What is the difference between a TBI and NPD, and can the two conditions co-exist in the same person?
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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:
- angry outbursts
- comprehension problems
- 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
- sleep troubles
- vision changes
- 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.