Narcissistic Personality Disorder (NPD) Resources

by Band Back Together | Nov 17, 2018

What Is A Personality Disorder?

Personality is the way of thinking, feeling and behaving that makes a person different from another. An person’s personality is influenced by experiences, environment (surroundings, life situations), and inherited characteristics. A personality disorder is a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress, or problems functioning, and lasts over time.

There are 10 specific types of personality disorders, including Narcissistic Personality Disorder. Common to all personality disorders is a long-term pattern of behavior and inner experience that differs significantly from what is expected. This pattern of experience and behavior begins by late adolescence or early adulthood, and causes distress and/or problems in the way a person functions. Without treatment, these behaviors and experiences becomes inflexible and usually long-lasting.

The pattern of behaviors is seen in at least two of these areas:

• Way of thinking about themselves and others
• Way of responding emotionally
• Way of relating to other people
• Way of controlling one’s behavior

The 10 specific personality disorders are grouped into three categories called “clusters.”

Cluster A: Odd or Eccentric Behaviors

• Paranoid personality disorder: a pattern of distrust and suspiciousness where others’ motives are seen as mean or spiteful. People with paranoid personality disorder often assume people will harm or deceive them and are reluctant to confide in others, and/or become close to them.
• Schizoid personality disorder: a pattern of detachment from social relationships and a limited range of emotional expression. A person with schizoid personality disorder typically doesn’t seek close relationships, chooses solitary activities, and appears indifferent to praise or criticism from others.
• Schizotypal personality disorder: a pattern of acute discomfort in close relationships, distortions in thinking or perception, and eccentric behavior. A person with schizotypal personality disorder may have odd beliefs or magical thinking, odd or peculiar behavior or speech, or may incorrectly attribute meanings to events.

Cluster B: Dramatic, Emotional, or Erratic Behavior

• Antisocial personality disorder: a pattern of disregarding or violating the rights of others. A person with antisocial personality disorder may not conform to social norms, may repeatedly lie or deceive others, and/or may act impulsively.
• Borderline personality disorder: a pattern of instability in personal relationships, emotional response, self-image and impulsivity. A person with borderline personality disorder may go to great lengths to avoid abandonment (real or perceived), have recurrent suicidal behavior, display inappropriate intense anger, and/or have chronic feelings of emptiness.
• Histrionic personality disorder: a pattern of excessive emotion and attention seeking. A person with histrionic personality disorder may be uncomfortable when he/she is not the center of attention, consistently use their physical appearance to draw attention, or show rapidly shifting or exaggerated emotions.
• Narcissistic personality disorder: a pattern of need for admiration and lack of empathy for others. A person with narcissistic personality disorder may have a grandiose sense of self-importance, a sense of entitlement, take advantage of others, and/or lack empathy.

Cluster C: Anxious or Fearful Behavior

• Avoidant personality disorder: a pattern of social inhibition, feelings of inadequacy and extreme sensitivity to criticism. A person with avoidant personality disorder may be unwilling to get involved with people unless he/she is certain of being liked, be preoccupied with being criticized or rejected, and/or may view himself/herself as being inferior or socially inept.,
• Dependent personality disorder: a pattern of needing to be taken care of and submissive and clingy behavior. A person with dependent personality disorder may have difficulty making daily decisions without reassurance from others or may feel uncomfortable or helpless when alone because of fear of inability to take care of himself or herself.
• Obsessive-compulsive personality disorder: a pattern of preoccupation with orderliness, perfectionism and control. A person with obsessive-compulsive personality disorder may be preoccupied with details or schedules, may work excessively to the exclusion of leisure or friendships, and/or may be inflexible in morality and values. (This is NOT the same as obsessive compulsive disorder)

Diagnosis of a personality disorder requires a mental health professional looking at long-term patterns of functioning and symptoms. For a person under 18 years old to be diagnosed, the symptoms must have been present for at least a year. Some people with personality disorders may not recognize a problem. Also, people often have more than one personality disorder. An estimated 9 percent of U.S. adults have at least one personality disorder.

What is Narcissistic Personality Disorder?

Narcissistic Personality Disorder is characterized by a person’s self-directed focus and inflated self-admiration.

While everyone likes to feel important and receive positive attention from those around them, people who have NPD take this to the next level. People with this condition are frequently described as arrogant, self-centered, manipulative, and demanding.

The hallmarks of Narcissistic Personality Disorder (NPD) are grandiosity, a lack of empathy for other people, and a need for admiration. They may also concentrate on grandiose fantasies (e.g. their own success, beauty, brilliance) and may be convinced that they deserve special treatments and rewards. These characteristics typically begin in early adulthood and must be consistently evident in multiple contexts, such as at work and in relationships.

Note: Having high self-confidence (a strong sense of self) is far different from narcissistic personality disorder; people with NPD typically value themselves over others to the extent that they openly disregard the feelings and wishes of others, and expect to be treated as superior, regardless of their actual status or achievements.

Moreover, the person with narcissistic personality disorder usually exhibits a fragile ego (self-concept), an intolerance of criticism, and a tendency to belittle others in order to validate their own superiority.

50 to 75 percent of the people diagnosed with narcissistic personality disorder are male; it’s been approximated that 1-2% of people have narcissistic personality disorder. The actual number of people who have NPD is likely to be far higher, as many who have this personality disorder don’t ever seek treatments.

People with narcissistic personality disorder believe they are superior or special, and often try to associate with other people they believe are unique or gifted in some way. This association enhances their self-esteem, which is typically quite fragile underneath the surface. Individuals with NPD seek excessive admiration and attention in order to know that others think highly of them. Individuals with narcissistic personality disorder have difficulty tolerating criticism or defeat, and may be left feeling humiliated or empty when they experience an “injury” in the form of criticism or rejection.

What Is The Prevalence of Narcissistic Behavior?

According to a study covered by US News and World Report, rates of narcissism are on the rise.

In the summer of 2018, [a study of] a nationally representative sample of 35,000 Americans found that 6 percent of Americans, or 1 out of 16, had experienced [clinical narcissistic personality disorder (NPD)] at some point in their lives.

And there was a big generational effect. You’d expect that people who are older would have a higher percentage of having experienced this because they’ve lived so many more years. But only 3 percent of people over 65 had had any experience with NPD, compared with almost 10 percent of people in their 20s. Given that you can only diagnose this when someone is 18, that’s a pretty short number of years in which to have this experience.

That’s a pretty big indication that this is an out-of-control epidemic.

What Are The Subtypes of Narcissistic Personality Disorder?

Subtype Description Personality traits

• Unprincipled narcissist Including antisocial features: These people have a deficient conscience; unscrupulous, amoral, disloyal, fraudulent, deceptive, arrogant, exploitive; a con artist and charlatan; dominating, contemptuous, vindictive.
• Amorous narcissist Including histrionic features:. These people are sexually seductive, enticing, beguiling, tantalizing; glib and clever; disinclined to real intimacy; indulges hedonistic desires; bewitches and inveigles others; pathological lying and swindling. Tends to have many affairs, often with exotic partners.
• Compensatory narcissist Including negativistic and avoidant features: These people cancel out deep feelings of inferiority and lack of self-esteem; offsets deficits by creating illusions of being superior, exceptional, admirable, noteworthy; self-worth results from self-enhancement.
• Elitist narcissist, Variant of pure pattern: These people feel privileged and empowered by virtue of special childhood status and pseudo-achievements; entitled façade bears little relation to reality; seeks favored and good life; is upwardly mobile; cultivates special status and advantages by association.
• Normal narcissist: Absent of the traits of the other four, this is the least severe and most interpersonally concerned and empathetic, still entitled and deficient in reciprocity; bold in environments, self-confident, competitive, seeks high targets, feels unique; talent in leadership positions; expecting of recognition from others.

Possible additional categories (not cited by the current theory of Millon might include):

• Fanatic narcissist: Including paranoid features. Grandiose delusions are irrational and flimsy; pretentious, expensive supercilious contempt and arrogance toward others; lost pride reestablished with extravagant claims and fantasies. Reclassified under paranoid personality disorder.
• Hedonistic narcissist: Mix of Millon’s initial four subtypes Hedonistic and self-deceptive, avoidant of responsibility and blame, shifted onto others; idiosyncratic, often self-biographical, proud of minor quirks and achievements, conflict-averse and sensitive to rejection; procrastinative, self-undoing, avolitive, ruminantly introspective; the most prone to fantastic inner worlds that replace social life.
• Malignant narcissist Including antisocial, sadistic and paranoid features. Fearless, guiltless, remorseless, calculating, ruthless, inhumane, callous, brutal, rancorous, aggressive, biting, merciless, vicious, cruel, spiteful; hateful and jealous; anticipates betrayal and seeks punishment; desires revenge; has been isolated, and is potentially suicidal or homicidal.

Will Titshaw also suggested three subtypes of narcissistic personality disorder. These are not officially recognized in any editions of the DSM or the ICD-10.

• Pure Narcissist: Mainly just NPD characteristics. Someone who has narcissistic features described in the DSM and ICD and lacks features from other personality disorders.
• Attention Narcissist Including histrionic (HPD) features. They display the traditional NPD characteristics described in the ICD & DSM along with histrionic features due to the fact that they think they are superior and therefore they should have everyone’s attention, and when they do not have everyone’s attention they go out of their way to capture the attention of as many people as possible.
• Beyond The Rules Narcissist :Including antisocial (ASPD) features. This type of narcissist thinks that because they are so superior to everyone they do not have to follow the rules like most people and therefore show behavior included in the ICD for dissocial personality disorder and behavior, included in the DSM for antisocial personality disorder.

Causes of Narcissistic Personality Disorder:

The exact cause of Narcissistic Personality Disorder is unknown; however, many psychologists believe that this shame-based disorder derives from a combination of biological, genetic, and social factors. It’s likely that the narcissist grew up in an extreme environment: living with neglect and abuse, pushed toward perfection or being praised for “having special talents.”

The causes of narcissistic personality disorder are unknown,The causes of narcissistic personality disorder are unknown. Experts tend to apply a biopsychosocial model of causation, meaning that a combination of environmental, social, genetic and neurobiological factors are likely to play a role in formulating a narcissistic personality.

Genetic Factors

There is evidence that narcissistic personality disorder is inheritable, and people are much more likely to develop NPD if there is a family history of the disorder. Studies on the occurrence of personality disorders in twins determined that there is a moderate to high inheritability for narcissistic personality disorder.

However, the specific genes and gene interactions that contribute to its cause – and how they may influence the developmental and physiological processes underlying this condition – have yet to be determined.

Environment

Environmental and social factors are also thought to have a significant influence on the onset of NPD. In some people, pathological narcissism may develop from an impaired attachment to their primary caregivers, usually their parents. This can result in the child’s perception of himself/herself as unimportant and unconnected to others. The child typically comes to believe they have some personality defect that makes them unvalued and unwanted. Overindulgent, permissive parenting as well as insensitive, over-controlling parenting, are believed to be contributing factors.

According to Leonard Groopman and Arnold Cooper, the following have been identified by various researchers as possible factors that promote the development of NPD:

• An oversensitive temperament (personality traits) at birth.
• Excessive admiration that is never balanced with realistic feedback.
• Excessive praise for good behaviors or excessive criticism for bad behaviors in childhood.
• Overindulgence and overvaluation by parents, other family members, or peers.
• Being praised for perceived exceptional looks or abilities by adults.
• Severe emotional abuse in childhood.
• Unpredictable or unreliable caregiving from parents.
• Learning manipulative behaviors from parents or peers.
• Valued by parents as a means to regulate their own self-esteem.

Cultural elements are believed to influence the prevalence of NPD as well since NPD traits have been found to be more common in modern societies than in traditional ones.

What Are The Co-Morbid Conditions Associated With NPD?

NPD has a high rate of comorbidity with other mental disorders. People with NPD are prone to bouts of depression, often meeting criteria for co-occurring depressive disorders.

In addition, NPD is associated with bipolar disorder, anorexia, and substance use disorders, especially cocaine. As far as other personality disorders, NPD may be associated with histrionic, borderline, antisocial, and paranoid personality disorders.

Symptoms Of Narcissistic Personality Disorder:

Narcissistic personality disorder usually develops in adolescence or early adulthood. It is not uncommon for children and adolescents to display traits similar to those of NPD, but such occurrences are usually transient, so it’s important to get an actual diagnosis before assuming their teen has NPD.

True symptoms of NPD are pervasive, apparent in various situations, and rigid, remaining consistent over time. The NPD symptoms must be sufficiently severe that they significantly impair the person’s capabilities to develop meaningful human relationships. Generally, the symptoms of NPD also impair the person’s psychological abilities to function, either at work, or school, or important social settings. The DSM-5 indicates that the traits shown by the person must substantially differ from cultural norms, in order to qualify as symptoms of NPD.

According to the DSM-5: “Many highly successful individuals display personality traits that might be considered narcissistic. Only when these traits are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress do they constitute narcissistic personality disorder.” Due to the high-functionality associated with narcissism, some people may not view it as an impairment in their lives.

Although overconfidence tends to make individuals with NPD ambitious, it does not necessarily lead to success and high achievement professionally.

These people can be unwilling to compete or may refuse to take any risks in order to avoid appearing like a failure. In addition, their inability to tolerate setbacks, disagreements, or criticism, along with lack of empathy, make it difficult for these people to work cooperatively with others or to maintain long-term professional relationships with superiors and colleagues.

The DSM-5 indicates that persons with NPD usually display some or all of the following symptoms (most often without the qualities or accomplishments they believe to have):

• Grandiosity with expectations of superior treatment from other people
• Fixated on fantasies of power, success, intelligence, attractiveness
• Self-perception of being unique, superior, and associated with high-status people and institutions
• Needing continual admiration from others
• Sense of entitlement to special treatment and to obedience from others
• Exploitative of others to achieve personal gain
• Unwilling to empathize with the feelings, wishes, and needs of other people
• Intensely envious of others, and the belief that others are equally envious of them
• Pompous and arrogant demeanor

People with NPD tend to exaggerate their skills, accomplishments, and their level of intimacy with people they consider high-status. This sense of superiority may cause them to monopolize conversations or to become impatient or disdainful when others talk about themselves. When their own ego is wounded by a real or perceived criticism (triggering narcissistic rage); narcissistic rage and anger is usually disproportionate to the situation, but generally, their actions and responses are deliberate and calculated.

Narcissistic people can be controlling, blaming, self-absorbed, intolerant of others’ views, unaware of others’ needs and the effects of their behavior on others, and insist that others see them as they wish to be seen. Narcissistic individuals use various strategies to protect themselves and their beliefs at the expense of others. They tend to devalue, derogate, insult, and blame others, and they often respond to threatening feedback with anger and hostility.

Since the fragile ego of individuals with NPD is hypersensitive to perceived criticism or defeat, they are prone to feelings of shame, humiliation, and worthlessness over minor or even imagined incidents. They usually mask these feelings from others with feigned humility or by isolating themselves socially, or they may react with outbursts of rage, defiance, or by revenge seeking.

The merging of the “inflated self-concept” and the “actual self” is seen in the inherent grandiosity of narcissistic personality disorder. Also at the heart of this process are the defense mechanisms of denial, idealization, and devaluation.

According to the Cleveland Clinic, those with Narcissistic Personality Disorder:

• Are self-centered and boastful
• Seek constant attention and admiration
• Consider themselves better than others
• Exaggerate their talents and achievements
• Believe that they are entitled to special treatment
• Are easily hurt but might not show it
• Might take advantage of others to achieve their goals
• Exaggerates his or her own importance
• Is preoccupied with fantasies of success, power, beauty, intelligence or ideal romance
• Believes he or she is special and can only be understood by other special people or institutions
• Requires constant attention and admiration from others
• Has unreasonable expectations of favorable treatment
• Takes advantage of others to reach his or her own goals
• Disregards the feelings of others, lacks empathy
• Is often envious of others or believes other people are envious of him or her
• Shows arrogant behaviors and attitudes
• A narcissist often exhibits intense and unstable emotions when their self-concept is challenged.

Other common traits of narcissistic personality disorder include:

• Preoccupation with fantasies that focus on unlimited success, power, intelligence, beauty, or love
• Belief that he or she is “special” and unique, and can only be understood by other special people
• Expectation that others will automatically go along with what he or she wants
• Inability to recognize or identify with the feelings, needs, and viewpoints of others
• Envy of others or a belief that others are envious of him or her
• Hypersensitivity to insults (real or imagined), criticism, or defeat; possibly reacting with rage, shame, and humiliation
• Arrogant behavior and/or attitude
• The narcissistic individual’s sense of self is extremely distorted. A narcissist feels they must demonstrate feelings of superiority to compensate for a severe lack of self-esteem.

Treatment For Narcissistic Personality Disorder:

Those with Narcissistic Personality Disorder rarely seek treatment, as they genuinely believe that everyone else is the problem.

Treatment for narcissistic personality disorder can be challenging because people with this condition present with a great deal of grandiosity and defensiveness, which makes it difficult for them to acknowledge problems and vulnerabilities. Individual and group psychotherapy may be useful in helping people with narcissistic personality disorder relate to others in a healthier and more compassionate way.

Mentalization-based therapy, transference-focused psychotherapy, and schema-focused psychotherapy have all been suggested as effective ways of treating narcissistic personality disorder.

If the individual with Narcissistic Personality Disorder is extremely impulsive, tests reality, or is self-destructive, they may end up in a medical facility to treat those fall-outs and receive a diagnosis there.

Psychotherapy can be helpful for Depression and difficulties within the narcissist’s interpersonal relationships.

Group therapy can be especially helpful for those with NPD, as they are put into a situation where a group (without an authority figure) challenges their psychological beliefs.

The Children Of Those Who Have Narcissistic Personality Disorder:

Read more about ACONs, Adult Children of Narcissists.It’s clear that there are hundreds of thousands of people around the world who were raised by at least one narcissist, and it wreaked havoc on our self-esteem, feelings of well-being and safety, and confidence and courage.

Being raised by a narcissist makes us believe that throughout our lives, we are just not “good enough” despite everything we try and bending over backwards to please others.

Children of narcissists who don’t become one themselves often have a common coping mechanism to deal with this: capitulation and sublimation (perhaps not the healthiest but effective). Give the narcissist what they want and then move on. It’s the path of least resistance, right? Except that by doing so, there are greater implications

Ultimately, it prevents these adult children of narcissists (ACON) from developing certain relationship and emotional boundaries as we get older. It’s not easy to do when you’re used to giving someone they “love” free reign to walk all over them. Narcissistic parents do not just disempower their us, they rob us entirely of our power, often leading us to seek extremely codependent relationships.

The unhealed wound of the child of a narcissist can also create a vacuum easily filled by adding another narcissist in our lives, often in our friendships and romantic relationships. Since we’ve learned not to be bothered by their parents’ narcissistic and self-absorbed behaviors, we subconsciously draw narcissists to us.

And narcissists, who are so adept at recognizing pressure points and how far to push boundaries, will engage in the same kind of push/pull dynamic we’ve had been normalized during our childhood.

These behaviors that seem disrespectful might very well be excused in a friend because like the parent, “that’s just how they are.”

NPD damages your boundaries; the invisible barriers between you and your outside systems that regulate the flow of information and input between you and these systems. These damaged boundaries may thwart your ability to communicate authentically and powerfully, and taint your own self-concept, which in turn damages your relationships and your capability to thrive personally and professionally in the world.

Most adult children of narcissists (ACONs) never get the help they need to recover and heal, because we have no idea that what we’ve experienced as children is unhealthy and destructive.

• Often, we, as children of narcissists, are overly-sensitive, deeply insecure, unable to see ourselves as good, worthy, and lovable. What’s worse is that we’re so familiar with narcissism (because we’ve dealt with it all their lives) that we unconsciously attract it into their lives, through our adult relationships, and in our work cultures, and careers.
• Feeling like we are never, ever good enough or valuable enough
• We can be deeply afraid to speak up confidently or challenge others
• We are quite attuned (to an almost uncanny degree) to what everyone around us is feeling, as we have a hyper-sensitivity to what others are experiencing. This is the way we survived living with a narcissistic parent, which can lead to our inability to protect themselves from others’ emotions.
• We may feel chronically unsure of ourselves, and overly-concerned about what others think of us
• We are very insecure, because we’ve never experienced unconditional love. Any love or care that we got through out childhood was only under certain challenging conditions that made ues feel inauthentic and fake.
• We may discover that the relationships we form (either at work or in personal life) are deeply challenging and unsatisfying (and even toxic and frightening). When we step back and look at these relationships honestly, we see narcissism all around them and they have no idea how to deal with this.
• Finally, we feel used and beaten up by our work, by our bosses. and our colleagues, and can’t understand why our careers are so challenged and difficult.

If the above experiences resonate with you, it’s time to gain greater awareness of what you’ve experienced in childhood, so you can have greater choice over your thoughts, mindsets and behaviors in order to heal.

We don’t just “get over” being raised by a narcissist. It takes strong therapeutic support to “peel back the onion” and heal the wounds — to have the courage to look at the specific brand of narcissism you experienced (it’s different in every family), how this has impacted you, and the way you operate, and learn new behaviors that will allow you to heal the child within and become the adult you long to be.

Romantic Relationships And The Narcissist:

Relationships with a narcissist are never about partnership because the nature of narcissistic love is a one-sided, mental, and/or physical connection that dictates the terms of the relationship. In romantic relationships, narcissists use scripted “romantic” gestures or words to express their “love.”

Sex will often dominate in a relationship with a narcissist. They will “do” more than “feel” in a relationship because they have an extremely limited emotional range.

If you choose a narcissist as a lover (although really they’re the ones choosing you), you may find your entire reality turned upside down. It’s easy to fall in love with a narcissist and not realize what hit you. They charm you, come off responsible, and in control.

On the surface, they seem like the whole package.

We’ve been socialized to look for a lot of attributes that narcissists possess in a partner. Romance books are filled with narcissistic men who are beautiful, possessive, jealous, and financially successful. Like every fairy tale or vapid romantic comedy, these books prop up this fantasy male who wants only the female character and will stop at nothing until he has her.

His love will make her feel special, chosen; even saved.

And, in turn, she will surrender her entire self to him, allowing obsession to become possession.

We’ve been programmed to love the narcissist and forsake our self-respect, our identities, and our power in the process. Nothing matters besides to serving and placating this person to whom we are indebted for their “love,” even if their love comes from a dark, twisted place. It’s very rare that we are able to notice how dark and bad things have become. A narcissist is excellent at getting us to put up with more than we should, get us to ignore their instincts, as well as control it so that we only see what they want us to see.

You can get a real high or rush from getting the love from a narcissist. This love makes feel great about ourselves; if someone held in such high esteem (whether that esteem matches reality is part of the narcissist’s game). Then, we reflect back what they ultimately want to see and believe about themselves, which is that they’re a really — fill in the blank — amazing, wonderful, incredible, generous, all around ideal person. It’s a real ego boost to appear so cared for (it’s all about appearances) to be with someone who has it “together” and provides for you.

It’s a cycle, and once you’re in it, it feels really good.

Until it doesn’t.

Inevitably, as with any relationship, there will be opportunities for growth as well as challenges. If you’re in a romantic relationship with a narcissist, they’re rarely bumps in the relationship, – they’re landmines, and before you know it you may find yourself in a a field of these landmines. Things you didn’t see until they’re too late.

One misstep (or perceived misstep) and they go into a narcissistic rage.

Narcissistic rage is the response to narcissistic injury. Narcissistic injury occurs when a narcissistic individual perceives to be criticized so deeply that it creates severe emotional pain or scarring. It throws them from the invisible throne of superiority down into the masses.

Some narcissists can be very nasty and say mean, horrible, awful things that can cut us to our core if and when we challenge them. Other narcissists may be overly critical, spouting out criticisms about co-workers or family members –  things we easily excuse or dismiss. The narcissist acting this way because he or she is  tired, hungry, stressed out, or having a really bad day.

They will eventually turn on you and you will become the source of their narcissistic rage.

The longer we’re in a relationship with a narcissist, the worse it becomes. We may internalize the criticism so much that we honestly everything that bothers or upsets him or her is our fault.

We may not have much room for our friends because dealing with a narcissist can be so time and energy-consuming, or they may not want to share us with our friends.

Whatever the reason, it’s the shame/guilt cycle that we don’t realize until much later, as it’s now accepted it as a normal relationship dynamic. 

Over time, we may find ourselves walking on eggshells around them, ensuring we don’t say or do the wrong thing to trigger them.

That’s always the rub with narcissists: we hurt them; it’s never the other way around unless we deserved it – but we always end up feeling we really deserved it. That’s the guilt. We are made to feel we perpetrated the wrong, and we are thereby doomed to feel shame over it.

One of the most difficult things about dealing with the guilt of being in relationship with a narcissist is realizing that if we want to save ourselves from the relationship, we have to let it go. 

Am I Dating Someone With Narcissistic Personality Disorder?

How do you know when you’re dealing with a narcissist?

While most of us are guilty of some of the following behaviors at one time or another, a pathological narcissist tends to exhibit habitually several of the following personas, while remaining largely unaware of (or unconcerned with) how his or her actions affect others.

Charming: Narcissists can be very charismatic and persuasive. When they’re interested in you (for their own gratification), they make you feel very special and wanted. However, once they lose interest in you (most likely after they’ve gotten what they want, or became bored), they may drop you without a second thought. A narcissist can be very engaging and sociable, as long as you’re fulfilling what she desires, and giving her all of your attention.

Breaks the Rules: The narcissist enjoys getting away with violating rules and social norms, such as cutting in line, chronic under-tipping (some will overtip to show off), stealing office supplies, breaking multiple appointments, or disobeying traffic laws.

Conversation Stealer: The narcissist loves to talk about him or herself, and doesn’t give you a chance to take part in a two-way conversation. You struggle to have your views and feelings heard. When you do get a word in, if it’s not in agreement with the narcissist, your comments are likely to be corrected, dismissed, or ignored.

Violates Your Boundaries: he or she shows wanton disregard for other people’s thoughts, feelings, possessions, and physical space. Oversteps and uses others without consideration or sensitivity. Borrows items or money without returning. Breaks promises and obligations repeatedly. Shows little remorse and blames the victim for his or her personal lack of respect

Conversation Interrupter: While many people have the poor communication habit of interrupting others, the narcissist interrupts and quickly switches the focus back to herself. He or she shows little genuine interest in you.

Pretending To Be They’re Something They’re Not: Many narcissists like to do things to impress others by making themselves look good externally. This “trophy” complex can exhibit itself physically, romantically, sexually, socially, religiously, financially, materially, professionally, academically, or culturally.

In these situations, the narcissist uses people, objects, status, and/or accomplishments to represent the self, substituting for the perceived, inadequate “real” self.

These grandstanding “merit badges” are often exaggerated.

The underlying message of this type of display is: “I’m better than you!” or “Look at how special I am—I’m worthy of everyone’s love, admiration, and acceptance!”

In a big way, these external symbols become pivotal parts of the narcissist’s false identity, replacing the real and injured self.

Psychological Manipulator: They think of others as extensions of themselves, making decisions for others to suit one’s own needs. The narcissist may use his or her romantic partner, child, friend, or colleague to meet unreasonable self-serving needs, fulfill unrealized dreams, or cover up self-perceived inadequacies and flaws.

They’re Owed: Narcissists often expect preferential treatment from others. They expect others to cater (often instantly) to their needs, without being considerate in return. In their firmly held beliefs, the world genuinely revolves around them.

Grandiose, Over-The-Top Personality: narcissists think of themselves as a hero or heroine, a prince or princess, and one of a kind special person. Some narcissists have an exaggerated sense of self-importance, believing that others cannot live or survive without his or her magnificent contributions.

Negative Emotions. Many narcissists enjoy spreading and arousing negative emotions to gain attention, feel powerful, and keep you insecure and off-balance. They are easily upset at any real or perceived slights or inattentiveness. They may throw a tantrum if you disagree with their views, or fail to meet their expectations.

They are extremely sensitive to criticism, and typically respond with heated argument (fight) or cold detachment (flight). Narcissists are often quick to judge, criticize, ridicule, and blame you.

Some narcissists are emotionally abusive. By making you feel inferior, they boost their fragile ego, and feel better about themselves.

Am I A Victim Of Narcissistic Abuse?

See also: Emotional abuse

See also: Psychological Manipulation

Imagine this: your entire reality has been warped and distorted. You have been mercilessly violated, manipulated, lied to, ridiculed, demeaned, and gaslighted into believing that you are imagining things. The person you thought you knew and the life you built together have been shattered into a million little pieces.

Your sense of self has been eroded, diminished. You were idealized, devalued, then shoved off the pedestal. Perhaps you were even replaced and discarded multiple times, only to be lured back into an abuse cycle that’s more torturous than it was before. Maybe you were relentlessly stalked, harassed, and bullied to stay with your abuser.

This was no normal break-up or relationship: this was a set-up for covert and insidious murder of your psyche and sense of safety in the world. There may not be visible scars to tell the tale; all you have are broken pieces, fractured memories, and internal battle wounds.

This Is What Narcissistic Abuse Looks Like:

Psychological violence by malignant narcissists can include verbal and emotional abuse, toxic projection, stonewalling, sabotage, smear campaigns, triangulation, along with a plethora of other forms of coercion and control. The narcissist is someone who lacks empathy, demonstrates an excessive sense of entitlement, and uses interpersonal exploitation to meet his or her needs at the expense of the rights of others.

As a result of chronic abuse, you may struggle with symptoms of PTSD, Complex PTSD if they had additional traumas like being abused by narcissistic parents or even what is known as “Narcissistic Victim Syndrome.” The aftermath of narcissistic abuse can include depression, anxiety, hypervigilance, a pervasive sense of toxic shame, emotional flashbacks that regress you back to the abusive incidents, as well as overwhelming feelings of helplessness and worthlessness.

When we are in the midst of an ongoing abuse cycle, it can be difficult to pinpoint exactly what we are experiencing because abusers are able to twist and turn reality to suit their own needs, engage in intense love-bombing after abusive incidents, and convince us that we are the abusers.

If you find yourself experiencing any of the symptoms below and you are (or have been) in a toxic relationship with a partner that disrespects, invalidates and mistreats you, you may just have been terrorized by an emotional predator:

You Isolate Yourself:

Many abusers isolate you as a power play, but you also isolate themselves because you feel ashamed about the abuse you’re experiencing. Given the victim-blaming and misconceptions about emotional and psychological violence in society, you may even be re-traumatized by law enforcement, family members, friends, and the harem members of the narcissist who might invalidate their perceptions of the abuse.

You fear no one will understand or believe you, so instead of reaching out for help, you withdraw from others as a way to avoid judgment and retaliation from your narcissistic abuser.

Dissociation Is How You Survive:

You feel emotionally and/or physically detached from your environment, experiencing disruptions in your memory, perceptions, consciousness and sense of self. As Dr. Van der Kolk (2015) writes in his book, The Body Keeps the Score, “Dissociation is the essence of trauma. The overwhelming experience is split off and fragmented, so that the emotions, sounds, images, thoughts, and physical sensations take on a life of their own.”

Dissociation can lead to emotional numbing in the face of horrific circumstances. Mind-numbing activities, obsessions, addictions, and repression may become your way of life because they give you an escape from your current reality. Your brain finds ways to emotionally block out the impact of your pain so you do not have to deal with the full terror of your circumstances.

You may also develop traumatized inner parts that become disjointed from the personality you inhabit with your abuser or loved ones. These inner parts may include the inner child parts of you never nurtured, the true anger and disgust you feel towards your abuser and parts of yourselves you feel you cannot express around them.

According to therapist Rev. Sheri Heller (2015), “Integrating and reclaiming dissociated and disowned aspects of the personality is largely dependent on constructing a cohesive narrative, which allows for the assimilation of emotional, cognitive, and physiological realities.” This inner integration is best done with the help of a trauma-based therapist.

You Become Distrustful Of All People:

The longer the abuse persists, the more you believe each person now represents a threat; you find yourself becoming anxious about the intentions of others, especially having experienced the malicious actions of someone you once trusted.

Your usual caution becomes hypervigilance.

Since the narcissistic abuser has worked hard to gaslight you into believing that your experiences are invalid, you have a hard time trusting anyone, including yourself.

You Walk On Constant Eggshells:

A common symptom of trauma is avoiding anything that represents reliving the trauma – whether it be people, places, or activities that pose that threat. Whether it be your friend, your partner, your family member, co-worker or boss, you find yourself constantly watching what you say or do around this person lest you incur their wrath, punishment, or become the object of their envy.

However, you realize that this does not work and you’re still the abuser’s target whenever he or she feels entitled to use you as an emotional punching bag.

You become perpetually anxious about ‘provoking’ your abuser in any way and may avoid confrontation or setting boundaries as a result.

You may also extend your people-pleasing behavior outside of the abusive relationship, losing your ability to be spontaneous or assertive while navigating the outside world, especially with people who resemble or are associated with your abuser and the abuse.

You’ve Stopped Being You:

You may have once been full of life, goal-driven, and dream-oriented. Now, you feel as if you are living just to fulfill the needs of another person. Once, the narcissist’s entire life seemed to revolve around you; now your entire life revolves around them.

You may have placed your goals, hobbies, friendships and personal safety on the back burner just to ensure that your abuser feels ‘satisfied’ in the relationship.

Of course, you soon realize that he or she will never truly be satisfied regardless of what you do or don’t do. You are struggling with health issues and somatic symptoms that represent your psychological turmoil.

Health Issues Begin To Arise That Represent Your Inner Psychological Turmoil:

You may have gained or lost a significant amount of weight, developed serious health issues that did not exist prior and experienced physical symptoms of premature aging. The stress of chronic abuse has sent your cortisol levels into overdrive and your immune system has taken a severe hit, leaving you vulnerable to physical ailments and disease.

You find yourself unable to sleep or experiencing terrifying nightmares when you do, reliving the trauma through emotional or visual flashbacks that bring you back to the site of the original wounds.

You Experience Suicidal Thoughts And Engage In Self-Harming Behaviors:

Along with depression and anxiety may come an increased sense of hopelessness pervading your life.

Your circumstances feel unbearable, as if you cannot escape, even if you wanted to. You develop a sense of learned helplessness that makes you feel as if you don’t wish to survive another day. You may even engage in self-harm as a way to cope. As Dr. McKeon, chief of the suicide prevention branch at SAMHSA notes, victims of intimate partner violence are twice as likely to attempt suicide multiple times. This is the way abusers essentially commit murder without a trace.

You Compare Yourself To Others, And Blame Yourself For The Abuse:

A narcissistic abuser is highly skilled at manufacturing love triangles or bringing another person into the dynamic of the relationship to further terrorize the you. As a result, you internalize the fear that you are not enough and may constantly strive to ‘compete’ for the abuser’s attention and approval.

You may also compare yourself to others in happier, healthier relationships or find themselves wondering why your abuser appears to treat complete strangers with more respect. This can send you down the trapdoor of wondering, “why me?” and stuck in an abyss of self-blame.

The truth is, the abuser is the person who should be blamed – you are in no way responsible for being abused.

You Sabotage Yourself And Self-Destruct:

You may often find yourself ruminating over the abuse and hearing the abuser’s voice in your minds, amplifying your negative self-talk and tendency towards self-sabotage.

Malignant narcissists ‘program’ and condition their victims to self-destruct – sometimes even to the point of driving them to suicide.

Due to the narcissist’s covert and overt put-downs, verbal abuse and hypercriticism, you may develop a tendency to punish yourself because you carry such toxic shame. The abuser may sabotage you goals, dreams, and academic pursuits. The abuser has instilled in you a sense of worthlessness and you begin to believe that you are undeserving of good things.

You’re Afraid To Do What You Love, Are Afraid of Success:

As many pathological predators are envious of their victims, they punish their victims for succeeding. This conditions you to associate their joys, interests, talents, and areas of success with cruel and callous treatment. This conditioning gets you to fear success lest you be met with reprisal and reprimand.

As a result, you may become depressed, anxious, lack confidence and you may hide from the spotlight to allow your abusers to ‘steal’ the show again and again. Realize that your abuser is not undercutting your gifts because they truly believe you are inferior; it is because those gifts threaten their control over you.

You Protect Your Narcissist And Rationalize The Abuse:

Rationalizing, minimizing and denying the abuse are often survival mechanisms for people in an abusive relationship. In order to reduce the confusion that erupts when the person who claims to love you mistreats you, victims of abuse convince themselves that the abuser is really not ‘all that bad’ or that they must have done something to ‘provoke’ the abuse.

It is important to reduce this cognitive dissonance by reading up on the narcissistic personality and abuse tactics; this way, you are able to reconcile your current reality with the narcissist’s false self by recognizing that the abusive personality, not the charming facade, is really who they are underneath it all..

Remember that an intense trauma bond is often formed between the victim and abuser because the victim is ‘trained’ to rely on the abuser for his or her survival. You may protect your abusers from legal consequences, portray a happy image of the relationship on social media or overcompensate by ‘sharing the blame’ of the abuse.

Leaving A Narcissist:

See also Domestic Abuse

See also Estrangement

Narcissists are hard nuts to crack. Don’t fall in love with a narcissist or entertain illusions they’re capable of the give and take necessary for intimacy. In such relationships, you’ll always be emotionally alone to some degree. If you have a withholding narcissist spouse, beware of trying to win the nurturing you never got from your parents; it’s not going to happen. Also, don’t expect to have your sensitivity honored. These people sour love with all the hoops you must jump through to please them.

Here are some suggestions for leaving a narcissist (or becoming estranged from them):

Don’t Fall For Their Manipulations

They will use every trick in the book to get you back so be prepared. Narcissists are really convincing. When you are ready to leave, stick to your convictions and move on to a more positive future filled with real love.

Set Limits and Boundaries

Since narcissists have no empathy, and cannot really love, you must leave them cold turkey and endure the pain. Set limits and say “no” to them and in your heart.

Then gather all your strength and keep walking into the unknown towards something better.

Enforce a “no contact” rule with your girl or boyfriend in order to take the time to heal, assess the situation and regain your emotional strength.

Focus on the Future

Once detached from a narcissist it is extremely important than you focus all your positive energy and thoughts on doing good things for yourself and the world. Don’t let your mind wander to the past or to what he is doing.

Be Kind to Yourself

Treasure yourself. Be very kind to yourself and know that you deserve a loving relationship with someone who can reciprocate that love.

Regain Your Self-Esteem

Regain your self-confidence and self love.  It is paramount that you regain your own sense of self worth and reject people that abuse, control or lie to you in your life.

It is self preservation and  right to all of us.

Be Safe

Leave the relationship in a safe manner. If you feel threatened by your spouse, enlist friends or family to assist you in your exit. Always be safe, and be smart.

Talk It Out

Find a friend to confide in. You may feel you have lost your support system due to the relationship demands of a narcissistic spouse, but chances are you have not. You need someone to confide in that you can trust.

Support Groups

Join a support group. Codependents Anonymous, or CODA, is a place to share your feelings and provides support and insight into healing from a traumatic relationship.

Why It’s Hard For You To Leave A Narcissist:

See also estrangement resources

See also: codependency resources

Giving Up Control to Your Partner

Often, you will find yourself giving up control in your life to keep your partner happy. Your trips to see your family and friends may shorten and become farther apart in time. You may give up your finances to keep the peace, or maybe you feel like a stranger redecorated your house because there is nothing of you in it. Although it is disturbing, it may be better than the continuous “bad mood” and incessant bickering of your partner if you don’t comply. Eventually, the narcissist may have taken over your life and you feel as though you have become helpless without him.

Treating the Narcissistic Behavior as Normal

As a good person, you may believe that eventually the narcissist will come around and love you back with the same compassion that you provide them. The idea of give and take in a relationship is a valued component of a love match that the narcissist is not capable of in the long term. If they promise not to treat you as they have in the past, they cannot not sustain the facade for very long.

They Know How To Push Your Buttons

It is common to leave a narcissist spouse or partner several times before the final breakup. They know what you want to hear and will promise to become the person that will treat you better, not abuse you, not lie to you, not control you, be more flexible, give you your space, trust you, etc. But a true narcissist cannot sustain those ideals and eventually return to their former behavior.

Narcissists Keep Returning to Win You Back

A narcissistic spouse will ask you to come back at intervals and will lie and promise anything if you to return. When you agree to “loving them” you feed the narcissistic supply of admiration and adoration in your narcissistic spouse. Usually, just when you feel you are healing and ready to move on, the narcissist returns with gifts and promises of showing you how they love you. Eventually, you find that nothing has changed in the relationship.

Mood Disorders Resources

by Band Back Together | Aug 28, 2018

What Are Mood Disorders?

We all experience mood changes and mood swings. Sometimes we’re happy – maybe even euphoric – and other times we’re sad and feeling low. These changes in your mood are completely normal. For others, however, their mood swings are so pronounced and lingering that they begin to affect people in major ways – loss of work, marital strife, divorce. Sometimes these mood swings even cause people to lose touch with reality, and may even be life-threatening. Situations like these represent mood disorders.

Mood disorders are considered to be disturbances in emotional experiences that are strong enough to intrude on living.

Marked by changes in mood, depression and bipolar disorder (also known as manic depression) are both highly treatable, medical illnesses. Unfortunately, many people don’t get the help they need because of the misunderstanding surrounding the illnesses or the fear associated with stigma. The following are brief descriptions of depression and bipolar disorder.

According to the 2005 National Comorbidity Survey-Replication study, about 20.9 million American adults, or 9.5 percent of the population ages 18 and older, have mood disorders. These include major depressive disorder; dysthymic disorder (a chronic, mild depression); and bipolar disorder (also called manic depression). Major depressive disorder is, by itself, the leading cause of disability among Americans age 15 – 44, according to the World Health Organization.

Changes in mood that interfere with everyday life may indicate a mood disorder such as depression or bipolar disorder. Mood disorders are treatable medical conditions. With appropriate diagnosis, treatment, and support, most people struggling with mood disorders will get better.

If you have concerns about mood or behavior changes in yourself or someone you know, it’s important that you gain an understanding of how to recognize mood disorders like depression and bipolar disorder, and how to get appropriate diagnosis and treatment for them.

Symptoms of Mood Disorders:

Depending on age and the type of mood disorder, a person may have different symptoms of depression. The following are the most common symptoms of a mood disorder:

• Ongoing sad, anxious, or “empty” mood
• Feeling hopeless or helpless
• Having low self-esteem
• Feeling inadequate or worthless
• Excessive guilt
• Repeating thoughts of death or suicide, wishing to die, or attempting suicide (Note: People with this symptom should get treatment right away!)
• Loss of interest in usual activities or activities that were once enjoyed, including sex
• Relationship problems
• Trouble sleeping or sleeping too much
• Changes in appetite and/or weight
• Decreased energy
• Trouble concentrating
• A decrease in the ability to make decisions
• Frequent physical complaints (for example, headache, stomachache, or tiredness) that don’t get better with treatment
• Running away or threats of running away from home
• Very sensitive to failure or rejection
• Irritability, hostility, or aggression

In mood disorders, these feelings are more intense than what a person may normally feel from time to time. It’s also of concern if these feelings continue over time, or interfere with one’s interest in family, friends, community, or work. Any person who expresses thoughts of suicide should get medical help right away.

The symptoms of mood disorders may look like other conditions or mental health problems. Always talk with a healthcare provider for a diagnosis.

Who Is At Risk For A Mood Disorder?

Anyone can feel sad or depressed at times. However, mood disorders are more intense and harder to manage than normal feelings of sadness. Children, teens, or adults who have a parent with a mood disorder have a greater chance of also having a mood disorder. However, life events and stress can expose or worsen feelings of sadness or depression. This makes the feelings harder to manage.

Sometimes, life’s problems can trigger depression. Being fired from a job, getting divorced, losing a loved one, death in the family, and financial trouble, to name a few, all can be difficult and coping with the pressure may be troublesome. These life events and stress can bring on feelings of sadness or depression or make a mood disorder harder to manage.

The risk of depression in women is nearly twice as high as it is for men. Once a person in the family has this diagnosis, their brothers, sisters, or children have a higher chance of the same diagnosis. In addition, relatives of people with depression are also at increased risk for bipolar disorder.

Medical Risk Factors For Mood Disorders Include:

Biochemical Factors

Depression is a type of mood disorder that some believe is triggered when neurotransmitters in the brain are out of balance. Neurotransmitters are chemical messengers that help the brain communicate with other parts of the body. These chemicals help regulate many physiological functions.

Low levels of neurotransmitters may play a role in why some people are more susceptible to depression, including the neurotransmitters:

• serotonin
• norepinephrine
• dopamine

Genetic Factors

Having an immediate family member with depression or a mood disorder can increase your risk for depression. The American Psychiatric Association (APA) states that if one identical twin is diagnosed with depression, the other twin has a 70 percent chance of developing it.

However, depression can occur in people with no family history, which is why some scientists believe it can be a product of both genes and life experiences.

Sleep disorders

Chronic sleep problems are associated with depression. Although experts don’t know if a lack of sleep causes depression, bouts of low mood do seem to follow periods of poor sleep.

Serious illness

The pain and stress that come with certain conditions can take a toll on a person’s mental state. Many chronic conditions are linked to higher rates of depression, including:

• chronic pain
• arthritis
• heart disease
• diabetes
• thyroid disease
• stroke
• cancer
• multiple sclerosis
• Alzheimer’s disease
• dementia
• Parkinson’s disease
• Huntington’s disease

Social Risk Factors for Depression:

Sometimes, our past and present experiences can trigger mood disorders, including depression.

Abuse:

People who were neglected or abused as children have a high risk for major depression. Such negative experiences can cause other mental disorders as well.

Gender:

Women are twice as likely to have depression as men, but this may be due to the fact that more women seek treatment for their symptoms than men. Some believe depression can be caused by hormonal changes throughout life. Women are particularly vulnerable to depression during pregnancy and after childbirth, which is called postpartum depression, as well as during menopause.

Lack of social support:

Prolonged social isolation and having few friends or supportive relationships is a common source of depression. Feelings of exclusion or loneliness can bring on an episode in people who are prone to mood disorders.

Major life events:

Even happy events, such as having a baby or landing a new job, can increase a person’s risk for depression. Other life events linked to depression include:

• losing a job
• buying a house
• getting a divorce
• moving
• retiring

The death of a loved one is certainly a major life event. Great sadness is a major part of the grieving process. Some people will feel better in a matter of months, but others experience more serious, long-term periods of depression. If your grieving symptoms last more than two months, you should see your doctor to be evaluated for depression.

Substance Risk Factors for Mood Disorders:

Substance abuse:

In many cases, substance abuse and depression go hand-in-hand. Drugs and alcohol may lead to chemical changes in the brain that raise the risk for depression. Self-medication with drugs and alcohol can also lead to depression.

Medications:

Certain medications have been linked to depression, including:

• blood pressure medication
• sleeping pills
• sedatives
• steroids
• prescription painkillers

If you are taking any such medications, speak to your doctor about your concerns. Never stop taking a medication without first consulting your physician.

What Are The Types of Mood Disorders?

Mood disorders describe a broad category of disorders in which a person’s mood is the primary underlying symptom.

If you have a mood disorder, your general emotional state or mood is distorted or inconsistent with your circumstances and interferes with your ability to function. You may be extremely sad, empty or irritable (depressed), or you may have periods of depression alternating with being excessively happy (mania).

Anxiety disorders can also affect your mood and often occur along with depression. Mood disorders may increase your risk of suicide.

Major Depressive (or Depression) Disorder:

Major Depressive Disorder requires two or more major depressive episodes. According to the National Institute of Mental Health (NIMH), major depression is one of the most common mental disorders in the United States.

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Also consider these options if you’re having suicidal thoughts:

• Call your doctor or mental health professional.
• Call a suicide hotline number — in the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). Use that same number and press “1” to reach the Veterans Crisis Line.
• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader or someone else in your faith community.

Diagnostic criteria:

Depressed mood and/or loss of interest or pleasure in life activities for at least 2 weeks and at least five of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning nearly every day:

• Depressed mood most of the day, almost every day.
• Lack of interest or pleasure in all or most activities
• Significant unintentional weight loss or gain
• Insomnia or sleeping too much.
• Agitation or psychomotor retardation noticed by others
• Fatigue or loss of energy.
• Feelings of worthlessness or excessive guilt.
• Diminished ability to think or concentrate, or indecisivenesss
• Frequent thoughts of death, dying, or suicide

Treatment:

Major Depressive Disorder is generally treated with a combination of antidepressants, including SSRI’s, SNRI’s, and talk therapy. Also, those with depression should eat well, exercise often, and stick to a stress-free life.

Dysthymia and Persistent Depressive Disorder

This is a chronic, low-grade, depressed, or irritable mood that lasts for at least 2 years.

Persistent depressive disorder, also called dysthymia is a continuous long-term (chronic) form of depression. You may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy. These feelings last for years and may significantly interfere with your relationships, school, work and daily activities.

If you have persistent depressive disorder, you may find it hard to be upbeat even on happy occasions — you may be described as having a gloomy personality, constantly complaining or incapable of having fun. Though persistent depressive disorder is not as severe as major depression, your current depressed mood may be mild, moderate or severe.

Diagnostic criteria:

Depressed mood most of the day for more days than not, for at least 2 years, and the presence of two or more of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning:

• Poor appetite or overeating.
• Insomnia or sleeping too much
• Low energy or fatigue
• Low self-esteem
• Poor concentration or difficulty making decisions.
• Feelings of hopelessness\

Treatment:

Treatment includes antidepressants, talk therapy, as well as good self-care habits.

Bipolar Disorders:

Bipolar disorder is characterized by more than one bipolar episode.

There are three types of bipolar disorder:

Bipolar 1 Disorder, in which the primary symptom presentation is manic, or rapid (daily) cycling episodes of mania and depression. A manic episode is a period of abnormally elevated mood and high energy, accompanied by abnormal behavior that disrupts life. Most people with bipolar I disorder also suffer from episodes of depression. Often, there is a pattern of cycling between mania and depression. This is where the term “manic depression” comes from. In between episodes of mania and depression, many people with bipolar I disorder can live normal lives.

Bipolar 2 Disorder, in which the primary symptom presentation is recurrent depression accompanied by hypomanic episodes (a milder state of mania in which the symptoms are not severe enough to cause marked impairment in social or occupational functioning or need for hospitalization, but are sufficient to be observable by others). Bipolar II is similar to bipolar I disorder, with moods cycling between high and low over time.However, in bipolar II disorder, the “up” moods never reach full-blown mania. The less-intense elevated moods in bipolar II disorder are called hypomanic episodes, or hypomania.

A person affected by bipolar II disorder has had at least one hypomanic episode in his or her life. Most people with bipolar II disorder suffer more often from episodes of depression. This is where the term “manic depression” comes from. In between episodes of hypomania and depression, many people with bipolar II disorder typically live normal lives

Cyclothymic Disorder, a chronic state of cycling between hypomanic and depressive episodes that do not reach the diagnostic standard for bipolar disorder. Cyclothymia — or cyclothymic disorder — is a relatively mild mood disorder. In cyclothymic disorder, moods swing between short periods of mild depression and hypomania, an elevated mood. The low and high mood swings never reach the severity or duration of major depressive or full mania episodes. People with cyclothymic disorder have milder symptoms than occur in full-blown bipolar disorder.

Manic episodes are characterized by:

A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)

Diagnostic Criteria:

During the period of mood disturbance, three (or more) of the following symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree:

• increased self-esteem or grandiosity
• decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
• more talkative than usual or pressure to keep talking
• flight of ideas or subjective experience that thoughts are racing
• distractability (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
• increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
• excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

Treatments:

Bipolar disorder is treated with three main classes of medication: mood stabilizers, antipsychotics, and, while their safety and effectiveness for the condition are sometimes controversial, antidepressants..

Typically, treatment entails a combination of at least one mood-stabilizing drug and/or atypical antipsychotic, plus psychotherapy. The most widely used drugs for the treatment of bipolar disorder include lithium carbonate and valproic acid (also known as Depakote or generically as divalproex). Lithium carbonate can be remarkably effective in reducing mania, although doctors still do not know precisely how it works. Lithium may also prevent recurrence of depression, but its value seems greater against mania than depression; therefore, it is often given in conjunction with other medicines known to have greater value for depression symptoms, sometimes including antidepressants.

Seasonal Affective Disorder (SAD)

is a form of depression most often associated with fewer hours of daylight in the far northern and southern latitudes from late fall to early spring

Seasonal affective disorder (SAD) is a type of depression that’s related to changes in seasons — SAD begins and ends at about the same times every year. If you’re like most people with SAD, your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody. Less often, SAD causes depression in the spring or early summer.

Treatment for SAD may include light therapy (phototherapy), medications and psychotherapy.

Don’t brush off that yearly feeling as simply a case of the “winter blues” or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year.

Common symptoms of SAD include fatigue, even with too much sleep, and weight gain associated with overeating and carbohydrate cravings. SAD symptoms can vary from mild to severe and can include many symptoms similar to major depression, such as:

• Feeling of sadness or depressed mood
• Marked loss of interest or pleasure in activities once enjoyed
• Changes in appetite; usually eating more, craving carbohydrates
• Change in sleep; usually sleeping too much
• Loss of energy or increased fatigue despite increased sleep hours
• Increase in restless activity (e.g., hand-wringing or pacing) or slowed movements and speech
• Feeling worthless or guilty
• Trouble concentrating or making decisions
• Thoughts of death or suicide or attempts at suicide

SAD may begin at any age, but it typically starts when a person is between ages 18 and 30.

Treatments:

Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, tell your doctor — this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode.

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a much more severe form of premenstrual syndrome (PMS). It may affect women of childbearing age. It’s a severe and chronic medical condition that needs attention and treatment. Lifestyle changes and sometimes medicines can help manage symptoms.

Diagnosis:

In general, to diagnose PMDD the following symptoms must be present:

Over the course of a year, during most menstrual cycles, 5 or more of the following symptoms must be present:

• Depressed mood
• Anger or irritability
• Trouble concentrating
• Lack of interest in activities once enjoyed
• Moodiness
• Increased appetite
• Insomnia or the need for more sleep
• Feeling overwhelmed or out of control
• Other physical symptoms, the most common being belly bloating, breast tenderness, and headache
• Symptoms that disturb your ability to function in social, work, or other situations
• Symptoms that are not related to, or exaggerated by, another medical condition

Treatment:

Two types of medication may help with PMDD: those that affect ovulation and those that impact the central nervous system (CMS).

Examples include the use of:

• SSRI antidepressants such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa)
• oral contraceptives that contain drospirenone and ethinyl estradiol
• gonadotropin-releasing hormone analogs such as leuprolide (Lupron), nafarelin (Synarel) and goserelin (Zoladex)
• danazol (Danocrine)

Cognitive therapy (CT) has been shown to help those with PMS. Combined with medication, CT may also help those with PMDD.

Disruptive Mood Dysregulation Disorder (Formerly Childhood Bipolar Disorder)

This is a disorder of chronic, severe and persistent irritability in children that often includes frequent temper outbursts that are inconsistent with the child’s developmental age.

The defining characteristic of disruptive mood dysregulation disorder (DMDD) in children is a chronic, severe, and persistent irritability. This irritability is often displayed by the child as a temper tantrum, or temper outburst, that occur frequently (3 or more times per week). When the child isn’t having a temper outburst, they appear to be in a persistently irritable or angry mood, present most of the day, nearly every day. As the DSM-5 Fact Sheet says, “Far beyond temper tantrums, DMDD is characterized by severe and recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation.”

This disorder, which was new to the DSM-5 in 2013, was created in an effort to replace the diagnosis of childhood bipolar disorder. The prevalence of this disorder is not yet known, but is expected to be within the 2 to 5 percent range for children.

The onset of symptoms must be before age 10, and a diagnosis should not be made for the first time before age 6 or after age 18.

Diagnostic Criteria for Disruptive Mood Dysregulation Disorder:

• Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation
• The temper outbursts are inconsistent with developmental level (e.g., the child is older than you would expect to be having a temper tantrum).
•  The temper outbursts occur, on average, three or more times per week
• The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, friends).
• The above criteria have been present for 1 year or more, without a relief period of longer than 3 months. The above criteria must also be present in two or more settings (e.g., at home and school), and are severe in at least one of these settings
• The diagnosis should not be made for the first time before age 6 years or after age 18. Age of onset of these symptoms must be before 10 years old.
• There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.
• The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder.

As with all child mental disorders, the symptoms also can not be attributable to the physiological effects of a substance or to another medical or neurological condition.

Treatment:

If you think your child has DMDD, it is important to seek treatment. DMDD can impair a child’s quality of life and school performance and disrupt relationships with his or her family and peers. Children with DMDD may find it hard to participate in activities or make friends. Having DMDD also increases the risk of developing depression or anxiety disorders in adulthood.

While researchers are still determining which treatments work best, two major types of treatment are currently used to treat DMDD symptoms:

• Medication
• Psychological treatments
  • Psychotherapy
  • Parent training
  • Computer based training

Psychological treatments should be considered first, with medication added later if necessary, or psychological treatments can be provided along with medication from the beginning.

It is important for parents or caregivers to work closely with the doctor to make a treatment decision that is best for their child.

Depression Related To Medical Illness

Is a persistent depressed mood and a significant loss of pleasure in most or all activities that’s directly related to the physical effects of another medical condition.

Depression associated with a chronic medical illness often aggravates the condition, especially if the illness causes pain and fatigue, or limits a person’s ability to interact with others. Depression can intensify pain, as well as fatigue and sluggishness. The combination of chronic illness and depression also can cause people to isolate themselves, which is likely to exacerbate the depression.

Research on chronic illnesses and depression indicates that depression rates are high among patients with chronic conditions:

• Heart attack: 40% to 65% experience depression
• HIV/AIDS
• Coronary artery disease (without heart attack): 18% to 20% experience depression
• Parkinson’s disease: 40% experience depression
• Multiple sclerosis: 40% experience depression
• Stroke: 10% to 27% experience depression
• Cancer: 25% experience depression
• Diabetes: 25% experience depression
• Chronic pain syndrome: 30% to 54% experience depression
• Hypothyroidism
• Lupus
• Huntington’s Chorea – depression is a hallmark of the beginning of the disease and the end of the disease

Depression Related To Substance Use And/Or Abuse:

It’s no secret that there is a strong connection between substance use and mental illness. In fact, substance abuse is nearly always linked to depression, this is called duel diagnosis, meaning that there are two closely related problems that need to be treated at the same time.

The National Bureau of Economic Research reports that people who have been diagnosed with a mental illness at some point in life consume 69 percent of the nation’s alcohol and 84 percent of the national’s cocaine. When a person struggles with substance abuse and a mental illness, this is known as a dual diagnosis or co-occurring disorder.

Depression is a mental illness frequently co-occurring with substance use. The relationship between the two disorders is bi-directional, meaning that people who abuse substances are more likely to suffer from depression, and vice versa. People who are depressed may drink or abuse drugs to lift their mood or escape from feelings of guilt or despair. But substances like alcohol, which is a depressant, can increase feelings of sadness or fatigue. Conversely, people can experience depression after the effects of drugs wear off or as they struggle to cope with how the addiction has impacted their life.

Depression is all too often a gateway into drug and alcohol use. It’s easy to see why. Those who experience feelings of depressions take alcohol and drugs in order to escape their negative emotions. But those who are clinically depressed are going to stay depressed if they do not seek treatment. And if these individuals are using drugs and alcohol on a regular basis, chances are their usage will soon turn into full-blown addiction as they continue in a vain attempt to self-medicate.

For some individuals who have depression and a substance use disorder, giving up drugs or alcohol can actually make depression worse. If you’ve been using alcohol for years to bury your depressive symptoms, you may find that your depression rises to the surface in sobriety. That’s why it’s so important to receive integrated treatment for both depression and substance abuse at the same time.

Without treating the depression that drives your addiction, or vice versa, you’re likely to go back to your addictive behaviors or to experience a return of your depressive symptoms as soon as you finish rehabilitation. In many cases, people who have depression and substance abuse drop out of conventional rehab programs because sobriety is too much to handle without the right level of therapeutic support.

How Are Mood Disorders Treated?

Mood disorders can often be treated with success. Treatment may include:

• Antidepressant and mood stabilizing medicines—especially when combined with psychotherapy have shown to work very well in the treatment of depression
• Psychotherapy—most often cognitive-behavioral and/or interpersonal therapy. This therapy is focused on changing the person’s distorted views of himself or herself and the environment around him or her. It also helps to improve interpersonal relationship skills, and identifying stressors in the environment and how to avoid them
• Family therapy
• Other therapies, such as electroconvulsive therapy and transcranial stimulation

Families play a vital supportive role in any treatment process. When correctly diagnosed and treated, people with mood disorders can live, stable, productive, healthy lives.