What are the possible Psychiatric diagnoses of abusers?
It might be helpful to understand the clinical diagnoses of those who create the most damage to personal relationships, those who are emotional abusers, manipulators, and controllers. Most often they are put in the category of Narcissistic Personality disorder, but there are other psychiatric conditions that may fit just as well or better, for a given person.
These psychiatric conditions can cause serious relationship problems and in effect, create an abusive situation. It is important to note that these are conditions that need psychiatric treatment and/or medications. You, as partner, parent or friend are not equipped to treat or change them. It just doesn’t work that way. I am hoping this review will be helpful in understanding the abuser and allowing a distance between you and the person who is putting you at risk.
The current “bible” of psychiatry is called the Diagnostic and Statistical Manual DSM – IV. These categories may be relevant in understanding one who abuses, manipulates or controls:
Personality Disorders, in general, are an enduring pattern of experience and behavior which include inflexibility and the tendency to blame others rather than take responsibility for oneself. You might see the abuser in one or more of the following categories:
- The most popular way of understanding the abuser is to see them as having a Narcissistic Personality Disorder. Preoccupied with themselves, they feel entitled to whatever they want, and seek approval without regard for their own behavior. There is a lack of empathy for others and they can be perceived as having a cold heart. The feeling that they automatically should get special attention and privileges is unrelated to real talent or accomplishments.
If someone does not give them respect, admiration or attention, they feel entitled to punish. Envy, arrogance, anger, envy, jealousy and vindictiveness are the bread and butter of this type of character. After all, “It’s all about them!”
- The Anti-Social Personality Disorder is a complex of characteristics that include a pervasive pattern of disregard for the rights of others and the rules of society. Rules may apply to others, but not them! On the extreme they may be chronically irresponsible, unsupportive, con artists and take from others in a manipulative way without conscience. Sometimes there is a superficial charm, but it is like a thin mask over greed and cold-heartedness. This can include criminal behavior like stealing, and to the extreme, even to the death of their victim.
A person with this type of disorder is totally selfish and commonly has a record of arrests. There is no remorse, no regard for the safety of others; there is lying and deception, sometimes physical assault and intimidation. A person with this disorder is profoundly dangerous.
- The Borderline Personality Disorder is characterized by intense, unstable relationships and a lot of drama. Moods run the gamut from moment to moment but always with the utmost intensity. A common theme for this type of disturbance is a fear of abandonment, chronic feelings of emptiness and unstable relationships. If combined with anger and feelings of entitlement a relationship with this person is a “nightmare.” Self-destructive behavior can include bulimia, alcoholism, drug addiction, promiscuity, (manipulative) suicide threats or attempts, self-mutilation, and intense flares of anger. There is often an underlying paranoia on the one hand, and aggressive behavior towards others on the other hand. Without the ability to control feelings, words or behavior they are like a wild card. Having a relationship with this kind of person is like living in a hurricane every day of your life.
- The Histrionic Personality Disorder – a person with this disorder is highly dramatic and there is a quality like acting in how they present themselves. It is as though life is a play and they see themselves as the central character. This type of character can be highly seductive, sexualized, and deeply manipulative. Excessive emotional display and the need for all attention to be focused on them rounds out the picture. If you get involved with a person like this, it is all about them – you are only an audience for their major production.
- Addiction: While not technically in the Personality Disorder category, the commonality is that the addict tends to blame, and take no responsibility for him or her self. Whether it is alcohol or drugs, gambling, food or relationships, those addicted become self-centered and cold. Their focus is on the object that they seek which they perceive to be alleviating pain. Nothing else matters. You, as the other, are an object to be used for their own purposes. This is abuse. As you enable them (sometimes out of what you think as loving) you give permission for them to selfishly pursue their own goals, regardless of how they affect others.
- Paranoid Personality Disorder – People with Paranoid Personality Disorder have a long-standing and pervasive distrust, and suspiciousness of others. They nearly always believe other people’s motives are suspect and malevolent. People with this disorder believe others want to exploit, harm or deceive them even though there is no evidence for those assumptions. No one is exempt from their suspicions.
Because they are fear-based and feel threatened from all sides they tend to be contentious, complaining, negative, argumentative, combative and hostile. The other side of the coin is the appearance of a coldness; they may appear hostile, quiet, aloof and exude what feels like a dangerous and bitter anger. The “silent treatment” is a favored punishment for perceived transgressions.
Stubborn, sarcastic and unavailable for rational discourse – it is nearly impossible to have a normal conversation about subjects that they are sensitive to. Their hostile behavior tends to elicit a negative response from others which only serves to confirm their original expectations. In effect, they unconsciously create the world that they fear.
Because individuals with Paranoid Personality Disorder lack trust in others they tend to be controlling and judgmental. They are rigid, unable to collaborate and have difficulty accepting criticism. If given feedback, they consistently receive it as criticism and often rage back with a verbal attack.
Another common characteristic is reading hidden demeaning or threatening meaning into innocent remarks or events and often take things personally that have nothing to do with them. Grudges and vendettas are common with the “banning” technique in full force. Sometimes baseless accusations of infidelity are clung to, in spite of truth to the contrary.
Other psychiatric conditions can present real relationship issues, sometimes putting the other in actual danger:
- Bi-Polar Disorder (previously knows as Manic Depression) This disorder is characterized by major mood swings. The depressive elements are quite clear: depressed mood, minimal interest in life, lack of motivation, insomnia or hypersomnia, physical agitation or slowed response, fatigue, feelings of worthlessness, difficulty concentrating, memory loss, and at the extreme, thoughts of suicide.
Mania is more complicated and has many sides. The DSM – IV describes mania as “A distinct period of abnormally and persistently elevated, expansive or irritable mood.” However, a person doesn’t come with a manual. I have seen variations of mania that don’t fit neatly in a book. I have seen patients in manic periods where they rage, scream, and yell, out of control. This is beyond irritability. I have seen the more traditional mania in which speech is pressured and rapid with grandiose ideas, sometimes moving from one scheme to the next. There may be a loosening of boundaries in which the manic person can “invade” you – without regard for your needs and wishes.
The grandiose aspect of a person in mania takes no social cue and has no ability to see the other – again, it is all about them. It is as though they are on a speeding train with rapid acceleration. When they go fast, they are unable to slow down. With insomnia if enough sleep is lost psychotic symptoms can ensue.
Aggression, paranoia and obsessional thinking are a dangerous combination. Being with a person in full-blown mania is a nightmare and has broken the back of many relationships. As a part of the disorder bi-polar individuals often feel they can handle the disease on their own – refusing medication. In my experience, this is not possible. Even if there is a long time lag between bouts, they are extremely destructive for themselves and their relationships if medically untreated. Traditional psychotherapy is insufficient; it is as though the therapist can hang on to the coattails of the patient in mania, but they are inaccessible to the working through process that therapy offers without medical help in mood stabilization.
Sometimes hospitalization may be the only course of slowing down the psychotic/manic process if in a full-blown manic/psychotic episode.
- Schizophrenia – this disease usually shows itself in adolescence. It is a devastating psychiatric condition characterized by delusions, hallucinations, disorganized speech, disorganized behavior and negative symptoms. Anyone who has lived with a schizophrenic knows the heartbreak, the fear and the devastation of a brilliant mind gone wrong. There are several types of this disorder, but the type below can be the most dangerous in interpersonal terms.
This type of schizophrenia is called paranoid schizophrenia. Signs and symptoms may include:
- Auditory hallucinations, including hearing voices
- Emotional distance
- Self-importance or condescending behavior
- Suicidal thoughts or behavior
The schizophrenic can terrorize with threats and intimidations and sometimes refuse medical treatment and medication. This is a serious brain disorder, which can have devastating interpersonal consequences.
Do you recognize the abuser you are involved with here?