Archives: Blogs

Narcissistic Personality Disorder: Differentiating It From Self-Confidence

Narcissism and high self-esteem – how can we tell them apart? It may be difficult to tell if someone is self-absorbed or rightfully self-assured as they may present in a similar manner. Confidence is extremely important in helping one set the foundation for a healthy way of living, promoting personal growth, success, and a sense of fulfilment. On the other hand, a narcissist’s self-absorption would hinder said personal growth, and such a way of thinking enables a toxic lifestyle.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM V), Narcissistic Personality Disorder (NPD) is defined as comprising a pervasive pattern of grandiosity (in fantasy or behaviour), a constant need for admiration, and a lack of empathy, beginning by early adulthood and present in a variety of contexts. For one to be diagnosed with NPD, the individual must fulfil the following, as indicated by the presence of at least 5 of the following 9 criteria:

  1. A grandiose sense of self-importance
  2. A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  3. A belief 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
  4. A need for excessive admiration
  5. A sense of entitlement
  6. Interpersonally exploitative behaviour
  7. A lack of empathy
  8. Envy of others or a belief that others are envious of him or her
  9. A demonstration of arrogant and haughty behaviours or attitudes

However, not everyone with NPD will get a clear diagnosis from a mental health professional. It is rare for someone with NPD to commit to seeking help, openly talk about their thoughts, or even attend a therapy session. Here are some points to consider when wondering if someone is confident or narcissistic.

 

Are they self-focused?

A narcissistic person may be obsessed with grandiosity, fantasising about achieving unlimited power, acceptance and resources, so much that they believe they deserve it more than others. As such, narcissism can be associated with the need to dominate others. However, a person with a healthy self-esteem will be inclined to establish deeper relationships with the people around them. Narcissism involves the inability to see beyond one’s self-interests, while self-confidence extends beyond self-focus, and to the needs of others.

 

Do they have a strong sense of entitlement and a tendency to exploit others?

As we have explored, people with NPD might feel they deserve more than others and have a strong sense of entitlement. This can manifest as the tendency to manipulate and exploit others to achieve their desires. Tactics such as spreading lies about others to get ahead are common, as they put personal gain above everything else.

 

Do they crave affirmation?

Praise, attention and affirmation are important to a narcissistic individual. With the need to fuel their sense of specialness, they may crave a constant expression of admiration and praise from others. Of course, we do not deny that everyone needs to be affirmed and encouraged to build self-confidence. However, unlike truly self-confident individuals, narcissists are hyper-sensitive to such attention and crave continual affirmations for emotional stability. Without them, they may feel disconnected, and even resent those who don’t think what they’re doing and saying is exceptional.

 

Do they have difficulty accepting constructive criticism? 

Despite the sense of specialness and outward sense of superiority, people with NPD may in fact struggle with pervasive feelings of insecurity. A subtype of NPD, covert narcissism,  can enable one to be defensive and over-sensitive to criticism. While the criticism may be a constructive one, they may treat it as a personal attack and react strongly against it. Their replies may be laced with contempt or passive-aggressiveness. This helps them seek relief and protect their self-esteem.

 

How do they respond to success?

We are all prone to a little envy when we compare ourselves to people of higher social status or with greater achievements – but how we manage this sense of envy sets a confident person and a narcissist apart. In order to uphold their image and take the spotlight, a narcissist might put others down and attribute their successes to luck or financial background instead of acknowledging their skills or character. Moreover, these may be baseless comments. In contrast, while a self-confident person may also feel envious at times, they are less likely to dim someone else’s light in order to prove their worth.

Hence, for persons with NPD, why is it important for them to seek therapy? Narcissism is found to be associated with externalising behaviour, including alcohol or substance abuse, antisocial behaviour, and aggression. These can lead to an unhealthy lifestyle and can be detrimental in the long run if no proper treatment is received.

While the pointers in this article may act as a guideline to help you differentiate between a confident person and a narcissist, a diagnosis for NPD should be left to trained mental health professionals only. While it may be tempting to label someone with a personality disorder or to make judgements with such information, the presentation of mental health conditions goes far beyond a few attitudes or behaviours. If you believe a family member or a close friend is in need of an assessment and therapy for NPD, feel free to contact us for more information.

You might also be interested in reading about what being in a relationship with a person with Narcissistic Personality Disorder is like, in our previous article: Healing from being with a persona with Narcissistic Personality Disorder.

References:

  1. https://blogs.scientificamerican.com/beautiful-minds/narcissism-and-self-esteem-are-very-different/ (Accessed 19/07/2022)
  2. https://www.goodtherapy.org/blog/the-insecurity-behind-narcissistic-personality-npd-explained-1107194 (Accessed 19/07/2022)
  3. https://www.medscape.com/answers/1519417-101764/what-are-the-dsm-5-diagnostic-criteria-for-narcissistic-personality-disorder-npd (Accessed 19/07/2022)
  4. https://psychcentral.com/disorders/narcissistic-personality-disorder#diagnosis (Accessed 19/07/2022)

To Forgive Others, Is To Set Myself Free

“I forgive you.” while on the surface seems to be an innocuous word and easy to say. But in reality, it’s one of the most difficult words to express in our human language. A few years ago, a middle-aged man angrily dragged his 13-year-old son to our clinic, it turned out that Mr Zhang (pseudonym) had discovered his son hiding in a corner of his room smoking, and slapped the boy hard in a fit of anger. Even after being scolded the boy was recalcitrant and didn’t even feel remorseful. In her efforts to appease the situation at home, his wife suggested bringing the son to see a counsellor.

On that day, I happened to walk past the therapy room. I could only hear the loud arguments between the father & son, and loud sobbings of the mom. Just as I stepped into my office, my office phone rang. It was an urgent call from my colleague, the therapist, who alerted that the situation was getting a bit out of hand, and asked for my assistance in the therapy room. Upon arriving at the scene, I could hear the son’s angry retort, “You’ve never loved me since young, why are you trying to control me now? All you’ve ever done was scolding me. So what if I behave myself? Would you even notice?”

It took more than an hour to calm all parties down. After which, I carefully interviewed both Mr Zhang and his son, and I finally got to the root of why the situation had become so tense between father and son.

It wasn’t the 13-year-old boy who had caused the breakdown in their relationship. The issues stem from painful experiences when Mr Zhang was growing up. Mr Zhang had grown up with an abusive father who was not only alcoholic and chain-smoked, who often vented his anger on his wife and children. As a result, Mr Zhang made a vow from young to never touch alcohol and cigarettes. Unfortunately, his demeanour also became very stern with hardly any smile on his face and had high expectations with his own children. Why did it become like this?  It was because he had never forgiven his own father. The deeply buried hurts had made him prone to irritability, and thus he didn’t know how to praise or encourage his own child, and only knew strict discipline as his way of bringing up his child. Moreover, his biggest worry had been over his child coming into contact with alcohol and tobacco.

Mrs Zhang explained, her husband was a good man, but was a man of few words, and was not good in expressing his feelings. She knew that he really cares about the child, but it was a pity that communication was poor between the father and son. As a result of a craving for his father’s love and experiencing scolding and punishment from young, the boy had grown to become more rebellious in recent years.

In fact, Mr Zhang’s father had quit smoking and drinking for many years. However, as a result of the poor relationship between Mr Zhang and his father coupled with a break in communications for more than a decade. Mr Zhang couldn’t come to terms with my conclusion initially. But for the sake of his own son, he finally agreed to receive counselling. After several months, he finally understood the root cause. He asked me, “I’ve finally understood that the root cause of my frustrations was the unresolved anger and hatred towards my own father, but what should I do after so many years?”

Fortunately, one day his mother decided to visit their grandson together with his father. Although he felt embarrassed initially, Mr Zhang struck up his courage, squarely faced his dad and said: “I forgive you.” This simple yet miraculous sentence seemed to untie the knots of anger and hurts between Mr Zhang and his father. From that day onwards, Mr Zhang began to smile more frequently face and he could finally express his love fully to his son. As a result, his son stopped being rebellious. Not only did he stop smoking, but also paid more attention to his studies.

As a psychiatrist, I’m truly happy for this family and admire Mr Zhang’s courage in forgiving his own father. They continued with counselling for some time, and finally mended their father and son relationship that was formerly broken.

Therefore, forgiving others is also giving ourselves a chance to receive complete healing.

Relationship Fortifying Versus Relationship Recovery

As a couple therapist, the question I sometimes get is, ”Is my problem serious enough to warrant a therapist?” 

I like to address this question in this article. 

There are 3 key reasons why you’d want to see a couples therapist/relationship coach

  1. When you have issues in the relationship that you’ve tried to solve but you’re unable to.
  2. When you want to do a health check for your relationship
  3. When you’d like to enhance your relationship 

Prevention is better than cure and this applies to relationship as well. If you’re in a committed relationship and not married yet, nothing should stop you from finding ways to strengthen your romantic competence. 

The majority of couples that I see now in my clinic are those with troubled marriage or also known as ‘relationship recovery’. Increasingly, I have more couples who decided to seek help and they are in under category 2 and 3. It’s highly encouraging for me to see this trend as younger couples are less affected by the stigma of seeking help.

In enhancing your relationship, what you can expect is the identification of possible conflict areas, assessment of your communication and conflict management skills, emotional regulation skills as well as the strength of your relationship. The former framework of therapy is based on looking at the problems and trying to fix them. What was missing is how to focus on what is good in the relationship and magnify and fortify those strength? This is equally important and it’s also more positive. 

For ‘relationship recovery process’, the types of cases that I see include infidelity, being stuck in conflicts, poor emotional regulation which leads to avoidance of conflict and rebuilding trust and commitment. 

There is a certain transition in life where relationship coaching or therapy is highly recommended. This is as follows:

  • Pre-marital: Before you make the lifelong commitment, you want to be ensured that your chances at staying married is as high as possible. You want to know what the non-negotiables are and learn skills that make the process of integrating your life smoother.
  • Transitioning to parenthood: While bringing a baby into a family is a happy occasion, it brings about a lot of stresses to the marriage. 2/3 or 67% of couples who transition to parenthood suffer a decline in their satisfaction of marriage. Help and support is available for  you to learn how you can mediate this and continue to keep the spark in the marriage alive. 
  • Couples who have suffered child lost or have unsuccessful attempts at assisted reproduction. 
  • Couples who are planning to adopt: You will want to know what are the expectations that you have of each other and what sort of rituals of connection you can establish so that you don’t lose sight of your own relationship.
  • When you have a child with special needs either physical, intellectual or mental: This additional stress could make or break the marriage and often times, couples place so much focus on the child that he/she ends up neglecting the partner. What you want to cultivate is the mindset “we against the world” rather than “I am alone in this marriage”. 
  • Empty nest: There is an increase in marital break-ups at this stage because they have waited for their young children to grow up. The many years of emotional disconnection and busyness of life in caring for the children may have caused neglect to the marriage but it is possible to breathe a new lease of life to the marriage so that you can enjoy your golden years meaningfully. 

Ultimately, relationship is hard work. You will need to consistently invest in it just like how you would a plant. You will need to Create an environment that’s conducive for the relationship to thrive; learn the skills that can help you connect better with your significant other and be intentional in what you want in the relationship. 

Psychological testing for children: What it is and what to expect

Parenting is an incredible journey filled with growth and transformation for both children and caregivers. As children progress through various developmental stages, it’s natural to witness changes in their behaviour and abilities. However, some challenges may arise, leaving parents concerned and seeking support. In such situations, psychological testing emerges as a valuable resource, offering parents insights into their child’s development and paving the way for tailored assistance.

In the article, “Psychological testing for children: What it is and what to expect,” written by Honeykid’s Esther Chung, we embark on a journey of understanding the significance of psychological testing and how it can positively impact children and families. Expert insights from Educational and clinical psychologists, Tan Su-Lynn and S. C. Anbarasu respectively, will illuminate the purpose and process of psychological testing. As caregivers, being well-informed about this process will empower us to provide the best support and nurture the full potential of our beloved children. So, let’s delve into the warmth and professionalism of psychological testing to embrace its benefits fully.

Follow this link to read the full article: https://honeykidsasia.com/psychological-testing-for-children/

Alexis Fosler talks with the editor of ANZA Magazine on ‘Spring Cleaning Your Mind For Better Well-being’

Visions by Promises’ Addictions therapist, Alexis Fosler, gave some great insights and tips for dealing with stress in an interview about “Spring Cleaning Your Mind For Better Well-Being” with ANZA Magazine’s editor.

 

Restrictions are lifting, the workforce is returning traditional office spaces, travel is go. On the outside many would say we are emerging into a ‘new normal’, but that doesn’t necessarily mean that our minds are at ease. Having a human brain, particularly right now, is stressful.

Much like how the homes we’ve become so bound to in the past few years have grown more cluttered, our minds are filled with chaotic debris and discontent too. Recent research by YouGov found that six in 10 Singapore residents have suffered adverse effects to their mental health due to the pandemic, with those aged 35 – 44 most affected.

“Covid-19 has certainly impacted both our thoughts and our behaviours, and studies have shown that population mental health has declined significantly during this period,” confims Alexis Fosler, psychotherapist at Promises Healthcare. “These same studies indicate that we may have given more time to think about our anxieties and our worries such as employment, health and our lack of social connection. We’ve put less brain power into thinking about others and about our future plans – both of which are associated with better wellbeing.”

Clutter-free environment

While we don’t experience seasonal changes in Singapore, the arrival of spring can serve as a natural point to take stock of our mental wellbeing and reconnect with the things that bring us purpose and joy. We know that positive outcomes are associated with physical decluttering. When we clean the messy spare room, give the kitchen a clear out or tidy the drawer that hasn’t closed properly since 2019, we experience lower levels of stress, greater productivity, better focus, higher self-esteem and increased mental health. Alexis believes that same positive effects can occur when you spring clean your brain.

“We know that our brains like order and are less likely to be distracted and overloaded in a clutter-free environment,” she says. “We live in two states: our external environment and our internal environment. Both can affect our overall wellness, so it’s equally important to live in an internal world that is not overwhelmed with noise and distraction.”

Creating a soothing internal landscape is easier said than done, but Alexis recommends achieving a calmer, clearer mind by “thinking about wellbeing as the house in which you live, which is supported by a number of important pillars”. Here are a few of her simple rules:

  • The first pillar to your house of wellbeing is exercise which improves mood and decreases feelings of depression, anxiety and stress. It also produces changes in parts of the brain that regulate stress and anxiety and boosts the production of endorphins, which are known to help produce positive feelings.
  • The second pillar is service to others. “The more I think about other people, the less I am concerned with myself, and the more I’m able to focus outwardly, and escape the natural whirlpools and eddies of my own mind,” Alexis says.
  • The third pillar is social connection. Research indicates that the number of social connections, and the type, quality and purpose of relationships, can affect brain function. So it seems that better social engagement is good for brain health (like we need another reason to love an ANZA Ladies Night!). There is also evidence that loneliness increases the risk of loss of thinking skills in older people.
  • The fourth pillar is learning or education. “At times in my life where I’ve felt stuck, picking up a new skill or a new degree has been a lifesaver – the rigour of studying hones our mental skills and keeps us engaged; it has a wider benefit of opening doors to new skills and relationships,” Alexis confirms.
  • The final and perhaps most significant pillar is meditation, something which many studies claim gives rise to mental focus and clarity. “I never really understood what this meant, but meditation completely changed my outlook,” admits Alexis. “Most people think about meditation as the absence of thought, but really, it’s the ability to observe your thoughts, thus allowing yourself to see where your mind takes you, and to press pause on negative thinking. If I’d known the power of meditation, I would have started many years ago!”

Having the ability to observe her thoughts, Alexis says she is much better able to detect negative thought patterns and allow herself to reframe situations she finds herself in. “The ability to monitor or control our thoughts allows for an internal – rather than external – locus of control, which is incredibly important in an era where there are so many things (a lingering pandemic, employment, war) that are beyond our control. She adds; “Once you realise that the power to change lies within the space between your ears, you can possess an unpolluted mind and the world can appear much more manageable.”

Promises Healthcare provides a comprehensive range of psychiatric, psychological & physical wellbeing services for children and adults.

*This article first appeared on ANZA’s website.

Positive Discipline and Gentle Parenting for Children

Positive discipline and gentle guidance are concepts which are not given enough recognition. In comparison to corporal punishments and other forms of authoritarian parenting, positive discipline aims to teach by first creating a safe relationship with children, putting connection before correction. According to recent neuroscience research, people learn best when they feel safe and connected to others, in the context of safe relationships. This helps to instil discipline with maximum efficacy in the long run.

What does positive discipline bring to the table? Apart from building trust and strengthening parent-child relationships, it teaches children responsibility, self-discipline, problem-solving skills and cooperation. By ensuring that learning isn’t fear-based – such as in the context of authoritarian parenting – it also helps children build on their self-esteem, develop their sense of significance, as well as manage their emotions effectively. However, it is key to note that gentle guidance may not always yield immediate results. Consistency plays a crucial role, and over time, parents will notice their children actively apply what they have learnt.

Positive Discipline Techniques

Redirection

This technique involves diverting your child’s attention to other activities when they are acting out, or when you’re trying to guide a child’s behaviour from inappropriate to appropriate. For example, if your child is running around in the kitchen while someone is cooking, stop them and introduce another item or toy that would be of interest to them. Rather than simply saying, “Don’t run in the house,” say, “ “It is not safe to run in the house. Please go outside if you want to run.”

In addition, follow up with questions to confirm that he/she understands the boundaries (i.e what is and isn’t acceptable). Questions can include:

“Is it safe to play in the kitchen while it is in use?”

“Where else could you play instead if you feel like running?”

Such open-ended questions confirming boundaries can also initiate child-led problem-solving.

With positive discipline, it is important that you describe the behaviour you want to see without lecturing, and whenever possible, let your child know what they can do, as opposed to what they cannot do.

Positive Reinforcement

Emphasise the positive things your child does. If you only pay attention to negative behaviour, you will end up reinforcing that behaviour. When your child does something worthy of praise, be sure to acknowledge it and give him/her recognition for it. Positive reinforcement is not limited to words of praise for good behaviour. In fact, rewarding your child with natural rewards can be an extremely effective method for encouraging similar behaviour in the future. For instance, if a child asks politely for a cup of juice instead of throwing a full-blown tantrum, consider giving a little more juice or even a nice topping to motivate similar polite requests in the future. Remember to point out what they did right and emphasise how you appreciate their polite behaviour. This kind of praise helps your child maintain a positive self-identity that they will want to live up to as well.

 

Natural Consequences

Punishing your child often can turn you into the enemy, fostering an unhealthy parent-child relationship. Many parents tend to punish their children in ways that are unrelated to the offence too, and this can be confusing or simply encourage their children to act in defiance. Where possible, allow the natural consequences of their actions to unfold. For instance, if your child throws a tantrum and refuses to put on a raincoat while it is raining, the natural consequence is that they would get wet. They will be far more likely to acquiesce the next time than if you respond with a time-out when a similar situation arises.

 

Time-in and Time-out

You may be familiar with the time-out consequence, a common disciplinary technique when a child has done something wrong. Solitary, boring time-outs can be effective when well-executed. However, research has shown that such disciplinary methods are best when occasional time-outs are paired with time-ins. Time-ins encourage good behaviour, and are carried out by having the parent spend quality time with the child after a bout of bad behaviour. Instead of lashing out at the child and sending them away, spend time with them and help them calm down if they are emotionally agitated. Once they’ve calmed down, it would be much easier to discuss better choices for the future, and encourage them to apologise for their bad behaviour.

 

Paying attention to language use

Language is very important when it comes to disciplining a child. When anger strikes, it’s easy to get caught up in the heat of the moment. Be mindful not to use derogatory language or words of insult, as this can be hurtful and harm the child’s self-esteem. Moreover, try rephrasing your sentences. Instead of saying, “you messed up”, begin sentences with “I” statements. Convey how you felt about their behaviour rather than solely focusing on what the child did. This makes the approach to discussing the situation less critical, and allows the child to calm down and feel less defensive especially if their actions were unintentional.

While gentle parenting is a brilliant method as a whole, it is still important that we do what we need to do if there is danger involved. For instance, if your child is running straight for a busy road, yelling or grabbing at them is completely valid and reasonable.

All in all, remember to focus on encouragement and redirection of bad behaviour to appropriate alternatives. Positive discipline can go a long way, and it will certainly benefit both parent and child.

 

References:

  1. https://srhd.org/media/documents/What20is20Positive20Discipline1.pdf (Accessed 15/07/2022)
  2. https://www.verywellfamily.com/examples-of-positive-discipline-1095049 (Accessed 15/07/2022)
  3. Photo by James X on Unsplash

Andrew da Roza on Tobacco tax hike with Today Online

Andrew da Roza speaks with an editor at Today Online about the Tobacco tax hike. Read on to find out the details.

Follow the link to read the full article: https://www.todayonline.com/singapore/tobacco-tax-hike-some-smokers-will-cut-back-others-illegal-vaping-2110991

*Visions is an addictions arm of Promises and we help assist clients in Singapore to enable them to improve their lives; and our website provides the images, names, languages, qualifications, and experience of specialists who can help.

Find out more about our services at Visions >>