Inside the mind of a narcissist

Dear doctor,

My boyfriend and I have been having problems in our relationship and people close to me keep saying that he is a narcissist. What exactly does this mean? Is there something that can be done, like counseling, to make him improve?

Michelle

Dear Michelle,

The word narcissist is nowadays used casually to refer to someone who is self-centred, boastful and controlling. The clinical definition, however, is narcissistic personality disorder, which is described as having a persistent sense of superiority, need for admiration and insensitivity to others, which ends up causing problems in the various dimensions of the individual’s life. Many people have narcissistic traits, but it can only be called a personality disorder if it is persistent over many years and the traits are inflexible, the individual cannot adapt to different situations and it causes problems with functioning or causes significant distress.

The symptoms of narcissistic personality disorder include:

-          Have an unreasonable sense of self-importance, including exaggerating their achievements or qualities and being pre-occupied with thoughts of achieving or having great success, intelligence, beauty, ideal love, among others.

-          Expect continuous admiration, even without achievements, expect special treatment, privileges and favours and insist on having the best of everything.

-          Believe that they are superior to others and can only be understood or spend time with those who are special like them; look down on and criticise those they feel are not important.

-          Inability or unwillingness to consider others’ feelings and needs, including taking advantage of others to get what they want.

-          Are jealous of others or believe others are jealous of them.

-          Have a deep sense of insecurity and vulnerability, being very sensitive to criticism and failure or not being recognised as superior, with associated feelings of shame and emptiness, depression, social withdrawal, an appearance of humility or anger, defiance and contempt.

-          Poor management of emotions and behaviour and poor stress management and adaptability to change

There is no known cause of narcissistic personality behaviour and there may be an interplay of genetics and environment among other factors. The personality disorder can cause problems with relationships, school and work, and carries an increased risk of other disorders like anxiety, depression, drugs and substance use and suicidal thinking and behaviour.

Management of narcissistic personality behavior is challenging, but improvement is possible over time. This is through psychotherapy to help the person to understand and manage their thoughts, emotions and behaviour, setting realistic goals, accept responsibility and how to relate better with others.

Dear doctor,

My sister’s son is 11 years old and his behaviour is really bad. He bullies other children and lies a lot. He has been caught stealing several times and he doesn’t seem to care about not following rules. I don’t think it’s a problem with the parents because his siblings behave normally. Could he be having a mental illness or is it spiritual?

Worried

Dear worried,

This child is likely to have conduct disorder, which is a disruptive behavioural disorder diagnosed in children and adolescents. The symptoms of conduct disorder are being aggressive to people and animals, lying and/or stealing, destroying property and disregarding rules. Aggression may include physical, verbal or sexual violence and bullying. The individual also has poor emotional control and has no regret or shame for the negative behaviour. These children and adolescents have poor relationships with their peers and have challenges at home and at school, sometimes resulting in running away from home and school. There’s also a higher risk of engaging in alcohol and substance use and engagement in other risky behaviours.

There’s no known exact cause of conduct disorder and there may be a complex interaction of genetics, biology (testosterone levels, brain injury, seizures), exposure to violence especially at home, environmental stress, inadequate parenting, exposure to crime and drugs and family history of other mental disorders. However, conduct disorder can occur in a child from a healthy and well-functioning home.

The disorder is diagnosed and managed by a child and adolescent psychologist or a psychiatrist. The management will include training to help the parent set and implement discipline and also learn positive reinforcement. The child is taken through individual therapy to improve emotional and behavioural regulation, anger management, problem-solving, conflict resolution and managing peer influences. Family therapy that includes the child and other family members is also vital. Sometimes, depending on the severity of the symptoms and lack of success of the intervention measures, it may be necessary to enroll the child in a corrective institution that provides structure and management of the disruptive behaviour.

It is of vital importance to manage the negative behaviour because if uncontrolled, it can grow to dangerous and illegal behaviour with dire consequences.

Dear doctor,

For some time now, I have been having mood swings and I get angry quickly. This is not my normal behaviour. I was also diagnosed with a thyroid problem recently and  started on treatment. Could the two be related?

Mary

Dear Mary,

The thyroid gland produces thyroid hormones, which are involved in how the body utilises energy, which means that it affects cells in the entire body. When there is thyroid disease, there may be over or under activity of the thyroid from several possible underlying causes.

With an over active thyroid, in addition to other symptoms, there may also be feelings of anxiety and irritability and mood swings, while an under active thyroid may lead to feeling low/depressed and constantly feeling tired or having no energy. In addition, being unwell for whatever reason can make someone have low mood, and the discomfort increases irritability.

Treatment of thyroid disease may lead to resolving of these symptoms. In case you are concerned despite the treatment, you can request the doctor for additional support, which may include psychotherapy and use of additional medication if necessary.