Narcissism and Generalized Anxiety Disorder

Anxiety Disorders - and especially Generalized Anxiety Disorder (GAD) - are often misdiagnosed as Narcissistic Personality Disorder (NPD).

Misdiagnosing Narcissism - Generalized Anxiety Disorder

BPD, NPD and other Cluster B PDs (Personality Disorders)

All personality disorders are interrelated, at least phenomenologically. There is no Grand Unifying Theory of Psychopathology. We do not know whether there are and what are the mechanisms underlying mental disorders. At best, mental health professionals record symptoms (as reported by the patient) and signs (as observed). Then, they group them into syndromes and, more specifically, into disorders.

This is descriptive, not explanatory science. The few theories extant (psychoanalysis, to mention the most famous) all fail miserably at providing a coherent, consistent theoretical framework with predictive powers.

Patients suffering from personality disorders have many things in common:

1. Most of them are insistent (except those suffering from the Schizoid or the Avoidant Personality Disorders). They demand treatment on a preferential and privileged basis. They complain about numerous symptoms. They never obey the physician or his treatment recommendations and instructions.
2. They regard themselves as unique, display a streak of grandiosity and a diminished capacity for empathy (the ability to appreciate and respect the needs and wishes of other people). They regard the physician as inferior to them, alienate him using umpteen techniques and bore him with their never-ending self-preoccupation.
3. They are manipulative and exploitative because they trust no one and usually cannot love or share. They are socially maladaptive and emotionally unstable.
4. Most personality disorders start out as problems in personal development which peak during adolescence. They are enduring qualities of the individual. Personality disorders are stable and all-pervasive not episodic. They affect most of areas of life: the patient's career, his interpersonal relationships, his social functioning.
5. Patients with personality disorders are rarely happy. They are depressed and suffer from auxiliary mood and anxiety disorders. But their defenses are so strong that they are aware only of their recurrent dysphorias and not of the underlying etiology (problems and reasons that cause their mood swings and anxiety). Patients with personality disorders are, in other words, consciously ego-syntonic, except in the immediate aftermath of a life crisis.
6. The patient with a personality disorder is vulnerable to and prone to suffer from a host of other psychiatric problems. It is as though his psychological immunological system is disabled by the personality disorder and he falls prey to other variants of mental illness. So much energy is consumed by the disorder and by its corollaries (example: by obsessions-compulsions), that the patient is rendered defenseless.
7. Patients with personality disorders have alloplastic defenses (external loci of control). In other words: they tend to blame the world for their mishaps and failures. In stressful situations, they try to preempt a (real or imaginary) threat, change the rules of the game, introduce new variables, or otherwise influence the outside world to fulfil their needs. This is as opposed to autoplastic defenses (internal loci of control) typical of neurotics (who change their internal psychological processes in stressful situations).
8. The character problems, behavioral and cognitive deficits and emotional deficiencies and instability encountered by the patient with personality disorders are, mostly, ego-syntonic. This means that the patient does not, on the whole, find his personality traits or behavior objectionable, unacceptable, disagreeable, or alien to his self. Neurotics, in contrast, are ego-dystonic: they do not like who they are and how they behave.
9. The personality-disordered are not psychotic. They have no hallucinations, delusions or thought disorders (except those who suffer from the Borderline Personality Disorder and who experience brief psychotic "microepisodes", mostly during treatment). They are also fully oriented, with clear senses (sensorium), good memory and general fund of knowledge.

The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (American Psychiatric Association, DSM-IV-TR, Washington D.C., 2000) defines "personality" as: "...enduring patterns of perceiving, relating to, and thinking about the environment and oneself... exhibited in a wide range of important social and personal contexts."

Click here to read the DSM-IV-TR (2000) definition of personality disorders.