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The Clinical Picture and Developmental Roots – Opening Remarks TerminologyCo-dependents People who depend on other people for their emotional gratification and the performance of ego or daily functions. They are needy, demanding, submissive. They fear abandonment, cling and display immature behaviors in their effort to maintain the “relationship” with their companion or mate upon whom they depend. No matter what abuse is inflicted upon them – they remain in the relationship.

See also the definition of the “Dependent Personality Disorder” in the DSM IV.

Inverted Narcissist Previously called “covert narcissist”, this is a co-dependent who depends exclusively on narcissists.

If you live with a narcissist, have a relationship with them, are married to them, work with them, etc. – it does NOT mean that you are an inverted narcissist.

To “qualify” as an inverted narcissist – you must WANT to be in a relationship with a narcissist, regardless of any abuse inflicted on you by him / her. You must ACTIVELY seek relationships with narcissists – and ONLY with narcissists – no matter what your (bitter and traumatic) past experience has been. You must feel EMPTY and UNHAPPY in relationships with ANY OTHER kind of person. Only THEN – AND if you satisfy the other diagnostic criteria of a Dependent Personality Disorder – can you be safely diagnosed as an “Inverted Narcissist”.

IntroductionThe DSM IV defines the NPD using a few criteria. It is sufficient to possess 5 of them to “qualify”. Thus, theoretically, it is possible to be NPD WITHOUT grandiosity. Many researchers (to mention a few: Alexander Lowen, Jeffrey Satinover, Theodore Millon) suggested a “taxonomy” of pathological narcissism. They divided narcissists to sub-groups (very much as I did with my somatic versus cerebral narcissist dichotomy – SV). Lowen, for instance, talks about the “phallic” narcissist versus others. Satinover makes a very important distinction between narcissists who were raised by abusive parents – and those who were raised by doting mothers or domineering mothers. See an expansion of the Satinover classification in: http://narcissism.cjb.net/faq64.htmlIn “Psychodynamic Psychiatry in Clinical Practice/ The DSM-IV Edition’s comments on Cluster B Personality Disorders – Narcissistic” we find this:

“…what definitive criteria can be used to differentiate healthy from pathological narcissism? The time honored criteria of psychological health – to love and to work – are only partly useful in answering this question.”

“An individual’s work history may provide little help in making the distinction. Highly disturbed narcissistic individuals may find extraordinary success in certain professions, such as big business, the arts, politics, the entertainment industry, athletics and televangelism field. In some cases, however, narcissistic pathology may be reflected in a superficial quality to one’s professional interests, as though achievement in and acclaim are more important than mastery of the field itself.

Pathological forms of narcissism are more easily identified by the quality of the individual’s relationships. One tragedy affecting these people is their inability to love. Healthy interpersonal relationships can be recognized by qualities such as empathy and concern for the feelings of others, a genuine interest in the ideas of others, the ability to tolerate ambivalence in long-term relationships without giving up, and a capacity to acknowledge one’s own contribution to interpersonal conflicts. People who are characterized by these qualities may at times use others to gratify their own needs, but the tendency occurs in the broader context of sensitive interpersonal relatedness rather than as a pervasive style of dealing with other people. One the other hand, the person with a narcissistic personality disorder approaches people as objects to be used up and discarded according to his or her needs, without regard for their feelings. People are not viewed as having a separate existence or as having needs of their own. The individual with a narcissistic personality disorder frequently ends a relationship after a short time, usually when the other person begins to make demands stemming from for his or her own needs. Most importantly, such relationships clearly do not “work” in terms of the narcissist’s ability to maintain his or her own sense of self-esteem.”

…These criteria (the DSM IV’s – SV) identify a certain kind of narcissistic patient – specifically, the arrogant, boastful, “noisy” individual who demands to be in the spotlight. However, they fail to characterize the shy, quietly grandiose, narcissistic individual whose extreme sensitivity to slights leads to an assiduous avoidance of the spotlight.”

The DSM-III-R incorporated an allusion to at least TWO TYPES of narcissists, but the DSM-IV committee chose to delete this: “… included criterion, “reacts to criticism with feelings of rage, shame, or humiliation (even not if expressed)” due to lack of “specificity”.

Others theoreticians, clinicians and researchers similarly suggested a division between “The Oblivious Narcissist” (aka overt) and “The Hypervigilant Narcissist” (aka covert).

The Compensatory versus the Classic NarcissistAnother interesting distinction suggested by Dave Kelly in his excellent PTYPES web site is between the “Compensatory” type NPD (the one around which my “Malignant Self Love – Narcissism Revisited” revolves) and the “Classic” NPD (DSM IV type):

Here are the Compensatory NPD criteria according to Dave Kelly:

Ptypes Personality Types proposes Compensatory Narcissistic Personality Disorder as a pervasive pattern of unstable, covert narcissistic behaviors that derive from an underlying sense of insecurity and weakness rather than from genuine feelings of self-confidence and high self-esteem, beginning by early adulthood and present in a variety of contexts, as indicated by six (or more) of the following:

The basic trait of the Compensatory Narcissistic Personality Type is a pattern of “overtly narcissistic behaviors [that] derive from an underlying sense of insecurity and weakness, rather than from genuine feelings of self-confidence and high self-esteem” (Millon).

The Compensatory Narcissistic Personality Type: seeks to create an illusion of superiority and to build up an image of high self-worth (Millon);

strives for recognition and prestige to compensate for the lack of a feeling of self-worth;

may “acquire a deprecatory attitude in which the achievements of others are ridiculed and degraded” (Millon);

has persistent aspirations for glory and status (Millon);

has a tendency to exaggerate and boast (Millon);

is sensitive to how others react to him, watches and listens carefully for critical judgment, and feels slighted by disapproval (Millon);

“is prone to feel shamed and humiliated and especially [anxious] and vulnerable to the judgments of others” (Millon);

covers up a sense of inadequacy and deficiency with pseudo-arrogance and pseudo-grandiosity (Millon);

has a tendency to periodic hypochondria (Forman);

alternates between feelings of emptiness and deadness and states of excitement and excess energy (Forman);

entertains fantasies of greatness, constantly striving for perfection, genius, or stardom (Forman);

has a history of searching for an idealized partner and has an intense need for affirmation and confirmation in relationships (Forman);

frequently entertains a wishful, exaggerated, and unrealistic concept of himself which he can’t possibly measure up to (Reich);

produces (too quickly) work not up to the level of his abilities because of an overwhelmingly strong need for the immediate gratification of success (Reich);

is touchy, quick to take offense at the slightest provocation, continually anticipating attack and danger, reacting with anger and fantasies of revenge when he feels himself frustrated in his need for constant admiration (Reich);

is self-conscious, due to a dependence on approval from others (Reich);

suffers regularly from repetitive oscillations of self-esteem (Reich);

seeks to undo feelings of inadequacy by forcing everyone’s attention and admiration upon himself (Reich);

may react with self-contempt and depression to the lack of fulfillment of his grandiose expectations (Riso).

Sources:

Forman, Max, (1976). Narcissistic disorders and the oedipal fixations. In Feldstein, J. J., (Ed.), The Annual of Psychoanalysis. Vol. IV. pp. 65-92, New York: International Universities.

Millon, Theodore, and Roger D. Davis. Disorders of Personality: DSM-IV and Beyond. 2nd ed. New York: Wiley, 1996. pp. 411-12.

Reich, Annie, (1986). Pathological forms of self-esteem regulation. In Morrison, A. P., (Ed.), Essential Papers on Narcissism. pp. 44-60. Reprint from (1960) Psychoanalytic Study of the Child. Vol. 15, pp. 205-32.

Riso, Don Richard. Personalty Types: Using the Enneagram for Self-discovery. Boston: Houghton Mifflin, 1987. pp. 102-3.

Speculative Diagnostic Criteria for Compensatory Narcissistic Personality Disorder A pervasive pattern of self-inflation, pseudo-confidence, exhibitionism, and strivings for prestige, that compensates for feelings of inadequacy and low self-esteem, as indicated by the following:

pseudo-confidence compensating for an underlying condition of insecurity and feelings of helplessness

pretentiousness; self-inflation

exhibitionism in the pursuit of attention, recognition, and glory

strivings for prestige to enhance self-esteem

deceitfulness and manipulativeness in the service of maintaining feelings of superiority

idealization in relationships

fragmentation of the self: feelings of emptiness and deadness

a proud, hubristic disposition

hypochondriasis

Substance abuse

self-destructiveness

Compensatory Narcissistic Personality Disorder corresponds to Ernest Jones’s narcissistic “God Complex”, Annie Reich’s “compensatory narcissism”, Heinz Kohut’s “Narcissistic Personality Disorder”, and Theodore Millon’s “Compensatory Narcissist”.

Millon, Theodore, and Roger D. Davis. Disorders of Personality: DSM-IV and Beyond. 2nd ed. New York: Wiley, 1996. 411-12.

Compare this to the classic type:

Narcissistic Personality Type The basic trait of the Narcissistic Personality Type is a pattern of grandiosity, need for admiration, and lack of empathy.

The Narcissistic Personality Type: reacts to criticism with feelings of rage, shame, or humiliation;

is interpersonally exploitive: takes advantage of others to achieve his own ends;

has a grandiose sense of self-importance;

believes that his problems are unique and can be understood only by other special people;

is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love;

has a sense of entitlement: an unreasonable expectation of especially favorable treatment;

requires much attention and admiration of others;

lacks empathy: fails to recognize and experience how others feel;

is preoccupied with feelings of envy.

This is mainly the DSM – III – R view. Pay attention to the not so subtle changes in the DSM IV – SV:

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition describes Narcissistic Personality Disorder as a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements);

is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love;

believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions);

requires excessive admiration;

has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations;

is interpersonally exploitive, i.e., takes advantage of others to achieve his or her own ends;

lacks empathy: is unwilling to recognize or identify with the feelings and needs of others;

is often envious of others or believes that others are envious of him or her;

shows arrogant, haughty behaviors or attitudes.

Summarized from: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th ed. Washington: Author, 1994.

The Inverted Narcissist It is clear to us that there is, indeed, a type ofnarcissist, hitherto rather neglected and obscure. It is the “self-effacing” or “introverted” narcissist. We call it the “Inverted Narcissist” (hereinafter: “IN”).

This is a narcissist who, in many respects, is the mirror image of the “classical” narcissist. No one is sure why. The psychodynamics of such a narcissist are not clear, nor are his developmental roots. Perhaps he is the product of a doting or domineering primary object/caregiver. Perhaps excessive abuse leads to the repression of even the narcissistic and other defense mechanisms against such abuse. Perhaps the parents suppressed every manifestation of grandiosity (very common in early childhood) and of narcissism – so that the defense mechanism that narcissism is was “inverted” and internalized in this unusual form.

These narcissists are self-effacing, sensitive, emotionally fragile, sometimes socially phobic. They import all their self-esteem and sense of self-worth from the outside (others), are pathologically envious (a transformation of aggression), are likely to intermittently engage in aggressive/violent behaviors, are more emotionally labile that the classic narcissist, etc.

We can, therefore talk about three “basic” types of narcissists:

(a) The offspring of neglecting parents

They resort to narcissism as the predominant object relation (with themselves as the exclusive object).

(b) The offspring of doting or domineering parents (often narcissists themselves)

They internalized these voices in the form of a sadistic, ideal, immature superego and spend their

lives trying to be perfect, omnipotent, omniscient and to be judged “a success” by these

parent-images.

(c) The offspring of abusive parents

They internalize the abusing, demeaning and contemptuous voices and spend their lives in an effort

to elicit “counter-voices” from their human environment and thus to extract a modicum of self esteem

and sense of selfworth.

All three types exhibit recursive, recurrent and Sysiphean failure. Shielded by their protective shells (defense mechanisms) they constantly gauge reality wrongly, their actions and reactions become more and more rigid and ossified and the damage inflicted by them on themselves and on others ever greater.

The Narcissistic parent seems to employ a myriad of primitive defenses in his dealings with his children. Splitting- idealizing the child and devaluing him in cycles which reflect internal dynamics of the parent rather than anything the child does. Projective Identification – forcing the child into behaviors and traits which reflect the parents’ fears regarding himself, his self image and his self worth. This is a particularly powerful and pernicious mechanism. If the narcissist parent fears his own deficiencies (”defects”), vulnerability, perceived weakenesses, susceptibility, gullibility, or emotions – he is likely to force the child to “feel” these rejected and (to him) repulsive emotions, to behave in ways strongly abhorred by the parent, to exhibit character traits the parent strongly rejects in himself. The child, in a way, becomes the “trash bin” of the parents’ inhibitions, fears, self loathing, self contempt, perceived lack of self worth, sense of inadequacy and failure and emotional reticence. Coupled with the treatment of the child by the parent as a continuation of himself by other means, it serves to totally inhibit the psychological growth and emotional maturation of the child. The child becomes an extension of the parent – a vessel through which the parent experiences and realizes himself for better (hopes, aspirations, ambition, life goals) and for worse (weknesses, “undesirable” emotions, “negative” traits). A host of other, simpler, defense mechanisms put to use by the parent is likely to obscure the predominant use of projective identification: projection, displacement, intellectualization, depersonalization. Relationships between such parents and their progeny easily deteriorate to sexual or other modes abuse because there are no functioning boundaries between them.

It seems that the reaction to a narcissistic parent can be either accommodation and assimilation or rejection.

ACCOMMODATION and ASSIMILATION The child accommodates, idealizes and internalizes the primary object successfully. This means that the “internal voice” we all have is a narcissistic voice and that the child tries to comply with its directives and with its explicit and perceived wishes. The child becomes a masterful provider of narcissistic supply, a perfect match to the parent’s personality, an ideal source, an accommodating, understanding and caring caterer to all the needs, whims, mood swings and cycles of the narcissist,an endurer of devaluation and idealization with equanimity, a superb adapter to the narcissist’s world view, in short: the ultimate extension. This is what we came to call an “inverted narcissist”.

We must not neglect the abusive aspect of such a relationship. The Narcissistic primary object always alternates between idealization of his progeny and its evaluation. The child is likely to internalize the devaluing, abusive, demeaning, berating, diminishing, minimizing, upbraiding, chastising voice. The parent (or caregiver) keeps living inside him (as part of a sadistic and ideal superego and an unrealistic ego ideal, to resort to psychoanalytic parlance for the sake of illustration). It is this voice that inhibits the development of reactive narcissism, the defense mechanism in the child. No grandiosity, sense of entitlement or total lack of empathy is possible in these circumstances.

The child turned adult maintains these traits. He keeps looking for narcissists in order to feel whole, alive and wanted. He seeks to be treated by a narcissist narcissistically (what others would call abuse is to him or her a homecoming and narcissistic supply). To him, the narcissist is a source of supply (primary or secondary) and the narcissistic behaviors constitute narcissistic supply. He feels dissatisfied, empty and unloved if not by a narcissist.

The roles of Primary Source of Narcissistic Supply (PSNS) and Secondary Source of Narcissistic Supply (SSNS) are reversed. To the inverted narcissist, a spouse is a source of PRIMARY supply, for instance.

The other reaction to the narcissistic parent is

REJECTION The child may react to the narcissism of the Primary Object with a peculiar type of rejection. He will develop his own narcissistic personality, replete with grandiosity and lack of empathy – BUT his personality will be antithetical to the personality of the narcissistic parent. If the parent were a somatic narcissist – he is likely to be a cerebral one, if his father prided himself on his virtue – he will emphasize his vices, if his mother bragged about her frugality, he is bound to flaunt his wealth.



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