99 Ways to Say NO

99 Ways to Say No

1. Not now.
2. Look! Squirrel! (This was the best NO suggestion I received from a commentor on my earlier post. I can't wait to use it.)
3. My word of the year is REST, so I can’t fit another thing in.
4. Nope.
5. No thanks, I won’t be able to make it.
6. Not this time.
7. Heck no.
8. No way, Jose. (Since my husband is named Jose, this is a favorite in our house.)
9. Regrettably, I'm not able to.
10. It's that time of the year when I must say no.
11. It's a Wednesday. I have a "No on Wednesday" policy.
12. Ask me in a year.
13. I know someone that might be a fit for that. I'll email you their information.
14. You're so kind to think of me, but I can't.
15. Maybe another time.
16. Sounds great, but I can’t commit.
17. Rats! Would’ve loved to.
18. I’m slammed.
19. Perhaps next season when things clear up.
20. I’m at the end of my rope right now so have to take a raincheck.
21. If only it worked.
22. I’ll need to bow out.
23. I’m going to have to exert my NO muscle on this one.
24. I’m taking some time.
25. Thanks for thinking of me, but I can’t.
26. I’m in a season of NO.
27. I’m not the girl for you on this one.
28. I’m learning to limit my commitments.
29. I’m not taking on new things.
30. Another time might work.
31. It doesn’t sound like the right fit.
32. I'm RESTing right now.
33. I’m not sure I’m the best for it.
34. No thank you, but it sounds lovely.
35. It sounds like you’re looking for something I’m not able to give right now.
36. I believe I wouldn’t fit the bill, sorry.
37. It’s not a good idea for me.
38. Not now.
39. I’m trying to cut back.
40. I won’t be able to help.
41. If only I had a clone!
42. I’m not able to set aside the time needed.
43. I won’t be able to dedicate the time I need to it.
44. I’m head-down right now on a project, so won’t be able to.
45. I wish there were two of me!
46. I’m honored, but can’t.
47. NoNoNoNoNoNo.
48. I’m booked into something else.
49. I’m not able to make that time.
50. Thanks, but no thanks.
51. I’m not able to make it this week/month/year.
52. Bye now.
53. I’ve got too much on my plate right now.
54. I’m not taking on anything else right now.
55. Bandwidth is low, so I won’t be able to make it work.
56. I wish I could make it work.
57. Not possible.
58. I wish I were able to.
59. If only I could!
60. I’d love to — but can’t.
61. Darn! Not able to fit it in.
62. Nah.
63. No thanks, I have another commitment.
64. Unfortunately, it’s not a good time.
65. Sadly I have something else.
66. Unfortunately not.
67. I have something else. Sorry.
68. Apologies, but I can’t make it.
69. Thank you so much for asking. Can you keep me on your list for next year?
70. I’m flattered you considered me, but unfortunately I’ll have to pass this time.
71. And my favorite, “Oh I wish I could help but you know, I bet Claire could help you with that.”
72. Thank you for thinking of me. Unfortunately it’s just not a match.
73. No, sorry, that’s not really my thing
74. Can I get back to you on that?
75. Ew.
76. No, I’d rather you didn’t, but thanks anyway
77. I can't make it work.
78. It just won't fit right now.
79. I'm really buckling down on my priorities right now, so I can't.
80. No say I.
81. What's the compensation?
82. How much are you able/willing to pay
83. Ick.
84. Are you able to better that offer?
85. Sorry, no can do.
86. I only say yes to very select opportunities, and unfortunately this doesn't meet my criteria.
87. The demands would be too much for me.
88. It's not feasible for me to take this on.
89. I wish I had all the time in the world.
90. My body double can.
91. In another life.
92. I cry, but decline.
93. My advisors won't agree to it.
94. My body says yes, but my heart says No.
95. I'm not the person you're looking for.
96. I don't have an iota of bandwidth left in my brain.
97. If only.
98. N to the O.
99. NO.

https://www.linkedin.com/pulse/20130501190655-52397036-100-ways-to-say-no

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Characteristics of Narcissistic Mothers

1. Everything she does is deniable. There is always a facile excuse or an explanation. Cruelties are couched in loving terms. Aggressive and hostile acts are paraded as thoughtfulness. Selfish manipulations are presented as gifts. Criticism and slander is slyly disguised as concern. She only wants what is best for you. She only wants to help you. 

She rarely says right out that she thinks you're inadequate. Instead, any time that you tell her you've done something good, she counters with something your sibling did that was better or she simply ignores you or she hears you out without saying anything, then in a short time does something cruel to you so you understand not to get above yourself. She will carefully separate cause (your joy in your accomplishment) from effect (refusing to let you borrow the car to go to the awards ceremony) by enough time that someone who didn't live through her abuse would never believe the connection. 

Many of her putdowns are simply by comparison. She'll talk about how wonderful someone else is or what a wonderful job they did on something you've also done or how highly she thinks of them. The contrast is left up to you. She has let you know that you're no good without saying a word. She'll spoil your pleasure in something by simply congratulating you for it in an angry, envious voice that conveys how unhappy she is, again, completely deniably. It is impossible to confront someone over their tone of voice, their demeanor or the way they look at you, but once your narcissistic mother has you trained, she can promise terrible punishment without a word. As a result, you're always afraid, always in the wrong, and can never exactly put your finger on why. 

Because her abusiveness is part of a lifelong campaign of control and because she is careful to rationalize her abuse, it is extremely difficult to explain to other people what is so bad about her. She's also careful about when and how she engages in her abuses. She's very secretive, a characteristic of almost all abusers ("Don't wash our dirty laundry in public!") and will punish you for telling anyone else what she's done. The times and locations of her worst abuses are carefully chosen so that no one who might intervene will hear or see her bad behavior, and she will seem like a completely different person in public. She'll slam you to other people, but will always embed her devaluing nuggets of snide gossip in protestations of concern, love and understanding ("I feel so sorry for poor Cynthia. She always seems to have such a hard time, but I just don't know what I can do for her!") As a consequence the children of narcissists universally report that no one believes them ("I have to tell you that she always talks about YOU in the most caring way!). Unfortunately therapists, given the deniable actions of the narcissist and eager to defend a fellow parent, will often jump to the narcissist's defense as well, reinforcing your sense of isolation and helplessness ("I'm sure she didn't mean it like that!") 


2. She violates your boundaries. You feel like an extension of her. Your property is given away without your consent, sometimes in front of you. Your food is eaten off your plate or given to others off your plate. Your property may be repossessed and no reason given other than that it was never yours. Your time is committed without consulting you, and opinions purported to be yours are expressed for you. (She LOVES going to the fair! He would never want anything like that. She wouldn't like kumquats.) You are discussed in your presence as though you are not there. She keeps tabs on your bodily functions and humiliates you by divulging the information she gleans, especially when it can be used to demonstrate her devotion and highlight her martyrdom to your needs ("Mike had that problem with frequent urination too, only his was much worse. I was so worried about him!") You have never known what it is like to have privacy in the bathroom or in your bedroom, and she goes through your things regularly. She asks nosy questions, snoops into your email/letters/diary/conversations. She will want to dig into your feelings, particularly painful ones and is always looking for negative information on you which can be used against you. She does things against your expressed wishes frequently. All of this is done without seeming embarrassment or thought. 

Any attempt at autonomy on your part is strongly resisted. Normal rites of passage (learning to shave, wearing makeup, dating) are grudgingly allowed only if you insist, and you're punished for your insistence ("Since you're old enough to date, I think you're old enough to pay for your own clothes!") If you demand age-appropriate clothing, grooming, control over your own life, or rights, you are difficult and she ridicules your "independence." 


3. She favoritizes. Narcissistic mothers commonly choose one (sometimes more) child to be the golden child and one (sometimes more) to be the scapegoat. The narcissist identifies with the golden child and provides privileges to him or her as long as the golden child does just as she wants. The golden child has to be cared for assiduously by everyone in the family. The scapegoat has no needs and instead gets to do the caring. The golden child can do nothing wrong. The scapegoat is always at fault. This creates divisions between the children, one of whom has a large investment in the mother being wise and wonderful, and the other(s) who hate her. That division will be fostered by the narcissist with lies and with blatantly unfair and favoritizing behavior. The golden child will defend the mother and indirectly perpetuate the abuse by finding reasons to blame the scapegoat for the mother's actions. The golden child may also directly take on the narcissistic mother's tasks by physically abusing the scapegoat so the narcissistic mother doesn't have to do that herself. 


4. She undermines. Your accomplishments are acknowledged only to the extent that she can take credit for them. Any success or accomplishment for which she cannot take credit is ignored or diminished. Any time you are to be center stage and there is no opportunity for her to be the center of attention, she will try to prevent the occasion altogether, or she doesn't come, or she leaves early, or she acts like it's no big deal, or she steals the spotlight or she slips in little wounding comments about how much better someone else did or how what you did wasn't as much as you could have done or as you think it is. She undermines you by picking fights with you or being especially unpleasant just before you have to make a major effort. She acts put out if she has to do anything to support your opportunities or will outright refuse to do even small things in support of you. She will be nasty to you about things that are peripherally connected with your successes so that you find your joy in what you've done is tarnished, without her ever saying anything directly about it. No matter what your success, she has to take you down a peg about it. 


5. She demeans, criticizes and denigrates. She lets you know in all sorts of little ways that she thinks less of you than she does of your siblings or of other people in general. If you complain about mistreatment by someone else, she will take that person's side even if she doesn't know them at all. She doesn't care about those people or the justice of your complaints. She just wants to let you know that you're never right. 

She will deliver generalized barbs that are almost impossible to rebut (always in a loving, caring tone): "You were always difficult" "You can be very difficult to love" "You never seemed to be able to finish anything" "You were very hard to live with" "You're always causing trouble" "No one could put up with the things you do." She will deliver slams in a sidelong way - for example she'll complain about how "no one" loves her, does anything for her, or cares about her, or she'll complain that "everyone" is so selfish, when you're the only person in the room. As always, this combines criticism with deniability. 

She will slip little comments into conversation that she really enjoyed something she did with someone else - something she did with you too, but didn't like as much. She'll let you know that her relationship with some other person you both know is wonderful in a way your relationship with her isn't - the carefully unspoken message being that you don't matter much to her. 

She minimizes, discounts or ignores your opinions and experiences. Your insights are met with condescension, denials and accusations ("I think you read too much!") and she will brush off your information even on subjects on which you are an acknowledged expert. Whatever you say is met with smirks and amused sounding or exaggerated exclamations ("Uh hunh!" "You don't say!" "Really!"). She'll then make it clear that she didn't listen to a word you said. 


6. She makes you look crazy. If you try to confront her about something she's done, she'll tell you that you have "a very vivid imagination" (this is a phrase commonly used by abusers of all sorts to invalidate your experience of their abuse) that you don't know what you're talking about, or that she has no idea what you're talking about. She will claim not to remember even very memorable events, flatly denying they ever happened, nor will she ever acknowledge any possibility that she might have forgotten. This is an extremely aggressive and exceptionally infuriating tactic called "gaslighting," common to abusers of all kinds. Your perceptions of reality are continually undermined so that you end up without any confidence in your intuition, your memory or your powers of reasoning. This makes you a much better victim for the abuser. 

Narcissists gaslight routinely. The narcissist will either insinuate or will tell you outright that you're unstable, otherwise you wouldn't believe such ridiculous things or be so uncooperative. You're oversensitive. You're imagining things. You're hysterical. You're completely unreasonable. You're over-reacting, like you always do. She'll talk to you when you've calmed down and aren't so irrational. She may even characterize you as being neurotic or psychotic. 

Once she's constructed these fantasies of your emotional pathologies, she'll tell others about them, as always, presenting her smears as expressions of concern and declaring her own helpless victimhood. She didn't do anything. She has no idea why you're so irrationally angry with her. You've hurt her terribly. She thinks you may need psychotherapy. She loves you very much and would do anything to make you happy, but she just doesn't know what to do. You keep pushing her away when all she wants to do is help you. 

She has simultaneously absolved herself of any responsibility for your obvious antipathy towards her, implied that it's something fundamentally wrong with you that makes you angry with her, and undermined your credibility with her listeners. She plays the role of the doting mother so perfectly that no one will believe you. 


7. She's envious. Any time you get something nice she's angry and envious and her envy will be apparent when she admires whatever it is. She'll try to get it from you, spoil it for you, or get the same or better for herself. She's always working on ways to get what other people have. The envy of narcissistic mothers often includes competing sexually with their daughters or daughters-in-law. They'll attempt to forbid their daughters to wear makeup, to groom themselves in an age-appropriate way or to date. They will criticize the appearance of their daughters and daughters-in-law. This envy extends to relationships. Narcissistic mothers infamously attempt to damage their children's marriages and interfere in the upbringing of their grandchildren. 


8. She's a liar in too many ways to count. Any time she talks about something that has emotional significance for her, it's a fair bet that she's lying. Lying is one way that she creates conflict in the relationships and lives of those around her - she'll lie to them about what other people have said, what they've done, or how they feel. She'll lie about her relationship with them, about your behavior or about your situation in order to inflate herself and to undermine your credibility. 

The narcissist is very careful about how she lies. To outsiders she'll lie thoughtfully and deliberately, always in a way that can be covered up if she's confronted with her lie. She spins what you said rather than makes something up wholesale. She puts dishonest interpretations on things you actually did. If she's recently done something particularly egregious she may engage in preventative lying: she lies in advance to discount what you might say before you even say it. Then when you talk about what she did you'll be cut off with "I already know all about it…your mother told me... (self-justifications and lies)." Because she is so careful about her deniability, it may be very hard to catch her in her lies and the more gullible of her friends may never realize how dishonest she is. 

To you, she'll lie blatantly. She will claim to be unable to remember bad things she has done, even if she did one of them recently and even if it was something very memorable. Of course, if you try to jog her memory by recounting the circumstances "You have a very vivid imagination" or "That was so long ago. Why do you have to dredge up your old grudges?" Your conversations with her are full of casual brush-offs and diversionary lies and she doesn't respect you enough to bother making it sound good. For example she'll start with a self-serving lie: "If I don't take you as a dependent on my taxes I'll lose three thousand dollars!" You refute her lie with an obvious truth: "No, three thousand dollars is the amount of the dependent exemption. You'll only lose about eight hundred dollars." Her response: "Isn't that what I said?" You are now in a game with only one rule: You can't win. 

On the rare occasions she is forced to acknowledge some bad behavior, she will couch the admission deniably. She "guesses" that "maybe" she "might have" done something wrong. The wrongdoing is always heavily spun and trimmed to make it sound better. The words "I guess," "maybe," and "might have" are in and of themselves lies because she knows exactly what she did - no guessing, no might haves, no maybes. 


9. She has to be the center of attention all the time. This need is a defining trait of narcissists and particularly of narcissistic mothers for whom their children exist to be sources of attention and adoration. Narcissistic mothers love to be waited on and often pepper their children with little requests. "While you're up…" or its equivalent is one of their favorite phrases. You couldn't just be assigned a chore at the beginning of the week or of the day, instead, you had to do it on demand, preferably at a time that was inconvenient for you, or you had to "help" her do it, fetching and carrying for her while she made up to herself for the menial work she had to do as your mother by glorying in your attentions. 

A narcissistic mother may create odd occasions at which she can be the center of attention, such as memorials for someone close to her who died long ago, or major celebrations of small personal milestones. She may love to entertain so she can be the life of her own party. She will try to steal the spotlight or will try to spoil any occasion where someone else is the center of attention, particularly the child she has cast as the scapegoat. She often invites herself along where she isn't welcome. If she visits you or you visit her, you are required to spend all your time with her. Entertaining herself is unthinkable. She has always pouted, manipulated or raged if you tried to do anything without her, didn't want to entertain her, refused to wait on her, stymied her plans for a drama or otherwise deprived her of attention. 

Older narcissistic mothers often use the natural limitations of aging to manipulate dramas, often by neglecting their health or by doing things they know will make them ill. This gives them the opportunity to cash in on the investment they made when they trained you to wait on them as a child. Then they call you (or better still, get the neighbor or the nursing home administrator to call you) demanding your immediate attendance. You are to rush to her side, pat her hand, weep over her pain and listen sympathetically to her unending complaints about how hard and awful it is. ("Never get old!") It's almost never the case that you can actually do anything useful, and the causes of her disability may have been completely avoidable, but you've been put in an extremely difficult position. If you don't provide the audience and attention she's manipulating to get, you look extremely bad to everyone else and may even have legal culpability. (Narcissistic behaviors commonly accompany Alzheimer's disease, so this behavior may also occur in perfectly normal mothers as they age.) 


10. She manipulates your emotions in order to feed on your pain. This exceptionally sick and bizarre behavior is so common among narcissistic mothers that their children often call them "emotional vampires." Some of this emotional feeding comes in the form of pure sadism. She does and says things just to be wounding or she engages in tormenting teasing or she needles you about things you're sensitive about, all the while a smile plays over her lips. She may have taken you to scary movies or told you horrifying stories, then mocked you for being a baby when you cried; she will slip a wounding comment into conversation and smile delightedly into your hurt face. You can hear the laughter in her voice as she pressures you or says distressing things to you. Later she'll gloat over how much she upset you, gaily telling other people that you're so much fun to tease, and recruiting others to share in her amusement. . She enjoys her cruelties and makes no effort to disguise that. She wants you to know that your pain entertains her. She may bring up subjects that are painful for you and probe you about them, all the while watching you carefully. This is emotional vampirism in its purest form. She's feeding emotionally off your pain. 

A peculiar form of this emotional vampirism combines attention-seeking behavior with a demand that the audience suffer. Since narcissistic mothers often play the martyr this may take the form of wrenching, self-pitying dramas which she carefully produces, and in which she is the star performer. She sobs and wails that no one loves her and everyone is so selfish, and she doesn't want to live, she wants to die! She wants to die! She will not seem to care how much the manipulation of their emotions and the self-pity repels other people. One weird behavior that is very common to narcissists: her dramas may also center around the tragedies of other people, often relating how much she suffered by association and trying to distress her listeners, as she cries over the horrible murder of someone she wouldn't recognize if they had passed her on the street. 


11. She's selfish and willful. She always makes sure she has the best of everything. She insists on having her own way all the time and she will ruthlessly, manipulatively pursue it, even if what she wants isn't worth all the effort she's putting into it and even if that effort goes far beyond normal behavior. She will make a huge effort to get something you denied her, even if it was entirely your right to do so and even if her demand was selfish and unreasonable. If you tell her she cannot bring her friends to your party she will show up with them anyway, and she will have told them that they were invited so that you either have to give in, or be the bad guy to these poor dupes on your doorstep. If you tell her she can't come over to your house tonight she'll call your spouse and try get him or her to agree that she can, and to not say anything to you about it because it's a "surprise." She has to show you that you can't tell her "no." 

One near-universal characteristic of narcissists: because they are so selfish and self-centered, they are very bad gift givers. They'll give you hand-me-downs or market things for themselves as gifts for you ("I thought I'd give you my old bicycle and buy myself a new one!" "I know how much you love Italian food, so I'm going to take you to my favorite restaurant for your birthday!") New gifts are often obviously cheap and are usually things that don't suit you or that you can't use or are a quid pro quo: if you buy her the gift she wants, she will buy you an item of your choice. She'll make it clear that it pains her to give you anything. She may buy you a gift and get the identical item for herself, or take you shopping for a gift and get herself something nice at the same time to make herself feel better. 


12. She's self-absorbed. Her feelings, needs and wants are very important; yours are insignificant to the point that her least whim takes precedence over your most basic needs. Her problems deserve your immediate and full attention; yours are brushed aside. Her wishes always take precedence; if she does something for you, she reminds you constantly of her munificence in doing so and will often try to extract some sort of payment. She will complain constantly, even though your situation may be much worse than hers. If you point that out, she will effortlessly, thoughtlessly brush it aside as of no importance (It's easy for you... / It's different for you...). 


13. She is insanely defensive and is extremely sensitive to any criticism. If you criticize her or defy her she will explode with fury, threaten, storm, rage, destroy and may become violent, beating, confining, putting her child outdoors in bad weather or otherwise engaging in classic physical abuse. 


14. She terrorizes. For all abusers, fear is a powerful means of control of the victim, and your narcissistic mother used it ruthlessly to train you. Narcissists teach you to beware their wrath even when they aren't present. The only alternative is constant placation. If you give her everything she wants all the time, you might be spared. If you don't, the punishments will come. Even adult children of narcissists still feel that carefully inculcated fear. Your narcissistic mother can turn it on with a silence or a look that tells the child in you she's thinking about how she's going to get even. 

Not all narcissists abuse physically, but most do, often in subtle, deniable ways. It allows them to vent their rage at your failure to be the solution to their internal havoc and simultaneously to teach you to fear them. You may not have been beaten, but you were almost certainly left to endure physical pain when a normal mother would have made an effort to relieve your misery. This deniable form of battery allows her to store up her rage and dole out the punishment at a later time when she's worked out an airtight rationale for her abuse, so she never risks exposure. You were left hungry because "you eat too much." (Someone asked her if she was pregnant. She isn't). You always went to school with stomach flu because "you don't have a fever. You're just trying to get out of school." (She resents having to take care of you. You have a lot of nerve getting sick and adding to her burdens.) She refuses to look at your bloody heels and instead the shoes that wore those blisters on your heels are put back on your feet and you're sent to the store in them because "You wanted those shoes. Now you can wear them." (You said the ones she wanted to get you were ugly. She liked them because they were just like what she wore 30 years ago). The dentist was told not to give you Novocain when he drilled your tooth because "he has to learn to take better care of his teeth." (She has to pay for a filling and she's furious at having to spend money on you.) 

Narcissistic mothers also abuse by loosing others on you or by failing to protect you when a normal mother would have. Sometimes the narcissist's golden child will be encouraged to abuse the scapegoat. Narcissists also abuse by exposing you to violence. If one of your siblings got beaten, she made sure you saw. She effortlessly put the fear of Mom into you, without raising a hand. 


15. She's infantile and petty. Narcissistic mothers are often simply childish. If you refuse to let her manipulate you into doing something, she will cry that you don't love her because if you loved her you would do as she wanted. If you hurt her feelings she will aggressively whine to you that you'll be sorry when she's dead that you didn't treat her better. These babyish complaints and responses may sound laughable, but the narcissist is dead serious about them. When you were a child, if you ask her to stop some bad behavior, she would justify it by pointing out something that you did that she feels is comparable, as though the childish behavior of a child is justification for the childish behavior of an adult. "Getting even" is a large part of her dealings with you. Anytime you fail to give her the deference, attention or service she feels she deserves, or you thwart her wishes, she has to show you. 


16. She's aggressive and shameless. She doesn't ask. She demands. She makes outrageous requests and she'll take anything she wants if she thinks she can get away with it. Her demands of her children are posed in a very aggressive way, as are her criticisms. She won't take no for an answer, pushing and arm-twisting and manipulating to get you to give in. 


17. She "parentifies." She shed her responsibilities to you as soon as she was able, leaving you to take care of yourself as best you could. She denied you medical care, adequate clothing, necessary transportation or basic comforts that she would never have considered giving up for herself. She never gave you a birthday party or let you have sleepovers. Your friends were never welcome in her house. She didn't like to drive you anywhere, so you turned down invitations because you had no way to get there. She wouldn't buy your school pictures even if she could easily have afforded it. You had a niggardly clothing allowance or she bought you the cheapest clothing she could without embarrassing herself. As soon as you got a job, every request for school supplies, clothing or toiletries was met with "Now that you're making money, why don't you pay for that yourself?" You studied up on colleges on your own and choose a cheap one without visiting it. You signed yourself up for the SATs, earned the money to pay for them and talked someone into driving you to the test site. You worked three jobs to pay for that cheap college and when you finally got mononucleosis she chirped at you that she was "so happy you could take care of yourself." 

She also gave you tasks that were rightfully hers and should not have been placed on a child. You may have been a primary caregiver for young siblings or an incapacitated parent. You may have had responsibility for excessive household tasks. Above all, you were always her emotional caregiver which is one reason any defection from that role caused such enormous eruptions of rage. You were never allowed to be needy or have bad feelings or problems. Those experiences were only for her, and you were responsible for making it right for her. From the time you were very young she would randomly lash out at you any time she was stressed or angry with your father or felt that life was unfair to her, because it made her feel better to hurt you. You were often punished out of the blue, for manufactured offenses. As you got older she directly placed responsibility for her welfare and her emotions on you, weeping on your shoulder and unloading on you any time something went awry for her. 


18. She's exploitative. She will manipulate to get work, money, or objects she envies out of other people for nothing. This includes her children, of course. If she set up a bank account for you, she was trustee on the account with the right to withdraw money. As you put money into it, she took it out. She may have stolen your identity. She took you as a dependent on her income taxes so you couldn't file independently without exposing her to criminal penalties. If she made an agreement with you, it was violated the minute it no longer served her needs. If you brought it up demanding she adhere to the agreement, she brushed you off and later punished you so you would know not to defy her again. 

Sometimes the narcissist will exploit a child to absorb punishment that would have been hers from an abusive partner. The husband comes home in a drunken rage, and the mother immediately complains about the child's bad behavior so the rage is vented on to the child. Sometimes the narcissistic mother simply uses the child to keep a sick marriage intact because the alternative is being divorced or having to go to work. The child is sexually molested but the mother never notices, or worse, calls the child a liar when she tells the mother about the molestation. 


19. She projects. This sounds a little like psycho-babble, but it is something that narcissists all do. Projection means that she will put her own bad behavior, character and traits on you so she can deny them in herself and punish you. This can be very difficult to see if you have traits that she can project on to. An eating-disordered woman who obsesses over her daughter's weight is projecting. The daughter may not realize it because she has probably internalized an absurdly thin vision of women's weight and so accepts her mother's projection. When the narcissist tells the daughter that she eats too much, needs to exercise more, or has to wear extra-large size clothes, the daughter believes it, even if it isn't true. However, she will sometimes project even though it makes no sense at all. This happens when she feels shamed and needs to put it on her scapegoat child and the projection therefore comes across as being an attack out of the blue. For example: She makes an outrageous request, and you casually refuse to let her have her way. She's enraged by your refusal and snarls at you that you'll talk about it when you've calmed down and are no longer hysterical. 

You aren't hysterical at all; she is, but your refusal has made her feel the shame that should have stopped her from making shameless demands in the first place. That's intolerable. She can transfer that shame to you and rationalize away your response: you only refused her because you're so unreasonable. Having done that she can reassert her shamelessness and indulge her childish willfulness by turning an unequivocal refusal into a subject for further discussion. You'll talk about it again "later" - probably when she's worn you down with histrionics, pouting and the silent treatment so you're more inclined to do what she wants. 


20. She is never wrong about anything. No matter what she's done, she won't ever genuinely apologize for anything. Instead, any time she feels she is being made to apologize she will sulk and pout, issue an insulting apology or negate the apology she has just made with justifications, qualifications or self pity: "I'm sorry you felt that I humiliated you" "I'm sorry if I made you feel bad" "If I did that it was wrong" "I'm sorry, but I there's nothing I can do about it" "I'm sorry I made you feel clumsy, stupid and disgusting" "I'm sorry but it was just a joke. You're so over-sensitive" "I'm sorry that my own child feels she has to upset me and make me feel bad." The last insulting apology is also an example of projection. 


21. She seems to have no awareness that other people even have feelings. She'll occasionally slip and say something jaw-droppingly callous because of this lack of empathy. It isn't that she doesn't care at all about other people's feelings, though she doesn't. It would simply never occur to her to think about their feelings. An absence of empathy is the defining trait of a narcissist and underlies most of the other traits I have described. Unlike psychopaths, narcissists do understand right, wrong, and consequences, so they are not ordinarily criminal. She beat you, but not to the point where you went to the hospital. She left you standing out in the cold until you were miserable, but not until you had hypothermia. She put you in the basement in the dark with no clothes on, but she only left you there for two hours. 


22. She blames. She'll blame you for everything that isn't right in her life or for what other people do or for whatever has happened. Always, she'll blame you for her abuse. You made her do it. If only you weren't so difficult. You upset her so much that she can't think straight. Things were hard for her and your backtalk pushed her over the brink. This blaming is often so subtle that all you know is that you thought you were wronged and now you feel guilty. Your brother beats you and her response is to bemoan how uncivilized children are. Your boyfriend dumped you, but she can understand - after all, she herself has seen how difficult you are to love. She'll do something egregiously exploitative to you, and when confronted will screech at you that she can't believe you were so selfish as to upset her over such a trivial thing. She'll also blame you for your reaction to her selfish, cruel and exploitative behavior. She can't believe you are so petty, so small, and so childish as to object to her giving your favorite dress to her friend. She thought you would be happy to let her do something nice for someone else. 

Narcissists are masters of multitasking as this example shows. Simultaneously your narcissistic mother is

1. Lying. She knows what she did was wrong and she knows your reaction is reasonable.
2. Manipulating. She's making you look like the bad guy for objecting to her cruelties.
3. Being selfish. She doesn't mind making you feel horrible as long as she gets her own way.
4. Blaming. She did something wrong, but it's all your fault.
5. Projecting. Her petty, small and childish behavior has become yours.
6. Putting on a self-pitying drama. She's a martyr who believed the best of you, and you've let her down.
7. Parentifying. You're responsible for her feelings, she has no responsibility for yours.

23. She destroys your relationships. Narcissistic mothers are like tornadoes: wherever they touch down families are torn apart and wounds are inflicted. Unless the father has control over the narcissist and holds the family together, adult siblings in families with narcissistic mothers characteristically have painful relationships. Typically all communication between siblings is superficial and driven by duty, or they may never talk to each other at all. In part, these women foster dissension between their children because they enjoy the control it gives them. If those children don't communicate except through the mother, she can decide what everyone hears. Narcissists also love the excitement and drama they create by interfering in their children's lives. Watching people's lives explode is better than soap operas, especially when you don't have any empathy for their misery. 

The narcissist nurtures anger, contempt and envy - the most corrosive emotions - to drive her children apart. While her children are still living at home, any child who stands up to the narcissist guarantees punishment for the rest. In her zest for revenge, the narcissist purposefully turns the siblings' anger on the dissenter by including everyone in her retaliation. ("I can see that nobody here loves me! Well I'll just take these Christmas presents back to the store. None of you would want anything I got you anyway!") The other children, long trained by the narcissist to give in, are furious with the troublemaking child, instead of with the narcissist who actually deserves their anger. 

The narcissist also uses favoritism and gossip to poison her childrens' relationships. The scapegoat sees the mother as a creature of caprice and cruelty. As is typical of the privileged, the other children don't see her unfairness and they excuse her abuses. Indeed, they are often recruited by the narcissist to adopt her contemptuous and entitled attitude towards the scapegoat and with her tacit or explicit permission, will inflict further abuse. The scapegoat predictably responds with fury and equal contempt. After her children move on with adult lives, the narcissist makes sure to keep each apprised of the doings of the others, passing on the most discreditable and juicy gossip (as always, disguised as "concern") about the other children, again, in a way that engenders contempt rather than compassion. 

Having been raised by a narcissist, her children are predisposed to be envious, and she takes full advantage of the opportunity that presents. While she may never praise you to your face, she will likely crow about your victories to the very sibling who is not doing well. She'll tell you about the generosity she displayed towards that child, leaving you wondering why you got left out and irrationally angry at the favored child rather than at the narcissist who told you about it. 

The end result is a family in which almost all communication is triangular. The narcissist, the spider in the middle of the family web, sensitively monitors all the children for information she can use to retain her unchallenged control over the family. She then passes that on to the others, creating the resentments that prevent them from communicating directly and freely with each other. The result is that the only communication between the children is through the narcissist, exactly the way she wants it. 


24. As a last resort she goes pathetic. When she's confronted with unavoidable consequences for her own bad behavior, including your anger, she will melt into a soggy puddle of weepy helplessness. It's all her fault. She can't do anything right. She feels so bad. What she doesn't do: own the responsibility for her bad conduct and make it right. Instead, as always, it's all about her, and her helpless self-pitying weepiness dumps the responsibility for her consequences AND for her unhappiness about it on you. As so often with narcissists, it is also a manipulative behavior. If you fail to excuse her bad behavior and make her feel better, YOU are the bad person for being cold, heartless and unfeeling when your poor mother feels so awful. 
 

Author unknown. Republished by parrishmiller.com in the hopes that it will be of help to someone. 

Healing Affirmations

1. My toxic mother won’t kill me. If she could, she would have already.

2. Any guilt I feel regarding my toxic mother was planted, watered and tended by my mother.

3. If my toxic mother were a co-worker or neighbor and I moved away, I’d never visit her again.

4. Family secrets instill guilt and shame. Are you being paid to keep family secrets? It’s not my job to keep family secrets.

5. If I hear my mother’s voice in my head belittling me, tell her out loud she’s wrong. It’s okay.

6. Any mother who could be cruel to a child is not going to apologize to that child when they’ve grown up.

7. I will take everything negative about my mother and flip it in my life: I will create a welcoming and warm home life; I will express love and encourage others daily; I will extend myself to those in need and I will remember: a life well-lived is the best revenge.

8. Five ways to say no to my toxic mother: No, I won’t be doing that. No, don’t count on my being there. No, I’m done subjecting myself to your drama. No, I choose not to accept the stress. No, I have more positive things to do.

9. I can tell my toxic mother that as I’ve grown into a woman (or man) I’ve developed a better understanding of the choices she made. (That should shut her up for a few moments).

10. My toxic mother can only intimidate me if I let her. While she’s busy trying to bully the child me, the adult me can reject her, ignore her, correct her, or report her to authorities.

11. I will amuse myself to avoid getting sucked in to her games. I will keep an egg timer, a pad and paper by the phone. I will tally the lies, the guilt trips and the demands she can make in 3 minutes. Then I will hang up.
12. I will never fight crazy with crazy. Crazy is my toxic mother’s “hood.”

13. Repeat after me: My toxic mother does not live in my head. She lives in her head.

14. When relatives and friends say they can’t understand how I can treat my mother the way I do, I’ll consider telling them the truth.

15. I know that a toxic mother is an unnatural disaster.

16. I can laugh or I can cry. I will laugh. It’ll annoy the hell out of my toxic mother.

17. I will never hand my toxic “mom bomb” the match.

18. On Mother’s Day and other family holidays I will focus on the positive women (and men) in my life. I will thank them for their caring, kindness and encouragement.

19. The cruel rule of RSVP is that the one person you hope will decline always comes. I promise to never actually extend an invitation to an event at which I’d hate to see my toxic mother.

20.Mother-daughter time is precious only if it’s positive.

21. I will give my toxic mother the one gift she never gave me: the truth.

22. I will not let my toxic mother rob me of rich friendships with women who on the surface remind me of her. (What are the odds your mother had an even more evil twin?)

23. Remember what my dad said: nobody can resist a joyous woman. I chose to remain joyous in spite of my mother.

24. I am open to consider that my toxic mother may have been treated even more badly as a child than I was. (This thought could keep you from throwing something).

25. I know there is no dishonor in retreat. I know that refusing to join in battle is a small victory when it comes to toxic mothers.

26. Keeping my children away from my toxic mother is a no-brainer. I choose to introduce them to kind, responsible elders instead. (Don’t know any? Consider visiting or volunteering with your child at a senior center or veterans home for an hour a week.)

27. Honor thy mother and father? I can choose to honor them by respecting myself first.

28. I will stare down my toxic mom fears until they fear me more.

29. That which is most personal is most universal. I know people will understand if I simply say, “My mother is not a nice person, but I am.”

30. Whose little girl am I? I can be my own little girl. I can care for and nurture her myself.

Source http://www.8womendream.com/15108/healing-affirmations-for-daughters-of-toxic-mothers

B.R.E.A.T.H.E

Yes, B.R.E.A.T.H.E.  

Boundaries. We erect boundaries to protect us from abuse.

Respect.  We respect ourselves enough to say "No" to more abuse.

Equal.  We are equal to anyone, and won't allow others to demean us.  

Action.  We will do more than talk-- we will take action to change our lives.

Truth.  We will stand up for ourselves and speak the truth, or let our silence speak in NC.

Heroes.  We will be our own heroes, drawing on our inner strength to overcome adversity.

Everyone.  We understand that everyone is entitled to live their own lives without interference from a PD.

Have a happy day tomorrow! 

Contributed by member illogical

You Carry the Cure in Your Heart

You Carry the Cure In Your Own Heart

by Andrew Vachss, Originally published in Parade Magazine, August 28, 1994

http://www.vachss.com/av_dispatches/disp_9408_a.html

Emotional abuse of children can lead, in adulthood, to addiction, rage, a severely damaged sense of self and an inability to truly bond with others. But—if it happened to you—there is a way out.

The attorney and author Andrew Vachss has devoted his life to protecting children. We asked Vachss, an expert on the subject of child abuse, to examine perhaps one of its most complex and widespread forms—emotional abuse: What it is, what it does to children, what can be done about it. Vachss' latest novel, "Down in the Zero," just published by Knopf, depicts emotional abuse at its most monstrous.

"We must renounce the lie that emotional abuse is good for children because it prepares them for a hard life in a tough world. I've met some individuals who were prepared for a hard life that way—I met them while they were doing life."

When your self-concept has been shredded, when you have been deeply injured and made to feel the injury was all your fault, when you look for approval to those who can not or will not provide it—you play the role assigned to you by your abusers. It's time to stop playing that role.

I'm a lawyer with an unusual specialty. My clients are all children—damaged, hurting children who have been sexually assaulted, physically abused, starved, ignored, abandoned and every other lousy thing one human can do to another. People who know what I do always ask: "What is the worst case you ever handled?" When you're in a business where a baby who dies early may be the luckiest child in the family, there's no easy answer. But I have thought about it—I think about it every day. My answer is that, of all the many forms of child abuse, emotional abuse may be the cruelest and longest-lasting of all.

Emotional abuse is the systematic diminishment of another. It may be intentional or subconscious (or both), but it is always a course of conduct, not a single event. It is designed to reduce a child's self-concept to the point where the victim considers himself unworthy—unworthy of respect, unworthy of friendship, unworthy of the natural birthright of all children: love and protection.

Emotional abuse can be as deliberate as a gunshot: "You're fat. You're stupid. You're ugly."

Emotional abuse can be as random as the fallout from a nuclear explosion. In matrimonial battles, for example, the children all too often become the battlefield. I remember a young boy, barely into his teens, absently rubbing the fresh scars on his wrists. "It was the only way to make them all happy," he said. His mother and father were locked in a bitter divorce battle, and each was demanding total loyalty and commitment from the child.

Emotional abuse can be active. Vicious belittling: "You'll never be the success your brother was." Deliberate humiliation: "You're so stupid. I'm ashamed you're my son."

It also can be passive, the emotional equivalent of child neglect—a sin of omission, true, but one no less destructive.

And it may be a combination of the two, which increases the negative effects geometrically.

Emotional abuse can be verbal or behavioral, active or passive, frequent or occasional. Regardless, it is often as painful as physical assault. And, with rare exceptions, the pain lasts much longer. A parent's love is so important to a child that withholding it can cause a "failure to thrive" condition similar to that of children who have been denied adequate nutrition.

Even the natural solace of siblings is denied to those victims of emotional abuse who have been designated as the family's "target child." The other children are quick to imitate their parents. Instead of learning the qualities every child will need as an adult—empathy, nurturing and protectiveness—they learn the viciousness of a pecking order. And so the cycle continues.

But whether as a deliberate target or an innocent bystander, the emotionally abused child inevitably struggles to "explain" the conduct of his abusers—and ends up struggling for survival in a quicksand of self-blame.

Emotional abuse is both the most pervasive and the least understood form of child maltreatment. Its victims are often dismissed simply because their wounds are not visible. In an era in which fresh disclosures of unspeakable child abuse are everyday fare, the pain and torment of those who experience "only" emotional abuse is often trivialized. We understand and accept that victims of physical or sexual abuse need both time and specialized treatment to heal. But when it comes to emotional abuse, we are more likely to believe the victims will "just get over it" when they become adults.

That assumption is dangerously wrong. Emotional abuse scars the heart and damages the soul. Like cancer, it does its most deadly work internally. And, like cancer, it can metastasize if untreated.

When it comes to damage, there is no real difference between physical, sexual and emotional abuse. All that distinguishes one from the other is the abuser's choice of weapons. I remember a woman, a grandmother whose abusers had long since died, telling me that time had not conquered her pain. "It wasn't just the incest," she said quietly. "It was that he didn't love me. If he loved me, he couldn't have done that to me."

But emotional abuse is unique because it is designed to make the victim feel guilty. Emotional abuse is repetitive and eventually cumulative behavior—very easy to imitate—and some victims later perpetuate the cycle with their own children. Although most victims courageously reject that response, their lives often are marked by a deep, pervasive sadness, a severely damaged self-concept and an inability to truly engage and bond with others.

We must renounce the lie that emotional abuse is good for children because it prepares them for a hard life in a tough world. I've met some individuals who were prepared for a hard life that way—I met them while they were doing life.
 
Emotionally abused children grow up with significantly altered perceptions so that they "see" behaviors—their own and others'—through a filter of distortion. Many emotionally abused children engage in a lifelong drive for the approval (which they translate as "love") of others. So eager are they for love—and so convinced that they don't deserve it—that they are prime candidates for abuse within intimate relationships.

The emotionally abused child can be heard inside every battered woman who insists: "It was my fault, really. I just seem to provoke him somehow."

And the almost-inevitable failure of adult relationships reinforces that sense of unworthiness, compounding the felony, reverberating throughout the victim's life.

Emotional abuse conditions the child to expect abuse in later life. Emotional abuse is a time bomb, but its effects are rarely visible, because the emotionally abused tend to implode, turning the anger against themselves. And when someone is outwardly successful in most areas of life, who looks within to see the hidden wounds?

Members of a therapy group may range widely in age, social class, ethnicity and occupation, but all display some form of self-destructive conduct: obesity, drug addiction, anorexia, bulimia, domestic violence, child abuse, attempted suicide, self-mutilation, depression and fits of rage. What brought them into treatment was their symptoms. But until they address the one thing that they have in common—a childhood of emotional abuse—true recovery is impossible.

One of the goals of any child-protective effort is to "break the cycle" of abuse. We should not delude ourselves that we are winning this battle simply because so few victims of emotional abuse become abusers themselves. Some emotionally abused children are programmed to fail so effectively that a part of their own personality "self-parents" by belittling and humiliating themselves.

The pain does not stop with adulthood. Indeed, for some, it worsens. I remember a young woman, an accomplished professional, charming and friendly, well-liked by all who knew her. She told me she would never have children. "I'd always be afraid I would act like them," she said.

Unlike other forms of child abuse, emotional abuse is rarely denied by those who practice it. In fact, many actively defend their psychological brutality, asserting that a childhood of emotional abuse helped their children to "toughen up." It is not enough for us to renounce the perverted notion that beating children produces good citizens—we must also renounce the lie that emotional abuse is good for children because it prepares them for a hard life in a tough world. I've met some individuals who were prepared for a hard life that way—I met them while they were doing life. 

The primary weapons of emotional abusers is the deliberate infliction of guilt. They use guilt the same way a loan shark uses money: They don't want the "debt" paid off, because they live quite happily on the "interest."

When your self-concept has been shredded, when you have been deeply injured and made to feel the injury was all your fault, when you look for approval to those who can not or will not provide it—you play the role assigned to you by your abusers. It's time to stop playing that role.
 
Because emotional abuse comes in so many forms (and so many disguises), recognition is the key to effective response. For example, when allegations of child sexual abuse surface, it is a particularly hideous form of emotional abuse to pressure the victim to recant, saying he or she is "hurting the family" by telling the truth. And precisely the same holds true when a child is pressured to sustain a lie by a "loving" parent.

Emotional abuse requires no physical conduct whatsoever. In one extraordinary case, a jury in Florida recognized the lethal potential of emotional abuse by finding a mother guilty of child abuse in connection with the suicide of her 17-year-old daughter, whom she had forced to work as a nude dancer (and had lived off her earnings).

Another rarely understood form of emotional abuse makes victims responsible for their own abuse by demanding that they "understand" the perpetrator. Telling a 12-year-old girl that she was an "enabler" of her own incest is emotional abuse at its most repulsive.

A particularly pernicious myth is that "healing requires forgiveness" of the abuser. For the victim of emotional abuse, the most viable form of help is self-help—and a victim handicapped by the need to "forgive" the abuser is a handicapped helper indeed. The most damaging mistake an emotional-abuse victim can make is to invest in the "rehabilitation" of the abuser. Too often this becomes still another wish that didn't come true—and emotionally abused children will conclude that they deserve no better result.

The costs of emotional abuse cannot be measured by visible scars, but each victim loses some percentage of capacity. And that capacity remains lost so long as the victim is stuck in the cycle of "understanding" and "forgiveness." The abuser has no "right" to forgiveness—such blessings can only be earned. And although the damage was done with words, true forgiveness can only be earned with deeds.

For those with an idealized notion of "family," the task of refusing to accept the blame for their own victimization is even more difficult. For such searchers, the key to freedom is always truth—the real truth, not the distorted, self-serving version served by the abuser.

Emotional abuse threatens to become a national illness. The popularity of nasty, mean-spirited, personal-attack cruelty that passes for "entertainment" is but one example. If society is in the midst of moral and spiritual erosion, a "family" bedrocked on the emotional abuse of its children will not hold the line. And the tide shows no immediate signs of turning.

Effective treatment of emotional abusers depends on the motivation for the original conduct, insight into the roots of such conduct and the genuine desire to alter that conduct. For some abusers, seeing what they are doing to their child—or, better yet, feeling what they forced their child to feel—is enough to make them halt. Other abusers need help with strategies to deal with their own stress so that it doesn't overload onto their children.

But for some emotional abusers, rehabilitation is not possible. For such people, manipulation is a way of life. They coldly and deliberately set up a "family" system in which the child can never manage to "earn" the parent's love. In such situations, any emphasis on "healing the whole family" is doomed to failure.

If you are a victim of emotional abuse, there can be no self-help until you learn to self-reference. That means developing your own standards, deciding for yourself what "goodness" really is. Adopting the abuser's calculated labels—"You're crazy. You're ungrateful. It didn't happen the way you say"—only continues the cycle.

Adult survivors of emotional child abuse have only two life-choices: learn to self-reference or remain a victim. When your self-concept has been shredded, when you have been deeply injured and made to feel the injury was all your fault, when you look for approval to those who can not or will not provide it—you play the role assigned to you by your abusers.

It's time to stop playing that role, time to write your own script. Victims of emotional abuse carry the cure in their own hearts and souls. Salvation means learning self-respect, earning the respect of others and making that respect the absolutely irreducible minimum requirement for all intimate relationships. For the emotionally abused child, healing does come down to "forgiveness"—forgiveness of yourself.

How you forgive yourself is as individual as you are. But knowing you deserve to be loved and respected and empowering yourself with a commitment to try is more than half the battle. Much more.

And it is never too soon—or too late—to start.
 

Emotional Regulation Disorder

Emotional Regulation Disorder (ERD) is an alternate name for Borderline Personality Disorder (BPD)

There are a number of different names used around the world for Borderline Personality Disorder:

• Borderline Personality Disorder (BPD)
• Emotional Regulation Disorder (ERD)
• Emotional Dysregulation Disorder
• Emotional Intensity Disorder (EID)
• Emotionally Unstable Personality Disorder (EUPD)
• Emotion-Impulse Regulation Disorder (EIRD)
• Impulsive Personality Disorder (IPD)

Continue to Borderline Personality Disorder Description

Personality Disorders DSM-IV to DSM-V

Summary

In 2013, The American Psychiatric Association (APA) voted down proposed changes in the way Personality Disorders will be classified and diagnosed in the 5th edition of the Diagnostic and Statistical Manual (DSM-5 or DSM-V). As a result, the DSM-IV definitions of Personality Disorders have been retained in the DSM-V.

Background

The DSM is sometimes referred to as the "bible" of all mental illnesses and is used by clinicians, mental healthcare providers and insurance companies as a diagnosis guide.

Personality Disorders are broken into 10 separate diagnoses in the 4th edition - DSM-IV. However, the DSM-IV diagnoses are often criticized for being subjective and vague and there is so much overlap (known as comorbidity) between the definitions that many patients are diagnosed with more than one personality disorder while others are given the catch-all diagnosis Personality Disorder - Not Otherwise Specified (PD-NOS)

A working group developing new definitions for the DSM-V tried to resolve this by eliminating some diagnoses and developing a scale of traits. However the new system was criticized as being too complex for practical everyday use. The early decision to drop Narcissistic Personality Disorder (NPD) from the list of disorders led to so much criticism that NPD was later added back in. However, the controversy did not subside and the changes were dropped.

At issue is the problem that the neurological causes for personality disorders is not well understood. Rather than having an objective test, such as a blood test for HIV or an ECG for a heart condition, personality disorders are instead described by groups of symptoms - or behavioral traits - which are often viewed as subjective and vague. Some clues to the root causes for personality disorders have been seen by researchers using functional magnetic resonance imaging (fMRI) but this is not settled science or widely available today.

It is for this reason that Out of the FOG first published a combined list of personality disorder traits - our list of Top 100 Traits of Personality Disorders. There appears to be a great deal of overlap in personality disorders and no single set of traits that applies to everyone. There is also still a healthy debate on the nature vs nurture question - whether a person is born with biological propensity to develop a personality disorder in their DNA or whether a personality disorder develops during developmental years as a result of environmental stresses - such as child abuse.

However, the lack of a clear clinical definition of personality disorders in the DSM-V is clearly a setback for millions who suffer from these disorders and for families and loved ones. Clearly we have a lot of work left to do. 

Proposed & Rejected DSM-V Personality Disorder Definitions

Here are the proposed personality disorder classifications which were rejected by the APA:

• Borderline Personality Disorder (BPD)
• Obsessive-Compulsive Personality Disorder (OCPD) 
• Avoidant Personality Disorder (AVPD)
• Schizotypal Personality Disorder (STPD)
• Antisocial Personality Disorder (ASPD)
• Narcissistic Personality Disorder (NPD)

Other:

• General Criteria for a Personality Disorder
• Personality Disorder Trait Specified (PDTS)

Source: American Psychiatric Association DSM-V

Rejected mapping from the DSM-IV to the DSM-V

Here is a table showing the proposed (rejected) mapping from the DSM-IV-TR to the DSM-V. 

Old DSM-IV-TR Personality Disorder	New DSM-5 Personality Disorder Type	Prominent Personality Traits/(Domains)
Paranoid	PD Trait Specified (PDTS)	Suspiciousness (NA) Hostility (A) Unusual beliefs & experiences (P) Intimacy avoidance (DT)
Schizoid	PDTS	Withdrawal (DT) Intimacy avoidance (DT) Restricted affectivity (DT) Anhedonia (DT)
Schizotypal	Schizotypal	Eccentricity (P) Cognitive & perceptual dysregulation (P) Unusual beliefs & experiences (P) Restricted affectivity (DT) Withdrawal (DT) Suspiciousness (NA)
Antisocial	Antisocial	Manipulativeness (A) Deceitfulness (A) Callousness (A) Hostility (A) Irresponsibility (DS) Impulsivity (DS) Risk taking (DS)
Borderline	Borderline	Emotional lability (NA) Anxiousness (NA) Separation insecurity (NA) Depressivity (NA) Impulsivity (DS) Risk taking (DS) Hostility (A)
Histrionic	PDTS	Emotional lability (NA) Manipulativeness (A) Attention seeking (A)
Narcissistic	Narcissistic	Grandiosity (A) Attention seeking (A)
Avoidant	Avoidant	Withdrawal (DT) Intimacy avoidance (DT) Anhedonia (DT) Anxiousness (NA)
Dependent	PDTS	Submissiveness (NA) Anxiousness (NA) Separation insecurity (NA)
Obsessive-Compulsive	Obsessive-Compulsive	Rigid perfectionism (C) Perseveration (NA)
Depressive	PDTS	Depressivity (NA) Anxiousness (NA) Anhedonia (DT)
Passive-Aggressive	PDTS	Hostility (A) Depressivity (NA)
PD Not Otherwise Specified (PDNOS)	PDTS	Individual trait profile

Notes: 

• NA = Negative Affectivity
• DT = Detachment
• A = Antagonism
• DS vs. C = Disinhibition vs. Compulsivity
• P = Psychoticism

A recent empirical project reduced the number of facet traits from 37 to 25, reduced the number of domains from 6 to 5, and provided provisional mappings of traits onto domains. Please see the rationale for the B criteria for further information.

Whenever a patient’s impairments in personality functioning are sufficiently severe to warrant a PD diagnosis, but the combinations of impairments and pathological personality traits do not meet criteria for one or more of the six specific personality disorder types, a diagnosis of PD Trait Specified (PDTS) is made. 

Source: American Psychiatric Association DSM-V

Rejected DSM-V General Criteria for a Personality Disorder

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose a personality disorder, the following criteria must be met:

A. Significant impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning.

B. One or more pathological personality trait domains or trait facets.

C. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma). 

Rejected DSM-V Criteria for Antisocial Personality Disorder (ASPD) 

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose antisocial personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning (a or b):

a. Identity: Ego-centrism; self-esteem derived from personal gain, power, or pleasure.

b. Self-direction: Goal-setting based on personal gratification; absence of prosocial internal standards associated with failure to conform to lawful or culturally normative ethical behavior.

AND

2. Impairments in interpersonal functioning (a or b):

a. Empathy: Lack of concern for feelings, needs, or suffering of others; lack of remorse after hurting or mistreating another.

b. Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to control others.

B. Pathological personality traits in the following domains:

1. Antagonism, characterized by:

a. Manipulativeness: Frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one„s ends.

b. Deceitfulness: Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events.

c. Callousness: Lack of concern for feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one„s actions on others; aggression; sadism.

d. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior.

2. Disinhibition, characterized by:

a. Irresponsibility: Disregard for – and failure to honor – financial and other obligations or commitments; lack of respect for – and lack of follow through on – agreements and promises.

b. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing and following plans.

c. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; boredom proneness and thoughtless initiation of activities to counter boredom; lack of concern for one„s limitations and denial of the reality of personal danger.

C. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

F. The individual is at least age 18 years.

Rejected DSM-V Criteria for Avoidant Personality Disorder (AVPD) 

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose avoidant personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning (a or b):

a. Identity: Low self-esteem associated with self-appraisal socially inept, personally unappealing, or inferior; excessive feelings of shame or inadequacy.

b. Self-direction: Unrealistic standards for behavior associated with reluctance to pursue goals, take personal risks, or engage in new activities involving interpersonal contact.

AND

2. Impairments in interpersonal functioning (a or b):

a. Empathy: Preoccupation with, and sensitivity to, criticism or rejection, associated with distorted inference of others‟ perspectives as negative.

b. Intimacy: Reluctance to get involved with people unless being certain of being liked; diminished mutuality within intimate relationships because of fear of being shamed or ridiculed.

B. Pathological personality traits in the following domains:

1. Detachment, characterized by:

a. Withdrawal: Reticence in social situations; avoidance of social contacts and activity; lack of initiation of social contact.

b. Intimacy avoidance: Avoidance of close or romantic relationships, interpersonal attachments, and intimate sexual relationships.

c. Anhedonia: Lack of enjoyment from, engagement in, or energy for life‟s experiences; deficits in the capacity to feel pleasure or take interest in things.

2. Negative Affectivity, characterized by:

a. Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to social situations; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of embarrassment.

C. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Rejected DSM-V Criteria for Borderline Personality Disorder (BPD) 

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose borderline personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning (a or b):

a. Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress. 

b. Self-direction: Instability in goals, aspirations, values, or career plans.

AND 

2. Impairments in interpersonal functioning (a or b):

a. Empathy: Compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilities.

b. Intimacy: Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between over involvement and withdrawal.

B. Pathological personality traits in the following domains:

1. Negative Affectivity, characterized by:

a. Emotional lability: Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.

b. Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.

c. Separation insecurity: Fears of rejection by – and/or separation from – significant others, associated with fears of excessive dependency and complete loss of autonomy.

d. Depressivity: Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior.

2. Disinhibition, characterized by:

a. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress.

b. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of personal danger. 

3. Antagonism, characterized by:

a. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.

C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Rejected DSM-V elimination of Dependent Personality Disorder (DPD) 

The Work Group recommends that this disorder be represented and diagnosed by a combination of core impairment in personality functioning and specific pathological personality traits, rather than as a specific type.

Prominent Personality Traits: Submissiveness, Anxiousness, Separation Insecurity

Source: American Psychiatric Association DSM-V

Because of this, it is likely in the future that people who would have been diagnosed with DPD will be diagnosed with other personality disorders which share a common set of traits, including Borderline Personality Disorder, Avoidant Personality Disorder or the generic Personality Disorder Trait Specified.

Rejected DSM-V elimination of Histrionic Personality Disorder (HPD) 

The Work Group recommends that this disorder be represented and diagnosed by a combination of core impairment in personality functioning and specific pathological personality traits, rather than as a specific type.

Prominent Personality Traits: Histrionism, Emotional lability

Source: American Psychiatric Association DSM-V

Because of this, it is likely in the future that people who would have been diagnosed with HPD will be diagnosed with other personality disorders which share a common set of traits, including Narcissistic Personality Disorder, Borderline Personality Disorder or the generic Personality Disorder Trait Specified.

Rejected DSM-V Criteria for Narcissistic Personality Disorder (NPD)

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose narcissistic personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning (a or b):

a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.

b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.

AND

2. Impairments in interpersonal functioning (a or b):

a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.

b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others’ experiences and predominance of a need for personal gain.

B. Pathological personality traits in the following domain:

1. Antagonism, characterized by:

a. Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others.

b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.

C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Rejected DSM-V Criteria for Obsessive-Compulsive Personality Disorder (OCPD) 

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose obsessive-compulsive personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning (a or b):

a. Identity: Sense of self derived predominantly from work or productivity; constricted experience and expression of strong emotions.

b. Self-direction: Difficulty completing tasks and realizing goals associated with rigid and unreasonably high and inflexible internal standards of behavior; overly conscientious and moralistic attitudes.

AND

2. Impairments in Interpersonal functioning (a or b):

a. Empathy: Difficulty understanding and appreciating the ideas, feelings, or behaviors of others.

b. Intimacy: Relationships seen as secondary to work and productivity; rigidity and stubbornness negatively affect relationships with others.

B. Pathological personality traits in the following domains:

1. Compulsivity, characterized by:

a. Rigid perfectionism: Rigid insistence on everything being flawless, perfect, without errors or faults, including one's own and others' performance; sacrificing of timeliness to ensure correctness in every detail; believing that there is only one right way to do things; difficulty changing ideas and/or viewpoint; preoccupation with details, organization, and order.

2. Negative Affectivity, characterized by:

a. Perseveration: Persistence at tasks long after the behavior has ceased to be functional or effective; continuance of the same behavior despite repeated failures.

C. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Rejected DSM-V Criteria for Personality Disorder - Trait Specified (PD-TS) 

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose a personality disorder, the following criteria must be met:

A. Significant impairments (i.e., mild impairment or greater) in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning.

B. One or more pathological personality trait domains OR specific trait facets within domains, considering ALL of the following domains.

1. Negative Affectivity

2. Detachment

3. Antagonism

4. Disinhibition vs. Compulsivity

5. Psychoticism

NOTE: Trait domain or one or more trait facets MUST be rated as “mildly descriptive or greater. If trait domain is rated as “mildly descriptive” then one or more of the associated trait facets MUST be rated as “moderately descriptive” or greater.

C. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Rejected DSM-V elimination of Paranoid Personality Disorder (PPD) 

The Work Group recommends that this disorder be represented and diagnosed by a combination of core impairment in personality functioning and specific pathological personality traits, rather than as a specific type.

Prominent Personality Traits: 

Suspiciousness, Intimacy avoidance, Hostility, Unusual Beliefs

Source: American Psychiatric Association DSM-V

Because of this, it is likely in the future that people who would have been diagnosed with PPD will be diagnosed with other personality disorders which share a common set of traits.

Rejected DSM-V elimination of Schizoid Personality Disorder (SPD) 

The Work Group recommends that this disorder be represented and diagnosed by a combination of core impairment in personality functioning and specific pathological personality traits, rather than as a specific type.

Prominent Personality Traits: 

Social withdrawal, Social detachment, Intimacy avoidance, Restricted affectivity, Anhedonia

Source: American Psychiatric Association DSM-V

Because of this, it is likely in the future that people who would have been diagnosed with SPD will be diagnosed with other personality disorders which share a common set of traits, including Avoidant Personality Disorder or the generic Personality Disorder Trait Specified.

Rejected DSM-V Criteria for Schizotypal Personality Disorder (STPD) 

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose schizotypal personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning:

a. Identity: Confused boundaries between self and others; distorted self-concept; emotional expression often not congruent with context or internal experience.

b. Self-direction: Unrealistic or incoherent goals; no clear set of internal standards.

2. Impairments in interpersonal functioning:

a. Empathy: Pronounced difficulty understanding impact of own behaviors on others; frequent misinterpretations of others‟ motivations and behaviors.

b. Intimacy: Marked impairments in developing close relationships, associated with mistrust and anxiety.

B. Pathological personality traits in the following domains:

1. Psychoticism, characterized by:

a. Eccentricity: Odd, unusual, or bizarre behavior or appearance; saying unusual or inappropriate things.

b. Cognitive and perceptual dysregulation: Odd or unusual thought processes; vague, circumstantial, metaphorical, over-elaborate, or stereotyped thought or speech; odd sensations in various sensory modalities.

c. Unusual beliefs and experiences: Thought content and views of reality that are viewed by others as bizarre or idiosyncratic; unusual experiences of reality.

2. Detachment, characterized by:

a. Restricted affectivity: Little reaction to emotionally arousing situations; constricted emotional experience and expression; indifference or coldness.

b. Withdrawal: Preference for being alone to being with others; reticence in social situations; avoidance of social contacts and activity; lack of initiation of social contact.

3. Negative Affectivity, characterized by:

a. Suspiciousness: Expectations of – and heightened sensitivity to – signs of interpersonal ill-intent or harm; doubts about loyalty and fidelity of others; feelings of persecution.

C. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Rejected DSM-V Criteria for Personality Disorder Trait Specified (PDTS)

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose a trait specified personality disorder, the following criteria must be met:

A. Significant impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning.

B. One or more pathological personality trait domains OR specific trait facets within domains, considering ALL of the following domains:

1. Negative Affectivity

2. Detachment

3. Antagonism

4. Disinhibition vs. Compulsivity

5. Psychoticism

C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

Bipolar Disorder

Introduction

The primary characteristic of Bipolar Disorder is cycles of elevated and depressed moods lasting several months at a time. Bipolar Disorder is sometimes referred to by it's old name: manic depressive disorder.

Bipolar Disorder is listed in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM-IV-TR) as an Axis I Mood Disorder.

There are four different types of Bipolar Disorder specified in the DSM-IV-TR as follows:

1. Bipolar I Disorder
2. Bipolar II Disorder
3. Cyclothymia
4. Bipolar Disorder NOS (Not Otherwise Specified)

Bipolar I Disorder

Bipolar I Disorder is a clinical course that is characterized by the occurrence of one or more Manic Episodes or Mixed Episodes. Often individuals have also had one or more Major Depressive Episodes.

Episodes of Substance-Induced Mood Disorder (due to the direct effects of a medication, or other somatic treatments for depression, a drug of abuse, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar I Disorder.

In addition, the episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Manic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1. inflated self-esteem or grandiosity 
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 
3. more talkative than usual or pressure to keep talking 
4. flight of ideas or subjective experience that thoughts are racing 
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) 
6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 
7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) 

C. The symptoms do not meet criteria for a Mixed Episode.

D. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatments) or a general medical condition (e.g., hyperthyroidism). Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

Mixed Episode

A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.

B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either:

1. depressed mood or
2. loss of interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful). Note: In children and adolescents, can be irritable mood. 
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) 
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. 
4. Insomnia or hypersomnia nearly every day 
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) 
6. Fatigue or loss of energy nearly every day 
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) 
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) 
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide 

B. The symptoms do not meet the criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Bipolar II Disorder

Bipolar II Disorder is defined as a clinical course that is characterized by the occurrence of one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode.

Hypomanic Episodes should not be confused with the several days of euthymia that may follow remission of a Major Depressive Episode.

Episodes of Substance- Induced Mood Disorder (due to the direct effects of medication, drug abuse, or toxin exposure) or Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar II Disorder.

In addition, the episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Major Depressive Episode

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either:

1. depressed mood or
2. loss of interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful). Note: In children and adolescents, can be irritable mood. 
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) 
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. 
4. Insomnia or hypersomnia nearly every day 
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) 
6. Fatigue or loss of energy nearly every day 
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) 
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) 
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide 

B. The symptoms do not meet the criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Hypomanic Episode

A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non depressed mood.

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1. inflated self-esteem or grandiosity 
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 
3. more talkative than usual or pressure to keep talking 
4. flight of ideas or subjective experience that thoughts are racing 
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) 
6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) 

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder.

Cyclothymia

A. For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode.

Note: In children and adolescents, the duration must be at least 1 year.

B. During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time.

C. No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance

Note: After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes (in which case both Bipolar I disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed)

D.The symptoms in Criterion are not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).

F) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Bipolar Disorder NOS (Not Otherwise Specified)

Bipolar Disorder NOS (Not Otherwise Specified is a form of "catch-all" diagnosis for people who meet some of the criteria for Bipolar Disorders - Bipolar I Disorder, Bipolar II Disorder or Cyclothymia but do not fit neatly or exactly into any of these diagnoses.

Examples of Bipolar Disorder NOS (Not Otherwise Specified):

• Manic episodes with little or no major depressive episodes
• Rapid cycling between manic and major depressive episodes
• Other disorders present with symptoms of Bipolar disorder

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• DISSOCIATIVE IDENTITY DISORDER
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• RELATED DISORDERS

Dissociative Identity Disorder

Introduction

Dissociative Identity Disorder (DID) is also known by it's former label of Multiple Personality Disorder (MPD) in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM)

Dissociative Identity Disorder is the condition in which a person displays more than one unique identity or personality, each with its own pattern of behaviors.

The diagnosis of Dissociative Identity Disorder requires that at least two personalities routinely take control of a person's behavior. This is accompanied by an associated memory loss that goes beyond normal forgetfulness. Each personality is unaware, or unfamiliar with the others.

Additionally, for a valid DID diagnosis, the symptoms cannot be explained by substance abuse or another medical condition.

Earlier versions of the DSM named the condition Multiple personality disorder (MPD) and the term is still commonly used.

DID is a controversial diagnosis. There is argument about its validity, existence, causes, and epidemiology.

DID Characteristics - The DSM-IV Criteria

Diagnostic criteria for 300.14 Dissociative Identity Disorder (formerly known as Multiple Personality Disorder)

A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self). 

B. At least two of these identities or personality states recurrently take control of the person's behavior. 

C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. 

D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.

Controversy 

DID/MPD is a controversial diagnosis. There are a number of influential voices who do not recognize it as a legitimate diagnosis and are advocating for its removal from the DSM.

The Amygdala and it's Link to BPD

The Amygdala is a small region of the brain which plays a key role in emotional regulation, emotional memory and responses to emotional stimuli.

Recent technological advances have given neurologists two new ways to create 3-D images of the brain. These techniques are known as Positron Emission Tomography (PET Scanning) and functional Magnetic Resonance Imaging (fMRI). By scanning a person's brain while prompting them to think in a certain way, scientists are unlocking clues as to which regions of the brain are responsible for different kinds of thought.

Much of this work has focused on the amygdala - a small region deep in the brain shown below. There is one amygdala the right side of the brain and one on the left.

The Amygdala, courtesy The Brain From Top To Bottom @ http://thebrain.mcgill.ca/

The Amygdala's Role in Emotional Reactions

It is believed that the amygdala has an important rule in producing lightning-fast emotional responses to events, whenever a person recognizes an event with a strong emotional element (good or bad) such as events that results in fear, anger or rage or events that result in delight, joy or excitement.

The amygdala is believed to be part of our fast, instinctive and reactive brains. Not much conscious thought is involved if an object is hurled towards us and we instinctively duck. This ability to react instinctively to danger is thought to have historically played a critical function in survival of most species. Similarly, witness the reaction of a crowd whenever a sports team scores a goal. There is a universal instant response of throwing hands in the air, widening the eyes, leaping into the air etc, without much thought given. When you see these instinctive reactions occur, the amygdala is at work.

The Amygdala and Memory

The amygdala has also been shown to have an important function in enhancing memory functions by releasing stress hormones, such as adrenaline. It has been shown experimentally that rats, who have had their amygdala disabled lose their fear of cats. It has also been shown that increasing stress hormones improves memory of an event. This helps explain why people can remember stressful moments in great detail - such as times of disasters or crises, when adrenaline is released and yet can easily forget long periods when nothing significant seems to have happened.

Gender Differences in the Way the Amygdala is Connected

Another interesting finding resulted from a study comparing amygdala activity in males and females. When shown images containing strong emotionally arousing content, it was found that the amygdala on the right side of the brain was the most active in men, while the amygdala on the left side of the brain was most active in women.

Other experiments with people who are relaxing have shown that in men, the right amygdala is more closely connected to the rest of the brain than the left, while women show a stronger connectivity between the left amygdala and the rest of the brain. Additionally, in men the right amygdala seems to be strongly connected to regions of the brain normally associated with interactions with the external environment while in women, the left amygdala seems to be strongly connected to regions of the brain normally associated with more internal thought. This suggests that in an emotional context, men are biased toward thoughts about the external environment and women toward thoughts about the internal environment.

Source: Human Brain Imaging Studies of Emotional Memory: Uncovering Influences of Sex and Hemisphere by Larry Cahill.

The Link between the Amygdala and Emotional Regulation Disorder / Borderline Personality Disorder

In a famous experiment at Yale University, 15 people diagnosed with BPD and 15 people with no BPD diagnosis were shown photographs of faces with neutral, happy, sad, and fearful facial expressions while mapping the activity in the brain using fMRI. It was found that there is a lot more activity in the left amygdala of people who had been diagnosed with Borderline Personality Disorder when exposed to an emotional stimulus than there is for most other people.

Source: Donegan et al, Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation.

High-Functioning and Low-Functioning

A High-Functioning Personality-Disordered Individual is one who is able to conceal their dysfunctional behavior in certain public settings and maintain a positive public or professional profile while exposing their negative traits to family members behind closed doors. A Low-Functioning Personality-Disordered Individual is one who is unable to conceal their dysfunctional behavior from public view or maintain a positive public or professional profile.

A Low-Functioning Personality-Disordered Individual is one who is unable to conceal their dysfunctional behavior from public view or maintain a positive public or professional profile.

Description:

Contrary to a popular myth, personality disorders have little correlation with intelligence. People who suffer from personality disorders span the spectrum of IQ from the lowest to the highest.

High-Functioning Personality-Disordered Individuals are those who are able to keep up appearances outside of the home and participate in society convincingly in the workplace, in social groups, in churches and organizations. Some high functioning personality-disordered individuals are leaders in their field of work, politicians, CEO's, teachers, church elders, police officers, judges etc. However, they may exhibit a very different set of behaviors behind closed doors.

Living with a High-Functioning Personality-Disordered Individual can be frustrating because there may be little support and validation from people outside the home, who may assume that what they see on the outside is a reflection of what goes on behind closed doors.High-Functioning Personality-Disordered Individuals may use their success in the public world as a way to bolster the opinion that there is nothing wrong with them and that any conflict within the home cannot be their fault. You may find yourself thinking "Everybody thinks I'm so lucky but nobody knows what this is really like." In reality there are many people who do know what it is like, but it's not the kind of thing that many people are willing to talk about openly in public.

Low-Functioning Personality-Disordered Individuals are at the opposite end of the spectrum, unable to hide their behaviors from public view. Examples include people who are reclusive, long-term unemployed, chronically depressed, people who are institutionalized in psychiatric facilities, people with alcohol & drug addictions or people who are repeatedly in trouble with law enforcement. Note that none of these conditions is necessary or sufficient for the diagnosis of a personality disorder, but someone who has been diagnosed with a personality disorder and also exhibits one of these traits might be considered "low-functioning".

Living with a Low-Functioning Personality-Disordered Individual can be frustrating because you may feel that you are being taken advantage of and you are doing all the hard work while the person with the personality disorder complains and puts demands on you while doing nothing to improve their own situation. You may also suffer from depression yourself as you torture yourself with the thought "How did I get stuck with such a loser?" In reality what sometimes keeps us stuck is our own sense of FOG- Fear Obligation & Guilt - in which we convince ourselves that we can't afford to make the changes necessary to unstick ourselves.

It is not unusual for some people with personality disorders to flip between periods of high-functioning and low-functioning behavior. This is very similar to people who suffer from Bipolar Disorder and may in some cases be indicative of Bipolar Disorder. Another common occurrence is for a personality-disordered individual to live with a kind of "split-personality" where in certain environments or situations they behave in a high-functioning manner and in others in a low-functioning manner. See our pages on Selective Competence and Selective Memory for more Information.

Acting In

Definition:

Acting In behavior refers to a subset of personality disorder traits that are more self-destructive than outwardly-destructive.

Description:

Personality-Disordered Individuals often behave in ways that are destructive to themselves and to those around them. When a behavior or trait is more self-destructive than outwardly-destructive, that behavior or trait is sometimes referred to as "acting-in".

People who suffer from Cluster A (odd or eccentric) personality disorders Paranoid personality disorder (PPD) Schizoid personality disorder (SPD) & Schizotypal personality disorder (STPD) more typically engage in "acting-in" behaviors.

People who suffer from Cluster B (dramatic, emotional, or erratic) disorders - Antisocial personality disorder (ASPD) Borderline personality disorder (BPD), Histrionic personality disorder (HPD) & Narcissistic personality disorder (NPD) more typically engage in "acting-out" behaviors.

People who suffer from Cluster C (anxious or fearful disorders) - Avoidant personality disorder (AVPD) Dependent personality disorder (DPD) Obsessive-compulsive personality disorder (OCPD) more typically engage in "acting-in" behaviors.

Examples of Acting-In Behaviors

Avoidance - The practice of withdrawing from relationships with other people as a defensive measure to reduce the risk of rejection, accountability, criticism or exposure.

Catastrophizing - The habit of automatically assuming a "worst case scenario" and inappropriately characterizing minor or moderate problems or issues as catastrophic events.

Cognitive Dissonance - A psychological term for the discomfort that most people feel when they encounter information which contradicts their existing set of beliefs or values. People who suffer from personality disorders often experience cognitive dissonance when they are confronted with evidence that their actions have hurt others or have contradicted their stated morals.

"Control-Me" Syndrome - This describes a tendency which some people have to foster relationships with people who have a controlling narcissistic, antisocial or "acting-out" nature.

Dependency - An inappropriate and chronic reliance by an adult individual on another individual for their health, subsistence, decision making or personal and emotional well-being.

Depression - People who suffer from personality disorders are often also diagnosed with symptoms of depression.

Dissociation- A psychological term used to describe a mental departure from reality.

Escape To Fantasy - Taking an imaginary excursion to a happier, more hopeful place.

Fear of Abandonment - An irrational belief that one is imminent danger of being personally rejected, discarded or replaced.

Identity Disturbance - A psychological term used to describe a distorted or inconsistent self-view

Low-Functioning - A Low-Functioning Personality-Disordered Individual is one who is unable to conceal their dysfunctional behavior from public view or maintain a positive public or professional profile.

Low Self-Esteem - A common name for a negatively-distorted self-view which is inconsistent with reality.

Mirroring - Imitating or copying another person's characteristics, behaviors or traits.

Panic Attacks - Short intense episodes of fear or anxiety, often accompanied by physical symptoms, such as hyperventilating, shaking, sweating and chills.

Perfectionism - The maladaptive practice of holding oneself or others to an unrealistic, unattainable or unsustainable standard of organization, order, or accomplishment in one particular area of living, while sometimes neglecting common standards of organization, order or accomplishment in other areas of living.

Selective Memory and Selective Amnesia - The use of memory, or a lack of memory, which is selective to the point of reinforcing a bias, belief or desired outcome.

Selective Competence - Demonstrating different levels of intelligence, memory, resourcefulness, strength or competence depending on the situation or environment.

Self-Harm - Any form of deliberate, premeditated injury, such as cutting, poisoning or overdosing, inflicted on oneself.

Self-Loathing - An extreme hatred of one's own self, actions or one's ethnic or demographic background.

Self-Victimization - Casting oneself in the role of a victim.

Acting Out

Definition:

Acting Out behavior refers to a subset of personality disorder traits that are more outwardly-destructive than self-destructive.

Description:

Personality-Disordered Individuals often behave in ways that are destructive to themselves and to those around them. When a behavior or trait is more destructive towards others than self- destructive, that behavior or trait is sometimes referred to as "acting-out".

People who suffer from Cluster A (odd or eccentric) personality disorders Paranoid personality disorder (PPD) Schizoid personality disorder (SPD) & Schizotypal personality disorder (STPD) more typically engage in "acting-in" behaviors.

People who suffer from Cluster B (dramatic, emotional, or erratic) disorders - Antisocial personality disorder (ASPD) Borderline personality disorder (BPD), Histrionic personality disorder (HPD) & Narcissistic personality disorder (NPD) more typically engage in "acting-out" behaviors.

People who suffer from Cluster C (anxious or fearful disorders) - Avoidant personality disorder (AVPD) Dependent personality disorder (DPD) Obsessive-compulsive personality disorder (OCPD) more typically engage in "acting-in" behaviors.

Examples of Acting-Out Behaviors

Alienation - The act of cutting off or interfering with an individual's relationships with others.

Baiting - A provocative act used to solicit an angry, aggressive or emotional response from another individual.

Blaming - The practice of identifying a person or people responsible for creating a problem, rather than identifying ways of dealing with the problem.

Bullying - Any systematic action of hurting a person from a position of relative physical, social, economic or emotional strength.

Chaos Manufacture - Unnecessarily creating or maintaining an environment of risk, destruction, confusion or mess.

Cheating - Sharing a romantic or intimate relationship with somebody when you are already committed to a monogamous relationship with someone else.

Circular Conversations - Arguments which go on almost endlessly, repeating the same patterns with no resolution.

Domestic Theft - Consuming or taking control of a resource or asset belonging to (or shared with) a family member, partner or spouse without first obtaining their approval.

Emotional Blackmail - A system of threats and punishments used in an attempt to control someone’s behaviors.

Engulfment - An unhealthy and overwhelming level of attention and dependency on another person, which comes from imagining or believing one exists only within the context of that relationship.

False Accusations - Patterns of unwarranted or exaggerated criticism directed towards someone else.

Favoritism - Favoritism is the practice of systematically giving positive, preferential treatment to one child, subordinate or associate among a family or group of peers.

Frivolous Litigation - The use of unmerited legal proceedings to hurt, harass or gain an economic advantage over an individual or organization.

Gaslighting - The practice of brainwashing or convincing a mentally healthy individual that they are going insane or that their understanding of reality is mistaken or false. The term “Gaslighting” is based on the 1944 MGM movie “Gaslight”.

Harassment - Any sustained or chronic pattern of unwelcome behavior by one individual towards another.

Holiday Triggers - Mood Swings in Personality-Disordered individuals are often triggered or amplified by emotional events such as family holidays, significant anniversaries and events which trigger emotional memories.

Hoovers & Hoovering - A Hoover is a metaphor taken from the popular brand of vacuum cleaners, to describe how an abuse victim trying to assert their own rights by leaving or limiting contact in a dysfunctional relationship, gets “sucked back in” when the perpetrator temporarily exhibits improved or desirable behavior.

Relationship Hyper Vigilance - Maintaining an unhealthy level of interest in the behaviors, comments, thoughts and interests of others.

Hysteria - An inappropriate over-reaction to bad news or disappointments, which diverts attention away from the real problem and towards the person who is having the reaction.

Impulsiveness - The tendency to act or speak based on current feelings rather than logical reasoning.

Infantilization - Treating a child as if they are much younger than their actual age.

Imposed Isolation - When abuse results in a person becoming isolated from their support network, including friends and family.

Narcissism - A set of behaviors characterized by a pattern of grandiosity, self-centered focus, need for admiration, self-serving attitude and a lack of empathy or consideration for others.

No-Win Scenarios - When you are manipulated into choosing between two bad options

Objectification - The practice of treating a person or a group of people like an object.

Parental Alienation Syndrome - When a separated parent convinces their child that the other parent is bad, evil or worthless.

Passive-Aggressive Behavior - Expressing negative feelings in an unassertive, passive way.

Pathological Lying - Persistent deception by an individual to serve their own interests and needs with little or no regard to the needs and concerns of others. A pathological liar is a person who habitually lies to serve their own needs.

Projection - The act of attributing one's own feelings or traits to another person and imagining or believing that the other person has those same feelings or traits.

Proxy Recruitment - A way of controlling or abusing another person by manipulating other people into unwittingly backing “doing the dirty work”

Push-Pull - A chronic pattern of sabotaging and re-establishing closeness in a relationship without appropriate cause or reason.

Raging, Violence and Impulsive Aggression - Explosive verbal, physical or emotional elevations of a dispute. Rages threaten the security or safety of another individual and violate their personal boundaries.

Sabotage - The spontaneous disruption of calm or status quo in order to serve a personal interest, provoke a conflict or draw attention.

Scapegoating - Singling out one child, employee or member of a group of peers for unmerited negative treatment or blame.

Shaming - The difference between blaming and shaming is that in blaming someone tells you that you didsomething bad, in shaming someone tells you that youare something bad.

Splitting - The practice of regarding people and situations as either completely "good" or completely "bad".

Stalking - Any pervasive and unwelcome pattern of pursuing contact with another individual.

Testing - Repeatedly forcing another individual to demonstrate or prove their love or commitment to a relationship.

Thought Policing - Any process of trying to question, control, or unduly influence another person's thoughts or feelings.

Threats - Inappropriate, intentional warnings of destructive actions or consequences.

Cognitive Dissonance

A  psychological term for the discomfort that most people feel when they encounter information which contradicts their existing set of beliefs or values.

Uncomfortable Realities:

Cognitive Dissonance occurs whenever a person is confronted with information which conflicts with their own world view. For someone with a Personality Disorder, this includes evidence their actions have hurt others or have contradicted their stated morals.

Examples of Cognitive Dissonance:

• If a person holds the view "mother's know what is best for their children" they may experience conflict when presented with evidence that a mother has acted in a violent, unkind or abusive way towards one of her children.
• If a person holds the view "all believers of a particular faith will go to heaven" they may feel cognitive dissonance when they witness a believer actingin a cruel or depraved manner.
• If a person holds the belief "I am a good person" they may experience cognitive dissonance whenever it is obvious their words or actions have hurt others.

Confronted by evidence which contradicts their values or beliefs, a person is forced to make an uncomfortable choice:

1. To hold to their belief and disregard the data they have been presented with or
2. To modify their beliefs and risk having to re-evaluate their world view, their choices and their character.

What it feels like:

People who are experiencing cognitive dissonance may adopt a pattern of denial, diversion and defensiveness to control their discomfort. They may also alternate between periods of denial and periods of admission when they try to compensate or make amends.

Non personality-disordered (Non-PD) individuals often experience cognitive dissonance when they are confronted with evidence that their partner, spouse, parent, sibling or child is not behaving in a loving way toward them. This may contradict their belief or desire that their family is healthy or "normal".

Non-PD's may also experience cognitive dissonance when they discover that their own reactions or responses to challenging behavior on the part of a family member do not reveal their best side. They may display occasional angry outbursts, actions of deception or retribution, such as violence, shouting, name calling, sabotage, affairs, gossip and slander. Following such actions they may feel shameful, worthless or powerless. They may feel regret that they have handed justification for bad behavior to the abusive person in their home. They may even blame themselves for contributing to the abuse and dysfunction in the home.

What NOT to do:

If you experience cognitive dissonance as a Non-PD:

• Don't blame yourself or shame yourself for having had contradictory thoughts or assumptions. Everybody has them. They are an important part of growth and learning.
• Don't assume that because you have been wrong or mistaken about one thing that you are wrong and mistaken about everything. Accept your errors for what they are and learn from them.
• Don't consider yourself worthless, useless or powerless.
• Don't try to over-compensate for your weaknesses by over steering in the direction of your strengths. Try to love and accept the whole you.
• Don't go into denial about things which are plain facts. Try to accept the truth and learn from it.
• Don't make any big announcements, dramatic gestures or life decisions while you are feeling emotional. Wait until you have had time to think and consider your options.

If a Personality-Disordered person in your life experiences cognitive dissonance:

• Don't take advantage of them by preaching, pontificating or nagging. Nobody likes that.
• Don't mock, ridicule, shame or criticize another person who is struggling, no matter how much you may feel they deserve it.
• Don't be surprised if they engage in denial, desperately seek an "out" or rationalize away flawed thinking, poor choices or unkind behavior.
• Don't blame yourself for another person's behaviors, words or beliefs. That's their stuff.
• Don't condone abusive behavior or speech. Protect yourself and children.
• Don't engage in circular arguments or thought policing.

What TO do:

If you experience cognitive dissonance as a Non-PD:

• Forgive yourself. Nobody is perfect. Everybody makes mistakes. It's not wrong to be wrong. Everyone who has ever lived has personal struggles.
• Take advantage of the opportunity for growth that comes from learning something new about yourself.
• Open your mind. Take advantage of the opportunity to see things from a totally different perspective.
• Get support. Talk to trusted friends, family and professionals who can help you work it out.

If a personality-disordered person in your life experiences cognitive dissonance:

• Give them space to explore their own thoughts.
• Encourage, support and validate them where appropriate.
• Accept that they have a right to have their own thoughts and feelings, even if you think they are "wrong".
• Find a supportive environment where you will independently feel validated and nurtured.
• Take care of yourself, regardless of what level of encouragement the personality-disordered individual gives you.