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Narcissistic Personality Disorder: Differentiating It From Self-Confidence

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)
Living with Post Traumatic Stress Disorder (PTSD): An Interview With #LadiesFirstTV’s Head Space

Living with Post Traumatic Stress Disorder (PTSD): An Interview With #LadiesFirstTV’s Head Space

Dr Elaine Yeo was interviewed by the popular Young Adults YouTube Channel #LadiesFirstTV (Titan Digital Media) about ‘Living with Post Traumatic Stress Disorder (PTSD)’.

In this 13 minutes video, hear how PTSD can come about, and learn handles to overcome and live with PTSD. The hosts also got very real and shared their journeys with living with PTSD.

Click on the red play button to watch.

 

EXPAT MENTAL HEALTH CHALLENGES

EXPAT MENTAL HEALTH CHALLENGES

“While the expat lifestyle can have a glamorous veneer, challenges often lie beneath. The experience of living overseas can be difficult and demanding, adding unique stressors to everyday living,” explains KRISTI MACKINTOSH, psychotherapist at Promises Healthcare, which provides holistic mental health and addiction treatment and recovery services to adults, adolescents and children suffering from all types of disorders. The clinic’s team of multidisciplinary specialists – including psychologists, psychiatrists and therapists, all with different expertise and specialisations – treat both local and expat patients on a daily basis.

In fact, studies show that expats as a group are 40 percent more likely to develop mental health conditions like depression, stress and anxiety, as compared to those who never move abroad.

“The challenging environment and less support than at home often leads to an increase in drinking, smoking, drug abuse – yes, even in Singapore – or self-harm to try and distract from the negative feelings.”

What’s more, the loss of the informal network of support from friends, family and acquaintances back home only compounds the stress and anxiety.

“Expats may often feel like they can’t share their difficulties because it seems like complaining or admitting to a failure. Isolation can lead to depression, and restrictions on travel and socialising because of COVID may have exacerbated feelings of social isolation for many expats.”

grief counselling family therapy in Singapore

How counselling can help – and tips to cope

“It’s important to be aware of the unique set of challenges that come with expat life and ensure you’ve got a good support structure in place,” says Kristi. “One of the most important things you can do is connect. Humans are social beings. While it may require more emotional honesty or reliance on those around you than you might usually be comfortable with, connection and support from others is important.”

Additionally, you can help reduce stress by:

  • getting enough sleep to help regulate your mental and physical health;
  • eating a balanced diet to prevent deficiency in minerals that may cause low mood;
  • staying active;
  • trying not to over-drink, over-eat or smoke; and
  • doing something that brings you joy – from reading a book to trying a new restaurant.

If you feel that you’re not coping or you’d like some extra support with your mental health, reach out to your GP or a professional counsellor or psychologist for therapy in Singapore.

Promises Healthcare
#09-22/23 Novena Medical Centre, 10 Sinaran Drive
6397 7309 | promises.com.sg

*This article first appeared on Expat Living Magazine’s website. 

It’s Time to Talk About … BURNOUT!

It’s Time to Talk About … BURNOUT!

Dr Joseph Leong & Dr Sean David speaks with an editor at Expat Living about Burn out. Read on to find out the details.


 

We’ve all been there – wired on coffee, exhausted, struggling to keep pace with hurdles and deadlines, before hitting the inevitable brick wall. When can we identify a state of “burnout”, and what does psychology have to say about it? We asked DR JOSEPH LEONG and DR SEAN DAVID from Promises Healthcare about this as current mental health issue.

burnout and mental health issues promises healthcare
DR JOSEPH LEONG

What does being “burnout” mean in a clinical context?

Joe: Burnout is an occupational phenomenon. It’s not classified as a medical condition but conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterised by feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficiency.

While we recognise that students and homemakers can also suffer similar anxieties, burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life. Sean: American social psychologist Christina Maslach, who is well known for her research on occupational burnout, stated: “What started out as important, meaningful and challenging work becomes unpleasant, unfulfilling and meaningless. Energy turns into exhaustion, involvement turns into cynicism, and efficacy turns into ineffectiveness.”

The behavioural manifestations of burnout may be procrastination on tasks; “presenteeism” at work, which is when a person is present at work while they’re disengaged or unwell; sleep and appetite disturbances, or even maladaptive coping methods such as increased smoking and drinking.

If burnout is not addressed early or adequately, it can lead to other mental health issues including major depression, anxiety disorders or even escalate to the severity of suicidality or illicit drug use. This will inadvertently have a profound impact on the afflicted person’s social and family life.

burnout and mental health issues promises healthcare
DR SEAN DAVID

Is there treatment for burnout? What “work hygiene” or mental habits can be cultivated to help keep our cogs turning?

Sean: The first step is to recognise when one has reached a stage of burnout, and not brush aside their inability to function due to just “stress”. Increasing awareness of the warning signs of impending burnout and avenues of help internally within one’s company, and externally using community resources or virtual self-help is important. Psycho-education reduces the stigma associated with seeking help for mental health conditions.

The second step is to analyse the specific causes of burnout for that unique person’s life situation. There are systemic and individual factors that can predispose, precipitate and perpetuate burnout.

The third and most crucial step is to take action and make lifestyle changes in accordance with the identified root causes of burnout.

Prescribed medications by doctors to aid sleep or relieve anxiety may also be abused. This can result in addiction. The first step is awareness that this could happen to anyone despite the belief that one knows their limits.

Joe: Some people cope by drinking, smoking or taking some pills to solve their “ills”. These coping strategies may temporarily relieve distress but are not healthy long term and can do more harm than good.

What distinguishes a clearly appropriate medical-use case from an addictive dependency on prescribed medication?

Joe: Chronic distress should be managed in a holistic way rather than self-medicating. Seeing a therapist or a counsellor to learn new skills or change one’s thinking would be helpful.

Appropriate medication use is within the doctor’s prescription weighing the indication, benefits, alternatives and risk of using or not using.

One should be honest with the use of medications and not doctor-hop or collect various medications from different doctors without revealing what was given by another doctor. Bringing all the medications during the consult will help in active use of the medication and reduce the dependency on medications.

burnout and mental health issues promises healthcare

How can employers instil and facilitate better mental health practices? How can we negotiate healthier working styles with our bosses and colleagues?

Joe: I recommend a frank discussion about what is working well and what is not. A person will do well with tasks where he or she is strong and interested in doing them, whereas other tasks may cause too much distress and dysfunction.

Sean: Fostering a positive and supportive working environment is encouraged, for example, allowing employees to have autonomy over their job scopes. Trusting them to make appropriate flexible work arrangements, especially if they are parents or care-givers, can ensure better work life balance and happier employees.

Encouraging an open discussion with employers about work strengths and weaknesses can also result in a better allocation of suitable work tasks. Employers can distribute responsibilities fairly at work and put in place multisource feedback channels to keep the effectiveness of work policies in check.

Finally, reminders from company HR for employees to use up their annual leave benefits instead of the repetitive cycle of carrying forward leave may ensure that employees take adequate rest in the work year to recuperate.

Seeking help for “being stressed at work” might seem outlandish to some. What can you share with readers to change their mind?

Joe: Think about it as executive coaching or career counselling. If the job is not a good fit and has caused physical, emotional, psychological and social distress and dysfunction, changing to another department or a better job may be a better outcome in the long term.

Sean: Seeking help is not a sign of mental weakness but instead a bold action taken by you to see a change, and find fruitful meaning in life.

In the words of BKS Iyengar, “Change is not something that we should fear. Rather, it is something that we should welcome. For without change, nothing in this world would ever grow or blossom and no one in this world would ever move forward to become the person they’re meant to be.”

Three Steps Out of Burnout

#1 Recognise when you’ve reached a stage of burnout, instead of brushing aside your inability to function due to just “stress”.

#2 Analyse the specific causes of burnout for your own life situation. There are systemic and individual factors that can predispose, precipitate and perpetuate burnout.

#3 The most crucial step is to take action and make lifestyle changes in accordance with the identified root causes of burnout.

About PROMISES

Promises Healthcare is a multidisciplinary mental health clinic with a team of psychiatrists, psychologists, therapists and executive coaches (and a rehabilitation physician) who take on a diverse and multidisciplinary approach to treatment. Care and wellbeing of patients is at the heart of the service, and treatments are based on the latest clinically proven protocols in the field of neuroscience and psychology.

Dr Joseph Leong believes that recovery is possible for anyone. He looks beyond finding the best combination of medications to recommending talk therapy and psycho-social rehabilitation and community partnerships.

Dr Sean David Vanniasingham is experienced in general psychiatry, addiction medicine, and neurostimulation treatment. He is a firm believer in the biopsycho-social model approach in the holistic and recovery-oriented care of his patients.

Visions by Promises is the addictions treatment arm of Promises Healthcare, providing recuperative care programmes such as one-on-one counselling, group therapy, an intensive outpatient program, specialist groups, family therapy and medical detox.

Promises Healthcare is at #09-23, #09-18 & #11-16 Novena Medical Center, 10 Sinaran Drive.
6397 7309 | promises.com.sg


*This article first appeared in the October 2022 edition of Expat Living and on their website.

Post-Traumatic Stress Disorder: Treating Its Debilitating Effects

Post-Traumatic Stress Disorder, or PTSD, is a mental health condition characterised by the failure to recover from exposure to a traumatic event, bringing about intense, disturbing thoughts and feelings related to the experience. Contrary to the widely-held belief, victims of PTSD need not necessarily experience the traumatic event first-hand – PTSD can also arise from witnessing something shocking, terrifying or disturbing. Similarly, PTSD triggers can have a broad spectrum, and the cause differs for everyone. Not everyone has to go through extreme, drastic events such as a war to develop PTSD – the condition can also be brought on by other distressing experiences such as abuse, accidents, assaults, or even adverse health or childbirth-related experiences. 

 

How is PTSD diagnosed?

As with most other mental health disorders, clinicians use the Diagnostic and Statistical Manual of Mental Disorders as a guideline to diagnose PTSD. The diagnostic criteria below are specific to adults, adolescents, and children older than six.

 

Criterion A: Stressor

(one required)

The person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

  • Direct exposure
  • Witnessing the trauma
  • Learning that a relative or close friend was exposed to a trauma
  • Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criterion B: Intrusion Symptoms

(one required)

The traumatic event is persistently re-experienced in the following way(s):

  • Unwanted upsetting memories
  • Nightmares
  • Flashbacks
  • Emotional distress after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders

Criterion C: Avoidance

(one required)

Avoidance of trauma-related stimuli after the trauma, in the following way(s):

  • Trauma-related thoughts or feelings
  • Trauma-related external reminders

Criterion D: Negative Alterations in Cognitions and Mood 

(two required)

Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

  • Inability to recall key features of the trauma
  • Overly negative thoughts and assumptions about oneself or the world
  • Exaggerated blame of self or others for causing the trauma
  • Negative affect
  • Decreased interest in activities
  • Feeling isolated
  • Difficulty experiencing positive affect

Criterion E: Alterations in Arousal and Reactivity

Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

  • Irritability or aggression
  • Risky or destructive behaviour
  • Hypervigilance
  • Heightened startle reaction
  • Difficulty concentrating
  • Difficulty sleeping

Criterion F: Duration (required)

Symptoms last for more than 1 month.

Criterion G: Functional Significance (required)

Symptoms create distress or functional impairment (e.g., social, occupational).

Criterion H: Exclusion (required)

Symptoms are not due to medication, substance use, or other illness.

Two Specifications

Dissociative Specification 

In addition to meeting the criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:

  • Depersonalization: Experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).
  • Derealization: Experience of unreality, distance, or distortion (e.g., “things are not real”).

Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although the onset of symptoms may occur immediately.

 

How PTSD May Go Undetected

Not all individuals will have their condition diagnosed and recorded on paper. The pervasive misconceptions about its complex cluster of symptoms can hinder one from seeking treatment, or simply realising that one may be suffering from PTSD. 

In the early onset of the disorder, attempts to weather the storm by turning to short-term coping mechanisms may include binge eating or distracting themselves with their favourite TV shows. However, this is not effective – nor is it healthy – in the long run. In addition, people with comparatively “less traumatising” experiences may feel as though they did not “earn” the diagnosis, considering that others might have gone through worse. This behaviour of downplaying one’s trauma can hold them back from seeking early treatment, as it may seem more convenient to adopt the mindset that they can quickly get over it in due course. With avoidance being the hallmark of PTSD, many victims turn to therapy only after long periods of struggling with the disorder, as if therapy were the last resort. But with delayed treatment, these individuals run the risk of having to navigate symptoms that, with earlier treatment, may never have developed in the first place.

 

Treatment Options for PTSD

Psychopharmacological Treatment

At present, the evidence-based pharmacological treatment for PTSD involves the use of Selective Serotonin Reuptake Inhibitors (SSRIs), which include medications such as Sertraline and Paroxetine. While there are also other medications available, these two are currently the only ones approved by the FDA for PTSD.

SSRIs play a well-recognised role in the management of mood and anxiety disorders. Their mode of action involves raising the levels of Serotonin, a neurotransmitter vital in regulating mood, anxiety, appetite, sleep, and other bodily functions.

Of course, there is no one-size-fits-all. While SSRIs are typically prescribed to treat PTSD, there are exceptions depending on the patient’s medical history. Clinicians will have to consider the patient’s response to the drugs, existing comorbidities, and personal preferences. As such, medications have to be tailored to each individual’s needs. 

 

Cognitive Behavioural Therapy (CBT)

One of the more common forms of psychotherapy, CBT aims to tackle the maladaptive thought processes and emotions associated with one’s trauma. Trauma-focused CBT involves three main categories – exposure procedures, anxiety management procedures, and cognitive therapy. These aim to help individuals understand what they’re afraid of, learn healthy and effective coping mechanisms, and work through dysfunctional thoughts. 

Moreover, having a therapist or psychologist that is trauma-informed can be of great benefit. A trauma-informed therapist is knowledgeable about trauma and can understand and empathise with how the traumatic experience could have impacted the patient. Prioritising physical and emotional safety ensures a smoother clinician-client collaboration, which in turn aids in increasing the transparency and efficacy of treatment. 

 

Eye Movement Desensitisation Therapy (EMDR)

Eye Movement Desensitisation Therapy may be less commonly heard, but it is an efficacious, empirically validated treatment for trauma and other adverse life experiences. In a different vein from cognitive behavioural therapy, EMDR doesn’t focus on altering a client’s thought patterns or behaviours. Instead, it relies on one’s own rapid, rhythmic eye movements, allowing the brain to process memories and resume its natural healing process. Simply put, EMDR therapy involves guiding the client towards reliving triggering experiences in short phases while the clinician directs his eye movements. When the client’s attention is diverted as they recall the traumatic event, the exposure to negative thoughts and memories is less upsetting, limiting a strong or negative psychological response.

To have a more detailed read on EMDR, do check out our article: Treating Trauma With Eye Movement Desensitisation and Reprocessing (EMDR)

If you suspect that you may be suffering from PTSD, do reach out and seek early intervention for the betterment of your physical and mental health. 

 


References:

  1. https://cnalifestyle.channelnewsasia.com/wellness/pstd-post-traumatic-stress-disorder-symptoms-308861 (Accessed 19/04/2022)
  2. https://www.brainline.org/article/dsm-5-criteria-ptsd (Accessed 19/04/2022)
  3. https://www.apa.org/ptsd-guideline/treatments/medications (Accessed 19/04/2022)