Narcissistic Personality Traits Maldon, Essex

Diagnosis: Alcohol overuse, Entitlement Schema. Target Behaviour: Narcissistic personality traits (Patient lives in Maldon, Essex)

"Fiona" (not her real name) is in her early 50s, and came to see me for an initial consultation because she felt "stuck" and had "hit a brick wall" emotionally, unable to function.

Through a process of 'guided discovery', we were able to understand that Fiona seemed to feel as if she would never get enough love from other people, in particular her daughter and husband. We were also able to learn how relationships for Fiona seemed to be a problem and that she often found it difficult to recognise how she was feeling because she would block her emotions which, when they built up, led her frequently to binge-purge; something her daughter hated, she told me.

Fiona claimed her husband had alienated her from her daughter. The two were close, but Fiona had a poor relationship with both husband and child.  Binge purging had increased recently, and I asked her about alcohol use, to which Fiona told me that she did drink, but no more than one or two glasses a night. However, she recognised that often it was the drinking that would lead her to her binge-purge behaviour.

When Fiona came back to my office to start therapy, I asked her for her reflections after our intial meeting. "You really hit on a few things, very accurate" was her description of how she found that session.  I noted that she did not seem to take any pleasure in this revelation quite the contrary it seemed to make her uncomfortable.

When completing the Depression and Anxiety inventory forms she really struggled as she didn't "fit into any of the boxes". Somehow she was too "unique" and her situation, too "different" to get a general view.  Most patients take five or six minutes to complete the forms, Fiona, becoming increasingly frustrated, took 30 minutes or more.

Fiona was extremely defensive and I felt as if she wanted to control the session. She became easily frustrated when completing the forms, reminding me that she was paying me "good money for this, but I will go along with it as you are supposedly the expert".

I asked her what her goals were for therapy. "I feel as if I have hit an emotional brick wall"  "I want to stop bingeing and purging and my alcohol use has gone up a bit so I'd like to get it back down to a manageable level"

I then asked her how much alcohol she drank. "About 1-2 bottles of wine a week. I went to see the alcohol addictions therapist at [a local rehab hospital] and we ended up in an argument.  He got it completely wrong, I don't have a problem with alcohol, its an emotional problem"

After some discussion, it also transpired that outside of her family, she had problems maintaining relationships. She claimed her husband was controlling, and would neglect her emotionally.  Her daughter (17) preferred her father and was distant and 'disrespectful' to her mother; they were often in conflict.

She was also angry with her sister and not speaking to her because her sister had arranged their mother's funeral without including her. She could give no reason as to why this might be. She had no relationship with her sister because it was "too painful".  She would not elaborate on this further.

We talked a little more about Fiona's history. Her mum left home when she was three, because dad was physically and mentally abusive to her. "I don't blame her now but I was angry with her for a long time. I wanted to be with mum but instead went to live with my dad.

"I felt rejected by mum. Then dad's new partner didn't want me either. Dad sent me to live with my uncle and aunt and I didn't see him after that either. They looked after my material needs but there was no real love or affection. They just did what they thought of as their moral duty."

I asked Fiona if she tended to feel rejection easily. "Yes, I do. Unfortunately it doesnt take a lot to make me feel like that."

And what was it that would most likely make her feel rejected? "It has been worse since I've been drinking more.

"I started seeing mum again when I was seven. She felt so guilty that she started overcompensating. Wanting my attention all the time and my sister's.  She was emotionally demanding and wanted me to live with her full time when I was 16.

ME: "How did you feel about that, going from absolutely no love to almost total love and attention"

FIONA: "It was confusing at first, then it felt good initially but soon it got quite smothering.  She was so needy and I felt like I had to give her what she wanted or I would lose her love again.  My sister reacted differently to me. In order to get away from Mum's smothering she went  into the army so she 'escaped' and I didnt. I was angry with her for leaving me with the responsibility of a needy mum and an equally needy brother.   Anyway my brother went into the army and then tragically died.  It was too much for mum and she started to drink.   She needed me even more after that.  I felt as if I was responsible for her.  She became an alcoholic and when I got married I moved out but I was always felt responsible for her.  She died 10 years ago because of the drinking"

Fiona also discussed how when her mood drops (usually at night) she would begin going over her painful past and then feel the urge to drink.  After drinking she would feel guilty and then head off to the kitchen to binge which would ultimately increase her guilt until she purged.  She claimed it was this behaviour that caused her daughter to feel disgusted and angry at her.  They would argue and she would turn to her father for comfort.  When her father would give emotional support to the daughter, Fiona would feel betrayed and rejected and would act out angrily towards her husband.  Her anger would cause her to damage their relationship and again the cycle would start at night when she would mull over the hurt and betrayal.    What became clear was the fact that she was still very angry about things that had happened all her life, not just current events.

Throughout the session, Fiona kept looking at the clock to ensure she did not run over time.  After our session Fiona left the room quickly.  Her husband who was late to pick her up came into my practice to speak to me.  He seemed agaitated and nervous,
"She's angry with me because I just missed her.  I don't know where she has gone but she wont answer her phone now"

I told him she might be waiting at the bus stop but he hung around as if he wanted to say more.

"I think I should come and see you because I need help too.  Did she tell you that she drinks about 2-3 bottles of wine a night?"  It's destroying the family, I really don't know what to do"

He seemed desperate but I told him
"I can't discuss your wife's therapy with you but if she agrees to having a joint session with you then I arrange that.  Otherwise, you should seek help for yourself with another therapist.  I understand that sometimes family members may need support too".

Had Fiona purposefully played down her use of alcohol?  Was she in denial of the problem?  Was this why her meeting with the addictions therapist ended so badly?

The answers to these problems were pre-empted by a phone call on the day of her session. Fiona had phoned to cancel without giving the required notice.  I offered her an appointment the following day and told her that if she took this appointment she would avoid the cancellation charge.  She became instantly very angry and abusive, claiming I did not care about her.  She told me "you shut up and listen, I am talking now", and I asked her to ring off and try to allow time to calm down and call me later when she was less angry so that we could discuss it properly.  Fiona cancelled her therapy and said she would not return.

Emotional Deprivation Schema
Essentially is the belief that others will never meet important emotional needs.  These needs could include affection, protection and guidance, nurturance and empathy from parents or caregivers.  Often the existence of this schema indicates that others were emotionally depriving to the child.  Often the child has experienced disconnection and rejection and may still be experiencing similar patterns (either real or imagined), as an adult.

Fiona experienced a detached and unpredictable family environment.  She grew up with the belief that her needs for stability, emotional nurturance and an intimate family relationship would never be met consistently.    Her Mother's later overcompensation of emotional nurturance meant that there were no limits or boundaries.  Mother would not criticise or point out when Fiona had been disrespectful or rude.  There was a sense of permissiveness and instead of maintaining healthy limits, Mum indulged Fiona as a way of making up to her for having abandoned her.  Fiona came to believe that she had the right to have her needs met before anyone else, even those of her own child, and that social norms, rules and others boundaries should not necessarily apply to her.  She 'expected' that others should make an exception to the rule for her and that if they did not,  it meant that they did not care for her, she was being abandoned and rejected all over again.