The trauma therapist sat a few feet away from the middle-aged woman who had been diagnosed with PTSD (Post Traumatic Stress Disorder). The middle-aged woman, whom we will call Cheryl, is a survivor of an abusive marriage. Cheryl used EMDR (Eye Movement Desensitization and Reprocessing), an integrative psychotherapy approach, to jumpstart her recovery.
The therapist handed Cheryl two small discs connected to electrical wires that the therapist controlled. She held one disc in each hand and her therapist asked her to state her false belief. Cheryl answered, “I’m unlovable.” Then, the therapist asked her on a scale of one to 10 how she would rate this belief to be true. The woman answered: “It’s a 10…some days I believe it’s a 12.”
The therapist asked her to think of a positive belief to replace her negative and false belief. Cheryl responded, “I guess it would have to be that I am lovable.”
Cheryl was told to close her eyes and repeat to herself the words, “I am lovable.” As Cheryl repeated the positive belief to herself (thinking it, not speaking it), the two discs began to vibrate in each hand. First her left hand holding the disc would feel a sensation, accompanied by a low humming sound, then her right. Sometimes Cheryl felt the sensations at the same time, but mostly she felt the discs vibrate back and forth, alternating, right-left or left-right.
She thought about the positive belief, felt the discs vibrate, and sat with her eyes closed as the therapist asked her to recall a time when she was made to feel unlovable. “Tell me what comes to mind. What do you see?” asked her therapist.
Cheryl began to see images. One, two, then a flood of memories came back to her. As each “memory snapshot” appeared, Cheryl described what she saw to her therapist.
According to the EMDR Institute:
“EMDR psychotherapy is an information processing therapy and uses an eight phase approach to address the experiential contributors of a wide range of pathologies. It attends to the past experiences that have set the groundwork for pathology, the current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experience needed to enhance future adaptive behaviors and mental health.”
This session was in the early phase of Cheryl’s EMDR treatment and here is only part of the dialogue taken from Cheryl’s EMDR session (omitting questions the therapist asked and directions the therapist gave her to help her re-process the information.) :
“He’s in a rage. He’s yelling at me because I spent too much for groceries. I was $10 over budget. He’s in my face screaming. He’s calling me stupid. He wakes up my son. My son is yelling from his bedroom, ‘Dad, quit bullying Mom,’ but he doesn’t stop. I just take it. I don’t do anything to stop it. I don’t want it to escalate.
“I see myself locked in the bathroom. He’s trying to knock the door down and he’s screaming that I should open the door. I’m crying. I finally open the door and he picks me up and throws me against the wall. I really begin to cry now. He just stares at me and I’m begging him to go away. Before he leaves he yells at me, ‘You deserved it.’ I don’t remember what the fight was about, but it was before our first anniversary.
“I see another one. It’s after another fight. He’s mad that I bought a sweater without asking him if I could. I’m crying, sitting on the couch and he leaves the room. I see him coming back. He has a camcorder and starts filming me cry. I tell him to stop but he won’t. I try to walk away but he blocks me so I can’t leave the room. I finally get away by slipping under his arm but he follows me. I’m crying and he’s laughing. He’s following me from room to room. He won’t stop following me and he’s filming the whole thing. I finally give up. I’m sitting on the couch and hide my face in my hands. I’m crying. He tells me this will make a funny video and then…he stands right in front of me…He’s pointing the camera right at me… filming me…he’s laughing at me as I cry.”
In early EMDR sessions, Cheryl was “blocked,” unable to see images or she would see images but then stop them because reliving these events brought up too much pain. Subconsciously, she didn’t want to “feel” the pain again. Her therapist had told her that she had become numb from all the years of abuse.
After more sessions, Cheryl was able see images from her dark past and share every “snapshot” that popped into her mind without stopping. She would identify her feelings about these memories and with guided discussion, lead by the therapist, she was able to release the pain of the past and reprocess the information that helped lift her depression.
With each session of EMDR, Cheryl was getting stronger and, in time, she was able to free herself from almost all of her negative and false beliefs. In time, she found the strength to divorce her abusive spouse.
Her therapist believed Cheryl’s ex had narcissistic characteristics or might even be in the spectrum of a narcissistic personality. Living with her ex-husband was a toxic existence. Her abuser never showed empathy or remorse for his actions. He was highly critical and controlling, especially over the finances.
Cheryl had to ask permission for everything: to go somewhere, to see a friend, to write a check, etc. He was angry and would rage without warning. She walked on eggshells, wanting to avoid any upset. She was always made to feel that it was her fault. He took no responsibility for his bad behavior and Cheryl recalled feeling that he had fooled her early on.
Before they were married, he was charming, loving, and a real gentleman. She had no idea that he was playing a role, and once she was in his possession, she was just an object to control, bully, and slowly try to destroy.
Did Cheryl’s ex have a Narcissistic Personality Disorder? She’ll never know for sure, because he refused to seek help for managing his anger. He believed that he was fine and that Cheryl was the problem.
So how do you know if you are dealing with a narcisist?
In a New York Times article, “Here’s Looking at Me Kid,” published in July 2008, Jan Hoffman, reported that the term “narcissist” had “rich layers of meaning.”
Hoffman reported: “Dr. Marion Solomon, a Los Angeles psychologist and author of Narcissism and Intimacy, said that true narcissists are startled when their spouses say they are miserable in the relationship. They come into treatment, she said, only at the urging of their partner.”
This was exactly the case for Cheryl. Here are some feelings the victim might have:
• Feeling like the marriage is unequal and feeling forced to play the role of the child in a parent-child relationship
• Feeling you’re the one who always has to apologize. You’re blamed for everything or doing nothing right
• Feeling depressed, numb, and tired of living a lie (no one would guess, based on how the couple appears in public, that there were serious problems in the privacy of their home. The couple appears happy or average, behaving like any other couple when around friends and family.)
• Feeling like your needs are not being met or validated
• Doing things because you are pressured to do so; sometimes feeling humiliated, and feeling that one is being constantly criticized
• Chronically feeling empty or not fully trusting your partner
In another article, “Refining the Construct of Narcissistic Personality Disorder: Diagnostic Criteria and Subtypes,” published by The American Journal of Psychiatry:
“Criteria for narcissistic personality disorder are too narrow, underemphasizing aspects of personality and inner experience that are empirically central to the disorder…Despite its severity and stability, narcissistic personality disorder is one of the least studied personality disorders.”
The article also reported: “In one study, a random national sample of psychologists and psychiatrists described patients with personality disorders by using the Shedler-Westen Assessment Procedure, an instrument that allows clinicians to record their psychological observations systematically and reliably.”
The goal of the study was to identify the most characteristic and distinctive features and subtypes of the disorder. Clinicians provided detailed psychological descriptions of patients using the Shedler-Westen Assessment Procedure-II, completed a checklist of axis II diagnostic criteria and provided construct ratings for each.
The study used 1,200 patients and, from this sample, 255 met the criteria for Narcissistic Personality Disorder, using the Axis II diagnostic criteria given on the checklist. Another 122 patients met the criteria using the construct ratings.
The article included a table that highlighted characteristics and features taken from both the checklist and construct rating. Some behaviors overlapped and others were quite different or missing.
Some of the characteristics and features used to identify a narcissist using the checklist included:
- Is articulate and can express self in words
- Tends to have extreme reactions to perceived slights or criticism (may react with rage or humiliation)
- Tends to hold grudges; may dwell on insults or slights for long periods
- When upset, has trouble perceiving both positive and negative qualities in the same person at the same time (may see in black or white, shift suddenly from seeing someone as caring to hurtful
- Tends to feel unhappy, depressed, or despondent
- Emotions spiral out of control, leading to extremes (rage)
- Lacks close friendships or relationships
Some of the characteristics and features used to identify a narcissist using the construct rating included:
- Wants to associate with people who are of high status feels a sense of entitlement
- Takes advantage of others or exploits people with little regard for their feelings or welfare
- Experiences little or no remorse for harm or injury caused to others
- Seeks power or influence in beneficial or destructive ways
- Attempts to dominate a significant other through violence or intimidation
- Lacks empathy or is unable to have an intimate emotional connection with partner; not sensitive to partner’s feelings
- May not respect other people’s needs for autonomy and privacy (for example, reads partners emails, goes through personal mail – he or she is emotionally intrusive)
- Shows reckless disregard for the rights, property, safety or feelings of others
- Tends to be oppositional, contrary or quick to disagree.
These are just some of the characteristics and specific features listed on the table as being identifiers. All were ranked in importance. The five top ranked items in the construct ratings were:
“Has an exaggerated sense of self-importance”; “Appears to feel privileged and entitled”; “Expects preferential treatment”; “Tends to be angry or hostile”; “Tends to be critical of others and known for getting into power struggles.”
According to this construct rating, patients with narcissistic personality disorder appear more hostile and power oriented than what they appear to be when using the checklist criteria. Some criterion indicators may not be present or the behaviors may overlap with other disorders, but the key findings were:
“Interpersonal vulnerability and underlying emotional distress are core features of narcissistic personality disorder. They typical patient tends to fear rejection and abandonment; feels misunderstood, mistreated or victimized; tends to have extreme reactions to perceived slights or criticism; has a tendency to externalize blame.”
The article also described the three subtypes of this personality disorder (Grandiose/Malignant; Fragile; High-Functioning/Exhibitionistic) and explained features and characteristics for each, but overall concluded that all of the features are unlikely to be identified using methods that rely exclusively on what the patient reports through an interview with a clinician.
And some features were missing when using the checklist description. The study concluded:
“Criteria for narcissistic personality disorder are too narrow” and there was a need for a more differentiated view to bridge the gap between empirical and clinical definitions of this disorder.
The disorder is a complex one and difficult to diagnose. In Cheryl’s case, her abusive partner never sought help, believing he was fine and she was the problem.
According to Judith Orloff, MD, an Assistant Clinical Professor of Psychiatry at UCLA, “My professional advice: 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.”
In her article, “How to Deal with a Narcissist” she writes:
“If a narcissist is draining you emotionally, use these methods to get your power back. Lower your expectations and strategize your needs.
• Keep your expectations realistic.
• Never make your self-worth dependent on them.
• Show how something will be to their benefit.
You can’t force a narcissist to get help. But if you are feeling emotionally empty, wounded or numb because you are living with one, seek professional help. It is possible to heal emotionally and feel freedom again.
Cheryl once believed it wouldn’t be possible but today she is a proud survivor. There is hope.
Eric Russ, Jonathan Shedler, Rebekah Bradley, and Drew Westen; Refining the Construct of Narcissistic Personality Disorder: Diagnostic Criteria and Subtypes; American Journal of Psychiatry, Nov. 2008; 165: 1473 – 1481.