Narcissists and Mood Disorders
http://health.groups.yahoo.com/group/narcissisticabuse/message/5067
Cases
Missing a Diagnosis That Hit Too Close to Home
By RONALD PIES, M.D.
Published: July 31, 2007
Mike and I must have done a hundred psychiatric emergency admissions
together  the hallucinating, the intoxicated, the violent ones, brought in
by the police. Mike was known as a smart, confident, level-headed nurse, one
of the few male nurses in the field, back in the 1980s. As a fledgling
psychiatrist, I always respected his assessments in the E.R.; when he said,
“This guy needs to be on a locked unit,†I listened. Even on our excellent
nursing staff, Mike was known as the “top gun.â€Â
Skip to next paragraph
Frank Stockton
One morning, as I arrived on our inpatient unit, I nearly froze in my
tracks. Our overnight admission stood in the hallway, looking disheveled and
sporting a dense 5 o’clock shadow. He had the vacant look of someone whose
spirit had been snuffed out like a cold candle. Our overnight admission was
Mike.
It turned out that he had been struggling with a ferocious bout of
depression for several weeks. Even those who had been with him recently in
the E.R. were shocked at his appearance; he looked as if his blood had been
drained and replaced with skim milk. I resolved immediately that I would be
the one to bring him back from the Land of the Unliving.
Before you can put some folks back together, as one of my supervisors liked
to say, they need to fall apart. Mike certainly qualified on that score. He
spent most of his time curled up in a ball, sleeping on his cot. He had the
usual symptoms of major depression: low self-esteem, loss of pleasure in
most activities, thoughts of suicide and a tremendous sense of guilt. The
precipitating causes were not clear, and Mike seemed humiliated at our
efforts to delve into them. He, too, saw himself as a sort of “top gun,†and
he had been ignominiously shot down.
I treated Mike with two robust antidepressant regimens over the course of
about two months. I saw him twice weekly in individual psychotherapy and
made sure he attended group therapy three days a week. Yet nothing seemed to
budge his depression. His lethargy and somnolence seemed almost contagious,
and our staff clearly felt uncomfortable working with Mike. He was a
disconcerting reminder of our own vulnerability to depression, to what
Winston Churchill used to call “The Black Dog.†I no longer wanted to meet
Mike’s gaze in the hallway for fear he would catch the look of failure in my
eyes.
In those days before managed care, we could keep patients on our unit for
eight weeks or even more. But after a couple of months, Mike signed out of
our unit, against medical advice. He was not suicidal, and there was no
legal justification to keep him. I sulked around the unit for days
afterward, wondering how I could have let him down so miserably.
A few weeks later, I ran into him outside the medical center. He looked as
if he had just come back from a vacation in Tahiti. “Ron!†he yelled, “Great
to see you! Hey, you won’t believe it! I saw this private psychiatrist and
he figured out my problem. I had atypical depression. He put me on this
fancy medication called an MAOI. I hate giving up wine and cheese, but I
feel like a million bucks!â€Â
As I tried to work up a smile, I wished nothing more than to sink into the
sidewalk. Atypical depression  how could I have missed it? I had actually
written a paper with one of my supervisors on this very diagnosis.
Atypically depressed patients often show a different clinical picture from
those with “classical†major depression. They often oversleep and overeat,
for example. (Indeed, Mike had not lost weight before his admission.) And
instead of feeling more depressed in the morning, as is common in major
depression, atypically depressed patients tend to “crash†in the evening.
Furthermore, as Mike’s private psychiatrist clearly knew, patients with
atypical depression often respond better to MAOIs (monoamine oxidase
inhibitors) than to standard antidepressants.
Why had I not prescribed an MAOI? Perhaps, on some level, I was afraid of
exposing Mike to a medication I knew to be potentially lethal, if proper
precautions weren’t taken. But the explanation doesn’t hold much water.
After all, that very medication helped give Mike back his life.
I think something else may have been at work: a phenomenon that Dr. Jerome
Groopman identifies in his new book, “How Doctors Think.â€Â
Dr. Groopman observes that V.I.P. or celebrity patients sometimes
short-circuit the physician’s normal diagnostic thinking. For example, these
patients may be spared the doctor’s usual tests and procedures. As our “top
gun,†Mike was just such a patient to me. Even as I entertained grandiose
fantasies about curing him, my unconscious may have steered me away from
doing everything I could to help him get better.
Ronald Pies is a psychiatrist in the Boston area.
The Depressive has pervasive and continuous depressive cognitions (thoughts)
and behaviors. They manifest themselves in every area of life and never
abate. The patient is gloomy, dejected, pessimistic, overly serious, lacks a
sense of humor, cheerless, joyless, and constantly unhappy. This dark mood
is not influenced by changing circumstances.
Continue to read this article here (click on this link):
http://samvak.tripod.com/personalitydisorders33.html
Many scholars consider pathological narcissism to be a form of depressive
illness. This is the position of the authoritative magazine “Psychology
Today”. The life of the typical narcissist is, indeed, punctuated with
recurrent bouts of dysphoria (ubiquitous sadness and hopelessness),
anhedonia (loss of the ability to feel pleasure), and clinical forms of
depression (cyclothymic, dysthymic, or other). This picture is further
obfuscated by the frequent presence of mood disorders, such as Bipolar I
(co-morbidity).
Continue to read this article here (click on this link):
http://samvak.tripod.com/journal83.html
Bipolar patients in the manic phase exhibit many of the signs and symptoms
of pathological narcissism - hyperactivity, self-centeredness, lack of
empathy, and control freakery. During this recurring chapter of the disease,
the patient is euphoric, has grandiose fantasies, spins unrealistic schemes,
and has frequent rage attacks (is irritable) if her or his wishes and plans
are (inevitably) frustrated.
Continue to read this article here (click on this link):
http://samvak.tripod.com/journal71.html
Question:
My husband is a narcissist and is constantly depressed. Is there any
connection between these two problems?
Answer:
Continue to read this article here (click on this link):
http://samvak.tripod.com/faq17.html
Question:
I know a narcissist intimately. Sometimes he is hyperactive, full of ideas,
optimism, plans. At other times, he is hypoactive, almost zombie-like.
Answer:
Continue to read this article here (click on this link):
http://samvak.tripod.com/faq43.html
Question:
Doesn’t the narcissist ever feel sorry for his “victims”?
Answer:
The narcissist always feels “bad”. He experiences all manner of depressive
episodes and lesser dysphoric moods. He goes through a full panoply of mood
disorders and anxiety disorders. He experiences panic from time to time. It
is not pleasant to be a narcissist.
Continue to read this article here (click on this link):
http://samvak.tripod.com/narcissistsorry.html
The Bipolar Disorder got its name because the mania is followed by - usually
protracted - depressive attacks. A similar pattern of mood shifts and
dysphorias occurs in many personality disorders such as the Borderline,
Narcissistic, Paranoid, and Masochistic.
Continue to read this article here (click on this link):