A Matter of Personality

From borderline to narcissism

The Family Dynamics of Narcissistic Personality Disorder and of Psychosomatic Illnesses

How can you be grandiose and feel inferior simultaneously?

The little man
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In my post of August 31, Self Sacrifice: For the Good of the Kin, I discussed how children act out certain roles in their family of origin in order to try to emotionally stabilize parents who are emotional unstable. Doing so also has the unfortunate side effect of maintaining dysfunctional relationship patterns so that the family operates in predictable but problematic ways (family homeostasis).

In my previous two posts, I described the roles of the spoiler (typical of many individuals with borderline personality disorder), the savior (typical of some cases of chronic minor depression or dysthymia), and the avenger (the prototype of the antisocial personality disorder). 

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Just to be clear this time, these roles are prototypes.  There is literally an almost infinite number of variations of them and degrees of severity.  People can play one role at one time and then quickly morph into a completely different one as their family situation requires.

Personality disorders are not diseases.  They are merely combinations of dysfunctional character traits that happen to occur together at a frequency much greater than would be predicted by chance.  Within each disorder, there are quite a few different combinations of the traits listed in the diagnostic criteria that qualify someone for the diagnosis.

Personality disorder researchers have found that if a given patient meets the threshold for one personality disorder, the chances are excellent that they will also meet the threshold for an average of just under two other personality disorders.  Any other two personality disorders.

Psychologists also talk about something called the primary attribution error.  Whenever we see others behaving in a certain way, we are all apt to attribute their behavior to inborn personality characteristics rather than seeing it as reactive to a particular environment.  This is considered by psychologists to be an error because the situation and social context people find themselves is often at least and usually far more important than their inborn tendencies in determining what they actually do. 

Not that our inborn tendencies are irrelevant.  It is just that our species is very good at adapting to its physical and particularly to its social environment.  The tendency to be adaptive is what is programmed into our DNA.

Before I proceed with describing two more roles, I would like to comment on a question a reader posed after my last post.  She wanted to know what the "fix" is if one finds oneself acting out one of these roles.  That's a great question but, unfortunately, a very complicated one.  In general, the fix involves employing certain techniques for altering both your own behavior and the reactions that your family has to it. If it is done poorly, however, results can be disastrous and make matters much worse. I generally do not recommend trying the techniques on your own without the guidance of a therapist versed in them.

I have my own psychotherapy model for individuals which is aimed at altering dysfunctional family dynamics.  I call it Unified Therapy. There are several other models for doing so which I list in Chapter Ten of my last book so potential patients can find the most appropriate therapist. I will be describing some of the characteristics and principles of Unified Therapy in future blog posts.

Today's post will cover narcissistic personality disorder (the little man),and somatization or use of illnesses for psychological and interpersonal purposes (the defective).

Little man: This scenario is a variant of the savior role that leads to narcissistic issues. It used to be seen primarily in males, but as gender equality has evolved, it is beginning to be seen more and more, in a slightly different form, in females. Gender role conflicts once again are the main culprit.

In this situation, a mother who may have been taught as a child to be dependent on men and defer to men for most major decisions has married a man who is inadequate in some way. She may describe him as "never there for me." He may be a poor provider due to a general unwillingness to work hard, a serial philanderer, a hound dog hanging around her door (apologies to Lieber, Stoller, and Willie Mae "Big Mama" Thornton),  or may even desert the family altogether.

She then apparently turns to her son to take care of her in all the ways his father did not. However, the son fails in this role for two reasons. One, he is probably too young and simply lacks the capabilities to look after her; he probably needs his mother to take care of him.

Second, and more importantly, the mother seems to resent his attempts at looking after her and subverts them. The reason for this is that she really is not - nor does she really want to be - as dependent as she may appear to be. The more the son tries to meet her needs, the more the mother emasculates him.

The double message in this situation is that the mother will build up the ego of her son at first (which leads to his apparent grandiosity) but then she figuratively castrates him.  She acts like what therapists used to call a help-rejecting complainer.

A striking example involved the case of an elderly woman who broke her hip after a fall in the bathroom and could not get up.  Her son was right in the hallway next to the bathroom, but the bathroom door was locked.  She refused to open it so her son could help her, however, explaining that she "did not want to bother" him.

A male with narcissistic personality disorder may marry a female with borderline personality disorder (BPD) . Such a union is a common couple type seen in marital therapy. What happens in such a relationship is an excellent example of what family systems therapists call a marital quid pro quo: members of a couple both volunteer to support or enable the role behavior of their spouse.

The female with BPD is almost a prototype of a woman who seems to be in dire need of someone who will take care of her, but who spoils any attempt by anyone to do so. The relationship of the narcissistic male with his mother is thusly re-created in an even more extreme form within the marital relationship.

The relationship between a narcissistic male and a female with borderline personality disorder can be extremely volatile, and domestic violence is not an uncommon result.  Usually, the man beats the woman, but this is hardly always the case. 

Some folks seem to think that women, being the "weaker" and smaller sex (at least most of the time), would not be able to physically abuse a man.  Really? Does the name Lorena Bobbitt mean anything to you?  A guy has to sleep sometime.  In June of 1993, when Ms. Bobbitt's husband was asleep, she cut off his penis with a carving knife, drove off with it, and then tossed the penis into a field. 

I have seen many cases in which men just let their wives beat on them without resisting.  Hard to believe, but true.  One man even said, when the police were called, that he was the one who was being abusive when in fact the reverse was true. He took the fall and spent some time incarcerated.

Another man was so angry with his wife that he took out the couple's life savings in cash and literally set fire to the money.  Gone forever!  His therapist almost wished he would have given the money to her instead, but therapists are not supposed to accept such gifts from their patients anyway.

The defective: This role often leads to somatization (bodily expression of intrapsychic or interpersonal conflict), or chronic psychological impairment. It is often seen in families with conflicts over the wish to be adventurous or lead an exciting life, or, once again, over traditional gender roles. The parents in these families are not conflicted over the role of parent per se as with the families of spoilers, but feel highly anxious when they are no longer needed in their capacity as traditional family caretakers.

The Defective
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Their children of course have to grow up, and the empty nest begins to loom on the horizon. During this period, the parents may have fantasies about being free from family obligations and indulging in their more individualistic tendencies. Unfortunately, they feel useless and/or vaguely guilty and/or unsettled if they do indulge them.

The children of such parents are afraid of becoming independent for fear their parents might develop a pathological empty nest syndrome. They respond by failing to become self-sufficient in some way.

So that the parents do not blame themselves for the child's lack of independence, or feel as though they had been inadequate parents, they blame their inability to take complete care of themselves on some physical or psychological disorder.

An actual disorder may or may not be present, and if present, may or may not be exaggerated. Often it is unclear whether or not the child is purposely exaggerating his or her apparent symptoms or disability. This way, depending on whether a parent is feeling guilty or angry at a given time, a child can assuage one polarity and feed into the other. He or she attempts to regulate exactly how much of each their parents' are experiencing, in order to provide maximum stability.

The diseases usually picked by a defective in need of a physical impairment are quite frequently those that have been traditionally thought to be "psychosomatic." These illnesses fit the bill perfectly because they can be easily faked. One can wheeze even when one is not having a real asthma attack, or have a pseudo-seizure when not having a real seizure.

Pseudo or non-epileptic seizures (also called conversion disorder) are particularly illustrative of this phenomenon.  According to studies using EEG evidence, a significant percentage of individuals who have pseudo-seizures also have real ones.  The illness can sometimes come in handy even when it is actually quiescent.

People can and will use whatever tools they have at their disposal in order to stabilize family homeostasis, and are quite willing to suffer the negative consequences to themselves in doing so.

David M. Allen, M.D., is a Professor of Psychiatry at the University of Tennessee and author of the book How Dysfunctional Families Spur Mental Disorders.

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