"All human suffering is an experience based on value judgements of what is good and bad."

A judgment is labeling some thing, person, or event as good or bad, based on your belief system. Lets take a look at the concepts of good and bad.

Does anything carry with it a value of good or bad, independent of human evaluation? Are good and bad inherent qualities or human assessments? Is any event, person, thing, circumstance inherently (exists as a permanent condition) good or bad? Or are they labels we use to define what we want and don't want?

How does Webster define "good?"

good (gud) adj. serving it's purpose well || having desired qualities || virtuous, kind, well-behaved, agreeable, pleasant, beneficial, worthwhile, profitable, efficient, competent, capable, safe, and valid.

The key phrase in that definition is "having desired qualities." We define good as being something we want. And look at the words used to define good. Are they not what we desire? For example, we want our children to be well behaved .We want our lives to be easy, to be around people who are pleasant and kind. We want what we do to be worthwhile, efficient, and hopefully, profitable. We want to feel safe, etc.

What about "bad?"

bad (bæd) wicked, evil || defective, inadequate || not prosperous || unwelcome || distressing, disagreeable, upset, harmful, and unskilled.

Again, look at the words. Aren't they simply defining what we don't want as "bad"? We don't want items that are defective. We don't want a corrupt government. We don't want to be "poor". ....on and on...you get the idea. Good = Want. Bad = Don't Want

"What disturbs people's minds is not events, but their judgments on events."

- Epictetus, 100 A.D

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If good and bad were inherent qualities (true regardless of our assessments), then they would remain the same throughout time. History has shown this to not be true. Through out lineage, what we've called good and bad has changed.

So if "good and bad" are assessments, then you are free to re-evaluate those assessments. When you look at situations (and yourself) in terms of desires, and not as value judgments, you remove the negative connotations associated with "good and bad". The examination of the situation becomes less volatile and hostile. You can simply make an observation, notice what you want or don't want, and respond according to those desires.

Observation And Value Judgments

Some people say we need judgments to be able to live in this world. "How could I make decisions if I didn't judge? Isn't that how we make decisions?" Let's make a distinction between a value judgment and an observation.

In an observation we see, hear, feel what is happening around us. We then state what we see. When we're judging something, we go one step further in the process of observation and add in a subjective evaluation. We label the event as either good, or bad. THAT, is the value judgment. You're not removing the decision making process, you're simply replacing "good and bad" with "I want, I don't want."

How does this apply to accepting yourself? Well, you do the same thing to yourself. You first make an observation about yourself, ("I am fat") then decide if it's a good or bad thing to be ("It's bad to be fat"). When we judge something about ourselves as "bad", it becomes impossible for you to accept (be okay with) that part of yourself. BUT, it is possible to accept (be okay with) your weight and still know you WANT to be thinner. Make sense?

"Judgment stands as an obstacle to self-love.
When you form judgments about another person,
for instance, "this person looks like a lazy person,
or a failure, or has terrible clothes," you create
a message to your subconscious that the world
is a place where you had better act in certain
ways if you want to be accepted...that you are
only going to accept yourself under certain
conditions. This leads to an inner dialogue of
self-criticism."

- Orin

What if you were to drop your value judgments and simply saw "what is" then identified what you wanted and why? It could totally transform your experience. What are the ramifications of doing so? Perhaps you would find a well of love for yourself and others that you never knew existed. Perhaps you'd notice the less you judge yourself, the less you'll judge others. And maybe, just maybe, the experience of acceptance would give you the solid foundation to move forward in creating yourself and your life the you've always dreamed.

next: You Are Always Doing Your Best

• Letters of Hope
• Letters of Pain
• Letters of Parents
• Letters of Recovery

Letters of Hope

Claire Age: 15 Anorexia

I don't exactly have one eating disorder. I have bulimic and anorexic tendencies. I don't know how common that is, but it's what my current situation is. I've had it since I was about 12. So, it's been 3 years now.

I was overweight for awhile when I was younger. Then I leveled off and when I entered junior high, I started putting on weight again. In junior high, it's a fate worse than death to be fat. So I began to diet. I went from a size 14 to a size 8, and then began to take diet pills. I then went from an 8 to a 1.

Only 2 people know about my eating disorder. My mom and one of my best friends. They are very understanding, but I don't think they fully understand what I'm going through. Sometimes they try to make me eat, which always results in a round of yelling and fuming.

Actually, what made me decide to get outside help was the story a Concerned Counseling friend of mine told me about her eating disorder experience. It was an eye opening experience and scared me.

I have tried therapy, but I have had bad experiences with most therapists and nutritionists. Concerned Counseling has been the one place where I have a good experience with a therapist. I am getting ready to seek help outside of Concerned Counseling, and it's kind of scary to me, but I'm willing to try.

I don't think I'll ever be fully recovered from my eating disorder. An eating disorder is something that's with you for life. I think I'm going to have to stay committed to it in a way. I'll always have to fight it, but it's a fight I'm willing to do.

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Anne Age: 20 Anorexia

I am a recovering anorexic and bulimic who, for at least eight years, has lived with the monster of ED (eating disorder). Those years were not always complete hell, but often, they were. Anyone who spent extended periods of time with me would attest to this without question or hesitation.

I was in denial most of the time, but part of me always knew something was wrong -- or at least different. After suffering quietly for about four years, I eventually got into eating disorder therapy with a psychologist and a psychiatrist. In addition, I have been hospitalized and have spent time in a residential eating disorder treatment center.

It was really helpful for me to be in the accepting and caring environment of the center. It provided me with a kind of rebirth to be with others in similar situations and the opportunity to share a mutual understanding of what we were fighting daily; suddenly my eating disorder didn't seem so powerful, knowing that we were all in on the battle and preoccupation together.

On the other hand, I hated the hospital because I felt even more alone, helpless, and hopeless there. Even though it probably saved my life at the time, it nevertheless was not beneficial for long-term help with the disease.

I continue to be in therapy and on medication. While I am working against this deadly enemy, I've experienced relapses. However, I now know that there is hope out there and that instead of ED killing me, I can kill ED.

With this in mind, I have learned to take not only one day, but one thing, at a time and to make the most of whatever I am presented with. Easier said than done, I often remind myself of what Emily Dickinson wrote:

"Hope is the thing with feathers

That perches in the soul,

And sings the tune without words,

And never stops at all."

 

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Sue Age: 33 Binger

I'm 33 years old now, and I've had my eating disorder for around half my life, since I was 17 or 18, and in college. I was a slender girl in high school and able to eat all I wanted. All of a sudden, I gained 15 pounds my freshman year and 10 my sophomore year.

Funny thing is, compared to now, I wasn't really that fat then. In fact, I'm still not obese. I'm about 20 pounds overweight.

Back then, I tried to diet and started to binge. I would go to three different vending machines to get junk food, then sneak it into the library. For awhile, I alternated between dieting a few days and all out binges. Then, I descended into bulimia. I discovered laxatives could make me feel "clean" again after my binges.

Until I was 22, I binged once, sometimes twice a day, using 10-15 correctols at a time. I remember visiting a professor and having dizzy spells; I almost fainted. After a few more near-misses, I realized the laxatives were taking their toll. Through student health (I was in a graduate program), I went through some eating disorder group therapy. It enabled me to quit using laxatives, but the binges were still there. I relapsed into laxative use for a brief stressful time, but overall since then I have managed to stay off them with only a few one-time use lapses a year.

When I began therapy, I was diagnosed with bipolar affective disorder, or manic depression. I started to see the first of quite a few psychiatrists and to take medication. For a while, the binges lifted to maybe one a week, and then they'd come back. I find it interesting that my moods don't really coincide with my binges. I could feel happy and still binge, and be depressed and not. I have had periodic remissions of the binge eating for a few months at different times over the years, and I don't know why.

The most recent thing I tried was a Breaking Free workshop by Geneen Roth. It worked for awhile. What I have come to realize is that sometimes the binge eating is useful and it helps me get through the day. Sometimes I allow it to exist. Other times I want to fight. I find that the chat room at this site has helped me resist binges. Someday I will beat this thing, I just need to keep trying different ways.

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Letters of Pain

Anna Age: 19 Anorexia

I am a nineteen year old female. I was anorexic when I was fifteen, but I still have to deal with this disease to this day.

At times I have to make myself eat and at other times I just have to decide that I won't listen to people's comments..

People's comments are what triggered this whole disease for me. I have always been skinny, but not as skinny as my older sister. I would look at her and think that I had to be skinnier than her since I was younger. People used to tell me that I was going to be fat when I got older. It was a big joke to a lot of people, but it affected me more than they will ever know. They made stupid comments like," Anna, you are getting so big that soon you won't be able to fit through the double doors."

Of course, I was not gaining weight but I just had to prove to everyone that I was not going to get fat. In the summer before ninth grade, I stopped eating. I tried to see how long I could go without eating anything.

I remember, one time I didn't eat for three weeks. I would chew gum and drink water, but never too much water because I thought that I might gain weight from the water. I liked to let people know that I had not eaten in three weeks and that I was just not hungry.

No one, except my sister, seemed to care that I was not eating. Her boyfriend's mom was a nurse so she talked to me about what I was doing to my body by not eating. I really didn't listen to her at first. Then I realized that by not eating I was not getting the attention that I wanted. I realized that there was other ways to get attention rather than starve myself.

At the beginning of the summer I weighed 105 lbs. By the end of the summer I weighed close to 85 lbs. and yet no one was really concerned about me.

I never had any treatment, but I wish that I had. I still have to make myself eat at times. I try to ignore people's comments. No matter how small they may seem, I know that they will affect me.

At times, I find myself not eating so I force myself to eat. My boyfriend knows all about my problems with eating and he strongly encourages me to eat. He knows when I haven't eaten in awhile and he makes me sit down and eat with him. I have problems eating with a lot of people especially if they are strangers.

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Lisa Age: 35 Compulsive Overeating

I have suffered from an eating disorder for about 8 years now! I am an overeater and a binger. When I get nervous or depressed, I tend to stuff my face with everything in sight until I get sick or diarrhea. Then I look at pictures of when I weighed between 110 and 120 and I go into severe manic depression.

Sometimes I just stay in bed for days and don't answer the phone or the door. When my kids and my husband ask me what is wrong, I just cry and tell them that I am a failure at everything and I wish I was dead! Of course, I then find solace in food or cigarettes. At other times, I go on diet binges and practically starve myself for days. Most times, I hide food from myself and everyone else and late at night I sneak out of bed and gorge. Then the cycle begins again!

I look in the mirror at myself and want to throw up. I am so disgusted with myself. Everyone that knows me says that I am a beautiful giving woman with a heart as big as Texas and that there isn't anything I wouldn't do for the people that I love. I just look at myself and see a butt as big as Texas!

This has caused many problems in my marriage and with our sex life. I won't let my husband even look at me with the lights on and our love making has dwindled down to practically nothing. Then I start thinking that he doesn't love me anymore and wants someone else because this has affected his performance too! He is afraid that if he can't perform, I will start thinking that it's because of my FAT! This is usually a correct statement. Thus, no sex life!

The kids really pussyfoot around me and basically stay out of my way or wait on me hand and foot when I get this way. I know I have a problem. I just don't know how to solve it! I have been to psychiatrists, counselors, doctors, and talk groups. I have tried every diet that has ever come out, even the quick weight loss program designed for patients who need surgery and starvation diets. I have tried exercise programs and walking. I have even tried taking laxatives!

PLEASE HELP me if you can, although at this point I feel there is no help! I am not a rich person and I don't have Richard Simmons helping me like I see all those people getting help on all those talk shows!

My family thinks that I am being silly and that I don't have any reason to feel depressed, so I keep it inside and eat some more.

 

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Karen Age: 27 Bulimia

I am currently afflicted with bulimia. I have been with this disorder for nearly 6 years. This disorder was a cure-all for my excessive weight in college. In fact, at first it wasn't a disorder at all. It was a gift. One that I did not, could not, let go. Now it is a curse, one I own.

I soon discovered this was consuming me and it was taking every essence of my being. I became obsessed with finding all I could about eating disorders. I was one who had control of it, not it of me. I researched for hours, denying myself of friends, of life. When I wasn't reading about it I was acting it out. I became involved with an eating disorder support group at the University of Northern Iowa. Not to get support but to satisfy my own obsession in hearing other people's stories. I could offer advice that would help but never needed any myself.

I finally admitted I more of a problem than I could 'solve' on my own. In the spring of my junior year I decided to go to a counselor. After a few sessions she urged me to go into an inpatient treatment facility. I shied away from this, but eventually entered.

I remained in for 9 weeks. I went through several methods of treatment. Antidepressant medication, psychotherapy and eating disorder group therapy. I came out of treatment with renewed strength and faith. After six months, I relapsed. I was continuing my counseling, but that ceased after a year. I was only getting worse.

My professional life was on the up and only getting better. My personal life was shot! I was becoming my disorder in a severe way. I began stealing food for my disorder. I continue to deteriorate and act out my disorder during any free minute I get. It is a compulsive habit that has become a full blown addiction.

My future? I wish I knew. I can only hope and envision myself becoming strong enough to overcome this. I have serious doubts that this will ever happen. I spend a vast amount of energy planning, covering up and acting out my other persona. I wish I could become a 'normal' person. I don't think that will ever happen.

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Shannon Age: 15 Anorexia

I suppose I do have an eating disorder. I have been depressed and I don't really know what kind of eating disorder I have.

I used to sort of be bulimic, but now I'm an anorexic overeater. I try to keep it from my friends and family, but it has affected me in a lot of ways. It's very frustrating and hard to deal with.

I do have a psychologist, but, because I am neither under weight or overweight, no one really takes me seriously. Last year and the year before, people thought I was anorexic. Now, everyone thinks everything is okay as long as I'm eating. No one really seems to understand that when I'm overeating, its just as bad as when I'm not eating at all.

I generally try to protect those around me, so I keep it hidden. I've never really figured out why eating is such a problem for me, but I always have a really hard time with food. I hope to someday be able to eat normally, without worrying about calories, or completely binging, but first I need to find the right help.

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Lynn Age: 33 Anorexia

I'm 33 years old and weigh 87 lbs, and I'm 5'3.

I guess you would say that I'm still in denial about having anorexia. I've had two doctors and one dietician tell me that my problems come from my low weight. When I initially went to the doctor because my heart beats too fast, he told me it was the result of an eating disorder. He put me on heart medication.

I haven't had any treatment for eating disorders. I refused to go because I don't think that's my problem. However, deep down, the more I look at things and talk to people, the more the doctors may be right. It's a fight within yourself, that I don't know who will win.

The crazy thing is: I'm 33 years old, a wife and the mother of two children. I'm a kindergarten teacher who asks the little guys what they eat for breakfast. I teach them that they need good food to grow nice and big and strong. Now they're saying that I'm anorexic.

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Lexie Age: 27 Compulsive Overeating

I am obese. I am 5'4" and weigh from 190 to 242...depending on the week. As a child, my parents were constantly after me to gain weight. As an adult, people feel the need to encourage me to lose weight.

The biggest problem I have is eating large quantities of food until I am sick. I don't want the food. I'm not hungry and it doesn't taste or feel good. I'm not sure why I do it. I have been told it is "self-medicating" to ease emotional pain.

It has GREATLY affected my relationships with others in that I cannot stand for people to touch me or stand close to me. When they do, I feel like I am so ugly and so dirty that it will "rub off" on them. I also feel like no one really wants to touch me or be around me because I am so disgusting. I punish myself physically for eating...cutting, hitting, and burning myself so that I won't eat again.

I guess part of the problem is that I go for days at a time eating nothing and then eat uncontrollably for a day or two, then eat nothing again. I hate myself. I hate how I look. I cry when I see myself in the mirror. I feel like I can never see exactly what I look like and I am constantly measuring and comparing myself to others to see if they are bigger or smaller.

I cannot eat out with others because I have to go to the restroom to throw up and I am afraid someone will hear me. At work, my boss recently asked if I was sick because she noticed an odor in the bathroom. So now, I have had to find another place to throw up so she won't know. Please excuse the graphic nature. I don't know how else to put it.

I want help. When you're low-income, it's hard to get.

 

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Letters from Parents

Michelle Daughter-16 Bulimia

I found out that my 16 year old daughter was bulimic approximately 2 years ago after I found a journal that she was writing. Actually, in my ignorance at the time, I thought she was just "going through a phase". I didn't believe that she was doing it often, nor did I believe that it would continue very long. These opinions were based on the fact that I never saw or heard her do it and she didn't appear to be losing weight.

I did not approach her with my discovery- and at about the same time she began counseling for depression. Her therapist confirmed to me that she was binging and purging.

She lost a classmate to suicide, then her beloved grandfather died suddenly of a heart attack. I know she started making herself throw up as a way of "having control" over her life, and "getting rid of the bad stuff". She never wanted to have me find out because she said that it is disgusting and she was afraid of disappointing me. In fact, it's only within the last few months that she became aware that I know about it.

She has seen a counselor for 2 years, which hasn't helped much. She says he doesn't understand. She took Prozac for 1 1/2 months, then refused to take it anymore-said it didn't make her feel better. She does access your message board and chatrooms which I think has helped her because she is able to talk to people who "understand".

No other members of the family are in counseling at this time. It seems like I am the only other person affected by it. I feel a tremendous amount of guilt! I feel like if I would have tried harder to give her a stronger self-esteem, she wouldn't be trying to hurt herself. I feel like I have failed her in some way. It scares me to think of the long term problems she is subjecting herself to. I also don't understand what would make a person want to do that.

That is why I access your channel, because I am desperately searching for ways to help my daughter before this gets completely out of control. I want to make her feel good about herself, and realize that she is a wonderful person.

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Letters of Recovery

Den Age: 34 Anorexia

Due to an 'on-going' horrendous childhood, I entered my teens with a very low opinion of myself.

I suppose I was around 12 when I first stopped eating. Looking back, I am not certain why? Only that I could, so I did! I think most people then considered it a 'teen' thing and that I would outgrow it. By the time I was 16, my periods had stopped and I weighed 84 pounds. I had full-blown anorexia.

My family doctor had me hospitalized. By then, it was no longer a choice element. The thought of food would bring on immediate nausea. I recall clearly one doctor that came to see me. He told me I was wasting his time and that my parents should 'do something' with me. That incident made me very wary of approaching medical people for a long time.

Over the years, I have received medication on and off, but I have quickly relapsed into my anorexia once support is withdrawn. The real crunch for me came in Spring '95. I collapsed. It was a heart attack. The years of self starvation had damaged my body irreversibly. I was in the hospital for 5 months. This time I received therapy for eating disorders as well as medication.

It has taken the 18 months since to regain my strength. I am now just over 105 pounds. I now do the grocery shopping. I couldn't face that for years. I even cook for my family.

To aid in my recovery, I was given extensive therapy on a one-to-one basis. I have to say that the therapy was the best treatment. The sub-conscious mind is an extraordinarily strong thing and my emotional difficulties needed to be addressed. I still have to use beta-blockers for my heart as I am left with a 'murmur' and morphine-based painkillers on occasion. I no longer though use medication for the anorexia.

Two things that I avoid that help me, weighing scales and mirrors. Both can bring about strong negative responses. It is a little like alcoholism. I will always have the tendency towards anorexia, but by avoiding certain triggers I can live a "normal life".

I will never be able to associate pleasure and food, but through education I can understand the necessity for it. I now acknowledge that eating is a task I must attend to and I've established a daily eating routine.

For me, it has always been about control, never weight. I do worry about relapsing and have never had the opportunity to talk to other people who have experienced this type of illness. Support is paramount and recovery can be tough as I often feel isolated. Few people understand how hard it is living with anorexia.

I hope that one day all kids will receive the help they need before their problem becomes deeply embedded. I now focus on today and worry about tomorrow when it arrives. I thank my husband and my kids for their support and belief in me.

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Amy Age: 28 Anorexia

I was 18 years old and off to college. I was overweight when I entered college, but by the end of my sophomore year I had lost over 100 pounds. I was diagnosed with anorexia nervosa.

What started as a "FAD DIET", became a compulsion for me. I had gotten so bad at school with my starving, laxatives and diet pills, that I was forever passing out in my dorm room. I was in treatment at school with a psychiatrist at a local hospital that was pushing for hospitalization.

After passing out in my dorm room, ending up in the emergency room with low potassium, I was hospitalized on a general psychiatric unit for one month.

Besides the "fad diet", the big thing that really triggered my eating disorder was being raped at college. After 30 days of continued weight loss, my family was called to take me home to a hospital in New York that specialized in eating disorders.

I suffered from my eating disorder for 8 years with multiple hospitalizations ( I gave up counting after 12). I was tube fed on IV's and miserable. I was placed on antidepressant medications including Anafranil, Disipramine, Prozac and .

At the height of my illness, the eating disorder consumed my entire life. I gave up my friends, isolated myself in the house, dropped out of college (temporarily) and spent 5 days a week at the eating disorders' clinic for nutritional counseling and group therapy. Add to that, medical appointments three times per week. My family didn't understand this. To them, being thin was desirable at ANY COST.

I suffered many relapses and my eating disorder progressed to the point that I wanted to die. I reached that point of death and woke up in the ICU in 1994... that was when my recovery really began. My last hospitalization was in 1995.

I'm currently on Elavil. I'm also in out-patient psychotherapy on a weekly basis with my psychiatrist.

I have great hope for the future. I'm as close to eating disorder free as I think I can get. I refuse to let my eating disorder get out of control.

I went back to school and received my Master's Degree in Social Work. I am a practicing social worker and my intention is to help others fight this battle. My hopes and dreams for the future are to work with a non profit organization here in New York to help people with eating disorders get the treatment they need, even when they can't afford it.

I'm now married. I now have 2 1/2 years free of hospitalizations. Relapses happen with ED's and the media doesn't help at all...it's a never ending battle.

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Michelle Age: 27 bulimia

I am a 27 year old female who has been bulimic since I was 11.

I first learned about bulimia during a school orientation. Several of my friends and I tried it and I was the only one who liked it. I liked the fullness and sudden emptiness, the complete high feeling afterwards and also the instant relaxation that comes after throwing up.

I really was not an overweight child. I was very athletic and also never really paid much attention to my body until I began binging and purging. I did it occasionally until the age of 13. That's when I was raped by a family friend.

I then began purging without binging and anorexia. I was anorexic until I was 21. I entered the hospital at age 21 with a ruptured esophagus at 5 feet 6 inches and 100 lbs. I had maintained this weight for several years. I was insistent that I did not have an eating disorder and that I had the flu for several months. They did not believe it and called my parents.

I was out-of-state, going to college, and my mom flew to see me. She gave me an ultimatum, move home or go for treatment. I moved home. It was a mistake. I can see that now, 6 years later. But at the time, I was not ready to admit that I even had an eating disorder much less get treatment for it.

After moving home, I entered counseling for depression. I began to see that I did have an eating disorder and that was the first time I talked about the rape.

Several years later, I left home again after taking a job in my field of study. I had decreased my bulimic behavior to several times a week and also began using prescription drugs and cocaine to substitute for the relief of the bulimic behavior. I had a suicide attempt about 6 months after moving away from home. At that time, I was binging and purging approximately 15-20 times a day and wasn't working and obviously not paying my bills. Actually I wasn't doing anything but being bulimic.

I was committed to a treatment facility for several months. I just could not let go and stop purging. Then the court system forced me into drug treatment. I was told at that time that I was chronic and that I would never get better. I really did not care. I was ready to let bulimia kill me. I went to drug treatment, entered a half way house and attempted suicide again, also binging and purging many times a day and was committed to a state institution.

It was at this time that I took a serious look at my life and decided that I did not want to be bulimic anymore. I just could not seem to stop the behavior. I felt as if I was addicted. I could not maintain a healthy weight and I was severely depressed. Medication did not do much good for me because I was purging so much that it never had an opportunity to get into my system. I spent several months in this state hospital and was released. I moved back near my family with the hopes of working things out and maybe that would "cure me".

I have found that the only cure for me is to be honest about my feelings and to not "throw them up". Bulimia is a way I punish myself. I punish myself for feeling sad, happy, succeeding, failing, not being perfect and for doing a good job. I am learning that life is just one moment at a time and that often I can only say: "okay, for the next 5 minutes I will not binge or purge."

After having serious health problems several months ago with my heart and my kidneys, I faced the ultimatum, was I going to listen to my body or my eating disorder. I have chosen to listen to my body. It is hard and not always what I do. I am finding that the more I do listen to my body, the less my head tells me to binge and purge.

I think the hardest part for me is letting go of what I thought my eating disorder represented in my life: "stability, love, nurturance and acceptance". Trusting myself, and others, to find those things outside of food, and also learning to accept my body, has been very freeing.

I am not at a place where I can honestly say I love my body, but I can accept it for what it does for me and stop punishing it for what it doesn't do. My expectations today of life are: "one day at a time"; and I am finding that at the end of the day, if I slip and purge, I can forgive myself, look at why it happened and know that tomorrow is another chance for me to choose to be healthy.

I hope that one day there will be a place where people with eating disorders can go to find support, help and love for where they are at at the moment and not for where everyone thinks they should be. That was the hardest part of recovery. Today I am grateful that I have the experiences I have and I look forward to finding out what life is like when I live on life's terms and choose to do that bulimia free.

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Mary Age: 17 Anorexia

I had anorexia for about two years. It started as a weight thing. I thought I needed to lose a little weight to look better. Everyone around me and in magazines seemed to be so thin and gorgeous.

I started eating less, maybe one meal a day. Sometimes I would have snacks in between, but soon, that ended, too.

In the beginning, I weighed about 100 lbs. In a few months, I was down to 90. This didn't seem to be enough. I had to lose it quicker. So I started exercising every night, like a maniac. I did about two hundred sit-ups, a hundred leg lifts, and several other small exercises.

I also started eating even less. One day, I would eat maybe half a sandwich, then I wouldn't eat the next. I finally thought I'd reached my goal! 80lbs. But I still thought I was big. To me, though, the problem had changed from wanting to be thin, to an obsession with depriving myself of everything, mainly food.

My parents sent me to a psychiatrist, but it didn't help. So after a few weeks, I was on medication. They changed my medication four times, trying desperately to get me to eat, but nothing worked. I had slowly gone downhill. I was depressed all the time, only thinking about my weight. I was so hungry, but the guilt seemed worse than the starvation, so I continued.

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My older brother had always been my hero, but one night, he cut his wrists. He lived, but it left a very vivid picture in my head. I could just kill myself and not have to worry anymore! I tried overdosing on muscle relaxers, but was only sent to the emergency room. A month later, I, too, cut my wrists. Nothing worked.

I ended up going to a hospital for other people with my problem, depression. But when I was in the hospital, I realized that nobody else had the two problems I had, depression and anorexia. I left the hospital after a week, unchanged. The psychiatrist changed my medication again, to Prozac. At this point, I was probably 75lbs. Three weeks passed, and I was slowly eating more, about a sandwich and a half each day. I pulled my weight up to 90 again. When I weighed myself, I started crying. I relapsed and dropped back down to 80lbs.

I cried all the time. Nothing was helping me and there was no way out. Everything seemed hopeless. A voice in my head constantly monitored what I ate, or even drank.

I returned to the hospital and this time listened to everything, and tried to actually learn what was causing this problem and what I could do to get out of the nightmare I had made for myself.

Now, a few months later, I feel somewhat relieved that most of this is over. I can eat more now and only hear the voice, if I let myself. Knowing that you can eat healthy, and stay thin, makes a big difference. You don't have to starve yourself to be that way.

I weigh 105 lbs. now and I feel happy about it. Every once in awhile, the voice will try to creep back in, but I just ignore it and continue trying to stay healthy.

I'm 17, but it seems like I've been through an awful lot. Thanks for asking me to write. I hope you can use it to help anyone that might have the same problems. They have to know, they're not the only ones, that's for sure!

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Denise Age: 17 Bulimia

It all started as an obsession with diet pills, but they never worked. So I started to starve myself. When I couldn't do that anymore either, that's when I decided that I can eat all I wanted and get "rid" of it. That's bulimia in a nutshell.

It was really easy at first and I had no problem doing it until I got weak and constantly felt sick. Not to mention the sore throat. In the beginning, I was 116 pounds. I'm 5'4". Now I realize that wasn't bad at all. I got down to 98 pounds and I was even more upset when no one had noticed that I had shed a pound.

I was constantly miserable and everyone around me had noticed. I also had an obsession with laxatives. Sounds gross, but it was another way to lose weight.

In my eyes, I think I still look horrible and I will never be perfect. I'm trying my hardest to stop this and slowly I am.

To most girls it sounds so perfect, but it's not. It's disgusting and painful and I would not want anyone to go though what I have been going through for the last few months.

I know it sounds like I am an old woman preaching this to you, but I'm not. I'm 17 years old and I'm really glad that I'm taking control of my problem before it got too serious.

next: Eating Disorders: Anorexia Nervosa - The Most Deadly Mental Illness
~ eating disorders library
~ all articles on eating disorders

The intention of this page is to speak to those who may not yet be in, or who've recently begun, depression treatment.

If you're not getting treatment for depression

Let's assume, right now, that you are reading this because you are pretty sure you have depression. I doubt that a page with this title would appeal to you, otherwise. Let's also assume that you haven't looked for depression treatment yet.

Having said that, I encourage you, as strongly as I can, to get help! Call your doctor, a crisis line (a suicide-prevention line will do--even if you aren't suicidal, they can help), a clergyman, or anyone listed in the Yellow Pages as a psychologist, social worker, or psychiatrist. Any of these people will be happy to help, either by beginning your treatment, or referring you to someone who will.

I know all of the reasons why you don't think you can, or should, do this. Here are some of the thoughts you may be having about it and my responses to them:

• I don't have depression, this is just "a phase" which will pass.

If your lousy mood has gone on for more than a few weeks, it's not going to "pass" all by itself. Get help.

• All I have to do is "get my act together." I can snap out of it.

Doesn't work that way. First of all, "get your act together" is meaningless. The reason you feel as though things are out of control is the depression itself. Until you address the depression, you cannot just "snap out of it." Get help.

• I don't need a pill to make me feel better.

Anti-depressants don't "make you feel better." They simply take the edge off of the depression so that you can work your way out of it. A professional, not you, is better able to tell if medication will help. Talk to one; get help.

• But I don't want to become addicted!

Anti-depressants are non-addicting. Get help.

• Therapy won't do any good, I can always talk to my friends.

Really? Hmm. How is it that you are depressed, then, if the help you need is there when you want it? Obviously this approach doesn't work for you! Get help.

• I don't feel like going to therapy and dredging up the past.

All the more reason to go. You may be depressed because of those things you don't want to talk about. Get help.

• If people find out I'm depressed, they'll think I'm nuts.

OK, I won't lie to you here. Depression carries a stigma in our culture. There will be people whose opinions of you may change if they hear you have depression. However, are those the type of people you really want to have around you? Of course not--they are ignoramuses. Besides, getting help doesn't mean everyone has to know you are depressed. Even if some people think you are "nuts," this is nothing compared to the depression. Get help.

• It won't work for me.

That's the depression talking. Tell it to "shut up" by getting help.

• I deserve this, I ought to suffer, I shouldn't get rid of it.

I've heard the "punishment from God" stuff before, and believe me, it just isn't so. The God most people worship doesn't want people to suffer. He wants them to be happy. Get help.

• I've heard it takes a long time to get better and I'm at the end of my rope, now; I can't wait.

I won't lie about this either. It will take a few weeks for you to feel noticeably better. But at least you know you're getting somewhere. Sitting around moping certainly isn't any better than trying treatment. Get help.

The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week. Or for a crisis center in your area, go here.

next: What To Do If You Are Suicidal
~ back to Living with Depression homepage
~ depression library articles
~ all articles on depression

"Some people find fault like there's a reward for it."
- Zig Ziglar

Self acceptance is being loving and happy with who you are NOW. Some call it self-esteem, others self-love, but whatever you call it, you'll know when your accepting yourself cause it feels great. Its an agreement with yourself to appreciate, validate, accept and support who you are at this very moment, even those parts you'd like to eventually change. This is important...even those parts you'd eventually like to change. Yes, you can accept (be okay with) those parts of yourself you want to change some day.

The Motivation Behind Your Lack of Acceptance

If acceptance feels so good and is so good for us, then why don't we accept ourselves? The answer is motivation. We use our lack of acceptance (punishment - cause it feels bad) as motivation to get us to do, not do, be, and not be what we think we should. Many people believe that if they accepted themselves as they are, they wouldn't change or that they wouldn't work on becoming more of who they want to be.

Typically, we judge ourselves unfavorably with the hope it will motivate us to change. We hope if we feel bad enough about ourselves, that maybe that will motivate us to change. Does this work? Sometimes, but only short term. Most times all it does is cause us to feel bad which saps the energy you might have used to make changes. It can be a vicious cycle. It works exactly counter to what you wanted to do.

"Acceptance allows change. The 'acceptance mode' includes everything, even my judgments. It allows me to be okay now, even before I reach my goals."

"When you begin to accept yourself the way you are right now, you begin a new life with new possibilities that did not exist before because you were so caught up in the struggle against reality that that was all you could do."

- Traveling Free, Mandy Evans

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So if it doesn't work, why do we keep doing it? Because we hope it will work. And if you don't know any other way to change, what options do you have? We've been trained to believe that in order to change, we need to first feel bad about it. That if we're accepting and loving of that particular quality, that we won't do anything to change the situation, which is not true! You don't have to be unhappy with yourself to know and actively change those things you'd like to change about yourself. Acceptance is actually the very first step in the process of change. For more about this, see "an interview about acceptance"

Think of acceptance of yourself like being okay with where you live now. You may want a bigger house one day. You may dream about that new home. But there ARE advantages to living in a smaller home if you only took the time to think about it. It is possible to be happy with the home you're in now, while still dreaming and working to make your new home a reality.

Process Of Acceptance

Acceptance exists at the core of your being. It is your default status. In order to reach this base level of acceptance, you need only remove the items laying on top. To do this, you must first identify all the things you do not accept about yourself. Then, one by one, eliminate them by examinging and questioning your beliefs around that issue.

• Know yourself and your beliefs
• Take a good hard look at your honesty level
• Know you are doing the best you can
• Relax your value judgments
• Examine guilt
• Understand your motivations
• Ask yourself questions about what you don't accept

next: Society and Acceptance

If you are feeling depressed or suicidal, here is a list of sites that provide contact information for depression and suicide crisis centers and hotlines in your area.

• National Suicide Prevention Hotline
  1-800-273-TALK (1-800-273-8255)
  For U.S.

• National Hopeline Network
  (1-800-SUICIDE, 1-800-784-2433)
  For U.S., Canada, UK, Singapore

• Befrienders International
  Crisis Lines
  41 countries worldwide

next: Conversation Techniques
~ back to Apocalypse Suicide homepage
~ depression library articles
~ all articles on depression

Learn about the dietary supplement folate and signs and symptoms of folate deficiency.

Table of Contents

• Folate: What is it?
• What foods provide folate?
• What are the Dietary Reference Intakes for folate?
• When can folate deficiency occur?
• What are some common signs and symptoms of folate deficiency?
• Do women of childbearing age and pregnant women have a special need for folate?
• Who else may need extra folic acid to prevent a deficiency?
• What are some current issues and controversies about folate?
• Caution About Folic Acid Supplements
• What is the health risk of too much folic acid?
• Selecting a healthful diet
• References
• Reviewers

Folate: What is it?

Folate is a water-soluble B vitamin that occurs naturally in food. Folic acid is the synthetic form of folate that is found in supplements and added to fortified foods [1].

Folate gets its name from the Latin word "folium" for leaf. A key observation of researcher Lucy Wills nearly 70 years ago led to the identification of folate as the nutrient needed to prevent the anemia of pregnancy. Dr. Wills demonstrated that the anemia could be corrected by a yeast extract. Folate was identified as the corrective substance in yeast extract in the late 1930s, and was extracted from spinach leaves in 1941.

Folate helps produce and maintain new cells [2]. This is especially important during periods of rapid cell division and growth such as infancy and pregnancy. Folate is needed to make DNA and RNA, the building blocks of cells. It also helps prevent changes to DNA that may lead to cancer [HealthyPlace.com Mental Health Communities]. Both adults and children need folate to make normal red blood cells and prevent anemia [4]. Folate is also essential for the metabolism of homocysteine, and helps maintain normal levels of this amino acid.

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What foods provide folate?

Leafy green vegetables (like spinach and turnip greens), fruits (like citrus fruits and juices), and dried beans and peas are all natural sources of folate [5].

In 1996, the Food and Drug Administration (FDA) published regulations requiring the addition of folic acid to enriched breads, cereals, flours, corn meals, pastas, rice, and other grain products [6-9]. Since cereals and grains are widely consumed in the U.S., these products have become a very important contributor of folic acid to the American diet. The following table suggests a variety of dietary sources of folate.

References

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Table 1: Selected Food Sources of Folate and Folic Acid [5]

Food	Micrograms (μg)	% DV^
*Breakfast cereals fortified with 100% of the DV, ¾ cup	400	100
Beef liver, cooked, braised, 3 ounces	185	45
Cowpeas (blackeyes), immature, cooked, boiled, ½ cup	105	25
*Breakfast cereals, fortified with 25% of the DV, ¾ cup	100	25
Spinach, frozen, cooked, boiled, ½ cup	100	25
Great Northern beans, boiled, ½ cup	90	20
Asparagus, boiled, 4 spears	85	20
*Rice, white, long-grain, parboiled, enriched, cooked, ½ cup	65	15
Vegetarian baked beans, canned, 1 cup	60	15
Spinach, raw, 1 cup	60	15
Green peas, frozen, boiled, ½ cup	50	15
Broccoli, chopped, frozen, cooked, ½ cup	50	15
*Egg noodles, cooked, enriched, ½ cup	50	15
Broccoli, raw, 2 spears (each 5 inches long)	45	10
Avocado, raw, all varieties, sliced, ½ cup sliced	45	10
Peanuts, all types, dry roasted, 1 ounce	40	10
Lettuce, Romaine, shredded, ½ cup	40	10
Wheat germ, crude, 2 Tablespoons	40	10
Tomato Juice, canned, 6 ounces	35	10
Orange juice, chilled, includes concentrate, ¾ cup	35	10
Turnip greens, frozen, cooked, boiled, ½ cup	30	8
Orange, all commercial varieties, fresh, 1 small	30	8
*Bread, white, 1 slice	25	6
*Bread, whole wheat, 1 slice	25	6
Egg, whole, raw, fresh, 1 large	25	6
Cantaloupe, raw, ¼ medium	25	6
Papaya, raw, ½ cup cubes	25	6
Banana, raw, 1 medium	20	6

* Items marked with an asterisk (*) are fortified with folic acid as part of the Folate Fortification Program.

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^ DV = Daily Value. DVs are reference numbers developed by the Food and Drug Administration (FDA) to help consumers determine if a food contains a lot or a little of a specific nutrient. The DV for folate is 400 micrograms (μg). Most food labels do not list a food's magnesium content. The percent DV (%DV) listed on the table indicates the percentage of the DV provided in one serving. A food providing 5% of the DV or less is a low source while a food that provides 10-19% of the DV is a good source. A food that provides 20% or more of the DV is high in that nutrient. It is important to remember that foods that provide lower percentages of the DV also contribute to a healthful diet. For foods not listed in this table, please refer to the U.S. Department of Agriculture's Nutrient Database Web site: http://www.nal.usda.gov/fnic/cgi-bin/nut_search.pl.

References

 

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What are the Dietary Reference Intakes for folate?

Recommendations for folate are given in the Dietary Reference Intakes (DRIs) developed by the Institute of Medicine of the National Academy of Sciences [10]. Dietary Reference Intakes is the general term for a set of reference values used for planning and assessing nutrient intake for healthy people. Three important types of reference values included in the DRIs are Recommended Dietary Allowances (RDA), Adequate Intakes (AI), and Tolerable Upper Intake Levels (UL). The RDA recommends the average daily intake that is sufficient to meet the nutrient requirements of nearly all (97-98%) healthy individuals in each age and gender group [10]. An AI is set when there is insufficient scientific data available to establish a RDA. AIs meet or exceed the amount needed to maintain a nutritional state of adequacy in nearly all members of a specific age and gender group. The UL, on the other hand, is the maximum daily intake unlikely to result in adverse health effects [10].

The RDAs for folate are expressed in a term called the Dietary Folate Equivalent. The Dietary Folate Equivalent (DFE) was developed to help account for the differences in absorption of naturally occurring dietary folate and the more bioavailable synthetic folic acid [10]. Table 2 lists the RDAs for folate, expressed in micrograms (μg) of DFE, for children and adults [10].

Table 2: Recommended Dietary Allowances for Folate for Children and Adults [10]

Age (years)	Males and Females (μg/day)	Pregnancy (μg/day)	Lactation (μg/day)
1-3	150	N/A	N/A
4-8	200	N/A	N/A
9-13	300	N/A	N/A
14-18	400	600	500
19+	400	600	500

*1 DFE = 1 μg food folate = 0.6 μg folic acid from supplements and fortified foods

There is insufficient information on folate to establish an RDA for infants. An Adequate Intake (AI) has been established that is based on the amount of folate consumed by healthy infants who are fed breast milk [10]. Table 3 lists the Adequate Intake for folate, in micrograms (μg), for infants.

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Table 3: Adequate Intake for folate for infants [10]

Age (years)	Males and Females (μg/day)	Pregnancy (μg/day)	Lactation (μg/day)
1-3	150	N/A	N/A
4-8	200	N/A	N/A
9-13	300	N/A	N/A
14-18	400	600	500
19+	400	600	500

The National Health and Nutrition Examination Survey (NHANES III 1988-94) and the Continuing Survey of Food Intakes by Individuals (1994-96 CSFII) indicated that most individuals surveyed did not consume adequate folate [12-13]. However, the folic acid fortification program, which was initiated in 1998, has increased folic acid content of commonly eaten foods such as cereals and grains, and as a result most diets in the United States (US) now provide recommended amounts of folate equivalents [14].

When can folate deficiency occur?

A deficiency of folate can occur when an increased need for folate is not matched by an increased intake, when dietary folate intake does not meet recommended needs, and when folate excretion increases. Medications that interfere with the metabolism of folate may also increase the need for this vitamin and risk of deficiency [1,15-19].

Medical conditions that increase the need for folate or result in increased excretion of folate include:

• pregnancy and lactation (breastfeeding)
• alcohol abuse
• malabsorption
• kidney dialysis
• liver disease
• certain anemias

References

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Medications that interfere with folate utilization include:

• anti-convulsant medications (such as dilantin, phenytoin and primidone)
• metformin (sometimes prescribed to control blood sugar in type 2 diabetes)
• sulfasalazine (used to control inflammation associated with Crohn's disease and ulcerative colitis)
• triamterene (a diuretic)
• methotrexate (used for cancer and other diseases such as rheumatoid arthritis)
• barbiturates (used as sedatives)

What are some common signs and symptoms of folate deficiency?

• Folate deficient women who become pregnant are at greater risk of giving birth to low birth weight, premature, and/or infants with neural tube defects.
• In infants and children, folate deficiency can slow overall growth rate.
• In adults, a particular type of anemia can result from long term folate deficiency.
• Other signs of folate deficiency are often subtle. Digestive disorders such as diarrhea, loss of appetite, and weight loss can occur, as can weakness, sore tongue, headaches, heart palpitations, irritability, forgetfulness, and behavioral disorders [1,20]. An elevated level of homocysteine in the blood, a risk factor for cardiovascular disease, also can result from folate deficiency.

Many of these subtle symptoms are general and can also result from a variety of medical conditions other than folate deficiency. It is important to have a physician evaluate these symptoms so that appropriate medical care can be given.

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Do women of childbearing age and pregnant women have a special need for folate?

Folic acid is very important for all women who may become pregnant. Adequate folate intake during the periconceptual period, the time just before and just after a woman becomes pregnant, protects against neural tube defects [21]. Neural tube defects result in malformations of the spine (spina bifida), skull, and brain (anencephaly) [10]. The risk of neural tube defects is significantly reduced when supplemental folic acid is consumed in addition to a healthful diet prior to and during the first month following conception [10,22-23]. Since January 1, 1998, when the folate food fortification program took effect, data suggest that there has been a significant reduction in neural tube birth defects [24]. Women who could become pregnant are advised to eat foods fortified with folic acid or take a folic acid supplement in addition to eating folate-rich foods to reduce the risk of some serious birth defects. For this population, researchers recommend a daily intake of 400 μg of synthetic folic acid per day from fortified foods and/or dietary supplements [10].

Who else may need extra folic acid to prevent a deficiency?

People who abuse alcohol, those taking medications that may interfere with the action of folate (including, but not limited to those listed above), individuals diagnosed with anemia from folate deficiency, and those with malabsorption, liver disease, or who are receiving kidney dialysis treatment may benefit from a folic acid supplement.

Folate deficiency has been observed in alcoholics. A 1997 review of the nutritional status of chronic alcoholics found low folate status in more than 50% of those surveyed [25]. Alcohol interferes with the absorption of folate and increases excretion of folate by the kidney. In addition, many people who abuse alcohol have poor quality diets that do not provide the recommended intake of folate [17]. Increasing folate intake through diet, or folic acid intake through fortified foods or supplements, may be beneficial to the health of alcoholics.

Anti-convulsant medications such as dilantin increase the need for folate [26-27]. Anyone taking anti-convulsants and other medications that interfere with the body's ability to use folate should consult with a medical doctor about the need to take a folic acid supplement [28-30].

Anemia is a condition that occurs when there is insufficient hemoglobin in red blood cells to carry enough oxygen to cells and tissues. It can result from a wide variety of medical problems, including folate deficiency. With folate deficiency, your body may make large red blood cells that do not contain adequate hemoglobin, the substance in red blood cells that carries oxygen to your body's cells [4]. Your physician can determine whether an anemia is associated with folate deficiency and whether supplemental folic acid is indicated.

Several medical conditions increase the risk of folic acid deficiency. Liver disease and kidney dialysis increase excretion (loss) of folic acid. Malabsorption can prevent your body from using folate in food. Medical doctors treating individuals with these disorders will evaluate the need for a folic acid supplement [1].

References

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What are some current issues and controversies about folate?

Folic Acid and Cardiovascular Disease
Cardiovascular disease involves any disorder of the heart and blood vessels that make up the cardiovascular system. Coronary heart disease occurs when blood vessels which supply the heart become clogged or blocked, increasing the risk of a heart attack. Vascular damage can also occur to blood vessels supplying the brain, and can result in a stroke.

Cardiovascular disease is the most common cause of death in industrialized countries such as the US, and is on the rise in developing countries. The National Heart, Lung, and Blood Institute of the National Institutes of Health has identified many risk factors for cardiovascular disease, including an elevated LDL-cholesterol level, high blood pressure, a low HDL-cholesterol level, obesity, and diabetes [31]. In recent years, researchers have identified another risk factor for cardiovascular disease, an elevated homocysteine level. Homocysteine is an amino acid normally found in blood, but elevated levels have been linked with coronary heart disease and stroke [32-44]. Elevated homocysteine levels may impair endothelial vasomotor function, which determines how easily blood flows through blood vessels [45]. High levels of homocysteine also may damage coronary arteries and make it easier for blood clotting cells called platelets to clump together and form a clot, which may lead to a heart attack [38].

A deficiency of folate, vitamin B12 or vitamin B6 may increase blood levels of homocysteine, and folate supplementation has been shown to decrease homocysteine levels and to improve endothelial function [46-48]. At least one study has linked low dietary folate intake with an increased risk of coronary events [49]. The folic acid fortification program in the U. S. has decreased the prevalence of low levels of folate and high levels of homocysteine in the blood in middle-aged and older adults [50]. Daily consumption of folic-acid fortified breakfast cereal and the use of folic acid supplements has been shown to be an effective strategy for reducing homocysteine concentrations [51].

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Evidence supports a role for supplemental folic acid for lowering homocysteine levels, however this does not mean that folic acid supplements will decrease the risk of cardiovascular disease. Clinical intervention trials are underway to determine whether supplementation with folic acid, vitamin B12, and vitamin B6 can lower risk of coronary heart disease. It is premature to recommend folic acid supplementation for the prevention of heart disease until results of ongoing randomized, controlled clinical trials positively link increased folic acid intake with decreased homocysteine levels AND decreased risk of cardiovascular disease.

Folic Acid and Cancer
Some evidence associates low blood levels of folate with a greater risk of cancer [52]. Folate is involved in the synthesis, repair, and function of DNA, our genetic map, and there is some evidence that a deficiency of folate can cause damage to DNA that may lead to cancer [52]. Several studies have associated diets low in folate with increased risk of breast, pancreatic, and colon cancer [53-54]. Over 88,000 women enrolled in the Nurses' Health Study who were free of cancer in 1980 were followed from 1980 through 1994. Researchers found that women ages 55 to 69 years in this study who took multivitamins containing folic acid for more than 15 years had a markedly lower risk of developing colon cancer [54]. Findings from over 14,000 subjects followed for 20 years suggest that men who do not consume alcohol and whose diets provide the recommended intake of folate are less likely to develop colon cancer [55]. However, associations between diet and disease do not indicate a direct cause. Researchers are continuing to investigate whether enhanced folate intake from foods or folic acid supplements may reduce the risk of cancer. Until results from such clinical trials are available, folic acid supplements should not be recommended to reduce the risk of cancer.

Folic Acid and Methotrexate for Cancer
Folate is important for cells and tissues that rapidly divide [2]. Cancer cells divide rapidly, and drugs that interfere with folate metabolism are used to treat cancer. Methotrexate is a drug often used to treat cancer because it limits the activity of enzymes that need folate.

Unfortunately, methotrexate can be toxic, producing side effects such as inflammation in the digestive tract that may make it difficult to eat normally [56-58]. Leucovorin is a form of folate that can help "rescue" or reverse the toxic effects of methotrexate [59]. There are many studies underway to determine if folic acid supplements can help control the side effects of methotrexate without decreasing its effectiveness in chemotherapy [60-61]. It is important for anyone receiving methotrexate to follow a medical doctor's advice on the use of folic acid supplements.

Folic Acid and Methotrexate for Non-Cancerous Diseases
Low dose methotrexate is used to treat a wide variety of non-cancerous diseases such as rheumatoid arthritis, lupus, psoriasis, asthma, sarcoidoisis, primary biliary cirrhosis, and inflammatory bowel disease [62]. Low doses of methotrexate can deplete folate stores and cause side effects that are similar to folate deficiency. Both high folate diets and supplemental folic acid may help reduce the toxic side effects of low dose methotrexate without decreasing its effectiveness [63-64]. Anyone taking low dose methotrexate for the health problems listed above should consult with a physician about the need for a folic acid supplement.

References

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Caution About Folic Acid Supplements

Beware of the interaction between vitamin B12 and folic acid Intake of supplemental folic acid should not exceed 1,000 micrograms (μg) per day to prevent folic acid from triggering symptoms of vitamin B12 deficiency [10]. Folic acid supplements can correct the anemia associated with vitamin B12 deficiency. Unfortunately, folic acid will not correct changes in the nervous system that result from vitamin B12 deficiency. Permanent nerve damage can occur if vitamin B12 deficiency is not treated.

It is very important for older adults to be aware of the relationship between folic acid and vitamin B12 because they are at greater risk of having a vitamin B12 deficiency. If you are 50 years of age or older, ask your physician to check your B12 status before you take a supplement that contains folic acid. If you are taking a supplement containing folic acid, read the label to make sure it also contains B12 or speak with a physician about the need for a B12 supplement.

What is the health risk of too much folic acid?

Folate intake from food is not associated with any health risk. The risk of toxicity from folic acid intake from supplements and/or fortified foods is also low [65]. It is a water soluble vitamin, so any excess intake is usually excreted in urine. There is some evidence that high levels of folic acid can provoke seizures in patients taking anti-convulsant medications [1]. Anyone taking such medications should consult with a medical doctor before taking a folic acid supplement.

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The Institute of Medicine has established a tolerable upper intake level (UL) for folate from fortified foods or supplements (i.e. folic acid) for ages one and above. Intakes above this level increase the risk of adverse health effects. In adults, supplemental folic acid should not exceed the UL to prevent folic acid from triggering symptoms of vitamin B12 deficiency [10]. It is important to recognize that the UL refers to the amount of synthetic folate (i.e. folic acid) being consumed per day from fortified foods and/or supplements. There is no health risk, and no UL, for natural sources of folate found in food. Table 4 lists the Upper Intake Levels (UL) for folate, in micrograms (μg), for children and adults.

Table 4: Tolerable Upper Intake Levels for Folate for Children and Adults [10]

Age (years)	Males and Females (μg/day)	Pregnancy (μg/day)	Lactation (μg/day)
1-3	300	N/A	N/A
4-8	400	N/A	N/A
9-13	600	N/A	N/A
14-18	800	800	800
19 +	1000	1000	1000

Selecting a healthful diet

As the 2000 Dietary Guidelines for Americans states, "Different foods contain different nutrients and other healthful substances. No single food can supply all the nutrients in the amounts you need" [66]. As indicated in Table 1, green leafy vegetables, dried beans and peas, and many other types of vegetables and fruits provide folate. In addition, fortified foods are a major source of folic acid. It is not unusual to find foods such as some ready-to-eat cereals fortified with 100% of the RDA for folate. The variety of fortified foods available has made it easier for women of childbearing age in the US to consume the recommended 400 mcg of folic acid per day from fortified foods and/or supplements [6]. The large numbers of fortified foods on the market, however, also raises the risk of exceeding the UL. This is especially important for anyone at risk of vitamin B12 deficiency, which can be triggered by too much folic acid. It is important for anyone who is considering taking a folic acid supplement to first consider whether their diet already includes adequate sources of dietary folate and fortified food sources of folic acid.

Source: Office of Dietary Supplements, National Institutes of Health

next: Botanical Dietary Supplements: Background Information

References

• 1 Herbert V. Folic Acid. In: Shils M, Olson J, Shike M, Ross AC, ed. Nutrition in Health and Disease. Baltimore: Williams & Wilkins, 1999.
• 2 Kamen B. Folate and antifolate pharmacology. Semin Oncol 1997;24:S18-30-S18-39. [PubMed abstract]
• 3 Fenech M, Aitken C, Rinaldi J. Folate, vitamin B12, homocysteine status and DNA damage in young Australian adults. Carcinogenesis 1998;19:1163-71. [PubMed abstract]
• 4 Zittoun J. Anemias due to disorder of folate, vitamin B12 and transcobalamin metabolism. Rev Prat 1993;43:1358-63. [PubMed abstract]
• 5 U.S. Department of Agriculture, Agricultural Research Service. 2003. USDA National Nutrient Database for Standard Reference, Release 16. Nutrient Data Laboratory Home Page, http://www.nal.usda.gov/fnic/cgi-bin/nut_search.pll
• 6 Oakley GP, Jr., Adams MJ, Dickinson CM. More folic acid for everyone, now. J Nutr 1996;126:751S-755S. [PubMed abstract]
• 7 Malinow MR, Duell PB, Hess DL, Anderson PH, Kruger WD, Phillipson BE, Gluckman RA, Upson BM. Reduction of plasma homocyst(e)ine levels by breakfast cereal fortified with folic acid in patients with coronary heart disease. N Engl J Med 1998;338:1009-15. [PubMed abstract]
• 8 Daly S, Mills JL, Molloy AM, Conley M, Lee YJ, Kirke PN, Weir DG, Scott JM. Minimum effective dose of folic acid for food fortification to prevent neural-tube defects. Lancet 1997;350:1666-9. [PubMed abstract]
• 9 Crandall BF, Corson VL, Evans MI, Goldberg JD, Knight G, Salafsky IS. American College of Medical Genetics statement on folic acid: Fortification and supplementation. Am J Med Genet 1998;78:381. [PubMed abstract]
• 10 Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. National Academy Press. Washington, DC, 1998.
• 11 Suitor CW and Bailey LB. Dietary folate equivalents: Interpretation and application. J Am Diet Assoc 2000;100:88-94. [PubMed abstract]
• 12 Raiten DJ and Fisher KD. Assessment of folate methodology used in the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). J Nutr 1995;125:1371S-98S. [PubMed abstract]
• 13 Bialostosky K, Wright JD, Kennedy-Stephenson J, McDowell M, Johnson CL. Dietary intake of macronutrients, micronutrients and other dietary constituents: United States 1988-94. Vital Heath Stat. 11(245) ed: National Center for Health Statistics, 2002:168.
• 14 Lewis CJ, Crane NT, Wilson DB, Yetley EA. Estimated folate intakes: Data updated to reflect food fortification, increased bioavailability, and dietary supplement use. Am J Clin Nutr 1999;70:198-207. [PubMed abstract]
• 15 McNulty H. Folate requirements for health in different population groups. Br J Biomed Sci 1995;52:110-9. [PubMed abstract]
• 16 Stolzenberg R. Possible folate deficiency with postsurgical infection. Nutr Clin Pract 1994;9:247-50. [PubMed abstract]
• 17 Cravo ML, Gloria LM, Selhub J, Nadeau MR, Camilo ME, Resende MP, Cardoso JN, Leitao CN, Mira FC. Hyperhomocysteinemia in chronic alcoholism: Correlation with folate, vitamin B-12, and vitamin B-6 status. Am J Clin Nutr 1996;63:220-4. [PubMed abstract]
• 18 Pietrzik KF and Thorand B. Folate economy in pregnancy. Nutrition 1997;13:975-7. [PubMed abstract]
• 19 Kelly GS. Folates: Supplemental forms and therapeutic applications. Altern Med Rev 1998;3:208-20. [PubMed abstract]
• 20 Haslam N and Probert CS. An audit of the investigation and treatment of folic acid deficiency. J R Soc Med 1998;91:72-3. [PubMed abstract]
• 21 Shaw GM, Schaffer D, Velie EM, Morland K, Harris JA. Periconceptional vitamin use, dietary folate, and the occurrence of neural tube defects. Epidemiology 1995;6:219-26. [PubMed abstract]
• 22 Mulinare J, Cordero JF, Erickson JD, Berry RJ. Periconceptional use of multivitamins and the occurrence of neural tube defects. J Am Med Assoc 1988;260:3141-5. [PubMed abstract]
• 23 Milunsky A, Jick H, Jick SS, Bruell CL, MacLaughlin DS, Rothman KJ, Willett W. Multivitamin/folic acid supplementation in early pregnancy reduces the prevalence of neural tube defects. J Am Med Assoc 1989;262:2847-52. [PubMed abstract]
• 24 MA, Paulozzi LJ, Mathews TJ, Erickson JD, Wong LC. Impact of folic acid fortification on the US food supply on the occurrence of neural tube defects. J Am Med Assoc 2001;285:2981-6.
• 25 Gloria L, Cravo M, Camilo ME, Resende M, Cardoso JN, Oliveira AG, Leitao CN, Mira FC. Nutritional deficiencies in chronic alcoholics: Relation to dietary intake and alcohol consumption. Am J Gastroenterol 1997;92:485-9. [PubMed abstract]
• 26 Collins CS, Bailey LB, Hillier S, Cerda JJ, Wilder BJ. Red blood cell uptake of supplemental folate in patients on anticonvulsant drug therapy. Am J Clin Nutr 1988;48:1445-50. [PubMed abstract]
• 27 Young SN and Ghadirian AM. Folic acid and psychopathology. Prog Neuropsychopharmacol Biol Psychiat 1989;13:841-63. [PubMed abstract]
• 28 Munoz-Garcia D, Del Ser T, Bermejo F, Portera A. Truncal ataxia in chronic anticonvulsant treatment. Association with drug-induced folate deficiency. J Neurol Sci 1982;55:305-11. [PubMed abstract]
• 29 Eller DP, Patterson CA, Webb GW. Maternal and fetal implications of anticonvulsive therapy during pregnancy. Obstet Gynecol Clin North Am 1997;24:523-34. [PubMed abstract]
• 30 Baggott JE, Morgan SL, HaT, Vaughn WH, Hine RJ. Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs. Biochem 1992;282:197-202. [PubMed abstract]
• 31 Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). National Cholesterol Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health, September 2002. NIH Publication No. 02-5215.
• 32 Selhub J, Jacques PF, Bostom AG, D'Agostino RB, Wilson PW, Belanger AJ, O'Leary DH, Wolf PA, Scaefer EJ, Rosenberg IH. Association between plasma homocysteine concentrations and extracranial carotid-artery stenosis. N Engl J Med 1995;332:286-91. [PubMed abstract]
• 33 Rimm EB, Willett WC, Hu FB, Sampson L, Colditz GA, Manson JE, Hennekens C, Stampfer MJ. Folate and vitamin B6 from diet and supplements in relation to risk of coronary heart disease among women. J Am Med Assoc 1998;279:359-64. [PubMed abstract]
• 34 Refsum H, Ueland PM, Nygard O, Vollset SE. Homocysteine and cardiovascular disease. Annu Rev Med 1998;49:31-62. [PubMed abstract]
• 35 Boers GH. Hyperhomocysteinaemia: A newly recognized risk factor for vascular disease. Neth J Med 1994;45:34-41. [PubMed abstract]
• 36 Selhub J, Jacque PF, Wilson PF, Rush D, Rosenberg IH. Vitamin status and intake as primary determinants of homocysteinemia in an elderly population. J Am Med Assoc 1993;270:2693-98. [PubMed abstract]
• 37 Mayer EL, Jacobsen DW, Robinson K. Homocysteine and coronary atherosclerosis. J Am Coll Cardiol 1996;27:517-27. [PubMed abstract]
• 38 Malinow MR. Plasma homocyst(e)ine and arterial occlusive diseases: A mini-review. Clin Chem 1995;41:173-6. [PubMed abstract]
• 39 Flynn MA, Herbert V, Nolph GB, Krause G. Atherogenesis and the homocysteine-folate-cobalamin triad: Do we need standardized analyses? J Am Coll Nutr 1997;16:258-67. [PubMed abstract]
• 40 Fortin LJ and Genest J, Jr. Measurement of homocyst(e)ine in the prediction of arteriosclerosis. Clin Biochem 1995;28:155-62. [PubMed abstract]
• 41 Siri PW, Verhoef P, Kok FJ. Vitamins B6, B12, and folate: Association with plasma total homocysteine and risk of coronary atherosclerosis. J Am Coll Nutr 1998;17:435-41. [PubMed abstract]
• 42 Eskes TK. Open or closed? A world of difference: A history of homocysteine research. Nutr Rev 1998;56:236-44. [PubMed abstract]
• 43 Ubbink JB, van der Merwe A, Delport R, Allen RH, Stabler SP, Riezler R, Vermaak WJ. The effect of a subnormal vitamin B-6 status on homocysteine metabolism. J Clin Invest 1996;98:177-84. [PubMed abstract]
• 44 Bostom AG, Rosenberg IH, Silbershatz H, Jacques PF, Selhub J, D'Agostino RB, Wilson PW, Wolf PA. Nonfasting plasma total homocysteine levels and stroke incidence in elderly persons: the framingham study. Ann Intern Med 1999; 352-5.
• 45 Stanger O, Semmelrock HJ, Wonisch W, Bos U, Pabst E, Wascher TC. Effects of folate treatment and homocysteine lowering on resistance vessel reactivity in atherosclerotic subjects. J Pharmacol Exp Ther 2002: 303:158-62.
• 46 Doshi SN, McDowell IF, Moat SJ, Payne N, Durrant HJ, Lewis MJ, Goodfellos J. Folic acid improves endothelial function in coronary artery disease via mechanisms largely independent of homocysteine. Circulation. 2002;105:22-6.
• 47 Doshi SN, McDowell IFW, Moat SJ, Lang D, Newcombe RG, Kredean MB, Lewis MJ, Goodfellow J. Folate improves endothelial function in coronary artery disease. Arterioscler Thromb Vasc Biol 2001;21:1196-1202.
• 48 Wald DS, Bishop L, Wald NJ, Law M, Hennessy E, Weir D, McPartlin J, Scott J. Randomized trial of folic acid supplementation and serum homocysteine levels. Arch Intern Med 2001;161:695-700.Homocysteine
• 49 Voutilainen S, Rissanen TH, Virtanen J, Lakka TA, Salonen JT. Low dietary folate intake is associated with an excess incidence of acute coronary events: The kuopio ischemic heart disease risk factor study. Circulation 2001;103:2674-80.
• 50 Lowering Trialists' Collaboration. Lowering blood homocysteine with folic acid based supplements. Meta-analysis of randomized trials. Br. Med. J 1998;316:894-8.
• 51 Schnyder, G., Roffi M, Pin R, Flammer Y, Lange H, Eberli FR, Meier B, Turi ZG, Hess OM., Decreased rate of coronary restenosis after lowering of plasma homocystein levels. N Eng J Med 2001;345:1593-60.
• 52 Jennings E. Folic acid as a cancer preventing agent. Med Hypothesis 1995;45:297-303.
• 53 Freudenheim JL, Grahm S, Marshall JR, Haughey BP, Cholewinski S, Wilkinson G. Folate intake and carcinogenesis of the colon and rectum. Int J Epidemiol 1991;20:368-74.
• 54 Giovannucci E, Stampfer MJ, Colditz GA, Hunter DJ, Fuchs C, Rosner BA, Speizer FE, Willett WC. Multivitamin use, folate, and colon cancer in women in the Nurses' Health Study. Ann Intern Med 1998;129:517-24. [PubMed abstract]
• 55 Su LJ, Arab L. Nutritional status of folate and colon cancer risk: evidence from NHANES I epidemiologic follow-up study. Ann Epidemiol 2001;11:65-72.
• 56 Rubio IT, Cao Y, Hutchins LF, Westbrook KC, Klimberg VS. Effect of glutamine on methotrexate efficacy and toxicity. Ann Surg 1998;227:772-8. [PubMed abstract]
• 57 Wolff JE, Hauch H, Kuhl J, Egeler RM, Jurgens H. Dexamethasone increases hepatotoxicity of MTX in children with brain tumors. Anticancer Res 1998;18:2895-9. [PubMed abstract]
• 58 Kepka L, De Lassence A, Ribrag V, Gachot B, Blot F, Theodore C, Bonnay M, Korenbaum C, Nitenberg G. Successful rescue in a patient with high dose methotrexate-induced nephrotoxicity and acute renal failure. Leuk Lymphoma 1998;29:205-9. [PubMed abstract]
• 59 Branda RF, Nigels E, Lafayette AR, Hacker M. Nutritional folate status influences the efficacy and toxicity of chemotherapy in rats. Blood 1998;92:2471-6. [PubMed abstract]
• 60 Shiroky JB. The use of folates concomitantly with low-dose pulse methotrexate. Rheum Dis Clin North Am 1997;23:969-80. [PubMed abstract]
• 61 Keshava C, Keshava N, Whong WZ, Nath J, Ong TM. Inhibition of methotrexate-induced chromosomal damage by folinic acid in V79 cells. Mutat Res 1998;397:221-8. [PubMed abstract]
• 62 Morgan SL and Baggott JE. Folate antagonists in nonneoplastic disease: Proposed mechanisms of efficacy and toxicity. In: Bailey LB, ed. Folate in Health and Disease. New York: Marcel Dekker, 1995:405-33.
• 63 Morgan SL BJ, Alarcon GS. Methotrexate in rheumatoid arthritis. Folate supplementation should always be given. Bio Drugs 1997;8:164-75.
• 64 Morgan SL, Baggott JE, Lee JY, Alarcon GS. Folic acid supplementation prevents deficient blood folate levels and hyperhomocysteinemia during longterm, low dose methotrexate therapy for rheumatoid arthritis: Implications for cardiovascular disease prevention. J Rheumatol 1998;25:441-6. [PubMed abstract]
• 65 Hathcock JN. Vitamins and minerals: Efficacy and safety. Am J Clin Nutr 1997;66:427-37.
• 66 Dietary Guidelines Advisory Committee, Agricultural Research Service, United States Department of Agriculture (USDA). HG Bulletin No. 232, 2000. http://www.usda.gov/cnpp/DietGd.pdf.
• 67 Center for Nutrition Policy and Promotion, United Stated Department of Agriculture. Food Guide Pyramid, 1992 (slightly revised 1996). http://www.nal.usda.gov/fnic/Fpyr/pyramid.html.

For more information about building a healthful diet, refer to the Dietary Guidelines for Americans http://www.usda.gov/cnpp/DietGd.pdf  and the US Department of Agriculture's Food Guide Pyramid http://www.nal.usda.gov/fnic/Fpyr/pyramid.html.

Disclaimer

Reasonable care has been taken in preparing this document and the information provided herein is believed to be accurate. However, this information is not intended to constitute an "authoritative statement" under Food and Drug Administration rules and regulations.

General Safety Advisory

The information in this document does not replace medical advice. Before taking an herb or a botanical, consult a doctor or other health care provider-especially if you have a disease or medical condition, take any medications, are pregnant or nursing, or are planning to have an operation. Before treating a child with an herb or a botanical, consult with a doctor or other health care provider. Like drugs, herbal or botanical preparations have chemical and biological activity. They may have side effects. They may interact with certain medications. These interactions can cause problems and can even be dangerous. If you have any unexpected reactions to an herbal or a botanical preparation, inform your doctor or other health care provider.

Reviewers

The Clinical Nutrition Service and the ODS thank the expert scientific reviewers for their role in ensuring the scientific accuracy of the information discussed in these fact sheets: Lynn B. Bailey, Ph.D., University of Florida Jesse F. Gregory, III, Ph.D., University of Florida Mary Frances Picciano, Ph.D., NIH, Office of Dietary Supplements Irwin H. Rosenberg, M.D., USDA Human Nutrition Research Center on Aging, Tufts University Richard J. Wood, Ph.D., USDA Human Nutrition Research Center on Aging, Tufts University

next: Botanical Dietary Supplements: Background Information

Some ADHD adults are actually adapting better to increasingly busy lives while other adults with attention disorders face challenges.

ADHD Symptoms Can Emerge as Life Gets More Demanding

Barbara Eddy is used to swiftly "spinning" from task to task, from tending to her twins, to her work, to her husband. It's in her nature as someone diagnosed with an attention deficit disorder.

So she feels right at home in this fast and fragmented age of cell phones, Googling, and hand-held e-mail.

"Society is finally coming up to fitting me," said Eddy, from Pasadena, California. "The world is coming up to be perfect for me."

Any parent can be challenged by the pace of modern family life -- the blur of dropping the kids off at tae kwon do, picking up dinner and doing catch-up work on the laptop. But it can present particular possibilities and challenges for adults with attention disorders. Some, like Eddy, can take to it.

But others, like her husband, she notes, lack a consistent way to maintain focus when jumping from task to task.

"It's getting worse all the time," said Melissa Thomasson, a psychologist who runs a support group. "Sometimes we see folks who could handle it through school perhaps, and through young adulthood," she said. "And as they marry and they have children and they're working and they're handling so many things, they're not able to hold it all together."

Hallmarks of adult attention deficit/hyperactivity disorder (ADHD) symptoms can include a lack of focus and impulsiveness. It's also known as attention deficit disorder (ADD), a term many adults use because they are not hyperactive. Adults with attention disorders describe having great stores of energy and creativity, but trouble focusing it.

Attention disorders are usually associated with children; many people assume they just "grow out of it." But researchers say the conditions can persist into adulthood. Preliminary figures from a survey by Dr. Ronald Kessler of Harvard Medical School indicate adult ADHD affects about 4 percent of the population.

Some Adults with ADHD May Find Today's Technology-Driven World to be a Hardship

There's no evidence our faster, more fragmented lifestyle results in more cases of attention disorders. But Dr. Arthur Robin, a professor of psychiatry and behavioral neuroscience at Wayne State University, said ADHD symptoms may create greater impairment in a technology-oriented, fast-paced society.

"People with ADHD, while they're hyperactive, the high-energy component is there so they can cope with a fast-paced situation, but they can't always multitask without dropping some of the balls," he said.

Adults with attention disorders typically find coping strategies to get through the days, things like keeping reminder lists or detailed planners. They often have a spouse handle the bills and keep track of birthdays. At work, they'll have an office assistant mind the books.

New York City resident Anita Gold, who was diagnosed with the ADHD, said she relied on a housekeeper and secretaries to cope when she was raising her children and working as a publishing executive. Eddy keeps color-coded notebooks keeping track of her family and professional lives.

But those strategies become harder in a dual-income family where both spouses are stretched for time. Thomasson notes that the proliferation of e-mail and hand-held communications devices has led to many workers essentially acting as their own secretaries.

For Some with Adult ADHD, Technology Is Helpful

Dr. Edward Hallowell, who has written books about ADHD, said a rapid-fire lifestyle can actually be a good thing for maybe half the people with attention disorders -- such as Eddy -- because they can easily shift from task to task.

"When they get stimulation they get adrenaline and adrenaline is nature's own stimulant medication. Chemically, it's very similar to Ritalin," he said.

But everyone is different, and that same combination of one thing after another, day after day can overwhelm anyone, whether or not they have an attention disorder. Hallowell said time management, priority-setting and organization are more important than ever.

"If you're not careful," he said, "you can get lost in the thicket."

Source: AP

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next: How to Use A Day Planner
~ adhd library articles
~ all add/adhd articles

Excerpts from the Archives of the Narcissism List Part 4

1. HPD (Histrionic Personality Disorder) and Somatic NPD
2. Narcissists and Depression
3. Narcissistic Self-Absorption
4. Narcissists as Friends
5. PDs and Self-Mourning
6. DID and NPD
7. NPD and ADHD
8. Psychodynamic Therapies
9. Self-Pity and Grief
10. Should We Licence Parents?
11. BPD, NPD and Other Cluster B PDs

1. HPD (Histrionic Personality Disorder) and Somatic NPD

I "invented" another category between NPD and HPD which I call "somatic narcissists". These are narcissists who acquire their Narcissistic Supply by making use of their bodies, of sex, of physical of physiological achievements, traits, or relationships.

Click here to read the DSM IV-TR definition of the Histrionic Personality Disorder.

2. Narcissists and Depression

If by "depression" we also mean "numbness" then most narcissists are simply numb, emotionally absent, non-existent. Their emotions are not accessible, not "available" to them. So, they inhabit a grey emotional twilight zone. They regard the world through a glass opaquely. It all looks false, fake, invented, contrived, in hues of wrong. But they do not have a sense of living in prison. I have been to prison. Once in it, you remember there's an "outside" and you know there's a way out. Not so in narcissism. The outside has long faded into oblivion, if it ever existed. And there's no way out.

3. Narcissistic Self-Absorption

Narcissists are so abnormally self absorbed because:

1. They are constantly in pursuit of narcissistic supply (fishing for compliments, for instance).
2. They feel bad, sad, distraught most of the time. As opposed to common (and even wrong professional) opinion, narcissists are ego-dystonic (don't "live well" with their personality, the effect they have on others and what I call their Grandiosity Gap - the abyss between their grandiose and fantastic self-perception and the much less fantastic reality).

4. Narcissists as Friends

If your friend is a narcissist - you can never get to really know him, to be friends with him, and ESPECIALLY to be in a loving relationship with him. Narcissists are addicts. They are no different to drug addicts. They are in pursuit of gratification through the drug known as Narcissistic Supply. Everything and EVERYONE around them is an object, a potential source (to be idealised) or not (and, then to be cruelly discarded).

Narcissists home in on potential supplies like cruise missiles with the most toxic load. They are excellent at imitating emotions, exhibiting the right behaviours, and manipulating.

There is an abyss between knowing and feeling and between feeling and healing. Otherwise I - who knows so much about narcissism - would have been healthy by now (and I am NOT). So, it does not matter what you think - it matters how you feel and behave.

5. PDs and Self-Mourning

An integral part of every personality disorder is the all-pervasive feelings of loss, sadness, helplessness, and the resulting rage. It is almost as if people with PDs grieve, mourn themselves, or rather the selves that could have been theirs. This perpetual state of bereavement is oft confused with depression or existential angst.

6. DID and NPD

Is the False Self an alter? In other words: is the True Self of a narcissist the equivalent of a host personality in a DID (Dissociative Identity Disorder) - and the False Self one of the fragmented personalities, also known as "alters"?

My personal opinion is that the False Self is a construct, not a self in the full sense. It is the locus of the fantasies of grandiosity, the feelings of entitlements, omnipotence, magical thinking, omniscience and magical immunity of the narcissist. It lacks so many elements that it can hardly be called a "self". Moreover, it has no "cut-off" date. DID alters have a date of inception, as a reaction to trauma or abuse. The False Self is a process, not an entity, it is a reactive pattern and a reactive formation. All taken into account, the choice of words was poor. The False Self is not a Self, nor is it False. It is very real, more real to the narcissist than his True Self. A better choice would have been "abuse reactive self" or something to that effect.

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7. NPD and ADHD

NPD has been associated lately with Attention Deficit / Hyperactivity Disorder (ADHD or ADD). The rationale is that children suffering from ADHD are unlikely to develop the attachment necessary to prevent a narcissistic regression (Freud) or adaptation (Jung). Bonding and object relations ought to be affected by ADHD. Research which supports this conjecture has yet to be made available. Still, many psychotherapists and psychiatrists use it as a working hypothesis.

8. Psychodynamic Therapies

Dynamic psychotherapy (or psychodynamic therapy, psychoanalytic psychotherapy, psychoanalytically psychotherapy):

Let us start with what it is NOT. As opposed to (wrong) common opinion it is NOT psychoanalysis. It is an intensive psychotherapy BASED on psychoanalytic theory WITHOUT the (very important) element of free association. This is not to say that free association is not used - only that it is not a pillar and the technique of choice in dynamic therapies. Dynamic therapies are usually applied to patients not considered "suitable" for psychoanalysis (such as PDs, except the Avoidant PD). Usually, different modes of interpretation are employed and other techniques borrowed from other treatments. But the material interpreted is not necessarily the result of free association or dreams and the psychotherapist is a lot more active than the psychoanalyst.

These treatments are open ended. At the commencement of the therapy the therapist (or analyst) makes an agreement (a "pact") with the analysand (AKA patient or client). The pact states that the patient undertakes to explore his problems no matter how long it takes (and how expensive it becomes). The patient is made to feel guilty if he breaks the pact. I never heard of a more brilliant marketing technique. This is a prime demonstration of the "captive market" concept. On the other hand, this makes the therapeutic environment much more relaxed because the patient knows that the analyst is at his/her disposal no matter how many meetings would be required in order to broach painful subject matter.

Sometimes, these therapies are divided to expressive versus supportive.

Expressive therapies uncover (=make conscious) the patient's conflicts but study his/her defences and resistances. The analyst interprets the conflict in view of the new knowledge thus gained and the happy ending, the resolution of the conflict, is at hand. the conflict, in other words, is "interpreted away" through insight and the change in the patient motivated by his/her insights.

Supportive therapies seek to strengthen the ego. Their premise is that a strong ego can cope better (and later on, alone) with external (situational) or internal (instincts, drives) pressures. notice that this is DIAMETRICALLY opposed to expressive therapies. Supportive therapies seek to increase the patient's ability to SUPPRESS conflicts (rather than bring them to the surface of consciousness). As painful conflict is suppressed - so are all manner of dysphorias and symptoms. This is somewhat reminiscent of behaviourism (the main aim is to change behaviour and to relieve symptoms). It usually makes no use of insight or interpretation (though there are exceptions).

9. Self-Pity and Grief

I think that grieving is an emotional process intended to overcome the clear and irrevocable loss of a loved object (including one's self). It is a coherent, all-consuming, all-pervasive, highly focused emotion. As a result it is short lived (has an "expiry date") and highly efficient and functional in that it allows for the removal / suppression / repression of the representation of the loved object and its transformation into a memory.

Self pity seems to me to be a diffuse, general, though also all-pervasive, emotion. It has no clear emotional aim. It is non-coherent. It is long lived, inefficient and dysfunctional (disturbs proper functioning).

10. Should We Licence Parents?

When we want to drive a car, to become a bank teller, or a dental assistant - we need to study and to be licensed.

Only if we want to become parents - it is a free for all. I honestly do not understand why. Parenting is by far the most complicated human vocation (or avocation) in existence. It involves the exercise of the highest possible mental and physical faculties in combination. A parent deals constantly with the most fragile, vulnerable, susceptible thing on earth (children). You need a licence to educate or care for someone else's children - but not for yours. This is insane. Every future parent must go through a course and learn basic parenting skills before obtaining a licence to procreate. As opposed to well-ingrained common opinion, parenthood is NOT a natural gift. It is learnt and usually from the wrong role models.

Should the mentally disabled be prevented from getting such a license? Should schizophrenics have children? what about MPDs? Other PDs? NPDs like me? OCDs? AsPDs? Where should the line be drawn and by whom on whose authority?

I don't have children because I think I will propagate my PD through them and to them. I don't want to reproduce myself because I conceive of myself as a defective product. But do I have the right NOT to give life to my children? I don't know.

11. BPD, NPD and Other Cluster B PDs

If NPD and BPD have a common source (pathological narcissism) this could be very meaningful. It could open up new vistas of understanding, coping and treatment.

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All PDs are interrelated, in my view, at least phenomenologically. True, there is no Grand Unifying Theory of Psychopathology. No one knows whether there are - and what are - the mechanisms underlying mental disorders. At best, mental health professionals register symptoms (as reported by the patient) and signs (as observed by them in a therapeutic setting). Then, they group them into syndromes and, more specifically, into disorders. This is descriptive, not explanatory science. Sure, there are a few theories around (psychoanalysis, to mention the most famous) but they all failed miserably at providing a coherent, consistent theoretical framework with predictive powers.

Still, observations are a powerful tool, if properly used. People 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.

1. 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.
2. They are manipulative and exploitative because they trust no one and usually cannot love or share. They are socially maladaptive and emotionally unstable.
3. Most personality disorders start out as problems in personal development which peak during adolescence and then become personality disorders. They stay on as enduring qualities of the individual. Personality disorders are stable and all-pervasive - not episodic. They affect most of the areas of functioning of the patient: his career, his interpersonal relationships, his social functioning.
4. The person suffering a PD is not happy, to use an understatement. He is depressed, suffers from auxiliary mood and anxiety disorders. He does not like himself, his character, his (deficient) functioning, or his (crippling) influence on others. But his defences are so strong, that he is aware only of the distress - and not of the reasons to it.
5. The patient with a personality disorder is vulnerable to and prone to suffer from a host of other psychiatric disturbances. It is as though his psychological immunological system has been disabled by the personality disorder and he is left prey to other variants of mental sickness. So much energy is consumed by the disorder and by its corollaries (example: by obsessions-compulsions), that the patient is rendered defenceless.
6. Patients with personality disorders are alloplastic in their defences. In other words: they would tend to blame the external world for their mishaps. In stressful situations, they will try to preempt a (real or imaginary) threat, change the rules of the game, introduce new variables, or otherwise influence the external world to conform to their needs. This is as opposed to autoplastic defences exhibited, for instance, by neurotics (who change their internal psychological processes in stressful situations).
7. The character problems, behavioural deficits and emotional deficiencies and instability encountered by the patient with personality disorders are, mostly, ego-syntonic. This means that the patient does not find his personality traits or behaviour objectionable, unacceptable, disagreeable, or alien to his self. As opposed to that, neurotics are ego-dystonic: they do not like what they are and how they behave on a constant basis.
8. The personality-disordered are not psychotic. They have no hallucinations, delusions or thought disorders (except those who suffer from a 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 and in all-important respects "normal".

The bible of the psychiatric profession is the Diagnostics and Statistics Manual (DSM) - IV-TR (2000). It 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 its definition of personality disorders

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next: Excerpts from the Archives of the Narcissism List Part 5

Excerpts from the Archives of the Narcissism List Part 3

1. Narcissists and Chemical Imbalances
2. Personal Anecdote
3. Should I Leave Him?
4. Significant Others, Significant Roles
5. Lasch, the Cultural Narcissist
6. Humans as Instruments
7. NPD and Dual Diagnoses
8. Narcissists Imitating Emotions
9. From "Narcissism and the Search for Interiority" by Donald Kalsched
10. Sam Vaknin, NPD

1. Narcissists and Chemical Imbalances

The narcissist does have mood swings. But his moods do not swing, pendulum wise, on a regular, almost predictable basis, from depression to elation.

On the one hand, the Narcissist endures mega-cycles which last months or even years (see my book and website). These cannot, of course, be attributed to blood sugar levels.

The narcissist's moods do change suddenly as a result of narcissistic injury. One can easily manipulate the moods of a narcissist by making a disparaging remark about him, by disagreeing with him, by criticising him, by doubting his grandiosity, or claims, etc.

Such mood shifts cannot correlate to blood sugar levels which are cyclical in nature. It is possible to reduce the narcissist to a state of rage and depression AT ANY MOMENT, simply by employing the above "technique". He can be elated, even manic - and in a split second, following a narcissistic injury, depressed, sulking or rageful.

The reverse is also true. The narcissist can be catapulted from the bleakest despair to utter mania (or at least to an increased and marked feeling of well being) by providing him with narcissistic supply (attention, adulation, etc.).

Because these swings are totally correlated to external events (narcissistic injury or narcissistic supply) I find it impossible to attribute them to cycles of blood sugar.

What is possible, though, is that a THIRD problem causes chemical imbalances, diabetes, narcissism and perhaps more. There might be a common cause, a hidden common denominator.

Other disorders, like Bi-polar (mania-depression), are characterized by mood swings NOT brought about by external events (endogenic, not exogenic). The Narcissist's mood swings are only the results of external events (as he perceives and interprets them, of course).

Narcissists are NOT emotional. They are absolutely insulated from their emotions. They are emotionally flat or numb.

All mental health disorders exhibit a mood alternation component. But there is a specific mental health category of mood disorders and narcissism is not one of them.

2. Personal Anecdote

Just to show you how all-pervasive narcissism is and how ill-effected it is by insight:

Yesterday I downloaded all the messages posted to the list.

Being a narcissist, I was under the impression that I am THE main contributor (quantitatively). I expected to find that 600-700 of the 1200 messages we all exchanged over the past three months to have either originated from me or included me as a correspondent.

I am a VERY self-aware narcissist. I have VERY deep insights regarding my condition. I can identify every twist and turn of my disorder. I thought that I was immune to narcissistic excesses of grandiosity.

Imagine my surprise when I discovered that less than 170 of the messages "met my criteria". ALL the other 1050 messages HAD NOTHING TO DO with ME. I was not a part of them, nor were they originated by me.

See what I mean by "incurable"?

3. Should I Leave Him?

First, you have to establish clear priorities. Who is more important to you (you or he)? What is more important to you (emotional wellness or something else)? What is your time frame (can you tolerate another 3 weeks like the past few ones?). Armed with the results, you should gather information: if you adopt behavior A - what will be the emotional, legal and material effects? And what about behavior B?

The result of all these deliberations should be a plan of action executed unhesitatingly and irreversibly.

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IF you are not likely to be effected legally and materially, my advice to you would be: leave NOW. Pack your things and go. Contact him through your lawyers. Narcissists are poisonous. Stay away. There is no way to leave such a situation in stages. There is no respectable retreat.

Many women are worried about the possible consequences of such an act. "Will he not commit suicide?" is a frequent concern.

Narcissists do entertain suicide thoughts (suicidal ideation) in such cases. They usually do not act on them or act half-heartedly so as to fail. BUT, you should take into consideration a possible suicide and you should teach yourself, internalize, until you FULLY accept it, without ANY reservations that you have NOTHING to do with a possible suicide. The narcissist is autistic. He lives in a world all his own. You exist merely as a reflecting mirror. To think that your leaving would have anything to do with his suicide would be to flatter yourself. Morally, you owe nothing to such a person. But you owe everything to yourself.

4. Significant Others, Significant Roles

I have no interest in intellectual stimulation by significant others (it is perceived by me as a threat). Significant others have very clear roles: accumulation and dispensation of past primary narcissistic supply in order to regulate current NS. Nothing less but definitely nothing more. Proximity and intimacy breed contempt for reasons that I elucidate in my work. A process of devaluation is always in full operation.

All the above and a passive witness to my past grandiosity, a dispenser of accumulated NS, a punching bag for my rages, a co-dependent, a possession (though not prized but taken for granted) and much more. Being my partner is an ungrateful, FULL TIME, draining job.

5. Lasch, the Cultural Narcissist

see my: The Cultural Narcissist: Lasch in an Age of Diminishing Expectations

Kernberg made a very pertinent distinction between:

1. Saying that a specific society/culture is sick (pathologizing culture)
2. Saying that because a culture is sick - all its members are sick
3. Saying that in a specific society, certain disorders can be manifested more easily and find more fertile ground, as it were.

I support the third assertion and find the first two untenable.

Freud was the first to study the link between culture/society and pathology. Horney pursued it (as did Mead and many others). Specific pathologies, specific psychopathologies, and the very notion of pathology were always used as metaphors (Sontag) or as tools for social coercion (see Foucault, Szasz, Althusser and many others.) See my Althusser - a Critique: Cometing Interpellations.

To my mind, the following two statements are NOT equivalent, let alone identical:

1. Societal values are internalized by the child in the process of socialization and formation of his personality (-structures, such as the SuperEgo, to use psychoanalytic parlance) AND

1. A whole culture is internalized and BECOMES (=takes over) the individual

There is a cyclical argument in Lasch's writings. He is a determinist. If we adopt determinism, consciousness or will become meaningless. If a person is determined by his culture or society and later determines it - Lasch's approach becomes a tautology. Moreover: if psychopathology mirrors culture/society - how can its subject matter be determined by it?

6. Humans as Instruments

Humans are not instruments. To regard them as such is to devalue them, to reduce them, to constrain them, to prevent them from materializing their potential. Narcissists lose interest in their paintbrushes (no matter how valuable) if they cannot serve them in their pursuit of glory and fame through painting. Narcissists do not care about others (especially competitors).

7. NPD and Dual Diagnoses

NPD almost never comes isolated. It is usually diagnosed with other Cluster B Personality Disorders (especially Histrionic PD and Antisocial PD). A single, clearly delineated personality disorder is exceedingly rare. The norm is double or triple diagnoses from various axes (with Obsessive Compulsive Disorder, for instance).

But a seductive behaviour is not an NPD trait.

Here is what the authoritative "Review of General Psychiatry" has to say:

"HPD must be differentiated from ... NPD. These disorders may coexist in some combination with HPD, in which case all relevant diagnoses may be assigned."

Elsewhere:

"... (NPDs) have far greater contempt for the sensitivities of others than those with HPD ..."

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8. Narcissists Imitating Emotions

Narcissists are excellent at imitating emotions. They maintain (sometimes consciously) "resonance tables" in their minds. They monitor the reactions of others. They see which behavior, gesture, mannerism, phrase, or expression evoke, provoke and elicit which kind of empathic reaction from their conversant or counter party. They map these correlations and store them. Then they download them in the right circumstances to obtain maximum impact and manipulative effect. The whole process is highly "computerized" and has NO emotional correlate, no INNER resonance. The Narcissist uses procedures: "this is what I should say, this is how I must behave, this should be the expression on my face, this should be the pressure of this handshake to obtain this reaction". Narcissists are capable of sentimentality - but not of (experiencing) emotions.

9. From "Narcissism and the Search for Interiority" by Donald Kalsched

"In the family backgrounds of narcissistic personalities we find many variations of this pattern where the child is not 'seen' in his or her own spontaneous expressiveness but rather serves a particular function within the psychic 'economy' of the family system, for example, as mother's darling or father's 'queen'. This is especially true where there is a great deal of unlived life in one or another parent. Under these conditions, the child's frequently endless need for attention ... may arouse an envious or wrathful response ... Or, the parent will simply ignore the independent needs of the child and respond adoringly to those special abilities, talents, or endearing set of attributes with which he/she can identify and perhaps obtain vicariously, through the child, the needed appreciative mirroring from others. It very often happens that the 'audience' from whom appreciation is wanted is the spouse, as for example, in the case of a father who appropriates his son's endearing qualities and 'shows him off' to his own wife from whom he feels otherwise estranged. Or, the audience maybe the grandfather or grandmother from whom the narcissistically deprived parent may be able to evoke the appreciative 'gleam in the parent's eye' that was never seen in response to his or her own personal accomplishments but now appears as a ready mirror for 'my son' or 'my daughter'. Sometimes it is the very expressive lovingness of the child which is appropriated.

Andras Angyal has made a vital contribution to our understanding of the personality by reminding us that among the spontaneous capacities of normal children is a deep capacity for loving.

Children who have experienced what Winnicott calls 'good enough' mothering have to be carefully taught not to love or not to love totally. Such total expressiveness may be gobbled up by the emotionally deprived parent so that the child quickly realizes that his loving does not come back to him ... it does not make an impact 'out there' and return. It disappears. The parent cannot get enough. Or, what is often worse, the parent appropriates the very lovingness of the child itself as the earliest of the many special talents the parent eventually sees in the child. The parent calls attention to the child's loving gestures and asks others to watch. This is another way of taking the love away. Without knowing it, the child becomes aware that his very warmth and affection itself is made into something for the parents' aggrandizement. This is often the precursor to the superficial warmth and charm of the narcissistic individual, so frequently noted in the literature."

10. Sam Vaknin, NPD

Philosophically, an narcissist, who "warns" others about his disorder (most narcissists are men) is a paradox.

Remember the ancient Greek liar's paradox? "I constantly and invariably lie" says I. If I am telling the truth - than the sentence is a lie and so on.

Narcissists do EVERYTHING in search and pursuit of Narcissistic Supply. There is no other motive or motivation in their lives. If warning others is what's going to get them the attention they are seeking (or the adulation, in some cases) they will do it. Fame is better than notoriety but notoriety is preferable to lack of attention. A narcissist describing his NPD is seeking to secure narcissistic supply by doing so. Narcissists are primitive "machines".

It might be difficult to ignore the fact that I am a narcissist. But two observations may make it easier:

1. A narcissistic discussing NPD "scientifically" and in a "detached" manner will always be objective. It is his reputation that he is trying to preserve by becoming known as "an authority on ...". You can TRUST the narcissist if this is the role that he plays to be completely honest, open and objective.
2. Intentions don't count - actions do. What does it matter WHY I do what I do, as long as I am able to constructively contribute to the dialogue? By exposing myself I am asking to be accepted as I am. If I am accepted unconditionally - this, indeed, may be a first in my life.

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next: Excerpts from the Archives of the Narcissism List Part 4

Excerpts from the Archives of the Narcissism List Part 2

1. A Letter to a Narcissist
2. Narcissists in the Family
3. Narcissistic Identity
4. Narcissists, Right and Wrong
5. In Defence of Narcissists
6. Narcissists Have Tables of Emotional Resonance
7. Contradictory Behaviours of Narcissists
8. From "The Alchemist" by Paulo Coelho
9. Narcissism's Gifts to Humanity
10. Narcissists and Manipulation
11. Narcissist Employer

1. A Letter to a Narcissist

I am very happy that you found the power within you to share. I am a narcissist, probably even worse than you are. It took me eternity to talk about IMPERSONAL things like my shirt size, let alone my painful history, my inner world. I still do so with trepidation. You write well and from the heart.

This outweighs any stylistic advantages I or others might have. I was MOVED by your letter. It is a HUMAN letter.

Intuitively, you seem to have chosen a path of healing. I sympathise with you. I also try to give selflessly (my websites, etc.). It is the only way to fight malignant self love - by real self love. This is the chemotherapy of love.

Unrepentant and "true" narcissists (as you paint yourself, into a corner of unconsciously cunning egotism) - are EGO SYNTONIC. This means in human-speak: they feel GOOD with themselves, they feel whole (well, most of the time, anyhow, according to the latest research). When a narcissist begins to feel BAD, UNHAPPY, REMORSEFUL - he is shedding his narcissism. I am not at this stage yet. I am still ego-syntonic. I am still fairly content with my incredibly destructive path. I don't feel remorse, pangs of awakening conscience. Sure, I feel depressed at times - over lost chances for the obtaining further Narcissistic Supply. I envy you. The worse you feel with yourself - the closer your salvation. Healing is bought with pain, with reliving the old pains that made you what you are, with re-enacting the old conflicts that defined you.

2. Narcissists in the Family

To react emotionally to a narcissist is like talking atheism to an Afghan fundamentalist. Narcissists have emotions, very strong ones, so terrifyingly strong and negative that they hide them, repress, block, and transmute them. They employ a myriad of defence mechanisms: projective identification, splitting, projection, intellectualisation, rationalisation... Any effort to emotionally relate to a narcissist is doomed to failure, alienation and rage. Any attempt to "understand" (in retrospect or prospectively) narcissistic behaviour patterns, reactions, his inner world in emotional terms - are equally hopeless. Narcissists should be regarded as "stykhia", a force of nature, an accident. There is always the bitter question: "why me, why should this happen to me", of course...

There is no master-plot or mega-plan to deprive anyone. Being born to narcissistic parents is not the result of a conspiracy. It is a tragic event, for sure. But it cannot be dealt with emotionally without professional help and in an unplanned manner. Luckily, as opposed to narcissists, the prognosis for the victims of narcissists is fairly bright.

3. Narcissistic Identity

Narcissists very rarely acknowledge that they are narcissists. A MAJOR life crisis and a very prolonged and frustrating (for the therapist) therapy are needed before a narcissist admits that something MAY be wrong with him/her.

Narcissism is not an identity, it is a humiliation. To define oneself as a narcissist is to define oneself as a ridiculously pompous, unrealistic, predator of human emotions. This isn't very flattering and it is not much of an identity either because the narcissist has NO identity. He feeds off of his FALSE self as reflected by others. It is there, in others, that he lives.

4. Narcissists, Right and Wrong

Narcissists know the difference between right and wrong and to a large extent they do CHOOSE to do the things they do. They are lazy and have no empathy. To be considerate and understanding one has to invest effort and thought and to empathise. I don't know what is the attitude of the courts: do personality disorders constitute a "diminished responsibility" defence? NPD is NOTHING like BPD. It is FAR more cerebral, premeditated and controlled. In this sense it is much closer to the Antisocial personality disorder than to BPD (Borderline) or HPD (Histrionic).

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5. In Defence of Narcissists

Fortunately, humanity is not a monolithic abstraction, or a dull formula. Its essence cannot be captured by symbolic representation. Humanity is elusive, it is diverse, it is vast. Without narcissists, or women, or blacks, or Jews, or Nazis, or the tribesmen of the Amazon - humanity would be a far less intriguing and successful proposition. It is in diversity that the secret of adaptation and survival lies. It is from adversity that resilience springs forth. We need narcissists because without them life itself would be - by definition - incomplete as narcissists are part of life. We need their drive to excel, their ruthlessness, their pathetic pursuit of our adulation, their neediness, their emotional immaturity - this is the stuff untrammeled ambition is made of. This is the stuff of life. Narcissists are beasts of prey lurking beneath a thin veneer of civilization. But it is thus that humanity first emerged. They are a reminder of our beginnings.

They are enamoured with their reflection, which is the reflection of us all. Staring deep into the lake that is our collective psyche, they reach for themselves, forever frustrated. Their death brings about a great flower of simple beauty. This is to teach us that in nature nothing is lost and everything has a reason, however cruel, however morally reprehensible, however tragic.

6. Narcissists Have Tables of Emotional Resonance

Narcissists are excellent at imitating emotions. They maintain (sometimes consciously) "resonance tables" in their minds. They monitor the reactions of others.

They see which behaviour, gesture, mannerism, phrase, or expression evoke, provoke, and elicit which kind of empathic reaction from their conversant or counter party. They map these correlations and store them. Then they download them in the right circumstances to obtain maximum impact and manipulative effect. The whole process is highly "computerised" and has NO emotional correlate, no INNER resonance. The narcissist uses procedures: this is what I should say now, this is how I must behave, this should be the expression on my face, this should be the pressure of this handshake to foster this reaction. Narcissists are capable of sentimentality - but not of (experiencing) emotions.

7. Contradictory Behaviours of Narcissists

To need to be loved is not synonymous to loving. The narcissist is looking for power, adulation, attention, affirmation, etc. This is called Narcissistic Supply. The narcissist experiences this as "love". But he is incapable of giving love back, of loving. And because he is afraid of being abandoned he initiates the abandonment. It gives him a feeling that the situation is under control, that he is the one who is doing the abandoning and that, therefore, it does not "qualify" as abandonment. He brings about his own abandonment to "get it over with" and to be able to say: "I made her leave me and good riddance. Had I not acted the way I did she would have stayed on."

A relationship is a contract. I provide intelligence, money, insight, fun, good company, status and so on. I expect Narcissistic Supply in return. The contract runs its natural course until it is terminated, as all business contracts do.

8. From "The Alchemist" by Paulo Coelho

VERY free translation from the French:

"The Alchemist took in his hands one book which was brought by someone from the convoy. The book was not bound but anyway he could find the author's name: Oscar Wilde. Leafing through the pages he came across a story about Narcissus.

The Alchemist knew the legend of Narcissus, the beautiful youth who used to daily observe his own beauty reflected in the waters of a lake. He was so blinded by his reflection that one day he fell into the lake and drowned. Where he drowned, a flower sprouted which was named after him, a narcissus. But the Oscar Wilde story did not end this way. According to him, after the death of Narcissus, the forest deities, the Oreads (The author is mistaken.

The Oreads were mountain deities - SV), came ashore this sweet water lake and found it transformed into an urn filled with bitter tears.
- Why are you crying? Asked the Oreades.
- I am crying for Narcissus - the lake answered.
- That doesn't surprise us at all, they said. We often chased him in these woods in vain. Only you could observe his beauty closely.
- Was Narcissus beautiful? Asked the lake.
- And who else can know this better than you? Answered the Oreads, amazed. Didn't he bend over your waters every day!
The lake remained speechless for a moment. After that it said:
- I am crying for Narcissus but I have never noticed that Narcissus was beautiful. I am crying for him because every time he bent over my waters, I could have seen deep in the bottom of his eyes the reflection of my own beauty.
This is truly a nice story, the Alchemist said."

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9. Narcissism's Gifts to Humanity

Narcissism is an awesomely powerful drive, force, compulsion. I know that when I get the urge to impress someone there is VERY little I won't do. It gets you places, though. Narcissism may be responsible for many scientific, literary, artistic and political achievements.

A wise person, whom I hold in high respect (not idealising, just respecting) once made two pertinent (I think) observations:

1. That perhaps narcissism is bad for the individual but good for the community.
2. That acts of self destruction may actually be acts of liberation from unwanted situations in life.

10. Narcissists and Manipulation

Narcissists are adept at manipulating what I call their Narcissistic Pathological Space ( country, family, friends, colleagues, workplace). They are excellent imitators ((Zelig-like types, chameleons). In the workplace they will project work ethic and the sharing of basic goals in a team work. To their spouse they will reflect "love", to their colleagues - collaboration and mutual respect. Scratch the surface though and out springs the ever-youthful narcissist: indignant, rageful, vengeful, dangerous, painful.

11. Narcissist Employer

To a narcissist-employer, his "staff" are Secondary Sources of Narcissistic Supply. Their role is to accumulate the supply (in humanspeak, remember events that support the grandiose self-image of the narcissist) and to regulate the Narcissistic Supply of the narcissist during dry spells (simply put, to adulate, adore, admire, agree, provide attention and approval, and so on, in other words, serve as an audience). The staff (or should I say "stuff"?) is supposed to remain passive. The narcissist is not interested in anything but the simplest function of mirroring. When the mirror acquires a personality and a life of its own, the narcissist is incensed. He may even fire the employee (an act which will help the narcissist recover his sense of omnipotence).

An employee's presumption to be his employer's equal (friendship is possible only among equals) narcissistically injures the narcissist. The narcissist is willing to accept the employee as an underling, whose very position as such serves to support his grandiose fantasies. But the grandiosity rests on such fragile foundations, that any hint of equality, disagreement, or of his needs (for a friend, for instance) threatens the narcissist profoundly. The narcissist is exceedingly insecure. It is easy to destabilise his impromptu "personality". His reactions are merely in self-defence.

Classic narcissistic behaviour is when idealisation followed by devaluation. The devaluating attitude develops as a result of disagreements OR simply because time has eroded the employee's capacity to serve as a FRESH Source of Supply.

In time, the employee is taken for granted by the narcissistic employer, and becomes uninspiring as a source of adulation, admiration and attention. The narcissist needs new thrills and stimuli.

The narcissist is notorious for his low threshold of resistance to boredom. He exhibits impulsive behaviours and has a chaotic biography precisely because of his need to introduce uncertainty and risk to what he regards as "stagnation" or "slow death" (=routine). Even something as innocuous as asking for office supplies constitutes a reminder of this deflating, hated, routine.

Narcissists do many unnecessary, wrong and even dangerous things in pursuit of the stabilisation of their inflated self-image.

Narcissists feel suffocated by intimacy, or by the constant reminders of the REAL, nitty-gritty, world. It reduces them, makes them realise the Grandiosity Gap (between their self image and reality). It is treated as a threat to the precarious balance of their personality structures (mostly "false" and invented).

Narcissists will forever shift the blame, pass the buck, and engage in cognitive dissonance. They "pathologise" the other, foster feelings of guilt and shame in the other, demean, debase and humiliate the other, in order to preserve their sense of grandiosity.

Narcissists are pathological liars. They think nothing of it because their very self is FALSE, an invention.

Here are a few useful guidelines:

• Never disagree with your narcissist-employer or contradict him.
• Never offer him any intimacy.
• Look awed by whatever attribute matters to him (for instance: by his professional achievements, or by his good looks, or by his success with women and so on).
• Never remind him of life out there and if you do, connect it somehow to his sense of grandiosity (these are the BEST art materials ANY workplace is going to have, we get them EXCLUSIVELY, etc., etc.).
• Do not make any comment which might directly or indirectly impinge on his self image, omnipotence, judgment, omniscience, diagnostic capabilities, professional record, or even omnipresence. Bad sentences start with: "I think you overlooked ... made a mistake here ... you don't know ... do you know ... you were not here yesterday so ... you cannot ... you should ...(perceived as rude imposition, narcissists react very badly to restrictions placed on their omnipotent freedom) ... I (never mention the fact that you are a separate, independent entity. Narcissists regard others as extensions of their selves, their internalisation processes were screwed up in their formative years and they did not differentiate objects properly) ...".

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next: Excerpts from the Archives of the Narcissism List Part 3