of the psychiatric illnesses, where the patient "manages" the behavior over the long-term?

Michelle Seliner: While some of our clients have been diagnosed with psychiatric disorders which may need to be managed over their lifetime, we do not view the behavior of self-injury as an addiction. It is our belief that once a client resolves underlying issues and learns to tolerate uncomfortable feelings rather than attempting to "stuff" them, self-injury becomes unnecessary. It is also our experience that when a client gets healthier, self-injury becomes painful rather than helpful.

Natalie: Is self-help, alone, a realistically effective tool in recovering from self-injury?

Michelle Seliner: Some people have gotten better with self-help. This means that they stopped injuring on their own and it doesn't necessarily mean that they have resolved the issues that underlie the behavior. Sometimes, these people are at risk for switching to another coping strategy such as drugs, alcohol or eating disorder.

Natalie: S.A.F.E. Alternatives opened its doors in 1985. That's over 20 years ago. Yet there are still relatively few therapists in the U.S. who know how to treat it. Why is that?

Michelle Seliner: Self-injury used to be an obscure psychiatric symptom. Most therapists didn't ever think they would be treating clients who engaged in these behaviors. The escalation of these behaviors has been so rapid that school, hospital, criminal justice, and mental health professionals have been caught off-guard.

Natalie: So are you saying that self-injury is no longer "out of the norm" when it comes to psychiatric symptoms? That a lot of people are engaging in that kind of behavior?

Michelle Seliner: Yes, the most current research shows that 1 in 5 college students engage in the behavior. This study came from Cornell. Similar studies have found similar statistics for middle and high school age students.

Natalie: So how does one go about finding a therapist who specializes in treating self-injury? And what credentials should a prospective patient be asking about?

Michelle Seliner: We have a list of therapists from a variety of states who have expressed an interest in working with self-injurers. In general, they have also received some training in working with this population. While we cannot endorse each of these therapists, it is a place for some clients to start their recovery or evaluation. We welcome any feedback regarding client experiences with the therapists listed on the website.

Natalie: Tell us a bit more about the S.A.F.E. Alternatives program. How does a patient get admitted? How long do they stay? And what should they expect?

Michelle Seliner: We would suggest finding a psychiatric professional who is at least masters prepared as either a psychologist, social worker, or counselor and is licensed in your state. Psychiatrists can help with medication evaluations. Some psychiatrists also do therapy.

The SAFE Alternatives philosophy is based upon the book, Bodily Harm: The Breakthrough Healing Program for Self Injurers. We believe that self-injury is a choice; that there is only pain, not relief in self-injury.

Self-injury negatively affects all portions of a person's life-physical, mental and social. The goal is complete abstinence. The S.A.F.E. program offers a continuum of care for the self-injuring client.

We have an intensive 30-day program, early intervention partial hospitalization program and weekly group psychotherapy. In addition, for professionals, we offer clinical consultation, program development, and training. We have several educational materials available. For more information please visit our website, www.selfinjury.com or call 1-800-DONTCUT.

Natalie: What is the average cost of the program? Does insurance partially or fully cover it?

Michelle Seliner: Yes, insurance typically covers the cost of the program. We have financial counselors available to discuss individual plans.

Natalie: What is the rate of relapse; recurrence of self-injury behaviors after going through the S.A.F.E. Alternatives program?

Michelle Seliner: We find that relapse upon leaving the program is not that unusual. However, the majority of clients find that SI no longer works for them as a soothing strategy as it did in the past. It is our experience that most clients stop the behavior after "testing" it upon leaving the program. In one study, we found that 75% were injury-free two years post-discharge.

Natalie: We have a lot of audience members with questions. Let's get to a few Michelle and then we'll continue on with the interview. Here's the first question:

Andrea484: What type of alternatives does your program suggest to those who come in?

Michelle Seliner: One of the first exercises our clients do is come up with a list of alternatives. When developing your list of alternatives, be sure to choose things that are healthy. For example, you would not want to have an alternative be something that could develop into another issue, like over-exercising. Some good alternatives may be journaling, calling a supportive person, nurturing yourself, going for a walk, reading, etc.

blackswan: What is the one thing you would recommend most to someone who's trying to overcome self-injury?

Michelle Seliner: First, I would recommend that they consider an evaluation from a professional so that together an appropriate plan of treatment can be developed. From there, I would develop a list of alternatives. It is important that you and your therapist agree on a plan of treatment.

aynaelynne: What should a therapist do to stop this behavior? I've heard of contracting, but if the client is unwilling what else and how pressing should the therapist be?

Michelle Seliner: First of all, the only person who can stop the behavior is the client. Contracting will only work if the client is motivated to stop injuring. If the client is unwilling, then alternative treatment should be pursued.

Natalie: So the audience understands, by contracting, I believe the term refers to where the patient signs an agreement not to self-harm.

Michelle Seliner: Yes, SAFE refers to this as the SAFETY Contract.

Natalie: Where is SAFE Alternatives based out of? And is the program open to people from across the U.S.?

Michelle Seliner: SAFE is based out of the Chicagoland area. We take clients from all over the world.

Natalie: Here's an audience comment and more questions:

saab32d: I am a recovering cutter. I did it for 9 years haven't done it for 16.

Michelle Seliner: Congratulations. Best wishes on your road in recovery.


motochik78: How can those with dissociative disorders work on ending self-injury that is done while in a dissociative state, especially when the "alter" that is "out" enjoys the self-injury so much that they purposefully hurt the person, that they can't overcome it?

Michelle Seliner: This is a difficult question. As you may know, there is controversy surrounding the diagnosis of DID. When we encounter someone who comes to us with a DID diagnosis we first work on grounding techniques, in hopes to prevent the "alters" from taking over. We treat dissociation the same way we do self-injury, in that we see it as a coping strategy to avoid uncomfortable feeling states. We ask clients to pay attention to their dissociation and to pair it with feeling states. If someone is DID, and can't sign our No-Harm contract, it may be that they need to do some more individual and integrative work before they would be ready for our program.

mousey!!: If a person enjoys self-injury, like doing it, I don't know, because it feels good, is there any way to get them to agree to get help?

Michelle Seliner: You can offer them support and information. Self-injury does serve a soothing purpose for someone who is struggling. Bodily Harm is a good resource for persons who self-injure, their families and professionals.

KrazyKelz89: What is the relapse rate of someone who self-injures and stops?

Michelle Seliner: We have found that post-treatment in the SAFE program that 75% of clients are self-injury free 2 years post-treatment. I cannot speak for the general population, as many self-injurers, prior to treatment, start and stop injuring. Typically a psychiatrist is used to manage medication for an accompanying diagnosis.

Psychiatrists usually do not do psychotherapy. Some clients have found a support group to be helpful.

Natalie: Michelle, do you think more people are self-injuring because it's glorified on tv or other media?

Michelle Seliner: Certainly that is a contributing factor but there are also others. It is a common coping strategy used by those struggling. We do not subscribe to the contagion effect, as healthy people do not self-injure.

miked123lf: What about the PEM program, the Psycho-Educational Model program where rewards are given for positive behavior? Could that work for cutters and people who self-injure? Or is this used for behavioral problems only?

Michelle Seliner: I am not familiar with this program being used for self-injurers. Applying what I know about self-injury, it is so important to remember that self-injury is a choice. Regardless of the rewards or who is asking you to give up the behavior, ultimately it is only you that can keep yourself safe.

Natalie: What are the characteristics of someone who is likely to be more successful when it comes to achieving a positive outcome from treatment?

Michelle Seliner: We have found it very difficult to predict who will do well. However, clients who seem to do best are those that honestly engage in the treatment process and recognize that treatment is for their own well-being and not for the treatment staff or parents.

Natalie: Is there an age limit to get into the SAFE program?

Michelle Seliner: We accept clients 12 and up. To date, our most senior client was 77 years old.

thelostone: Can the S.A.F.E program also help someone my age (43) recover from years of self-harm and not dealing with my feelings for years?

Michelle Seliner: Yes, often times we are a client's last resort. Some of our clients have been hospitalized hundreds of times. For some, it is their first hospitalization.

Natalie: I'm assuming since there are very few self-injury treatment programs, your program is very busy. How long does it take to get in? Is there a waitlist?

Michelle Seliner: Yes, there is a waiting list. It can take 2 weeks to 1 month.

NobodyKnows: How would somebody go about seeking admission to the program?

Michelle Seliner: To seek admission to the program, please contact us through the website or call 1.800 DONTCUT (1-800-366-8288).

Natalie: Is there a group of people who self-injure who are treatment-resistant; who despite trying various methods of treatment won't be able to control their behavior?

Michelle Seliner: Unless there is significant neurological damage, we don't believe that people can't control learning to stop self-injury. As stated before, some clients will continue to deal with disorders such as depression, anxiety, thought disorders, bipolar, etc. They may still experience intense emotional states, but they can learn to respond in a healthier, more productive way.

Natalie: We also have parents of children who self-injure, along with family members and loved ones, in the audience tonight. For these individuals, discovering and seeing that someone they care about is hurting themselves it can be very scary, alarming, distressing. What would you say to these people? And what can they do to help the self-injurer?

Michelle Seliner: The first thing to recognize is that they are not "crazy." They are instead trying to cope and survive in the best way they know how. The good news is that people can and do get better all the time and go on to live healthy, happy and productive lives. It is important for the family to take the behavior seriously, but anger and hysterics are counter-productive.

It's important to keep the lines of communication open. Parents and friends should not be the therapist, it is helpful for self-injurers to have someone to talk to who can truly help them to identify the problem and learn healthier ways of responding.

Natalie: Our time is up tonight. Thank you, Michelle, for being our guest, for sharing this valuable information on self-injury treatment and for answering audience questions. We appreciate you being here.

Michelle Seliner: Again, thank you for the opportunity to share our approach to the treatment of self-injury.

Natalie: Thank you, everybody, for coming. I hope you found the chat interesting and helpful. Good night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

APA Reference
Tracy, N. (2007, April 11). Treating Self-Injury, HealthyPlace. Retrieved on 2024, December 29 from https://www.healthyplace.com/abuse/transcripts/treating-self-injury-transcript

Last Updated: June 20, 2019

The Relationship Between Eating Disorders and Self-Injury

Help for self-harm. Self-injurious behavior can range from cutting and burning to eating disorders. How to recover from a lifetime of self-injury.

Getting help for self-harm and the relationship between eating disorders and self-injury

Dr. Sharon Farber, the author of When The Body Is The Target: Self-Harm, Pain and Traumatic Attachments and therapist, believes self-injury is addictive and counsels people on self-injurious behavior ranging from cutting, burning, and general self-mutilation to eating disorders, including bulimia (binging and purging). She discussed the trauma that can lead to self-harm and how to recover from a lifetime of self-injury

David: HealthyPlace.com moderator.

The people in blue are audience members.


Self-Injury Conference Transcript

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Getting Help For Self-Harm." Our guest is author and therapist, Dr. Sharon Farber.

Our topic tonight is "Getting Help For Self-Harm." Our guest is author and therapist, Dr. Sharon Farber. Dr. Farber is a board-certified clinical social worker and author of the book: When The Body Is The Target: Self-Harm, Pain and Traumatic Attachments.

Dr. Farber maintains that there's an addictive-like nature to self-injury. We're going to be talking about that along with the role that childhood neglect, abuse, and other trauma play in self-harm, along with why it's still difficult to find qualified therapists to treat this problem and where you can get help.

Good Evening, Dr. Farber, and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Could you please tell us a little more about yourself and your experience in the area of self-harm?

Dr. Farber: I have been in practice for around thirty years. My interest in self-harm came about when I developed a specialty in treating people with eating problems. (Detailed information on different types of eating disorders.)

I came to understand that a lot of people with eating problems, especially those who binge and purge, have problems with self-injury (especially picking their skin or scratching themselves, sometimes even more obtrusively through burning). Then I went on to do some original research. I wanted to understand why people who injure themselves may also have some kind of disordered eating, or why people who have disordered eating may injure themselves.

I did research where I compared bulimic behavior with self-mutilating behavior for similarities and differences. The similarities were extraordinary. Very powerful. I became fascinated and began treating more patients who self-injured. (Symptoms of Bulimia Nervosa)

I should also tell you, when I use the word self-injury or self-mutilation, I am also talking about a passive form of self-mutilation, and that includes people who compulsively get their bodies pierced or tattooed or branded.

David: What were the similarities between those with bulimia and those who self-mutilated?

Dr. Farber: Well there were quite a lot of similarities. Both of them seemed to be an individual's attempt to solve emotional problems, to make himself or herself feel better. They really served as a form of self-medication. Just as drug addicts and alcoholics use drugs or alcohol in order to medicate themselves, in order to calm themselves down or to rev themselves up, they use self-mutilation to make themselves feel better.

I came to regard both the binging and purging and the self-injury as functioning as someone's drug of choice. I found that the self-injurious behavior and the bulimic behavior, especially the purging (which is the most painful part of that experience), were being used as an attempt to release tension or to interrupt or end a feeling of depression or extreme anxiety.

David: In the introduction, I mentioned that you believe there's an addictive nature to self-harm. Can you elaborate on that, please?

Dr. Farber: Sure, what happens is that a person may start out scratching at their skin or pulling off scabs. It starts out, usually, in a milder form, possibly in childhood, and tends to, for the time being, make the person feel better. The problem is that it doesn't last - the feeling better. So what happens is then they have to do it again and again; just as an alcoholic becomes an alcoholic (what is an alcoholic?). He develops a tolerance for alcohol, so he has to drink a greater quantity and much more frequently. The same thing happens with self-injurious behavior. So someone who starts as picking at the skin then turns to mild cutting, which then becomes more wild and severe. In other words, they develop a tolerance for the self-injury, so they have to up the ante and do it more severely.

One of the things that I have found that was very interesting has to do with symptom substitution. That is if somebody tries to give up their self-injury but they are not psychologically ready, but they are doing it to please somebody (a boyfriend, parent, therapist), what will happen is another self-destructive symptom will crop up in its place.

One of the things that I have found in my study that was very, very interesting is that both the cutting and the purging (very, very painful and violent) seem to have the same kind of strength as a form of self-medication. Both are extremely powerful, and so often people will react as if they took instant or immediate-acting Prozac. It's that powerful as a form of self-medication and that is why it tends to be so addictive. Of course, it means that if they need something so powerful to make themselves feel better, getting into treatment with a therapist that is knowledgeable and understands how the self-harm behavior works is very, very important. The right kind of treatment can help enormously.

David: We have several audience questions on what we've discussed so far. Let's get to those and then we'll continue with our conversation.


Detached9: Why do you think self-injury is so common in people with anorexia or bulimia? possibly punishment?

Dr. Farber: Well the fascinating thing is that punishment is one of the functions it can serve, but for many people, it's a form of their body's speaking for them. In other words, the body says for the person what they cannot allow themselves to say or know in words. It's about speaking about the emotional pain that they cannot put into words, so their body speaks for them. If you want to think of the bleeding as a form of tears that they couldn't cry, I think that's a good metaphor.

It can be about punishment. Punishing one's self or punishing another. It can be about ridding themselves of something bad or evil inside. A form of cleansing or purifying themselves, except, of course, it doesn't work. If it did work, they would only do it once and they would be sufficiently cleansed or purified.

It starts as someone's solution to an emotional problem, but the solution can become more problematic than the original problem. The solution can take on a life of its own, and become like a runaway train. One of the psychological problems with self-harm is that it creates, for the person, a sense of being in control but then it becomes very out of control.

Cissie_4233: But anorexics and bulimics deal with a certain amount of vanity, therefore why are they now concerned with the scarring?

Dr. Farber: Well because anorexia and bulimia are not always about vanity. It's not always about wanting to look thin. For many people, it is more about emotional pain. And for many people who have a problem with eating they have difficulty with using words to express their emotional pain. So when someone says "I feel fat," they really mean "I feel anxious" or "I feel depressed" or "I feel lonely." For many people with eating problems, the obsession with their physical appearance is just a cover for much deeper emotional pain.

David: I just want to clarify one thing. You are saying that there's a link between eating disorders and self-injury. But, of course, there are people who self-injure who don't have an eating disorder. What about them? Why have they turned to self-injury to cope with their emotions?

Dr. Farber: What I have found in my study is that the people who have suffered the most trauma in their lives, especially childhood trauma (and that trauma can be the trauma of physical or sexual abuse, or children who suffer through various medical or surgical procedures), may need to use more than one form of self-harm.

Sometimes trauma is not the dramatic kind of trauma that I have just mentioned. It can be a loss, like a child suffering the loss of a parent or grandparent in childhood. Children can be traumatized by being constantly or chronically neglected (either emotionally or physically or both).

Abi: How/why, as you say, is body piercing, tattooing or branding described as a 'passive' form of self-mutilation when there are obviously so many people that have such things done and yet do not self-harm as in cutting or burning, etc?

Dr. Farber: Because they are having someone else mutilate their skin, their body tissue, you know? With people who get themselves tattooed constantly, many of them do it not only for the way it looks but for the experience of the pain. Some people will get a buzz from the tattooing. Some people even experience this erotically and get turned on by it. And the same thing goes for the people who purge.

About the piercing and tattooing, I am not talking about someone who just gets a tattoo in order to look cool or because their friends are doing it. I am not talking about that. I am talking about people who feel a "need" to do this to their bodies and have this kind of physical experience. What it does for them is what cutting or burning does for others. It distracts them from the pain that is inside; the internal pain. In other words, they'll have pain inflicted on themselves in order to divert the emotional pain that is inside.

TheEndIsNow: Many people talk about cutting, or other forms of self-injury prevalent among the abused. Are there other common reasons as to why a person might turn to self-injury?

Dr. Farber: Yeah. As I have said before, it usually comes from experience in childhood of trauma, but the trauma doesn't have to be the trauma of physical or sexual abuse; it certainly can be. It can be the trauma of losing a parent or grandparent. They may have no one in their lives that can help them express their pain so they may turn to doing something to their body.

lra20: What about the people who don't know why they do it? I have never been physically or sexually abused.

Dr. Farber: You don't have to be physically or sexually abused. People experience events very very differently. Trauma can be parents splitting up and all of a sudden the child no longer sees his or her father or mother, and that is a terrible trauma for a child, and that is terribly painful, and that child may start to express that pain through scratching himself or throwing up.

The trauma of physical or sexual abuse is certainly one of the major factors in self-harm, but there are many people that have been traumatized but not through physical or sexual abuse. Trauma comes in many different forms.

David: Here's the link to the HealthyPlace.com Self-Injury Community.

David: I want to address the treatment of self-injury, Dr. Farber. What does it take to recover from self-harm?

Dr. Farber: Well, first of all I think it takes a lot of courage. I think it also takes a relationship with a therapist in which you feel really safe -- And this feeling of safety doesn't have to start right from the beginning of therapy.

Most people who harm themselves come into therapy feeling very suspicious or wary of the therapist, but over time a sense of trust develops and the patient feels the therapist is not trying to control her (but when I say her, I am speaking of my own experiences, where most people who do this are female. Please understand when I say her, I mean her or him). I think when you are in therapy, you need to feel in control of yourself and that your therapist isn't trying to control you or insisting you stop hurting yourself. That is a good start. What can be very helpful is if a therapist can try to help you make it less dangerous (through medical help).

Also, it helps if a therapist can let someone know, right from the beginning, that even if you can't articulate in words why you are doing what you are doing, you must have good reasons for doing it. I think in good therapy, the patient and therapist work together to try to understand how and why self-injury became necessary in your life. When you do that, you can try to find other ways to make yourself feel better that are not so harmful - ways that can make you feel better about yourself, ways that you don't have to hide. And I think while all of this is going on, you start to have more control over yourself than you thought, and you find you are more able to speak about the pain that you are feeling inside than you thought, and you don't need to cut yourself or burn yourself so much in order to express that.


David: Are you saying that one method of treating self-injurious behavior is to taper off; sort of like quitting smoking cigarettes, where you smoke lower nicotine cigarettes or use nicotine substitutes until you finally quit?

Dr. Farber: I am not suggesting anything about how they do it. I think when people feel understood, they start to understand the how and why of why they felt the need to hurt themselves and they'll find other ways to make themselves feel better and the self-injury quite naturally diminishes.

You see, when I talk about treatment, I am not talking about treatment of just the symptom (the self-injury), I am talking about treatment of the person who has that symptom.

I think, very often, that people who hurt themselves tend to have relationships with others that are very painful, where they really cannot trust other people and I think that when someone can start to feel really safe in a therapeutic relationship, really safe with the therapist, that this attachment with the therapist, this relationship, can even become stronger than the relationship to self-harm, than the relationship to pain and to suffering.

David: Then what you are saying is: that until the person can work through their psychological issues, it is very difficult to control the self-injury.

Dr. Farber: I am saying that people need to do both at the same time. They kind of work together, both understanding how and why the need for self-injury arose. Therapists can help their patients find ways to control the self-harm behavior. One way I find extremely effective is when they are feeling the impulse to hurt themselves if they can try just to delay it for five or ten minutes. During those five or ten minutes, pick up a pencil and start to write. Try to put into words what you are feeling. In the process of doing that, in the process of using words to put shape or form into the pain you are feeling inside, the pain inside starts to diminish and by the time you finish writing, the urge to hurt yourself may well be much, much less. It's a way of starting to use your mind to deal with the pain rather than to use your body to deal with the internal pain, and that's the key to recovering from a life of self-injury.

David: We have many audience questions and I want to get to those. I have one last question for the moment. I know that you teach therapists how to treat self-injurers. In your estimation, are there many qualified therapists out there right now to provide proper self-injury treatment?

Dr. Farber: Not many at all, unfortunately. There are a number of reasons for this. One is that therapists become very anxious around people who hurt themselves, and really, there is nothing much in our training that teaches us how to handle people who do this to themselves.

One of the things I have become very interested in doing, and have begun doing, is teaching other mental health professionals how to understand and how to treat people who harm themselves. I want to make therapists less frightened. One of the ways that I am doing this is this summer I will be teaching a seminar at the Cape Cod Institute in July on the treatment of people who harm themselves, and anyone who is interested can go to the Cape Cod Institute website. I also have a toll-free phone number (888-394-9293) for information about the program this summer. You will receive a catalog with the registration information.

David: I ask that because I know that self-injury is still not understood, or is misunderstood, by many. So where does one go for qualified treatment? How do you find the proper treatment for self-injury?

Dr. Farber: I wish I could answer that, really. It can be difficult. First, find a therapist who is willing to learn about self-injury, if they don't already know about it. Then, you really need to search for qualified professionals. I know there are a number of websites about self-injury that have names and addresses of different clinics or therapists that are interested in working with patients who self injure, so that may be a good way to do it. Also, there are some therapists that are learning to do DBT (Dialectical Behavioral Therapy) and this is often a group treatment for people who harm themselves in different ways, who have various kinds of self-destructive behavior.

David: So, for those in the audience, that means if you are looking for treatment, you need to interview the therapists before starting treatment with them. Make sure they have an understanding of self-injury, or at the very least, they are willing to find out more about it. Here are some audience questions:

shattered_innocents: Hi Dr. Farber. Do you recommend any kind of art therapy for dealing with self-injury?

Dr. Farber: I think that anything that can help you express your emotional pain can be helpful - art therapy, poetry, music. Anything to help you express what you are feeling inside, so you don't have to use your body to express it, is wonderful.

Crissy279: Are there any alternatives to cutting or burning that you find have a high success ratio?

Dr. Farber: As I have already said, I think if people can get themselves to sit down and write what they are feeling inside, that can be enormously successful. Often people are afraid to write. You are not writing for publication, so forget about grammar and spelling. Just write what is in your heart. Just as you could use art or poetry or music or dance to express what is feeling inside - these are all much healthier, much more constructive ways of dealing with your emotional pain than using your body to express your pain. You deserve better than to hurt yourself in that way.

angels0ul: Am I just crazy, because my parents are together, my family is supportive and functional, I'm a straight-A student, busy in my community, and have never been through what you could really call "trauma" - not even the death of relatives or friends, and I still SI and struggle with anorexia?

Dr. Farber: As I have said before, trauma comes in all different forms and sometimes it is not nearly so obvious. If you can sit down with a therapist who wants to understand, you may be able to piece together why self-injury came about in your life and why it is something you need to use. You may not be able to know this now or articulate this now, but in time you may be able to.

jjjamms: I really would like to know why I cannot have feelings - good or bad ones. I have anorexia, MPD and self-injurious behavior. I try so hard to get through the feelings, but they are intolerable. How do I HAVE feelings?

Dr. Farber: Well, to be able to feel your feelings, I think first you need to be able to try to express them to somebody. Often that can be a therapist, and often at the beginning, it doesn't come out as something understandable or intelligible. For most people, to go from the experience of inflicting pain on your body to the experience of articulating your pain into words is a long process that doesn't happen overnight. It is also one of the reasons that short-term therapies are not that effective.


peanuts: How often is self-injury found in those with high abilities to dissociate?

Dr. Farber: Most people who self-injure dissociate either when they are self-injuring or right before. What the self-injury does is, if you are in a dissociated state that starts to feel intolerable, the SI can help bring you out of that state.

For some people, they can be in a state of extreme anxiety (hyper-arousal). Sometimes, when they self injure, the self-injury ends that state of hyper-arousal and brings about a dissociative state which may be more desirable. So self-injury can be used to interrupt a dissociated state or a state of hyper-arousal or a state of depression or a state of anxiety.

aurora23: I self injure and sometimes I feel suicidal and wonder: if I just went a little bit further or I cut a little bit deeper this time, what would happen. But my self-injury is not a suicide attempt. Are these feelings normal or should I have some concerns about these thoughts?
(note: Extensive information here on suicide,suicidal thoughts)

Dr. Farber: You should have some concerns about these feelings because there are some people who do not have the intention to end their lives but they like to flirt with the idea of going a little further and die in the process, although that was not the intention.

David: Earlier, you mentioned substituting one self-injurious behavior for another. Here's a question about that:

asilencedangel: If a person should turn their razors over to a therapist as the beginning of giving up self-injury and then starts abusing their body sexually and physically, could this be symptom substitution and how do I stop before it too gets out of hand?

Dr. Farber: I think if the person gives up the cutting before they are ready to do it, psychologically, they will find some other ways to hurt themselves or find other people to do it. So before someone gives up their cutting implements they need to think about whether they are ready to do this or not. You really need to be honest with yourself about it.

Asilencedangel, why did you turn your razors over to your therapist?

asilencedangel: I thought that I wanted to stop cutting, but now I am starting to question that.

Dr. Farber: I would say that if you turned over your razors to your therapist because the therapist requested it, and you did it for your therapist and not for yourself, then it is not going to work.

mucky: I think that turning razors over just makes it worse, makes me crave it more. At least if I have the razors, I can talk myself down or write a lot of times. Is this ok?

Dr. Farber: Of course it is okay. I think a lot of people who give up their self-injury do it knowing that if they really need to do it (self injure), they can (it's like having an ace up the sleeve). Making the decision to give it up makes someone feel more desperate - forbidden fruit always tastes sweeter. When you give something up, it makes you yearn for it more. I think getting beyond self-injury is more than giving up a certain behavior. It's about giving up a way of life that is attached to pain and suffering, emotional pain and emotional suffering, and when this happens, the self-injury falls by the wayside because it is not needed.

David: Here are a few more audience comments on this subject, then we'll go to the next question.

Jus: That was kind of my question too because someone told me that you should be SI free for 7 months before getting rid of your blades, etc.

2nice: My therapist said she couldn't see me anymore if I didn't stop and it scared me. I couldn't imagine starting all over again with a new person. So I gave everything to my shrink.

cassiana1975: My question is, how do you let everyone know about the self-injury? No one knows I do it. I know that I need help. I want help from friends and family, but I am afraid they will call me crazy.

Dr. Farber: I think you need to be able to talk about it with someone that is not your family or friends. Someone that will help you find a way to tell your family or friends. SI thrives in an atmosphere of secrecy and that promotes the shame. When you can come out to family or friends about it you are taking the behavior that seemed shameful and you're turning it into something else. You are starting to connect more with the other people in your life and that can only be good. Sometimes a therapist can help you to tell your friends or your family about what it is that you are doing, if you feel that you can't do this all by yourself.

David: Here are a few audience suggestions on where you might consider finding someone to talk to:

Trina: Teachers, GP (General Practitioner), guidance counselors, a walk-in clinic are all places teens can go to talk.

peanuts: My GP was supportive - admitting not knowing much about it, not being able to do therapy, but he was willing to listen anytime I needed to talk. It was a start and got me to therapy and other help.

Silent Night: How can I help my mom better understand self-injury?

Dr. Farber: Your mom may want to look at some of the websites about self-injury. There are a number of books out there. And try talking with your mom in an honest way; that would be a good place to start.

David: I know it's getting very late. Thank you, Dr. Farber, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful.

Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others: http://www.healthyplace.com.

Dr. Farber: It was a pleasure being here and I thank you for inviting me, and I hope this has been helpful to the people that have tuned in. And to everyone, I wish you all health and hope and healing.

David: Thank you, again, Dr. Farber. I hope everyone has a pleasant weekend. Good night.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

APA Reference
Tracy, N. (2007, April 11). The Relationship Between Eating Disorders and Self-Injury, HealthyPlace. Retrieved on 2024, December 29 from https://www.healthyplace.com/abuse/transcripts/getting-help-for-self-harm

Last Updated: May 14, 2019

Treatment for Self-Injury

How to stop self-injuring. Getting treatment for self-injury and ending self injury behaviors. Conference transcript w/ Dr. Wendy Lader from SAFE Alternatives.

How to Stop Self-Injuring

Dr. Wendy Lader, our guest speaker, is an expert on the treatment of self-injury. She is the clinical director of SAFE (Self Abuse Finally Ends) Alternatives. She is the author of the book "Bodily Harm: The Breakthrough Healing Program for Self-Injurers".

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

Self-Injury Chat Transcript

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. I hope everyone's day has gone well. Our conference tonight is on "Treatment for Self-Injury. How To Stop Self-Injuring".

Our guest is Wendy Lader, Ph.D., clinical director of the SAFE (Self-Abuse Finally Ends) Alternatives Program.

Dr. Lader is an internationally recognized expert on the treatment of the self-injurer. She is co-developer and clinical director of S.A.F.E. (Self Abuse Finally Ends) Alternatives, currently housed at MacNeal Hospital in Berwyn, Illinois. Developed in 1985, S.A.F.E. remains the only inpatient and partial hospitalization program designed exclusively for the self-injury patient.

She is the co-author of the book, "Bodily Harm: The Breakthrough Healing Program for Self-Injurers" and has published journal articles and lectured extensively on the subject.

Good evening Dr. Lader and welcome to HealthyPlace.com. We appreciate you being here tonight. Just so everyone is on the same page here, please give us your definition of self-injury, what is it and what it isn't.

Dr. Lader: Self-injury is the deliberate harming of one's body in a non-lethal way, with the purpose of managing uncomfortable emotions. It isn't a suicide attempt.

David: Please correct me if I am wrong about this, but people are not "born" being self-injurers. In other words, there's no genetic predisposition to self-injury. What is it then that pushes someone into this type of behavior?

Dr. Lader: You're correct. There is no gene for self-injury. However, there may be some predisposition for lower tolerance for frustration. In general though, we find most of our clients come from homes in which communication is indirect or at times violent.

David: I have heard people who are self-injurers say that by cutting themselves, they actually feel better. I think that's difficult for some people to understand. Can you elaborate on that?

Dr. Lader: Self-injury is a form of numbing, similar to drugs or alcohol. It may even release naturally occurring opiates that make people feel better.

David: And when you say that people come from homes where communication is indirect, can you explain that to us, please? And why would that result in self-injurious behavior?

Dr Lader: The answer to this question is complicated. In general, families have difficulty expressing feelings through words. Instead, sometimes these feelings are expressed through action or just not talked about at all. So, people may learn the only way to get attended to is through action or it "turns up the volume" so that people notice that something is wrong.

David: So, are you saying that in some instances, this may be an attention-getting mechanism?

Dr. Lader: That's minimizing the problem. When people need to express themselves in this way, it's because other avenues have not been responded to. This creates tremendous frustration and anger without an outlet.

David: You also mentioned the numbing sensation, similar to drugs and alcohol. Would you say that self-injurious behavior is addictive or similar to having an addiction?

Dr. Lader: We don't believe it's an addiction, because we do believe that people can fully recover. However, it's addictive-like in that it helps people feel better, though temporary, and it often increases in severity and intensity over time.

David: Here are some audience questions, Dr. Lader:

siouxsie: I know a lot of self-injurers have been abused but I have never been abused in any way and I am a Self-Injurer. Is this common?

Dr. Lader: Yes. While many self-injurers have experienced physical abuse or sexual abuse, a large number have not.

Exfear: Why do most self-injurers like myself, find that we have to self injure in order to get the help?

Dr. Lader: Many people come from families that do not respond to more subtle cries for help.

daybydaymomof2: Is self-injuring in any way hereditary?

Dr. Lader: Self-injury itself is not hereditary. However, family histories of mood disorders, low tolerance for frustration and other forms of addiction are common.

Silkyfire: I have felt that the feeling of the blood running down my arm is a symbol of the stress leaving. Is that average?

Dr. Lader: We hear that very frequently and bloodletting has a long history in our culture as a release of "toxins." And maybe, in this case, it's toxic feelings.

savanah: Is there such a thing as healthy self-injury?

Dr. Lader: We don't believe there is. We view self-injury as an escape from dealing with the "real" problem which is facing uncomfortable events and feelings.

wonder: I run the website Self-Harm Links. I receive emails weekly asking for help for self-harm. I am not a doctor. I have only my personal experience. Given the lack of professionals who deal with self-injury, what do you think a good response would be to refer people who need more help than I can offer?

Dr. Lader: Tell them to call the informational line - 1 800 DON'T CUT or they can read our book, "Bodily Harm: The Breakthrough Healing Program for Self-Injurers".

David: I want to get into the treatment aspect of self-injury. First, can you give us some details about the SAFE Alternatives Program-- how it works, what the goals are, what the costs are. Then we'll get into other aspects of treatment for self-injury.

Dr. Lader: We forgot to mention that we have a website - www.safe-alternatives.com. On our website, we also answer some of those questions. In general, we're a thirty-day inpatient/day hospital program that uses a combination of impulse control logs, writing assignments, individual and group therapies. The cost depends on the number of inpatient days versus partial, and many insurance companies cover much of these costs.

David: Does insurance cover the costs or most of the costs?

Dr. Lader: It really depends on the insurance company and each individual's benefit plan.

David: And just to give people in the audience an idea of the costs involved, can you give us a range, please?

Dr. Lader:Approximately $20,000 for 30 days.

David: Before I get into the treatment details, I'm wondering if a person with self-injury can be completely "cured" or is it like an addiction, where they live with it day-to-day and manage it day-to-day?

Dr. Lader: We believe that people can be completely cured.

David: Regarding treatment for self-injury, what are the various treatments available and how effective are they?

Dr. Lader: I can only speak for the effectiveness of our program. Our preliminary outcome data indicate that approximately 75% of our clients are injury-free at the two-year post-discharge mark.

David: And what kinds of treatments are available to help someone recover from self-injury?

Dr. Lader: We believe in a combination of cognitive-behavioral and psychodynamic approaches. In other words, we attend to the symptom of self-injury as a clue that indicates underlying unresolved issues. But we also believe that as long as one is edging in the symptom and therefore self-medicating, that it is harder for them to deal with the underlying issue.

David: How do you make someone stop self-injuring?

Dr. Lader: One of the reasons we do this in an intensive care setting, is because we know that self-injury is a difficult symptom to give up without twenty-four-hour support. Once someone has recognized alternative choices, and has learned how to deal with the feelings, self-injury is no longer necessary.

David: Earlier, you mentioned the use of "impulse control logs". What are those and how do they work?

Dr. Lader: Impulse control logs are designed to give clients a "window of opportunity."This means putting a thought in-between an impulse to self injure and the actual action. We recognize self-injury as a clue that one is wanting to avoid a seemingly intolerable emotional state. The logs identify the precipitant of the impulse, the related feelings and what the individual is trying to communicate to others, and what the consequence for the action would be.

David: Our audience members have lots of questions Dr. Lader. Here are some:

Marci: What are the main things that one can do to manage self-injury, especially if a program like yours is unavailable to them?

Dr. Lader: We strongly advise being in individual psychotherapy. We also encourage within this therapy, the use of impulse control logs and our writing assignments (also included in our book) to help structure the therapy.

sadeyes: I haven't had any success with impulse control logs. Do they work for some, and not for others?

Dr. Lader: In general, the clients who come here find them extremely helpful. It may be that you need some guidance on how to use them, and for some, it takes some practice. They don't always help right away.

tiggergrrl555: Is it possible to recover from self-injurious behavior without going to a program like SAFE?

Dr. Lader: Yes, many people do.

David: And how do they do it?

Dr. Lader: Through supportive individual therapy, and the willingness to take the risk to face the uncomfortable feelings.

wendles: Many people I have met and asked about my scars have never heard of self-injury. What is the best way to explain it to them so I can get help?

Dr. Lader: Self-injury has been my way of coping with intense feelings. It has helped me survive but I would like to learn how to communicate feelings through words instead of action.

David: And that also brings up another point, Dr. Lader. Some people have great difficulty finding a therapist who will treat those with self-injury. How does one deal with that?

Dr. Lader: I think it's good that certain therapists admit that they don't know how to deal with this particular issue. It's fine to interview therapists to find one that has treated other self-injurers or is willing to get supervision.

David: For those in the audience who are self-injurers, I'd be interested in knowing what you did or said to let someone know about your self-injury behavior.

What about the use of medications to treat self-injury, Dr. Lader? Are there any that are used in the treatment of self-injury?

Dr. Lader: Our clients come in on many different medications and we do believe that medications can help clients deal with the acute and intense anxiety that many clients experience.It has been our experience that a low dose of neuroleptics helps with this acute anxiety, and the hope is that clients only need to be on them for limited amounts of time. Other medications that some people find helpful are anti-depressants and mood stabilizers.

David: Here are some of the audience responses to how do you let someone else know about your self-injury? Hopefully, by sharing these, we'll be able to help each other:

wonder: I only let people know about my self-harm if they ask. I am very scared that they will interpret it as attention seeking if I tell them without their asking.

Liz Nichols: The first person I told was my mom. I didn't know what to tell her, so instead, I just showed her the cuts/scars and started crying. She thought they were suicide attempts but later on, she started to understand what it was.

kayla_17: The first time that someone found out, he was shocked, and he didn't really know what to do. He asked me about it and wanted to know why I've done it. But I really was trying to let him see it because I needed someone to know

Lela: When someone asked me about my scars, I said that I deliberately cut myself. I added that it was the dumbest thing I'd ever done and that I don't recommend it for anyone.

Chickie96: One of my friends brought up her problem, and it turned out that another two people present (myself included) in this group of four were doing it too. We use each other for support, and we talk to each other about our problems too.

Trainer: How my husband found out? I had been very withdrawn. I couldn't bring it up verbally so I purposely left drops of blood on the floor by the toilet. He then confronted me on it.

BPDlady23: I tell people that ask about my scars that I self injure. I go on to explain that I cut myself, but am not a danger to others. This usually leads to more questions, which I am glad to answer.

David: What is it like to get treatment for self-injury, Dr. Lader? You mentioned the possibility of needing anti-anxiety medications. For instance, alcoholics need to "dry out" first and go through the "shakes". Do people who self-injure have similar withdrawal experiences?

Dr. Lader: People have all kinds of fears about what will happen if they don't self injure such as, "I'll go crazy, "I'll explode," "I'll start crying and never stop," or "I'll die."But in all of the fifteen years that we've been doing this, I've never seen any of these happen.

David: Some more audience responses to how you shared the news with others that you self-injure:

darknesschild: When people say "what happened?" I just say "razor blade." Then they don't ask anything else.

Cathryn: I've only told a few close friends. No one in my family knows, not my husband nor my daughters.

ang2 A: The first person that asked me, saw wrists bandaged and motioned a question so in private simply told him the whole story. The second one found me out one night and asked how I was. When I said "I've been better," he questioned me what's wrong. So told him what was bothering me and the whole thing.

wendles: I never tell anyone unless they ask. Sometimes I tell them my dog scratched me. I finally confessed to my mom and my best friend.

bluegirl: I told a friend that I had tried to hurt myself. I didn't really say self-injury or suicide attempt or anything. And I told her that I had been at the hospital getting stitches and they had tried to admit me involuntarily. She was the first non-therapist-type person I told.

Rabbit399: What is the draw that a person may have that moment right before they self injure for the first time? Have you any information on the reasons why a person may pick up that object and hurt himself or herself without ever doing so before? Also, is it more common for people to just be self-injurers, or is it something they become because they first saw it and wanted to try to see if it worked?

Dr. Lader: Most people don't know why they picked up the first object to hurt themselves. It's becoming more common, however, for people to have heard about it from other people and then try it.

David: For those of you who are wondering if it's possible to recover from self-injury, here's a comment from one of our audience members tonight:

mazey: I have been in treatment 2 times with Dr. Lader being my psychologist. I have been injury-free, I'm honestly not sure, maybe going on 2 years now. I didn't think that I would ever stop, but I did. Not easily, though. It's been a lot of hard work and tears.

I attended treatment. I have impulse logs in my car, by the computer, in my binder so when I'm in class, I surrender. I barrel right on through the emotions. I take it head on because I have the tools to not injure. I try to just say it, and I cry and cry and don't try to stop the feelings. The thoughts of injuring lessoned until I realized I was thinking about it all the time

Lela: I've been a self-injurer for 2 years and recently decided to quit. But I keep occasionally going back to it. How can I stop completely?

Dr. Lader: It's important to recognize that the self-injury itself is not the problem. Many people have been able to go for months and sometimes even years between episodes, but unless they deal in more direct ways with their feelings, the symptom is likely to persist.

David: For those who asked for it, here's the link to the HealthyPlace.com Self-Injury Community. You can click on this link and sign up for the mail list at the top of the page so you can keep up with events like this.

Now, to follow-up on that comment, what you are saying is, even after attending a treatment program like yours, it's important to receive follow-up therapy on a regular basis?

Dr. Lader: Absolutely.

thycllmemllwyllw: I have not been self-harming as long as some people but I know a lot of people that have self-harmed for a while and they come to me to vent, and they are always threatening to die. I want to know what are some ways that I can calm them down without talking about myself or getting myself down about it?

Dr Lader:I would suggest helping them focus away from the "escape" (self-injury or suicide) and focus instead on identifying feelings and finding solutions for the problem. Also, to identify and challenge thoughts that fuel escalation rather than calming.

mammamia: It's important for me to cut veins, in order to see the blood run out. It feels almost like I'm ridding my body of all the bad stuff. I'm getting very weak because of this. It has become very serious; I'll cut 3 or 4 times a day. How do I get help when living so far away from Illinois? I'm scared.

Dr. Lader: It's important to be in therapy and to recognize that the object is not to rid oneself of anything but to accept uncomfortable feelings like anger and sadness. These feelings are not "bad" just uncomfortable.

Cathryn: OMGosh! mammamia, I do that for the same reasons too!! Actually, I cut different ways for different reasons. I am trying so hard to get the feelings out, rather than cut. But being threatened with abuse for crying as a child dries up the tears. I cry red tears now.

David: And mammamia, even if you can't get to the SAFE program, hopefully, you can find a therapist near where you live who can help. That's the most important thing. Finding a treatment specialist who can help you.

Sometimes I hear people say, "What you are saying is triggering to me. I have to cut myself." For some who are not self-injurers, it's difficult to understand how just saying something can induce someone to self-injure. Can you explain that phenomenon to us?

Dr. Lader: Some of these questions are very complicated and we recognize that some of our answers may seem and in fact are simplistic. However, in answer to this question, triggers are important clues. Don't lose that information. Analyze it and try to understand and face the fear directly.

We B 100: Is it normal to not know why I self-injure?

Dr. Lader: Yes. Most people don't know why they injure. The action itself is at first so automatic that the reason is often lost. In fact, the purpose of self-injury is to distract from the underlying problem.

David: Here are some audience comments about what is being said tonight:

insight: My experience has been that it was easier to self-injure to prevent memories of past abuse to surface. The emotional pain was what I was afraid of.

sweetpea1988: We all need to learn to let ourselves express our feelings

sweetpea1988: Plus it is what we were taught about anger

jenny3: I have been cutting since I was 17 and I am now 26. I find it is very hard to keep hiding from people. I am on medication to help me with this but they don't seem to be working yet

sweetpea1988: To not know why is because we have not learned to express ourselves in a safe way.

Lela: The reason I first cut was out of curiosity. A girl at school triggered me and I picked up a pair of scissors. I was amazed by the way the pain left me so quickly.

tree101: I find that when I am triggered, it's because what someone is saying is taking me back to uncomfortable feelings or situations. It increases my feeling of been bad and my need to be back in control

wonder: There has never been an instance where someone has said something that made me want to cut. But usually, I feel like I want to cut after reading a lot about it or very graphic descriptions on the net. It brings up old "junk" when I think about self-harming too long.

cherrylyn24: My parents are not very supportive of me and I have reached out for help in other ways. They have gotten angry at me for that, and whenever they yell at me, it seems like the answer is to cut. I know I need help, but have been in therapy before and hated it, plus my parents complained about taking me.

Chickie96: my father's alcoholism numbed me as a child, and now I can't really deal with admitting emotions easily.

jenny3: My parents don't know that I cut and I don't want them to know

TeddybearBob: We need to see that self-injury is a lie that it takes the pain away from us. It doesn't give us any real control..

Liz Nichols: The first time I ended up cutting myself was when my family was having a fight. When I was cutting myself I was more thinking about killing myself than anything. Then I started feeling better. I started when I was 16 and I'm now 18.

wendles: I took chunks of skin out of my arm with a fingernail clipper. I didn't even realize what I was doing was self-injury. I still don't understand why I did it.

David: I'm getting some comments about Dr. Lader's book "Bodily Harm" not being available in stores. If you click on this link you can get it now: "Bodily Harm: The Breakthrough Healing Program for Self-Injurers".

ang2 A: The book is wonderful, finally people that understand!

Dr. Lader: Thanks! That's what we hope for.

David: Here are a few more questions:

imahoot: Is severe headbanging to the point of fracturing skull common in Self-injury as is cutting?

Dr. Lader: Yes. Many of our clients hit various parts of their body severely.

ktkat_2000: I was told by my psychiatrist that the self-injury behavior would be in my life until I am in my 50's when I will "grow out of it". Is there any truth to this?

Dr. Lader: No. We have many teenage clients as well as young adults who have stopped this behavior. It's not a matter of growing out of it. There are things you can do to take true control. We know that people don't just grow out of this, as we have many clients calling us and coming to our program of all ages, including those over 50.

Maddmom: Is it uncommon to not plan, not have a favorite tool, and to hurt in other ways rather than cutting?

Dr. Lader: No. Some clients have rituals and plan their self-injury, but an equal number or maybe more, act impulsively.

David: Maddmom breaks her fingers. Does that fall under self-injury?

Dr. Lader: Yes, it does.

biker_uk: Do you think that message boards are a good or bad thing for self-injury?

Dr. Lader: I think there are many people, including therapists who try to be helpful, but may not be accurately informed.

David: Thank you, Dr. Lader, for being our guest tonight. We're grateful that you came and shared your knowledge and insights with us. The SAFE Alternatives phone number is 1-800-DONTCUT. Their website address is www.safe-alternatives.com.

Dr. Lader: Thanks so much for having us. The audience and moderator questions were excellent.

David: I also want to thank everyone in the audience for coming tonight and participating. I hope you found tonight's conference helpful.

Thank you again, Dr. Lader. I hope you'll agree to come back and be our guest again.

Dr. Lader: We'd love to. Good night.

David: Good night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

APA Reference
Tracy, N. (2007, April 11). Treatment for Self-Injury, HealthyPlace. Retrieved on 2024, December 29 from https://www.healthyplace.com/abuse/transcripts/how-to-stop-self-injuring

Last Updated: June 20, 2019