Treatment Tuesday - Multi-Disordered Assessment

This week’s assessment is for Angie over at Gumbo Writer. I’m excited to do her assessment for two reasons:

1) I’m always glad to look at characters and pick them a part. This is an occupational hazard of being a therapist.
2) Angie’s character really has some issues…most of which I’ve been covering in my Personality Disorder Parade! So this will be a great tie-in for several of them.

Angie’s character has the multiple disorders/problems listed below:

--Paranoid PD, which may just be fallout from a history of wrecked relationships
--Obsessive-Compulsive Disorder, consistent manifestations but not full-blown, seems to be aggravated by stress or situational bouts
--Histrionic PD, long-term and obvious, always seeks Knight in Shining Armor as mate
--Narcisstic PD, heavy on entitlement and exploitative/manipulative aspects
--Depression and some eating issues; has lost/gained 100+ pounds several
pounds)
--Past issues with alcohol
--Pathological Liar Syndrome (Angie’s new addition to the Diagnostic and Statistical Manual-V when it comes out in 2012) :)

Angie wants to know: What would her life look like? And if she abuses prescription drugs, can you predict the future that will be hers?

We need to do triage on this person, stat! No, seriously, if this client were to appear in my office, most likely she would be seeking help for the OCD or depression and binge eating/dieting cycle she’s on. The physical manifestations of both of these problems would draw attention from a therapist and be the most obvious. (Of course, because she’s a pathological liar, I’d have to collaborate with other people in her life to make sure she’s telling me the truth!)

OCD is an egodystonic disorder, meaning that the person does not want the thoughts and compulsions. On the contrary, they cause them much distress. So they know when they are obsessing. They know when they perform a compulsive act to help rid their mind of the obsession, and they hate it. If her OCD isn’t full blown, but situationally-bound to times when she’s under stress, perhaps this isn’t such a big deal to her.

The binge eating/dieting phase is something I’m really interested to know more about. What triggers her to lose weight? And then what triggers her to gain it back? I have a theory—just that, a theory—for you to consider while you write this interesting character. Read on.

Since you’ve indicated that she’s got some traits of some personality disorders, I’ll start there. Of the three that you’ve listed, Narcissistic and Histrionic are the hardest to treat. (For the sake of simplicity, let’s say her paranoia doesn’t reach the level needed for a full diagnosis of that disorder. Your reasoning behind why she might be a tad paranoid is totally feasible.)

But personality disorders can often be comorbid, and by that I mean that they often are found together in people. And if your character has both, then I think maybe expounding on narcissism a bit would help, as I believe the key to her weight gain and loss, even her past history with alcohol and dabbling in prescription drugs could come down to this point in my theory.

There are supposedly two types of narcissists, the cerebral narcissist and the somatic narcissist, and each has a different way of getting their ego-strokes. The cerebral narcissist gets their strokes from their insight and intelligence. They are like a computer, and want the accolades and recognition for it in the same way a drug junkie craves meth. It's their addiction. The more people think their ideas are superior, their intellect non-paralleled, the better they feel. Most could care less about their body.

The somatic narcissist, however, uses his or her body and physical attributes to get their strokes. They want people to notice their health, constitution, shape, sexual prowess, possessions, and physical beauty. Even recognition for bodily “extensions” is desired, common examples being flashy cars, expensive clothes, penthouse suites, flying first class, platinum charge cards, the latest and greatest electronic gizmo or gadget, celebrity "friends" and name-dropping. These are all "extensions" of themselves that they feel should garner attraction.

A person is dominantly one type, but during times of stress, the other type can come to the forefront. If your character is mainly a cerebral narcissist, then when she experiences stress, her recessive somatic narcissism comes out from hiding. She then goes on a binge diet and exercises a lot, losing a ton of weight and exacerbating her histrionic symptoms. Let me explain.

There are some overlaps with somatic narcissism and histrionic symptoms simply due to the nature of the two disorders. You can see my post here on Histrionic Personality Disorder, but two of the main symptoms are dressing/behaving suggestively and provocatively and using their physical appearance to draw attention to themselves. One way in which to do this is to take extreme care of the body. Working out, eating healthy, being overly concerned of the slightest malady (like a hypochondriac)…these are all ways to draw attention to a person’s physical self. Throw on some revealing clothes, and she’s a somatic narcissist as well. Make sense? So your character’s weight fluctuation could be attributed to this.

The thing to figure out is which narcissist type the character predominantly is. If she’s somatically inclined, then when she experiences stress or if she suffers a major narcissistic injury (someone tells her she’s ugly or something—which a somatic narcissist would rather die than hear), her cerebral narcissist might come out of hiding….thus you get more OCD symptoms during those times. This seems a likely explanation, but only you as her author will know for sure. :)

As it would with anything, alcohol can potentially exacerbate any and all of the above. Drugs and alcohol impair judgment, which could make for some interesting "trips" in her head when she's having an OCD obsession. But if she's in her somatic narcissist stage, I doubt she'd want much alcohol, as the prevailing idea is that alcohol can make you fat. I'm not sure how big a role her past issues with alcohol will be, but once an alcoholic, always an alcoholic. THIS IS TRUTH. According to the Alcoholics Anonymous curriculum, they label themselves as "recovering alcoholics." So she'll still likely have urges to drink even if she withstands them and remains sober. You might want to include this, or you might not.

You'll have to be creative in getting the pathological liar syndrome across on the page. (Which, by the way, for those who may not know, isn't a real disorder. It's actually probably more of a symptom of her narcissism. Narcissists often embellish things to make themselves appear more exciting than they really are.) Someone will have to either call her on the lie in dialogue, or you'll have to have the points of view of other people taking about how she's lying. So that's tricky...and it could potentially get old for the reader, I suppose. But one or two big lies would be really interesting, I think. You could weave the story world around those lies...kind of like how the viewer of A Beautiful Mind gets the shock of their lives half-way through when they realize the main character's story world is completely a lie.

Anyway, this assessment has been fun. Lots to work with in this character, and hopefully you can work with some of the stuff I've presented. As always, questions are welcome in the comments section, either from Angie or others.

This service is for fictional characters only, so any resemblance to real life examples is entirely coincidental. Any other fictional character assessment questions can be directed to charactertherapist@hotmail.com.

Stop by Thursday for a look at the interesting Schizotypal Personality Disorder. Funny name, not so funny disorder.

Q4U: Any thoughts about the cerebral v. somatic narcissists? Have you known people who got their ego strokes from their intellect or from their physical attributes?