Yeah, I’m being vague — Frankly, I’m too embarrassed about the situation to go into detail. Lets just say I recycled and now I’m paying the price with gaping wounds and wicked regrets.

Pathological narcissism occurs in a spectrum of severity. In its more extreme forms, it is narcissistic personality disorder. NPD is considered to result from a person’s belief that he or she is flawed in a way that makes the person fundamentally unacceptable to others. This belief is held below the person’s conscious awareness; such a person would typically deny thinking such a thing if questioned. In order to protect themselves against the intolerably painful rejection and isolation they imagine would follow if others recognized their supposedly defective nature, such people make strong attempts to control others’ view of them and behavior towards them.

The common use of the term “narcissism” refers to some of the ways people defend themselves against this narcissistic dynamic: a concern with one’s own physical and social image, a preoccupation with one’s own thoughts and feelings, and a sense of grandiosity. There are, however, many other behaviors that can stem from narcissistic concerns, such as immersion in one’s own affairs to the exclusion of others, an inability to empathize with others’ experience, interpersonal rigidity, an insistence that one’s opinions and values are “right,” and a tendency to be easily offended and take things personally.

To the extent that people are pathologically narcissistic, they can be controlling, blaming, self-absorbed, intolerant of others’ views, unaware of other’s needs and of the effects of their behavior on others, and insistent that others see them as they wish to be seen.

People who are overly narcissistic commonly feel rejected, humiliated and threatened when criticized. To protect themselves from these dangers, they often react with disdain, rage, and/or defiance to any slight, real or imagined. To avoid such situations, some narcissistic people withdraw socially and may feign modesty or humility.

Though individuals with NPD are often ambitious and capable, the inability to tolerate setbacks, disagreements or criticism, along with lack of empathy, make it difficult for such individuals to work cooperatively with others or to maintain long-term professional achievements. With narcissistic personality disorder, the person’s perceived fantastic grandiosity, often coupled with a hypomanic mood, is typically not commensurate with his or her real accomplishments.

The interpersonal relationships of patients with NPD are typically impaired due to the individual’s lack of empathy, disregard for others, exploitativeness, sense of entitlement, and constant need for attention. They frequently select as mates, and engender in their children, “co-narcissism,” which is a term coined to refer to a co-dependent personality style similar to co-alcoholism and co-dependency. Co-narcissists organize themselves around the needs of others. They feel responsible for others, accept blame readily, are eager to please, defer to other’s opinions, and fear being considered selfish if they act assertively.

It is unusual for people to seek therapy for NPD. Subconscious fears of exposure of inadequacy are often met with defensive disdain of therapeutic processes.

Because NPD contributes to negative, stressful life experiences characterized by the mental health field as “clinically significant distress” or “impairment”, co-existing conditions of depression and anxiety are typical, and can ameliorate with pharmaceutical interventions. NPD sufferers are more likely to seek such treatment from primary care physicians for relief of immediate symptoms of distress / depression.

Patients with NPD are particularly susceptible to problems of substance abuse, impulse control, and suicidal and/or self-destructive behavior, which may shorten their lives.

Patients should be advised that their patterns of perception and response are the results of some combination of inheritance and personal history, and that recovery is therefore likely to be a prolonged process, requiring effort and attention. The relevance of ongoing psychotherapy to long-standing vulnerabilities requires frequent reemphasis by the physician.

Most clinical writers seem unaware that narcissists’ self-reports are unreliable. This is troubling, considering that lying is the most common complaint about narcissists and that, in many instances, defects of empathy lead narcissists to wildly inaccurate misinterpretations of other people’s speech and actions, so that they may believe that they are liked and respected despite a history of callous and exploitative personal interactions.

– my personal experiences with a narcissist are still way to fresh for me to be able to write about at the moment. Frankly, I’ve been accused of being a narcissist myself, but I’m glad to say I’m very aware of my shortcomings and selfishness and I know exactly when I’m being hurtful. It’s not a subconscious thing.  I’m happy to report that I am a selfish, self-absorbed, arrogant, intelligent, procrastinating, asshole; Nothing less, nothing more.

Please feel free to add your feelings and/or experiences … No names please, thats not what this is about.  

A little note:

I won’t mention her name or even an initial. Although I do keep this journal a pretty good secret from most people, I’d hate for someone who knows the two of us to eventually put 2 and 2 together. Not that talking about this sort of thing is bad, but so many people are quick to judge and label this type of thing … I’m just going to keep it as anonymous as possible.

I’m going to describe her from my point of view and share a few insights that she’s given me. I’m going to try and do this in a way that’s very neutral — Not holding back, but not judging her behavior either. It’s going to be a bit difficult as, I’ll admit, I’m very biased.

Since I don’t outline anything I write, and I try not to revise too much, this may come out as a bunch of randomness or a cohesive group of statements. Neither you or I will know ’til I’m done writing it and you’re done reading.

Ok, so I think the Dx is wrong. Since the Dx is wrong, the Rx is (probably) wrong. In the end a bad Dx + a bad Rx probably = a pointless spinning of wheels and a liver thats getting pounded for no reason.

Sometimes she really does fit the Dx of someone that’s severely and chronically depressed. Lets run down her behavior and make sure we agree. She:

• Feels helpless and empty.
• Hypersomnia (Sleeps forever sometimes, Insomnia others).
• Endless self-loathing.
• Unable to feel pleasure — of any kind.
• No energy.
• Suicidal thoughts … and unfortunately intentions.

All those typical indicators … All the obvious things you’d tell your PDoc about, right. Now here’s where the problem starts… Despite having all those indicators she also:

• Becomes extremely irritable.
• Talks on ten levels of tangents.
• Makes lists and gets ultra organized (We’re not talkin’ about your average make a shopping list behavior).
• Doesn’t “Give a shit” — not in the depressed, just don’t care way, but in the aggressive intentional distancing way.
• Things are very black and white — there is no gray area.

While I can see these things as indicators of a manic state, from our conversations I don’t think she’s aware of these things a lot of the time. In not being aware of them (to the extent that a 3rd party like myself or others around her are) I don’t know that she expresses them to her PDoc — which I think may be a common reason for mis-diagnosis of a bipolar patient.

Now, lets add some alcohol. Yeah, she likes to party a bit — as do I. So when we add a few drinks we get all the above behavior — both the depressive and the manic. Usually the cycle goes from a daily/weekly rotation to a washer on the spin cycle. Sometimes she’ll go the whole night in a good place, sometimes it’ll be a bad place — but both sides are elevated 100%.

To make things worse — she gets pretty neurotic … Now, most of us are neurotic to some extent, and for many of us this behavior is magnified when we’re intoxicated so maybe this isn’t an indicator of anything at all, but sometimes I wonder.

“He is incapable of holding an external dialog. Even when he seems to be interacting with someone else – the narcissist is actually engaged in a self-referential discourse. To the narcissist, all other people are cardboard cut-outs, two dimensional animated cartoon characters, or symbols. They exist only in his mind. He is startled when they deviate from the script and prove to be complex and autonomous.”
– Sam Vaknin

Although that quote only describes her when she’s really has too much, it does (from an outside and much more sober point of view) seem like the places she’s coming from. In her defense, I have seen the world from that place once or twice (or 10 times) after having a few too many as well, so again — maybe nothing.

Ok, so … Thats where I’m gonna stop. I’m distracted and having a real hard time writing much more about it — I’m even pondering deleting the last few paragraphs, but since I don’t really want to censor myself I guess it’s gotta stay.

What it all boils down to is that I’m worried about her.

Her current Rx (Effexor, Lamictal and one other med I can’t remember) isn’t working so she’s weening off the Effexor and on to Cymbalta (Quickly moving up to 30mg BID instead of trying 20mg BID to start).

Her suicidal confessions to me the other night.

I just can stand to see my best friend in this state. And I surely can’t stand by just watching and waiting if I think she’s been mis-diagnosed.

I’m guessing if anyone reads this they’ll have an opinion one way or the other — Tell me what you think.

Don’t try and make light of it please — Feel free to be negative about any other post on the site, but not here. If you can’t be constructive, I’ll kindly ask you to shut the fuck up.