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Is My Spouse Really Narcissistic? How People Are Commonly Overpathologized

Originally posted at: https://drlorischade.wordpress.com/2016/07/18/how-spouses-are-commonly-overpathologized/

“How much do you know about Narcissism?” asked yet another female client, on the same day that a male client asked, “How much do you know about Borderline Personality Disorder?” It seems like therapists I supervise or I am asked a version of these questions at least weekly.  I can confidently state that I likely know more about both of them than most of my clients do.  I believe that these labels are used prematurely and inaccurately in short, because they simplify complex problems for people who are desperately trying to make sense out of the seemingly nonsensical.  Here are some reasons why they are incorrectly overused:

Narcissistic Personality Disorder (NPD) and Borderline Personality Disorder (BDD) are labels that describe sets of behaviors and internal states identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM).  This is a tome published by the American Psychiatric Association for the purpose of categorizing and typifying groups of mental health disorders in order to conceptualize diagnoses and treatment options for various clinical presentations.  The book is the best we have for making sense out of mental health disorders.  As a collaborative clinician for the most recent issuance (5th edition), I have respect for the amount of study and diligence that goes into refining the descriptors as an attempt at treatment accuracy.  The problem is that the taxonomy is clumsy, largely subjective, politically influenced, and always controversial among mental health and medical professionals.

For example, one of the identifying specifiers for NPD is “Requires excessive admiration,” (p. 669).  What?  Who decides how much is “excessive?”  Another feature is, “Shows arrogant, haughty behaviors or attitudes,” (p. 670).  Do you see the problem?  What exactly is “arrogant or haughty?”  What is the context for such behavior?  Many of the remaining identifiers are equally ambiguous.  The lack of precision throughout the DSM is an enormous problem because it is so subjective and can vary tremendously from clinician to clinician.

Let’s look at BPD.  The first listed criterion is, “Frantic efforts to avoid real or imagined abandonment,” (p. 663).  So, what, exactly, is “Frantic?”  Does that mean if a spouse is threatening to divorce and walks out the door, the panicky reaction of a partner is “BPD?”  The 7th identifier is “chronic feelings of emptiness.”  Huh?  How empty?  Does “emptiness” mean the same thing to different people?  How about “Inappropriate, intense anger or difficulty controlling anger?”  I have seen plenty of that in partners who experienced betrayal, or a number of other emotionally-laden events.  This does not mean the individual has BPD.

Hopefully, most clinicians are very careful in using these labels.  Unfortunately, I see way too many who are not.  Many clinicians use the labels as a way to dismiss clients when they are overwhelmed with the behaviors, particularly in couple cases where the emotion is notoriously high, and the dynamics exceed the therapist’s competence and skill level.  Personality disorders are by nature considered durable and nearly unchangeable.  If a client has a legitimate personality disorder, in a sense, the clinician can just write off the case as untreatable.  Many do.  To be honest, sometimes I think it’s laziness at best and negligence at worst.  This is a particularly egregious practice when a therapist has diagnosed a spouse based on the report of their client, without ever actually meeting that individual (and yes, this happens, not infrequently).  I’m not a DSM expert, but as a licensed clinician with DSM training, I believe the actual prevalence of these cases in a population is far lower than they are diagnosed by mental health professionals, at least informally, behind closed doors.

Among the client population, the overpathologizing might be more pervasive.  Currently, the ability to easily research anything on the internet has provided fertile ground for spouses to gain just enough information to be dangerous.  Most of us are guided by confirmatory bias, meaning that we have a tendency to give more credence to information that supports what we already believe.  If I think I’m married to a narcissist (or an autistic or a bipolar individual or…) then I will find all kinds of information supporting my viewpoint.  Ditto for borderlines.  Then, if I read that it is not very treatable, I might prematurely give up on the relationship.

Much of the highly emotional behavior observed in panicky, anxious pursuing partners (often wives who get labeled “Borderline”), is exacerbated by, if not a direct result of, the withdrawing or stonewalling behavior by spouses who are flooded.  Likewise, the withdrawing husband who numbs himself because he doesn’t ever feel like he can calm down his wife’s emotions, may appear incapable of empathizing (Aha!  Narcissism!), when the apparent lack of empathy is really a conditioned response generated from years of feeling helpless to impact a partner’s emotional reactions.  The pattern becomes cyclical, more pronounced, and anticipatory until partners can and do appear to be Narcisstic and Borderline.  In short, protective behaviors of stonewalling and withdrawal that make sense in an intense situation are incorrectly labeled, and desperate, clingy, panicky emotional behaviors that come as a result of not knowing what else to do to save a relationship are prematurely pathologized.  Various trauma responses based on previous client history can also be prematurely lumped into a personality disorder.

I have no illusions about my self-indulgent blog post changing anything in general.  That would require a readership larger than three people.  However, I want to be on record somewhere articulating and highlighting this problem because it is endemic with therapists who don’t place behavior in a highly emotional couple context, and it is a problem with spouses who are desperately trying to make sense out of painful marriages they feel powerless to change.

Don’t get me wrong.  I have seen clients who I believe meet criteria for both of these disorders.  However, far more often, I see people who are very reactive to each other after years of feeling rejected, and their behaviors look like some of the personality disorder specifiers.  In other words, I see more instances which are treatable than those which aren’t.  If you think your spouse has a personality disorder, you could be right, but it is more likely that you are incorrectly labeling contextual, reactive behavior.  Be very careful in your unofficial diagnosis.

Now it’s time to return to my real life of being mom to 7 children, or, as I like to call it, my “Acute Stress Disorder,” or my “Circadian Rhythm Sleep-Wake Disorder,” for which the recognized treatment is “birth control.”  Oops….too late!  Happy diagnosing!

Reference: Diagnostic and Statistical Manual of Mental Disorders, 5th edition (2013), American Psychiatric Association: Arlington, Virginia.

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One Simple Thing You Can do to Protect Your Marriage

Originally posted at: https://drlorischade.wordpress.com/2016/07/22/one-simple-thing-you-can-do-to-protect-your-marriage/

I was on a hike with another couple a few nights ago, and the husband asked me to identify the number one thing I would tell people to keep their marriages strong.  I’m not usually asked to reduce marital tips down to one dimension, but I was intrigued by the challenge.  I thought for a minute and realized I had a definite answer, informed by the cases I have had over the last 5 years.

“I would say,” I replied, “To realize that when you are texting someone, you are in essence entering a private room with that person.”  I’m expanding on the image here.  The room has no windows.  The social response is in real time, so it is as if you are right next to the person having an actual conversation.  If you text daily, you are entering that room daily.  If you text on and off all day long, you are in that room most of the day.  Everyday.

I see a lot of infidelity cases.  One hundred percent of them in the last few years have all developed through texting.  In most cases, a romantic interest did not precede the texting relationship.  Most of them started in a benign way between co-workers, church members working together on projects, neighbors and best friends of the couple.  Here’s the typical developmental course (IMHO):

  1. Begin texting to communicate practical information.
  2. Increase frequency of texting, still to communicate practical information.
  3. Add a joke to your text, making it more conversational in nature.
  4. Get a response to your joke, and continue the playful banter.
  5. Feel a positive chemical boost after a text exchange.
  6. Find yourself checking your phone to see if the person texted.
  7. Realize that you are starting to look forward to getting texts from that person.
  8. Tell yourself that since you aren’t seeing that person face-to-face, you are fine and not being disloyal to your spouse.
  9. Increase casual and playful texting.
  10. Shift from playful banter to deeper emotional disclosures.
  11. Experience an increase in the euphoric chemical boost.
  12. Find yourself hiding your phone from your spouse, because you don’t want the texts to be “misinterpreted.”  (ALERT: Tipping Point)
  13. Continue to tell yourself that nothing is going to happen, because you still aren’t in this person’s physical presence, so you are still in control.
  14. Realize you have an emotional yearning for this individual.
  15. As you increase the need to hide your texts, begin to see your spouse as the enemy.
  16. Find yourself disconnecting from your spouse to find a place to text this person more often and privately.
  17. Hide more.
  18. Declare your deepest feelings and yearnings for this person and plan to meet in a private location.
  19. Engage in physical affection.
  20. Bam!
  21. Feel as if you have “fallen,” in love with this person and want him/her more than your spouse.
  22. Tell yourself this is your true love connection…otherwise you wouldn’t have “fallen,” in love, and you wouldn’t have these feelings.
  23. See your spouse as the one thing standing between you and true love and happiness.
  24. Destabilize your family.
  25. Make an appointment with [a therapist].

This may sound harsh to some readers…definitely to those who see themselves somewhere on this continuum.  I’m not changing my story.  If you would not repeatedly enter a private room with someone without a window where someone can see in, frequently enough that you start to share feelings with someone that you wouldn’t share with your spouse, don’t do it on a cell phone.

Here’s one more thing that should not surprise you:  If your texting partner is an old boyfriend or girlfriend, you can expect to immediately resurrect the same emotions you felt when you were dating that person.  You will exaggerate all the good memories you had and minimize the negative memories you had from that relationship.  That’s not unique.  Your texting affair is not unique, and the effect is as if you are on drugs.  I’ve written this before, and I stand by it.

Lastly, realize that no matter how great you think your marriage is, this can happen to you.  It is the failure to be watchful and set boundaries that gets people into trouble.  If you think you could never end up having an affair, you’re kidding yourself—FWIW.

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Does Forgiveness Mean Instant Trust?

SOURCE:  Leslie Vernick

Can I Trust You?

Sometimes the burden to trust again has been unfairly placed upon the shoulders of the betrayed person and linked with forgiveness. The thinking goes like this: if you forgive me, then what happened between us is in the past. We don’t need to discuss this anymore and trust should be automatically restored.

But that’s not true.

We can genuinely forgive someone and still not trust him (or her).

Forgiveness is something we do because God calls us to do it, not necessarily because someone is sorry, repentant, or is genuinely interested in rebuilding trust. However, reconciliation of the relationship, including trusting again, requires forgiveness but not just forgiveness. It also requires the one who broke trust to show genuine repentance as well as make efforts to rebuild broken trust.

Typically we think of broken trust, especially in marriage, only in the sexual realm. However below are three additional areas where trust can be broken and must be rebuilt if a relationship is to be restored.

1.  Authenticity: People immediately mistrust someone who feels false. When you are married to someone, work with someone, or are close to someone who has one persona in public and another in private, you intuitively do not trust him, even when you have no specific reason not to. You don’t trust his public persona (i.e. great guy), because you also bear witness to his or her hypocrisy elsewhere. This person’s core self is not authentic and therefore he cannot or should not be trusted.

To rebuild trust with someone who has been inauthentic requires him or her to acknowledge his or her false image and learn to be more real. In most instances a person who has a double self will not acknowledge it nor do they typically change. When confronted, they just get more devious.

2. Reliability: When we are in relationship with someone, personal or professional, we want to know whether we can count on that person to do what he says he will do. Or, likewise, can I trust that he will stop doing the things that he says he will stop doing?

In rebuilding broken trust with someone who has a track record of unreliability, we must look at what the person does, not what the person says that he or she will do. For example, does he say he will put filters on his computer but never does? Does she say she will stop drinking, or spending money on the credit card but does nothing? Does he say he wants restoration of the marriage but won’t go to counseling or do any work towards that end? Does she tell you she will make more efforts to call you and reach out to you in order to have a more mutual relationship but her promises don’t turn into real phone calls?

Proverbs 25:19 says, “Putting confidence in an unreliable person in times of trouble is like chewing with a broken tooth or walking on a lame foot.” It’s foolish.

John Mark was someone who was not reliable and as a result, lost the apostle Paul’s trust (See Acts 15). Later on we see that trust was restored, not because Paul gave him trust, but because John Mark proved he was reliable and Paul’s trust was restored (2 Timothy 4). In the same way, building consistent reliability into our character rebuilds broken trust, not empty promises.

3. Care: In our closest relationships we ask ourselves: can I trust that you care for my good? My well-being?  When I share my thoughts and feelings do you hear me? Value me? Protect me? Or is there mocking, contempt, avoidance, or indifference? Proverbs 31:11,12 says, “The heart of her husband trusts in her.” Why?  Because, “He trusts her to do him good not harm all the days of his life.”

One of the foundations of relational trust is that love does not intentionally harm the other (Romans 13:10).  And, if in weakness and sin there is harm, every effort is made to make amends and not repeat that harm.

A destructive person does not want to hear the other person’s grievances against him. It’s true; it does hurt our feelings (and pride) to hear how we have hurt someone. It takes effort to listen and care about the other person’s feelings when you have broken her trust. Yet without consistent compassion, empathy, and care for the other, rebuilding trust is not possible. And if we don’t trust that someone cares for our well being, a close relationship with that person is not possible.

Rebuilding broken trust takes time and specific evidence of change, not merely words or promises of change.  

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This Is What It’s Like To Date An Actual Narcissist (And You Never Want To Do It)

Originally posted at: http://thoughtcatalog.com/%tc-coauthor%/2016/07/this-is-what-its-like-to-date-an-actual-narcissist-and-you-never-want-to-do-it/

Last winter, I ended a relationship with a man who I came to realize was narcissistically abusive.

Our six-month partnership began with the “love bombing” that characterizes any relationship with a narcissist. He lavished me with constant attention, meals, and gifts. Within a matter of weeks, we developed an emotional connection that made me feel as if I had known him forever.

Although I had always been a skeptic when it came to romance and relationships, he insisted we were soul mates.

But in textbook fashion, the love-bombing phase ultimately gave way to one of gradual and inevitable “devaluation.”

When disagreements arose, he would increasingly erupt in anger, unleashing a torrent of often alcohol-fuelled verbal abuse against me.

During one argument, I remember realizing with matter-of-fact detachment that the man who claimed to care so much about me was willing to say absolutely anything – maybe even do anything – in order to hurt me, in order to “win.”

Yet I struggled to reconcile this behavior with the person I believed I had fallen in love with.

How could such a charismatic and compassionate man – a health care professional who presented himself as a “healer” – become so angry and hurtful behind closed doors?

This cognitive dissonance ultimately made me doubt my own perception and even my memory of what had happened.

Besides, he would always apologize – sometimes even breaking down in tears – blaming the verbal assaults on his ADHD medication or the alcohol. Then he would accuse me of not being “supportive” enough.

I became convinced that if I just tried harder, things would go back to the way they were.

But, eventually, it seemed as if any perceived slight would upset him and even enrage him, especially if he had been drinking: a flat tire, misplaced keys, a client cancelling, the barista making his latte too slowly.

I walked on daily trails of eggshells, praying that nothing would happen to ruin his fragile mood.

I stopped confronting him with things I was unhappy about, knowing that he would either explode in anger or stonewall me by emotionally withdrawing or leaving his own apartment – once for hours.

By this point, we were practically living together, and I had become consumed with the relationship. I worked from home more often now (his home). I rarely saw friends or colleagues.

But the constant waiting for the other shoe to drop, the persistent feeling that things were never completely stable began to far outweigh the intermittent reinforcement that kept me tethered to him. I was finally able to end the relationship — on the third try.

Characteristically, he made more excuses and insisted I was to blame.
I should have made him give up alcohol. I should have spent more time with him instead of working on my damn Ph.D. I was too cold and heartless to “fight for love.”

But, the important thing was: I was free. Or so I thought.

As I entered therapy and began to pick up the pieces of my self-esteem and my heart, I naively expected everything to fall back into place.

Thus, it was especially painful for me to realize the first hard truth about narcissistic abuse: that an abuser will never, ever acknowledge or take responsibility for the pain they have caused you. Especially if they are a narcissist.

Although you thought you had left the crazy-making and emotional invalidation of the relationship behind, you get to experience it all over again once the relationship is over.

Because the only other individual in your toxic relationship – the only other person in the world who was “there” and saw it all unfold – absolutely refuses to accept your version of events.

Instead, they continue to make excuses and minimize their behavior, attempting to “hoover” you back into the relationship.

Despite blocking the narcissist from my phone and Facebook and never once responding, he continued to contact me for months after the relationship had ended – by email, letter, a different phone number, and even online sites it hadn’t occurred to me to protect, such as LinkedIn and Pandora.

But most insidiously of all? Eventually, the abuser pretends as if nothing ever happened.

Five months after the break-up, the narcissist announced in an email that he would finally leave me alone. He ended the message with: I love you.

Basically, it didn’t matter that this man’s behavior had constantly made me feel unstable and unsafe because he “loved” me.

And now he had finally decided to stop months of unwanted and unreciprocated contact…because he felt like it.

That is when I learned a second hard truth about narcissistic abuse: that the abuser always gets the last word. That the abuser is the one who gets to decide when the abuse stops.

Only they get to carry out the ultimate “discard.” Because they don’t just require the upper hand during the relationship, but all the way until its bitter end.

I wish I could say that I have moved past all of this, but I am still coming to terms with the realities of narcissistic abuse. And yet, I still have hope.

Just as I am a bit of a skeptic, I am also a rather stubborn optimist.

I am hopeful that someday, it really won’t matter that my abuser will never take responsibility and acknowledge the pain he caused – because I will be able to validate my feelings and perception of reality, for myself.

I am hopeful that someday I will get to the point where I get to decide that the abuse is over. That eventually it will all just be a memory, as will the constant fear of him unexpectedly showing up at my door.

I am hopeful that someday I will be able to trust people again.

Because, hard as it is, simply knowing the truth can also be beautifully freeing. And, for now, that will have to be enough freedom for me.

 

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Phrases That Make Arguments and Fights Worse

SOURCE:  Brandon Specktor/Readers Digest

When you argue, you are at your most animal. Your brain literally enters fight-or-flight mode, your heart-rate escalates, and logic and reasoning physically shut down. It’s little wonder you usually say a lot of bonehead things you end up regretting in the morning. Don’t worry: We are all guilty of the same stupidity, and sometimes the key to a painless argument is what you don’t say.

For starters, here are six research-backed phrases proven to make any bad argument worse.

Don’t mention getting calm — “Calm Down”

According to parenting experts and hostage negotiators alike, the biggest mistake most people make in an argument is denying the other person’s feelings. Think for a moment if the words “calm down” have ever actually made you calmer. More than likely, they’ve only ever made you feel more annoyed—Why does this person think I’m overreacting? He doesn’t understand me at all! Telling a person to calm down assigns them a negative emotion (be it anger, anxiety, stubbornness, etc.) while denying their actual feelings. This seeming lack of empathy can be detrimental to reaching a mutual understanding, which is a far more important outcome than “winning” an argument. So instead of telling your companion how to feel, seek first to understand how they feel. Step one: listen.

Don’t try to quiet their emotions — “Shut Up”

Always let the other person vent, no matter how long or loud that venting may be. “If the emotional level is high, your first task is to take some of the emotion out,” says Linda Hill, professor of business administration at Harvard Business School. “Hold back and let them say their piece. You don’t have to agree with it, but listen.” Often times, just talking honestly about a problem is enough to make a person feel better about it (hence, therapy). And as an argument participant, know that every word your companion says is a step toward mutual understanding. Just be careful how you approach it.

Don’t fake-empathize — “I Know How You Feel”

This stock phrase almost always comes across wrong; you may be trying to say, “your emotions are valid,” but the other person will more likely hear, “I get it—so stop talking.” Instead of merely saying you understand someone’s feelings, show them by doing what FBI negotiators do: paraphrase. “The idea is to really listen to what the other side is saying and feed it back to them,” says FBI hostage negotiator Chris Voss. “It’s kind of a discovery process for both sides. First of all, you’re trying to discover what’s important to them, and secondly, you’re trying to help them hear what they’re saying to find out if what they are saying makes sense.” If everyone’s on the same page, you can start moving toward reconciliation.

Don’t tell someone how to feel — “You Shouldn’t Feel That Way”

It may sound to you like you’re acknowledging the other person’s feelings, but by adding a “should” or “shouldn’t” you are condemning and judging them just as much. Psychologists call this subtractive empathy—a response that diminishes and distorts what the other person has just said, often making them feel worse. Instead of judging a feeling, try giving it a concrete name by saying something like, “You sound pretty hurt about [problem]. It doesn’t seem fair.” That’s what psychologists call additive empathy—it identifies a feeling, then adds a new layer of understanding that can lead to a potential solution. Think you have a solution? Be careful how you phrase it.

Don’t tell someone what to do — “Here’s What You Need To Do”

When the fight-or-flight response is triggered, power becomes deceptively crucial to us. Telling someone what to do takes away their power; if they listen to your advice, they may feel less smart or less autonomous, and they will resent you for that. What’s more, insisting that an answer depends solely on the other person changing their behavior removes personal responsibility from the equation, and that’s no way to make friends or learn from your mistakes. The superior phrase: “What would you like me to do?” This handy question leaves the other person with their autonomy, and proves you’re willing to meet them halfway. It also moves your brains away from fight mode, and closer to the land of logical compromise.

Don’t force a resolution — “We Need To Settle This Now”

Never fret if you can’t settle an argument in one shot. According to relationship psychologist John Gottman, PhD, 69 percent of a couple’s problems are perpetual—they will never be resolved. “By fighting over [inherent] differences, all [couples] succeed in doing is wasting their time and harming their marriage,” Gottman says. While this may sound depressing to anyone new to a serious relationship, it’s meant to be liberating. Once you realize some arguments can never be won, it makes them that much easier to drop. You fight. You make up. You move on with life. Despite what your fight-or-flight brain chemistry is telling you, “winning” doesn’t matter; most of the time, it isn’t even possible. However, pay attention to these red-flag warning signs of a toxic relationship or signs of a toxic friendship.