----- Original Message -----
From: Sam Vaknin, author of "Malignant Self Love - Narcissism Revisited"
Sent: Sunday, March 16, 2008 9:31 PM
Subject: Misdiagnosing Personality Disorders (cont.) - Abusive Relationships Newsletter - Number 136
NEW! Photos of a Psychopathic Narcissist and His World
http://www.narcissistic-abuse.com/narcissismphotos.html
The Monster in the Mirror (Sunday Times)
http://women.timesonline.co.uk/tol/life_and_style/women/relationships...
Egomania (UK Documentary)
http://www.channel4.com/health/microsites/0-9/4health/mind/wwr_manic....
http://en.wikipedia.org/wiki/Egomania_(UK_TV_Documentary)
Sam Vaknin has just published a NEW e-BOOK "Personality Disorders Revisited" (April 2007)
450 pages about the Borderline, Narcissistic, Antisocial-Psychopathic, Histrionic, Paranoid, Obsessive-Compulsive, Schizoid, Schizotypal, Masochistic, Sadistic, Depressive, Negativistic-Passive-Aggressive, Dependent, and other Personality Disorders!
Click on this link to purchase the ebook:
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An electronic book is a computer file, sent to you as an attachment to an e-mail message. Just save it to your hard disk and click on the file to open, read, and learn!
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NEW!!!
Narcissistic Abuse Forum
http://ngoaccess.net/narcabuse/
The Psychopath and Narcissist Forum
http://thepsychopath.freeforums.org/
Personality Disorders Topic Index and CASE STUDIES!
http://www.narcissistic-abuse.com/faqpd.html
NEW EDITION - Download The Narcissism Book of Quotes
http://www.narcissistic-abuse.com/NPDQuotes.rtf
NEW EDITION - Download Sample chapters from "Malignant Self Love - Narcissism Revisited"
http://www.narcissistic-abuse.com/MSL2excerpts.rtf
NEW links directory here:
http://health.groups.yahoo.com/group/Narcissistic_Personality_Disorde...
NEW! Amazon blog
http://www.amazon.com/gp/blog/id/A3FGJDBSMCSG7G/
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Abused? Stalked? Harassed? Victimized? Afraid? Confused? Need HELP? Click on these links!
NEW, January 2007, EIGHTH Revised Impression of "Malignant Self Love - Narcissism Revisited"
And NEW, November 2006 EDITIONS of our e-books JUST RELEASED!
From Barnes and Noble ($15 DISCOUNT)
http://search.barnesandnoble.com/bookSearch/isbnInquiry.asp?r=1&ISBN=...
(Or, click on this link - http://www.bn.com - and search for "Sam Vaknin" or "Malignant Self Love").
Malignant Self Love - Narcissism Revisited is now available from Amazon Canada:
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And from Amazon.com:
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The sixth print edition from the publisher (with a bonus pack):
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_MSL
II. NEW!!! "Malignant Self Love - Narcissism Revisited" - EIGHTH, Revised Edition (November 2006)
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_MSL-EBOOK
III. NEW!!! "Toxic Relationships - Abuse and its Aftermath" e-book edition (February 2006)
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_ABUSE
IV. NEW!!! "Abusive Relationships Workbook" e-book edition (February 2006)
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_WORKBOOK
V. "Pathological Narcissism FAQs" - EIGHTH, Revised Edition (November 2006)
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_FAQS
VI. "The World of the Narcissist" - EIGHTH, Revised Edition (November 2006)
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_ESSAY
VII. "Excerpts from the Archives of the Narcissism List" e-book edition
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_EXCERPTS
VIII. "Diary of a Narcissist" e-book edition (November 2005)
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_JOURNAL
IX "The Narcissist and Psychopath in the Workplace" e-book edition (September 2006)
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_WORKPLACE
X. "The Narcissism Series" - EIGHTH, Revised Edition (November 2006)
EIGHT e-books regarding Pathological Narcissism, relationships with abusive narcissists, and the Narcissistic Personality Disorder (NPD).
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_SERIES
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Please FORWARD this message to interested parties and relevant discussion lists and groups
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Misdiagnosing Personality Disorders as Anxiety Disorders
"Personality Disorders Revisited" (450 pages e-book) - click HERE to purchase!
First published here: "Personality Disorders (Suite101)"
By: Dr. Sam Vaknin
What is Anxiety
Anxiety is uncontrollable and excessive apprehension, a kind of unpleasant (dysphoric), mild fear, with no apparent external reason. Anxiety is dread in anticipation of a future menace or an imminent but diffuse and unspecified danger, usually imagined or exaggerated. The mental state of anxiety (and the concomitant hypervigilance) has physiological complements. It is accompanied by short-term dysphoria and physical symptoms of stress and tension, such as sweating, palpitations, tachycardia, hyperventilation, angina, tensed muscle tone, and elevated blood pressure (arousal). It is common for anxiety disorders to include obsessive thoughts, compulsive and ritualistic acts, restlessness, fatigue, irritability, and difficulty concentrating.
Personality Disorders and Anxiety
Patients with personality disorders are often anxious. Narcissists, for instance, are preoccupied with the need to secure social approval or attention (Narcissistic Supply). The narcissist cannot control this need and the attendant anxiety because he requires external feedback to regulate his labile sense of self-worth. This dependence makes most narcissists irritable. They fly into rages and have a very low threshold of frustration.
Subjects suffering from certain personality disorders (e.g., Histrionic, Borderline, Narcissistic, Avoidant, Schizotypal) resemble patients who suffer from Panic Attacks and Social Phobia (another anxiety disorder). They are terrified of being embarrassed or criticized in public. Consequently, they fail to function well in various settings (social, occupational, interpersonal, etc.).
Narcissism, Obsession-Compulsion, and Anxiety
The personality disordered often develop obsessions and compulsions. Like sufferers of anxiety disorders, narcissists and compulsive-obsessives, for instance, are perfectionists and preoccupied with the quality of their performance and the level of their competence. As the Diagnostic and Statistical Manual (DSM-IV-TR, p. 473) puts it, GAD (Generalized Anxiety Disorder) patients (especially children):
"… (A)re typically overzealous in seeking approval and require excessive reassurance about their performance and their other worries."
This could apply equally well to subjects with the Narcissistic or the Obsessive-Compulsive Personality Disorder. Both classes of patients - those suffering from anxiety disorders and those tormented by personality disorders - are paralyzed by the fear of being judged as imperfect or lacking. Narcissists as well as patients with anxiety disorders constantly fail to measure up to an inner, harsh, and sadistic critic and a grandiose, inflated self-image.
From my book "Malignant Self Love - Narcissism Revisited"
"The narcissistic solution is to avoid comparison and competition altogether and to demand special treatment. The narcissist's sense of entitlement is incommensurate with the narcissist's true accomplishments. He withdraws from the rat race because he does not deem his opponents, colleagues, or peers worthy of his efforts.
As opposed to narcissists, patients with Anxiety Disorders are invested in their work and their profession. To be exact, they are over-invested. Their preoccupation with perfection is counter-productive and, ironically, renders them underachievers.
It is easy to mistake the presenting symptoms of certain anxiety disorders with pathological narcissism. Both types of patients are worried about social approbation and seek it actively. Both present a haughty or impervious facade to the world. Both are dysfunctional and weighed down by a history of personal failure on the job and in the family. But the narcissist is ego-syntonic: he is proud and happy of who he is. The anxious patient is distressed and is looking for help and a way out of his or her predicament. Hence the differential diagnosis."
Bibliography
Goldman, Howard G. – Review of General Psychiatry, 4th ed. – London, Prentice-Hall International, 1995 – pp. 279-282
Gelder, Michael et al., eds. – Oxford Textbook of Psychiatry, 3rd ed. – London, Oxford University Press, 2000 – pp. 160-169
Klein, Melanie – The Writings of Melanie Klein – Ed. Roger Money-Kyrle – 4 vols. – New York, Free Press – 1964-75
Kernberg O. – Borderline Conditions and Pathological Narcissism – New York, Jason Aronson, 1975
Millon, Theodore (and Roger D. Davis, contributor) – Disorders of Personality: DSM IV and Beyond – 2nd ed. – New York, John Wiley and Sons, 1995
Millon, Theodore – Personality Disorders in Modern Life – New York, John Wiley and Sons, 2000
Schwartz, Lester – Narcissistic Personality Disorders – A Clinical Discussion – Journal of Am. Psychoanalytic Association – 22 (1974): 292-305
Vaknin, Sam – Malignant Self Love – Narcissism Revisited, 8th revised impression – Skopje and Prague, Narcissus Publications, 2008
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Many additional Frequently Asked Questions (FAQs) about Personality Disorders - click HERE!
(continued below)
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Abused? Stalked? Harassed? Victimized? Afraid? Confused? Need HELP?
"The Narcissism Series" - (November 2006)
Eight e-books regarding Pathological Narcissism, relationships with abusive narcissists, and the Narcissistic Personality Disorder (NPD).
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_SERIES
http://malignantselflove.tripod.com/thebook.html
NEW! Analyze This - Short Fiction about Narcissists
http://groups.msn.com/NARCISSISTICPERSONALITYDISORDER/analyzethis.msnw
Case Studies in the Narcissistic Personality Disorder List
http://groups.msn.com/NARCISSISTICPERSONALITYDISORDER/drvakninsweekly...
http://groups.msn.com/NARCISSISTICPERSONALITYDISORDER/drvakninsweekly...
Ask Sam on the Narcissistic Personality Disorder Support Group
http://groups.msn.com/narcissisticpersonalitydisorder/general.msnw?ac...
http://groups.msn.com/NARCISSISTICPERSONALITYDISORDER/general.msnw?ac...
http://groups.msn.com/NARCISSISTICPERSONALITYDISORDER/general.msnw?ac...
http://groups.msn.com/NARCISSISTICPERSONALITYDISORDER/general.msnw?ac...
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Misdiagnosing Personality Disorders as Eating Disorders
"Personality Disorders Revisited" (450 pages e-book) - click HERE to purchase!
First published here: "Personality Disorders (Suite101)"
By: Dr. Sam Vaknin
The Eating Disordered Patient
Eating disorders - notably Anorexia Nervosa and Bulimia Nervosa - are complex phenomena. The patient with eating disorder maintains a distorted view of her body as too fat or as somehow defective (she may have a body dysmorphic disorder). Many patients with eating disorders are found in professions where body form and image are emphasized (e.g., ballet students, fashion models, actors).
The Diagnostic and Statistical Manual (DSM) IV-TR (2000) (pp. 584-5):
"(Patients with personality disorders exhibit) feelings of ineffectiveness, a strong need to control one's environment, inflexible thinking, limited social spontaneity, perfectionism, and overly restrained initiative and emotional expression ... (Bulimics show a greater tendency to have) impulse-control problems, abuse alcohol or other drugs, exhibit mood lability, (have) a greater frequency of suicide attempts."
Eating Disorders and Self-control
The current view of orthodoxy is that the eating disordered patient is attempting to reassert control over her life by ritually regulating her food intake and her body weight. In this respect, eating disorders resemble obsessive-compulsive disorders.
One of the first scholars to have studied eating disorders, Bruch, described the patient's state of mind as "a struggle for control, for a sense of identity and effectiveness." (1962, 1974).
In Bulimia Nervosa, protracted episodes of fasting and purging (induced vomiting and the abuse of laxatives and diuretics) are precipitated by stress (usually fear of social situations akin to Social Phobia) and the breakdown of self-imposed dietary rules. Thus, eating disorders seem to be life-long attempts to relieve anxiety. Ironically, binging and purging render the patient even more anxious and provoke in her overwhelming self-loathing and guilt.
Eating disorders involve masochism. The patient tortures herself and inflicts on her body great harm by ascetically abstaining from food or by purging. Many patients cook elaborate meals for others and then refrain from consuming the dishes they had just prepared, perhaps as a sort of "self-punishment" or "spiritual purging."
The Diagnostic and Statistical Manual (DSM) IV-TR (2000) (p. 584) comments on the inner mental landscape of patients with eating disorders:
"Weight loss is viewed as an impressive achievement, a sign of extraordinary self-discipline, whereas weight gain is perceived as an unacceptable failure of self-control."
But the "eating disorder as an exercise in self-control" hypothesis may be overstated. If it were true, we would have expected eating disorders to be prevalent among minorities and the lower classes - people whose lives are controlled by others. Yet, the clinical picture is reversed: the vast majority of patients with eating disorders (90-95%) are white, young (mostly adolescent) women from the middle and upper classes. Eating disorders are rare among the lower and working classes, and among minorities, and non-Western societies and cultures.
Refusing to Grow Up
Other scholars believe that the patient with eating disorder refuses to grow up. By changing her body and stopping her menstruation (a condition known as amenorrhea), the patient regresses to childhood and avoids the challenges of adulthood (loneliness, interpersonal relationships, sex, holding a job, and childrearing).
Similarities with Personality Disorders
Patients with eating disorders maintain great secrecy about their condition, not unlike narcissists or paranoids, for instance. When they do attend psychotherapy it is usually owing to tangential problems: having been caught stealing food and other forms of antisocial behavior, such as rage attacks. Clinicians who are not trained to diagnose the subtle and deceptive signs and symptoms of eating disorders often misdiagnose them as personality disorders or as mood or affective or anxiety disorders.
Patients with eating disorders are emotionally labile, frequently suffer from depression, are socially withdrawn, lack sexual interest, and are irritable. Their self-esteem is low, their sense of self-worth fluctuating, they are perfectionists. The patient with eating disorder derives narcissistic supply from the praise she garners for having gone down in weight and the way she looks post-dieting. Small wonder eating disorders are often misdiagnosed as personality disorders: Borderline, Schizoid, Avoidant, Antisocial or Narcissistic.
Patients with eating disorders also resemble subjects with personality disorders in that they have primitive defense mechanisms, most notably splitting.
The Review of General Psychiatry (p. 356):
"Individuals with Anorexia Nervosa tend to view themselves in terms of absolute and polar opposites. Behavior is either all good or all bad; a decision is either completely right or completely wrong; one is either absolutely in control or totally out of control."
They are unable to differentiate their feelings and needs from those of others, adds the author.
To add confusion, both types of patients - with eating disorders and personality disorders - share an identically dysfunctional family background. Munchin et al. described it thus (1978): "enmeshment, over-protectiveness, rigidity, lack of conflict resolution."
Both types of patients are reluctant to seek help.
The Diagnostic and Statistical Manual (DSM) IV-TR (2000) (pp. 584-5):
"Individuals with Anorexia Nervosa frequently lack insight into or have considerable denial of the problem ... A substantial portion of individuals with Anorexia Nervosa have a personality disturbance that meets criteria for at least one Personality Disorder."
In clinical practice, co-morbidity of an eating disorder and a personality disorder is a common occurrence. About 20% of all Anorexia Nervosa patients are diagnosed with one or more personality disorders (mainly Cluster C - Avoidant, Dependent, Compulsive-Obsessive - but also Cluster A - Schizoid and Paranoid).
A whopping 40% of Anorexia Nervosa/Bulimia Nervosa patients have co-morbid personality disorders (mostly Cluster B - Narcissistic, Histrionic, Antisocial, Borderline). Pure bulimics tend to have Borderline Personality Disorder. Binge eating is included in the impulsive behavior criterion for Borderline Personality Disorder.
Such rampant comorbidity raises the question whether eating disorders are not actually behavioral manifestations of underlying personality disorders.
Additional resources
Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM-IV-TR) - Washington DC, The American Psychiatric Association, 2000
Goldman, Howard G. – Review of General Psychiatry, 4th ed. – London, Prentice-Hall International, 1995
Gelder, Michael et al., eds. – Oxford Textbook of Psychiatry, 3rd ed. – London, Oxford University Press, 2000
Vaknin, Sam – Malignant Self Love – Narcissism Revisited, 8th revised impression – Skopje and Prague, Narcissus Publications, 2006
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Many additional Frequently Asked Questions (FAQs) about Personality Disorders - click HERE!
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AUTHOR BIO:
Sam Vaknin ( http://samvak.tripod.com ) is the author of Malignant Self Love - Narcissism Revisited and After the Rain - How the West Lost the East. He served as a columnist for Global Politician, Central Europe Review, PopMatters, Bellaonline, and eBookWeb, a United Press International (UPI) Senior Business Correspondent, and the editor of mental health and Central East Europe categories in The Open Directory and Suite101.
Visit Sam's Web site at http://samvak.tripod.com
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EIGHTH EDITION From Barnes and Noble ($15 DISCOUNT)
http://search.barnesandnoble.com/bookSearch/isbnInquiry.asp?r=1&ISBN=...
(Or, click on this link - http://www.bn.com - and search for "Sam Vaknin" or "Malignant Self Love").
Malignant Self Love - Narcissism Revisited is now available from Amazon Canada:
http://www.amazon.ca/exec/obidos/tg/detail/offer-listing/-/8023833847...
And from Amazon.com:
http://www.amazon.com/exec/obidos/tg/detail/-/8023833847/
=============================================================
Links of Interest
NEW! Toxic Relationships Study Group
http://groups.yahoo.com/group/toxicrelationships
NEW! Open Site Narcissistic Personality Disorder (NPD)
http://open-site.org/Health/Conditions_and_Diseases/Psychiatric_Disor...
NEW!!! Google Base Narcissistic Personality Disorder and Abuse in Relationships
http://base.google.com/base/search?authorid=1070013
NEW!!! 360 Degrees on Pathological Narcissism and Abusive Relationships
http://360.yahoo.com/vaksam
Download chat transcripts, interviews, dialogs, articles, and bibliographies - click on this link:
http://www.narcissistic-abuse.com/NPDBibliography.zip
Download links to 309 narcissism and personality disorders online resources:
http://www.narcissistic-abuse.com/NPDWebliography.zip
NEW EDITION - Download The Narcissism Book of Quotes
http://www.narcissistic-abuse.com/NPDQuotes.rtf
NEW EDITION - Download Sample chapters from "Malignant Self Love - Narcissism Revisited"
http://www.narcissistic-abuse.com/MSL2excerpts.rtf
NEW!!! Tips of All Sorts
http://www.tipsofallsorts.com/stalking-stalker.html
http://www.tipsofallsorts.com/divorcing-a-narcissist.html
http://www.tipsofallsorts.com/paranoid-ex-spouse.html
NEW! Amazon blog
http://www.amazon.com/gp/blog/id/A3FGJDBSMCSG7G/
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Refer journalists and editors to my media kit:
http://malignantselflove.tripod.com/mediakit.html
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Abused? Stalked? Harassed? Victimized? Afraid? Confused? Need HELP?
Click on these links to purchase the PRINT BOOK and EIGHT E-BOOKS:
You can buy the EIGHTH PRINT edition of "Malignant Self Love - Narcissism Revisited" (January 2007) from Barnes and Noble (the cheapest - but includes no bonus pack):
http://search.barnesandnoble.com/bookSearch/isbnInquiry.asp?r=1&ISBN=...
(Or, click on this link - http://www.bn.com - and search for "Sam Vaknin" or "Malignant Self Love").
Malignant Self Love - Narcissism Revisited is now available from Amazon Canada (no bonus pack):
http://www.amazon.ca/exec/obidos/tg/detail/offer-listing/-/8023833847...
And from Amazon.com (no bonus pack):
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Or from the publisher (sixth edition, more expensive, but includes a bonus pack):
More information
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To purchase from the publisher - click on this link:
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Buy seven electronic books about narcissism and abusive relationships
More information
http://malignantselflove.tripod.com/thebook.html
To purchase the electronic books from the publisher - click on these links:
1. "Malignant Self Love - Narcissism Revisited" - EIGHTH, Revised Edition (November 2006)
The e-book version of Sam Vaknin's "Malignant Self - Love - Narcissism Revisited". Contains the entire text: essays, frequently asked questions (FAQs) and appendices regarding pathological narcissism and the Narcissistic Personality Disorder (NPD).
Click on this link to purchase the ebook:
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_MSL-EBOOK
2. "The Narcissism Series" - EIGHTH, Revised Edition (November 2006)
EIGHT e-books (more than 2500 pages), including the full text of "Malignant Self Love - Narcissism Revisited", regarding Pathological Narcissism, relationships with abusive narcissists, and the Narcissistic Personality Disorder (NPD).
Click on this link to purchase the ebook:
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_SERIES
3. "Toxic Relationships - Abuse and its Aftermath" - Fourth Edition (February 2006)
How to identify abuse, cope with it, survive it, and deal with your abuser and with the system in divorce and custody issues.
Click on this link to purchase the ebook:
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_ABUSE
4. "Abusive Relationships Workbook" (February 2006)
Self-assessment questionnaires, tips, and tests for victims of abusers, batterers, and stalkers in various types of relationships.
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_WORKBOOK
5. "Pathological Narcissism FAQs" - EIGHTH, Revised Edition (November 2006)
Dozens of Frequently Asked Questions regarding Pathological Narcissism, relationships with abusive narcissists, and the Narcissistic Personality Disorder.
Click on this link to purchase the ebook:
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_FAQS
6. "The World of the Narcissist" - EIGHTH, Revised Edition (November 2006)
A book-length psychodynamic study of pathological narcissism, relationships with abusive narcissists, and the Narcissistic Personality Disorder, using a new vocabulary.
Click on this link to purchase the ebook:
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_ESSAY
7. "Excerpts from the Archives of the Narcissism List"
Hundreds of excerpts from the archives of the Narcissistic Abuse Study List regarding Pathological Narcissism, relationships with abusive narcissists, and the Narcissistic Personality Disorder (NPD).
Click on this link to purchase the ebook:
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_EXCERPTS
8. "Diary of a Narcissist" (November 2005)
The anatomy of one man's mental illness - its origins, its unfolding, its outcomes.
Click on this link to purchase the ebook:
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_JOURNAL
9. "The Narcissist and Psychopath in the Workplace" (September 2006)
Identify abusers, bullies, and stalkers in the workplace (bosses, colleagues, suppliers, and authority figures) and learn how to cope with them effectively.
http://www.ccnow.com/cgi-local/cart.cgi?vaksam_WORKPLACE
10. After the Rain - How the West Lost the East
The history, cultures, societies, and economies of countries in transition in the Balkans.
III. Download free electronic books - Click on this link:
http://malignantselflove.tripod.com/freebooks.html
Malignant Self Love, Toxic Relationships - and MORE!!!
http://malignantselflove.tripod.com/thebook.html
Free excerpts from the EIGHTH, Revised Impression of "Malignant Self Love - Narcissism Revisited" are available as well as a NEW EDITION of the Narcissism Book of Quotes.
Click on this link to download the files:
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Have a safe and sunshine week!
Sam
