What is the difference between a TBI and NPD, and can the two conditions co-exist in the same person?
This video is in response to a request made by one of my subscribers during a recent live morning chat on my YouTube Channel. If you’d like to participate in one of these, I go live every weekday around 9 a.m. CST, and every Tuesday at 1 p.m. CST. You can text “AngieLive” (no spaces) to 33222 and I’ll text you five minutes before I go live each time to give you a heads up – that way, you’ll never miss an opportunity for a live session.
If you’ve ever dealt with someone who has had a traumatic brain injury or TBI, you may already know that one of the first and most prominently-displayed symptoms tends to be a problem with anger; that is, someone affected by a TBI may display anger more rapidly and intensely than prior to the injury.
They are also more likely to display egocentrism, a marked lack of empathy and various delusions that may seem outrageous and maybe even a serious propensity for blurting out whatever comes to mind, with no apparent concern on how this affects the people around them.
Even more surprising, they can also sometimes target their own caregivers with these delusions and anger, worrying that they are not there to help them, but are actually out to get them. And, they can have extreme anxiety, missing memories and PTSD as a result of the injury. In addition, they can feel quite entitled sometimes.
Here's a more complete list of symptoms of TBI:
dizziness &/or vertigo
personality changes (such as once being optimistic, but becoming pessimistic after the TBI)
reduced attention span
sensory changes (sensitivity to light or sound for example)
short term memory loss
if the TBI affects a child, he or she is likely to stop maturing emotionally beyond the age the TBI occurred.
The truth is that if you’re dealing with someone who has a TBI, you might find yourself feeling very alone and isolated, just like you would if you were dealing with someone who has NPD.
The difference between the two conditions is hard to see, and in fact, rests mostly in the way they feel about their behavior, from what I understand. But it isn’t really that simple, because the person with a TBI may also be a person with Narcissistic Personality disorder; and this could have been the case prior to the injury, but not always.
A the person with a TBI could, at least on occasion, understand that they are being unreasonable, and they might feel embarrassed and upset about their own behavior. It’s almost as though they can’t control it because of the injury to their brains.
The TBI makes a person feel confused, and often like they have no control. And like they’re alone – lost – fearful. And as a result, they project their anxiety and stress on to you. In reality, they wish they could just make the injury go away so they can get back to their “normal lives,” and at the same time, they may be angry at the world in general (which is often shot in your direction when you’re their primary relationship).
This is a difficult place to be if you’re the person in that primary relationship spot, because quite honestly, what you get is straight up narcissistic-type abuse. I’m not saying the person with a TBI is also a narcissist, necessarily, but the injury itself often causes the same kinds of symptoms and behaviors. The lack of empathy for example is a typical effect of a TBI because empathy is suppressed when this happens.
And ego-centrism does take over in that case – so the abuse can be almost identical to narcissistic abuse. This is confusing for a lot of people and it puts us in a difficult place because often, you may not even know that a TBI has been experienced unless the person tells you.
In fact, until around 2000, most people never reported TBIs to their doctors or their other medical caregivers, partially because they just didn’t know any better. Back in the day, as long as a person wasn’t bleeding or completely out of it, a good knock on the head was “just that,” and people didn’t seek any medical follow-up.
This could lead to some interesting and horrifying consequences – the first being the development of a narcissistic personality. This may be in part due to the fact that the person stopped maturing emotionally at the time of injury, so if it happened in childhood, the person with a TBI may be 12 years old emotionally (or 15, or 7 – however old they were).
And with the lowered EQ, their adult selves may be genuinely incapable of developing beyond this point as an adult.
This makes the person with TBI feel anxious and confused often, and this is furiously bolstered by the fact that no one seems to “get him or her” – but in reality, the TBI causes the affected person to not “get” everyone else.
I am endlessly fascinated by how the brain works, and this has given me new paths to research. But while I’m an expert in NPD, I am not an expert in TBI, so I’m sharing some information with you from someone who IS – and that is Stuart C. Yudofsky, M.D., who is the D.C. and Irene Ellwood Professor and Chair of the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine.
In an article from Psychiatric News (incorrectly noted in the video - reference here: http://psychnews.psychiatryonline.org/doi/10.1176/pn.47.9.psychnews_47_9_27-a), Yudofsky says that it’s common for TBI and personality disorders to be comorbid. He notes that both conditions are very common, and the CDC says that approximately 1.7 people are victims to TBI every year. These injures are responsible for about 52,000 deaths, 275,000 hospitalizations and more than 1.3 million hospital visits each year as well.
Yudofsky points out that published studies of all personality disorders show that between 11 and nearly 13 percent of patients with TBIs also demonstrate personality disorders – and of those, only about .61 percent seem to demonstrate narcissistic personality disorder.
He also notes that personality disorders may actually increase a person’s risk for sustaining a TBI, interestingly enough. He says that due to their propensity for impulsivity, recklessness, irritability and aggressiveness, they may have more physical altercations and other risky behaviors that could lead to these injuries.
And, unfortunately, if that IS the case, the TBI will often intensify the symptoms of NPD and other personality disorders – which leads to the inflation of the person’s inability to accept help or support from others in their lives, including family, friends and healthcare professionals. Since they can otherwise often appear normal, this makes it very difficult for doctors to even identify them at times.
This, like your standard NPD, will often put a great deal of stress and painful emotional consequences on the family and caregivers of someone with a TBI, and the relationships will almost inevitably suffer.
Yudofsky adds that if the person had the personality disorder prior to the TBI, the relationships may have already been tenuous and that they may be unrepairable without serious intervention. He does state that he has had some therapeutic success in treating patients with TBI and co-morbid personality disorders.
In the case he illuminated in his article, the TBI patient had been NPD prior to the injury but since he sought treatment after the injury, a combination of prescribed medication and intensive therapy was helpful, according to Yudofsky.
Another study found that Dementia and Alzheimer’s disease exacerbate the symptoms of NPD. Apparently, as their brains succumb to the diseases, the affected person becomes increasingly frustrated by their inability to accomplish things and to articulate themselves as they previously could. This makes them stay focused on getting their needs met and how to communicate that to other people. If they were NPD prior to one of these diagnoses, their display of symptoms may become more intense.
When their looks begin to fade and their talents become a thing of the past, a narcissistic injury is created, and they tend to lash out at anyone in their path.
And according to Janet M Cromer, a professor and registered nurse who has become an expert due to her husband’s TBI, “Brain injury can also contribute to psychiatric issues including depression, severe anxiety, substance abuse, or obsessive compulsive disorder. Some survivors experience post-traumatic stress disorder (PTSD) as a consequence of the circumstances and medical events that caused the brain injury.”
So how do you manage these relationships? Without therapeutic intervention, you’d manage it much like a standard case of NPD, but if you know that you’re dealing with someone with a TBI, knowledge is power, and you can attempt to convince the person to get help from a qualified psychiatrist and/or other medical professional, and attempt to support him or her through the treatment.
I can go into more detail on this in a future video, if you’re interested, so if you are, please leave me a comment below saying so.
Now it’s time for the question of the day! The question of the day is: have you experienced dealing with someone who has a TBI, and if so, did they display symptoms of NPD or other personality disorders? If they did display symptoms of a personality disorder, do you know if they had the disorder prior to the injury? Share your thoughts in the comments section below and let’s get a meaningful discussion going here.
Communication as we all know is incredibly important in any relationship, but when we’ve been involved with narcissists, even the most skilled communicators can feel helpless and handicapped when it comes to being understood – narcissists will inevitably refuse to understand us, especially when what we’re saying is not something like “OMG, you’re so amazing.”
For example, try telling a narcissist exactly how you feel about the way they belittle and invalidate you – and watch how they twist the conversation around. In some of the most extreme cases, you will end up apologizing for not thinking they’re perfect and for having the nerve to even suggest otherwise.
And, when we go through years of this, not to mention that narcissists often isolate their victims from others who might actually offer some support, we sort of forget HOW to communicate – in a way. We stop feeling like we can (or even should) talk about OURSELVES, and we stop trying to make valuable contributions to conversations, in part because we’ve been conditioned to believe that we have nothing of value to say and nothing to offer.
We believe that we’re not good enough and that no one wants to hear what we have to say anyway. When we do speak up, we tend to keep it short and to the point when it relates to ourselves or our own opinions or beliefs.
There was a time in my life when, if you asked me a question about myself, I might not even know WHAT to say, or even if I did, I’d feel awkward saying it and wanted to get the attention off me as soon as possible.
This was because I had been conditioned to think that nothing about me was interesting or even worth hearing about.
We might also develop other issues – various compulsive behaviors, or an eating disorder or substance abuse problem, because sometimes, we try to sort of ‘self-medicate” to deal with our issues.
We could have flashbacks or panic attacks, and we will most definitely deal with a certain amount of self-doubt. Some of us experience suicidal thoughts – and in the worst cases, some people find themselves seeking or even carrying out the abuse they experienced as a child. On the flip side of that, you may go so far in the other direction that you are a different kind of unhealthy – for example, an abused child who grows up to be a doormat parent (as in, allowing your kids to become spoiled and run the show). It’s a fine line, isn’t it?
But back to communication.
There are certain issues that can directly affect our ability to communicate after this kind of abuse – and as always, I’m going to tell you that I believe knowledge is power – and the first step to power is to realize there’s a problem. We’ve got to first discover it and then admit it if we’re ever going to heal.
So, after abuse, the issues that might affect your ability to communicate are multifaceted. The first one I’d like to outline is our heightened reactions to various common relationship issues – we may become triggered over something small, such as an innocently-used phrase that used to mean something awful. Example from one of my clients: her narcissist would always say “Who are you trying to impress?” So when she was later in a healthy relationship, this same phrase uttered by her new partner triggered her and caused her to revert for a moment to her “former self,” the abused self.
This leads to my next point: emotionally-fueled disagreements. When we’re healing, we don’t always know how to deal with conflict and we may get overly emotional when we don’t mean to. Going back to the client I just mentioned, in that situation, her trigger led her to an emotionally-fueled discussion with her new guy – but in his healthy state, he actually calmed her down by validating her and reminding her that it was okay to be emotional sometimes, and then by comforting her and HEARING her (IMAGINE!).
We may also withdraw and become unresponsive when triggered by our old issues, which obviously affects our ability to communicate, and we almost always feel a serious aversion to conflict. This can lead to an inability to talk through our issues especially if we feel judged or like the person we’re communicating with is somehow not on our side.
We may always have a lingering doubt about how our partners in the future feel about us and sometimes doubt their faithfulness, especially when our narcissists include romantic partners in the past.
And thanks to the fact that many of us have never felt loved unconditionally, we often find ourselves having difficulty accepting any love at all – we are suspicious of people who try to offer it to us and we often need repeated reassurance of the fact that someone cares about us.
This of course can push people away from us and isolate us even further, which will make communication even harder.
So how can we get over this? What can we do to improve our ability to communicate after abuse?
First of all, you have to let go of the fear and start with the basics. Let me ask you a few questions.
Do you dread talking to strangers or those you barely know? Some people seem to be born with the gift of gab. They talk to anyone, anywhere, anytime, about anything. By understanding a few strategies and putting in a little practice, you can talk to anyone with ease, too. You don't have to be mesmerizing. You just have to convince the other person they are.
A successful social conversation puts the emphasis on your conversation partner. It's also a highly effective way to sell products and services.
You can become an excellent conversationalist, even after narcissistic abuse. Try these tips.
1. Make a good first impression. People make a lot of conclusions about you before you ever open your mouth. Conveying the message that you're friendly, confident, and relevant provides a huge advantage. People will naturally want to engage with you and will listen to what you have to say.
* Stand or sit up straight. Put on your best confident smile. Look them in the eye.
2. Pay attention. Everyone wants to matter. By giving your conversation partner your full attention, you can accomplish that with ease. Avoid looking at your watch, your phone, or scanning the room. Keep your attention on the other person.
3. Avoid worrying about what you'll say next. This could easily fall under the previous point, but deserves specific attention. Are you one of those people that's viewed as socially awkward? That's because you're worried about what you're going to say next. You're not listening intently to the other person.
* When your mind is furiously working to think of something to say, you become fidgety, your eye contact wavers, and your anxiety is obvious. It makes others uncomfortable. Just listen, and the other person will give you plenty of material to move the conversation forward.
4. Turn the spotlight on the other person. You'll find that your most successful conversations will be about the other person. People love it when you show an interest in them. Keep turning the conversation toward the other person, their interests, and opinions. Your new friend will greatly enjoy the conversation.
5. Worried about running out of things to say? Repeat the last few words of your conversation partner.
* "So, you went scuba diving on the great barrier reef?" Then just sit back and relax.
6. Always have something interesting to say. You will have to contribute something interesting to the conversation on occasion. Be prepared. You wouldn't blindly reach into a dark closet and wear the first thing your hand touched. There's no reason to blurt out the first thing that comes to mind. Be prepared.
* Watch the news before you head out the door and be aware of the latest global and local happenings.
* Have a story or two prepared.
7. Expect success. Your expectations and results match more often than not. Expect to have a good conversation. Believe that you're a great conversationalist. Visualize conversational success.
8. Give one sincere compliment. Avoid making a direct compliment, because it can be potentially awkward and begs for a response.
* "You're the most beautiful woman I've ever seen" is too much.
* "Wow, you obviously work out. What type of exercise do you do?" is very complimentary without going too far.
* One sincere compliment is enough.
Even after abuse, you can learn conversation skills - or re-learn them.
I am happy to share with you that I will be participating in and supporting this year’s 2nd Annual Healing from Narcissistic Abuse Virtual Summit in honor of World Narcissistic Abuse Awareness Day. I'll be going live with the group at 5 p.m. Central Time today!
World Narcissistic Abuse Awareness Day (WNNAD) is celebrated on June 1st every year and is a growing global movement dedicated to raising the profile of narcissistic abuse. To learn more about WNAAD or to join the cause, please visit http://www.wnaad.com
This year’s Telesummit is hosted once again by Bree Bonchay, LCSW, founder of WNAAD and AthenaMoberg, CPC, co-founder of Trauma Recovery University and the 2nd Annual Healing from Narcissistic Abuse Virtual Summit.
Access to all of the expert interviews is complimentary for a limited time. You maysign up now for complimentary access.
Once you are signed up, you may listen at your leisure beginning June 1st.
Here is a list of the speaker panel and the topics which they will be presenting on at this year’s event.
Sandra L. Brown, MA-Why It's More Than Just Being an 'Empath'--Understanding the Personality Science Behind Why You Are Targeted
Richard Grannon- C-PTSD -How to Stop Emotional Flashbacks
Lisa A Romano- The Dynamics Between Codependency and Narcissism- Why Do Codependents Attract Narcissists?
William Brennan, ME.D, LMHC, CAP- E.M.D.R Treatment- Healing The Aftermath of Narcissistic Abuse
Christine Louis de Cannonville-The Pathological Behaviors of Narcissistic Mothers
Steve Becker, LCSW, CH.T- The Red Flags of Psychopathic Personalities
HG Tudor- Inside the Mind of A Narcissist- What The Narcissist Thinks When You Go 'No Contact" and The Most Effective Strategies to Release Their Hold On You
Jennifer Young, LMHC- Has the Narcissist Really Changed with their New Partner?
Sherri Renner, JD- Legal Battles with Cluster B Individuals in Family Court: What to Expect, When to Prepare, and How to Survive the Crucible
Heather Tuba, BA- The Importance in Advocacy in Healing from Narcissistic Abuse andSupporting A Spouse With Complex Post Traumatic Stress Disorder
Kami Lindgren, BA- Life Beyond Pain: Healing from Chronic Illness through Neuroplasticity
Again, if you would like to reserve your free access, all you need to do is register at http://www.wnaad.com
Join me there! I look forward to seeing you and sharing a message of hope with all survivors of Narcissistic Abuse.
What’s the difference between someone with Asperger’s Syndrome and someone with narcissistic personality disorder? Is there one? And could narcissistic personality disorder possibly fit on the autism spectrum?
Turns out, there’s been a LOT written on this topic, and it looks like that’s because there’s a commonly misunderstood issue at play here. As you’re probably well-aware, narcissists don’t seem to have much (if any) true empathy for people in their lives; that is, they don’t seem to care how their behavior makes others feel, nor do they seem to understand why people feel the way they do about various situations in their lives – they don’t “feel” people, so to speak, in the same way that you might if you’re an empath.
The issue that’s misunderstood is not related to narcissists in this case, though, it’s related to people who have Asperger’s syndrome. There’s a commonly held but totally incorrect belief that people with Asperger’s syndrome also do not have empathy, but according to my research, that couldn’t be further from the truth.
According to what people who understand the syndrome have told me, and from what my research says, people with Asperger’s DO feel things, and they tend to be incredibly empathic. The disconnect is not directly with their emotions, but with the way they express them.
As I understand it, people with Asperger’s tend to have trouble with verbal expression of their feelings and they also tend to struggle to read faces, which may cause them to appear narcissistic. BUT, the difference here is that they DO feel the emotions and, according to some researchers, maybe more deeply than someone who is more neurotypical.
But they can also become quite overwhelmed by these emotions, and combined with the struggle to communicate effectively, this often causes the person with Asperger’s to simply withdraw from the situation – so if you didn’t know better, you might think they didn’t care.
So what are the differences between the two conditions?
We can’t discuss the differences without also covering the similarities, so let’s start there.
From what I gather, while both narcissists and people with Asperger’s are both goal-focused (often to a fault) and may appear to not care about the way people feel, one key difference is that your average narcissist really doesn’t care if they hurt you or your feelings (and they may even take delight in doing so), while someone with Asperger’s would truly prefer not to hurt you or anyone else.
As you know, my advice to someone who is dealing with someone with a severe case of NPD is to go no-contact if necessary – especially when the person is abusing you, mentally or physically.
But when it comes to someone with Asperger’s, the best course of action isn’t always so clear. See, even though you might take their behavior very personally and find yourself feeling emotional pain as a result of it, if they don’t mean it personally, it’s really not right for you to take it that way.
What I mean is that it’s not reasonable (or fair) to treat someone who is just not able to communicate well enough to express their true feelings in a way that you understand as though they are intentionally trying to hurt you – they aren’t in this case.
So, rather than reacting harshly and yelling or talking AT them, try being calm and talking with them, letting them know how their specific behavior affected you and what it caused you to feel or do in response, which you’d prefer not to do or feel. Explain on a logical level, and offer a potential alternative for the next time this situation occurs.
While someone with Asperger’s may be weak in certain areas, they’re strong in others – and they are capable of learning new ways of coping and dealing with people in many cases, and this is especially true if you speak to them in a respectful manner.
That brings me to another big difference between someone with narcissistic personality disorder and someone with Asperger’s. If you DO come to them to express your feelings, you'll get entirely different results.
While a narcissist will deny any weakness and play mind games with you, often attempting to gaslight you so that you doubt your own mind and your own experiences, someone with Asperger’s is likely to be surprised that your feelings were hurt and have genuine remorse for what happened – they didn’t really mean to hurt you.
The person with Asperger’s is only trying to continue moving toward their goals, and they generally aren’t known to ever want to hurt anyone, especially not someone they care about.
All of this is contrary to the belief of one British psychiatrist, though, who claims that narcissistic personality disorder ought to be on the autism spectrum. No, I’m not kidding.
I found this article in Psychology Today that features the opinions of Dr. Khalid Mansour – and I’m just going to share a few points with you.
In an article in the Pan Arab Journal of Psychiatry, the good doctor says exactly that – simply that narcissistic personality disorder could potentially deserve classification as an autistic spectrum disorder.
Dr. Mansour writes, “There is now significant level of agreement that emotional processing problems like: lack of empathy, poor self-awareness, self-centeredness, poor reciprocation of emotion, poor ability to maintain emotional relationships, anxiety and anger outbursts are more or less central features of autism (10, 50,51).”
So, just reading that paragraph, you’d feel like he’s discussing NPD, right? Nope. It’s, according to him, a description of both narcissism and autistic spectrum disorders.
He also quotes from the ICM-10 listing these features of autism:
–Self-centeredness; inappropriate to developmental level and cultural expectations
–Poor self-awareness, poor ability to develop remorse or learn from mistakes
–Poor empathy or appreciation of others feelings
–Poor ability to reciprocate emotions.
–Hostile dependency on safe relations.
–Failure to develop emotional relationships appropriate to developmental level and social norms
–Treating people as objects or preferring objects over them
Again, this list certainly sounds a lot like narcissism.
Dr. Monsour concludes that “… it is noticeable that people with NPD, do not show a major degree of functioning problems in stress free environment or when they are supported (except that they are perceived as “not pleasant characters” to deal with). However under stress and without support they can become quite dysfunctional in a way not far from what we usually see in Asperger’s syndrome. “
So, what does all that mean? Well, if you ask me, the good doctor may be a little off-base, but what do I know? After all, I’m no psychiatrist, but based on what I’ve learned about these two conditions, I must respectfully disagree with this idea. I believe he is mistaken on the fact that people with Asperger’s lack empathy, as I explained previously, and I think that simple fact alone negates the possibility – not to mention the other differences between the two, which I can cover more extensively in another video, if you’re interested.
This, of course, brings me to the Question of the Day!
So you tell me – what do YOU think? Could this guy be on to something? Or do you agree with those who say that people with Asperger’s are often quite empathic, but lack the ability to communicate their feelings effectively and combined with their trouble reading faces, may simply appear to lack empathy?
Share your thoughts and experiences in the comments below – I’d love to get a meaningful conversation going here.
Today I’m sharing a story from a SPAN member who says her husband has been healed of his narcissism by Dr. David Hawkins, who has claimed to know the cure for narcissism. With her permission, I’m printing her letter in full here – but we’ll refer to her husband as Mr. X to protect their identities.
“Hi Angie, just watched your video referencing Dr. Hawkins. My husband Mr. X (name changed) and I have been clients of Dr. Hawkins’ for 18 months. Prior to Dr. H, nothing worked. Mr. X could sell ice to Eskimos and fool me, himself, our previous counselor, etc.
Hawkins knew who and what he was dealing with-- he called out every attempt of blame shifting, gaslighting, etc. He easily drilled down and identified Mr. X's triggers.
He taught me how to respond and react in a way that cut off Mr. X from abusing me and he wasn't allowed to interact with me again until he made appropriate amends as approved by Dr. H. If his amends were BS, Dr. H called him out on that too.
Over time he identified Mr. X's abuse cycle and the triggers for each phase of it. He taught Mr. X how to identify his thinking errors along with a process to replace his stinking thinking with healthy thinking.
The abuse cycle used to be short, repeated every few days or weekly, then as Mr. X became a humble participant in his own therapy with Dr. H the abuse cycle occurred maybe once a month. Mr. X's "narcissist mode episodes" happened less and less.
It was hard work, we had to work together daily, per Dr. H we read Lundy Bancroft's book, "Why does he do that?", this taught us both why abuser's abuse, how they think, what needs to occur for them to change, etc. This was one of many helpful assignments from Dr. H.
If the NPD spectrum was a 1 to 10 scale, Mr. X would have been rated a 4-5. I think any WILLING Narc rated 5 and under could change with Dr. H's approach, but only if they truly want to and only if they stick with it.
Mr. X spends a min if 1 hour a day working on his recovery. He also worked the 12 steps even though he doesn't drink! Many years ago, Dr. H wrote a book on the 12 steps, basically the principals teach you to let go of resentment and a lot of the workbooks and exercises address narc behaviors.
So, I wanted to share! It was hard, it's a new lifestyle, Mr. X will be in therapy forever. His inner narc is rarely triggered, and if I even think I'm seeing a glimpse of it I announce it and Mr. X uses his tools before it takes over.
Just like anything, it's not for everyone. I'm the Mom of a son who happens to have ODD, Asperger’s, and Anxiety. I've mastered identifying and redirecting triggers. I don't want to be a Mom to a Narc and I refuse to do so.
Before Dr. H I was apartment shopping and thought I'd consult him as one last effort before running! Mr. X had very good qualities that were present way more than his Narc side.
Dr. H saved my husband and our marriage. Your videos so helpful in teaching me more about gaslighting etc. It made it easy to see what was happening and get help! Thanks Angie, you are a hero!”