#trauma and personality disorders

[hauntedselves]

Steele's Notes on NPD

NPD vs BPD

Generally have less capacity than BPD to mentalize, lack more insight, have more difficulty recalling early abuse/neglect, have less empathy toward others

Severely avoidant of genuine connection;

May need to keep a power differential in the relationship

Don’t respond well to being reassured that they are “human” and “normal,” unlike most borderline clients.

Classic NPD symptoms & behaviours

Arrogant, entitled, critical, controlling, lacks empathy

Inflated “self” is a defense against shame and devalued “self”

Experiences related to devalued self are completely avoided or denied

Generally are unable to acknowledge devalued self

Therapist should not explicitly confront the defense

Acknowledge that it might be lonely and challenging to feel that no one else is good enough

Explore any perceived disadvantages to the defense

Fragile NPD

Alternate between grandiosity and inadequacy

Unhappy, critical of others, anxious, envious, competitive, and have extreme reactions to perceived slights or criticism

Tend to obsessively compare themselves with others

Strong perfectionism

Have narcissistic defenses that work well until they are criticized or rejected

Can access their devalued self: therapist can focus on root causes of devalued self

Reversed NPD

Strong belief and need to be the worst, the sickest, the most traumatized patient

Underlying need to be special, but due to dysfunction, not adequacy

Strong need for validation and compassion

Therapist focuses on emotional validation and less on content of distress

Encourage client to communicate through more positive experiences and affect (compassionately shift focus from negative to positive experiences

Treatment approaches for NPD

Trauma-based in many clients

Certainly affected by quality of early relationships (neglect)

Work with conflicting idealized and devalued selves

Work with inner critic and perfectionism

Mentalization based treatment

Transference based psychotherapy

Dialectical behavior therapy

EMDR and other approaches to resolve early traumatic memories (often not explicitly accessible in the narcissistic patient)

Treatment approaches in Fragile NPD

Identify the conflicting idealized and devalued selves

Help client notice swings between the two

Help client recognize the distortions in both

“I suffer more than anyone; my abuse was the worst; I am completely damaged”

Versus

“I could have been and should be the best”

Help client deal with relentless inner critic

From Kathy Steele’s presentation 'Integrating Personality Disorders in our Work with Complex Trauma and Dissociation' (PDF), 18 August 2021, Delphi Centre.

[Transcribed from a PowerPoint presentation without notes; therefore this post is without context]

[happyherringbonkpickle]

[chronicsymptomsyndrome]

*displays textbook symptomatic behavior of my own disorder that I am well educated on* what’s my deal why am I like this

[whiteringaway]

I just want to be soft

Why am I so angry, so harsh, so violent, so destroying.

It’s unfair

[rainywhispersblog]

[ed-recoverry]

Some of my favorite posts on r/BenignExperience from the past week

Thanks to the tumblr post that made me aware of this subreddit. It makes me smile.

Part two, part three, part four

[c-0-yote-teeth]

[jobackmanhorsesworld]

[borderlinejackiee]

[riversidekid]

[hauntedselves]

Steele's Notes on AvPD

AvPD Types

Fearful avoidant – highly dysregulated and explicitly fearful of rejection or criticism. Avoids relationships in order to avoid being hurt. Typically has insight into this conflict.

Dismissive avoidant – Over-regulated. Unaware of need to connect; finds relationships useless or peripheral to work or other activities. View relationships as a “bother.” Has same fear of being abandoned or rejected, but lacks insight and reflection. More challenging to treat.

AvPD Symptoms

Not only avoidant of relationship but of inner experience in general

Strong emotions are highly avoided

May be highly functional / intellectual

May be less functional, unable to work because of avoidance

May have co-occurring shyness / introversion

AvPD Treatment

Therapist should use a collaborative approach, making efforts not to over-activate the client’s attachment system.

Dismissive clients work well when they have specific collaborative goals to work on.

Therapist should not try to get the client to discuss the therapeutic relationship early in treatment. Let the relationship work in more implicit  ways (“in the back seat of the car”)

Allow the client to regulate distance and closeness. Therapist should stay steady and not pursue or distance from the client.

Limit session to once a week; keep firm boundaries; don’t encourage dependency or regression

From Kathy Steele’s presentation 'Integrating Personality Disorders in our Work with Complex Trauma and Dissociation' (PDF), 18 August 2021, Delphi Centre.

[Transcribed from a PowerPoint presentation without notes; therefore this post is without context]

[its-simply-just-krys]

“Mouthful of Forevers”, Clementine von Radics

[gh0stgirl-hotline]

Born to love cursed to be unlovable

[hollowedoutbrain]

i know deep down i really am never going to make it, and this will end by my own hands

[traaumaa]

[rainywhispersblog]