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Suggest Treatment For Narcisstic Personality Disorder Along With Anti-social Personality Traits

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Posted on Wed, 22 Oct 2014
Question: I am in a bad situation and very concerned. Please forgive me for length but I want to give a thorough understanding of the past and current situation.

My bro in law has an erratic behavioral history. He and my husband, my best friend's husband, and my sister's fiancee are part of a close knit group who have been friends for over 20 years.

The females involved (myself, my sister, my best friend) have all known him for close to ten years. During that time we have noted, starting almost immediately, disconcerting behaviors that have been escalating for the entire time we've known him. Oddly, maybe because our sig others were all so close with him, we've never discussed these concerns until the last week.

Some examples would be leaving college at 25, two weeks before finals and sacrificing all the year's credits- not because he was failing- but because he claimed to have just changed his mind about school. Leaving at least three lucrative jobs in this time including the last one which paid well into the six figures. He once brought a little 2 year old boy to our house to play with our kids (our daughter was also two). He confessed to us that this was his son by an old flame that he just found out about, and spent around four hours telling us how this had happened, how he had discovered he was a father, how he felt, that they were considering marriage, that he hasn't told his parents yet because he wanted to share it with us first since we would understand his excitement at becoming a father so unexpectedly (my sons are from a previous marriage so my husband got an "instant family"). Then, as he was leaving he grinned and said, "He's not my kid." It was just an ex girlfriend's kid he was babysitting. He considered this a funny prank as we congratulated him and talked about how wonderful this was and excited we were at this sudden addition to the family. He has spent hours bemoaning his inability to find true love, but can't name the last time he didn't have sex the first night he met a girl, and all of them are always described almost entirely in terms of breast size and sexual prowess in front of me, sometimes my sister or BF and more than once in front of my kids. He frequently wants to show 'our men' porn in our presence, recently he tried to show my sis' fiancée a porn vid in a restaurant full of children. All this despite our (the gals') constant requests that he stop, that he refrain from such vulgarity and dehumanizing of women, at least in our homes and our presence. When we protest he laughs openly at our concerns then acts like our men are henpecked and this is just a completely unreasonable request on our part.

On the other hand he is almost frighteningly intelligent, and there have been times we have engaged in hours long fascinating debates and talks, and I love his company during these times. Moreover I love him, as family, I truly do.

He is my husband's youngest bro and they unfortunately endured a delusional, fanatical mother who physically abused and neglected them to the point that their sister (eldest, 48 to my husband's 38 and bro in law's 30) told me after she married and moved out, six months later the 2 boys remaining in the home (my hubby had run away to his grandmother at 12) were so malnourished she had to take them to her home for nearly a year. Their father worked out on the road for weeks at a time and they were alone with this woman who to this day is frightening. She has been diagnosed manic depressive and paranoid schizophrenic, but takes no meds and this diagnosis is easily twenty years old.

Until the last week or so, the men have tended to laugh at his 'foibles' chalking it up to his 'quirkiness' while I, and I now know the other females have found his behavior increasingly disturbing. The change happened thus:

As usual he was dating another giant breasted, single mom, bar pickup that he almost immediately decided was his soul mate. One week we heard they were splits, two weeks later they announce their engagement on Facebook, after about three months of knowing each other. Two months later, he called us all out of the blue asking for money, telling us she was cheating on him, had tried to steal his stuff through some convoluted scheme to put his things in storage under her name. He tells us various stories depending on who he's talking to, about quitting his job and being broke. One he tells he quit "because I was sick of being low man on the totem pole." Another, that they cut his hours so severely his pay was cut in half and denied him a "30% cost of living raise" so "basically I was taking an 80% pay cut and that's bull***t!" He says they cut his hours, but then let's slip that his boss told him, "people say you're hard to work with, so I told him 'people say you're an a**hole!'" This makes me suspicious that his hours weren't cut as a company wide policy as he also claimed, but because there were limited jobs they could place him on. He is incredibly, obnoxiously prideful, claiming he's so smart a team of physicists had to eat crow when he proved them wrong, and recruiters were beating down his door to get his talents. Yet he is flat broke after receiving a $6,000 final paycheck plus $4,000 from his parents, maybe another thousand combined from friends who would have killed for the job he left, all in the space of two months when he has supposedly been homeless.

He is constantly drunk, drives completely plastered, and recently my sis' fiancée caught him sending vicious texts to an ex girlfriend he has not dated in seven years. One text he sent told her "Don't break your neck looking up at me." She replied that he "has to stop or [she is] going to the police." He replied, "Eat a d***." Sis' fiancée took the phone and deleted her contact info.

Then he told sis' fiancée that he followed the man his latest ex is now seeing (a marine) to his home and "knocked on his door just to let him know I know where he is." And left. He has also been following the ex, and claims he hacked her phone to get the name of the marine, then remotely reset it to the factory settings. Essentially wiped the entire phone. He has further confessed that he also followed the previous ex, a girl he knew only a couple of months.

He has told my husband none of this, but on the phone last night he kept saying things like "I'm a husband that can't even see my kids. She looks down on me because I don't have a job and now some marriage wrecking marine is f***ing my wife and seeing my kids and I can't even go home to them. I just wanna go home that's all. And people I thought were my friends, they're looking down on me like I'm lazy because I left my job, and I'm like, 'f*** you! I used to make three times what you make! Don't look down on me motherf***ers!'" I was taking notes and that's an actual quote. He then mentioned that my sis' fiancée has been avoiding his calls and I think that's who he was talking about. They have a house near his ex and he wants to live there for free while they are out of state working. The answer is going to be no, but we are trying to decide what TO do to help. He never married this woman. They are not his wife and kids. Yet he was saying the marine could "be court-martialed for f***ing another man's wife! That's a criminal offense, you know!"

So finally, about a decade after the ladies began noticing this bizarre and disconcerting downward spiral, our men also think there's a problem. The thing is he is in another state, 1900 miles from where we are all working. Last night we had tentatively decided to bring him here (if he's willing to leave his obsession behind) under the condition that he engage in intensive psychotherapy. There were all these ground rules we settled on, narcanon meetings, no bars, no strangers, no car at first, regular therapy sessions, no sex talk in front of me or the kids. My boys are 12 and 14 and I worry about his passive influence on their developing sexuality, and my daughter is 7 and I've no desire to expose her to an attitude that women are essentially an inconveniently autonomous backdrop for breasts. Let me be clear: I am not easily offended. I was a Marine. I have worked in almost exclusively type-A male dominated fields for two decades. Locker room talk doesn't phase me a bit and I am no prude. Sex is not a taboo subject at all in our house. Yet his particular attitude and verbal expression regarding women is almost hateful, it makes me incredibly uncomfortable and is not in any way limited to the occasional rant when a woman has done him wrong. It's a pervasive sentiment that genuinely disturbs all three of the women involved here.

After doing serious reading today, not on violence against women blogs, but on actual psychiatric peer reviewed papers, diagnostic criteria, etc, I am very concerned about bringing him here. The menfolk seem to believe 6 months to a year of therapy will have him functional and on his feet, but looking at the criteria for personality disorders, my husband reluctantly counted off 9 out of 9 persistent, disruptive traits on the Narcissistic Personality Disorder and 14 of 16 for Antisocial PD. And from my understanding, there's a huge difference in the outlook for personality disorders versus mood disorders such as depression, PDs having deeply entrenched schemata that are almost impossible to alter, and most cognitive therapy focusing on attendant MDs like substance abuse.

Further, this stalking behavior is of significant concern to me. Rejection appears to be his trigger. Last night we were all agreed that if he didn't follow the rules we would have to cut him off. This is supposed to be our final huge effort to help him or else he's going to be on his own. But what happens when WE are the ones who reject him?

So essentially this has become a battle of the sexes. The men saying they've known him all their life and they don't believe he would hurt anyone, or at least not yet, so let's get him here and fix him before he does, seems to be the sentiment. Along with "loyalty."

The women are responding, you knew him all your life, but it wasn't until last week when you found our about the stalking that you saw any problems, we've seen it coming on for a decade, maybe you're a little blinded to his potentiality for causing harm.

Knowing what you do now of his history and current behavior, would you say there is a high likelihood of his engaging in therapy to his benefit AND following the rules we listed? And most importantly, IF he does not, and we have to basically kick him out of our home, is there a potential for danger to me or my family?

Thank you so much for your consideration.

XXXX
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (1 hour later)
Brief Answer:
There is low likelihood of engagement in therapy

Detailed Answer:
Dear XXXXXXX
Thanks for using Healthcaremagic and posting a detailed query.

Regarding diagnosis I do not have any doubt after going through your query but whatever the number of criteria present, For me he is first Narcisstic personality disorder with anti social personality traits. I may be wrong as still the mental status examination, most important tool for diagnosis can be carried out. To make it easy he is suffering and making others to suffer with cluster B personality disorder.

Regarding therapy as these patients do not have awareness about their condition and till confronted in proper way, find very hard to engage in therapy.
But the most important factor is to way of confrontation and I hope the therapist in your city is well equipped to do that.

As these patients are very impulsive and involve in risk taking behavior, they become threat to close ones if not handled properly. Rejecting him is not a solution and we need to be more optimistic.

In recent years there is lot of success report in patients with various personality disorders and Cluster B is no different.

Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
Thanks and regards
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Dr. Ashok Kumar Choudhary (25 minutes later)
Thank you very much for your reply. To clarify, we do not have the ability to care for him if he continues the destructive behavior. He has a tendency to bring home strangers from bars for example. To drive drunk. This would not be acceptable and we would not be willing to bring him up here and open our home unless there was a definite set of ground rules. Depending on the frequency and severity of the breach, at some point we may need to ask him to leave.

Based on his past behavior, including and especially this recent stalking, I fear we could become targets if it came to that. Some of those involved believe this is an overreaction and unreasonable fear. In your opinion, is it

?
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (47 minutes later)
Brief Answer:
This seems to ge genuine fear

Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.

What your thinking is completely based on his behavior and due to personality disorder. It is not unusual for a person with personality disorder to react in a different way endangering life of self or others.

Having said this I am of the opinion that everybody should be given fair trial to improve his/her behavior. Before you ask him for engagement to therapy and declaring threat to family will not going to solve the problems.

'Hope I have answered your query. If you have any further questions I will be happy to help".
Thanks

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Dr. Ashok Kumar Choudhary (31 hours later)
He has decided not to come, so he is still several states away. He has veen obsessing over how he cant go home to "his kids" because of the mom "looking down on" him. Is this ex of his or her children in significant enough danger that they should be warned of his behavior?
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (9 minutes later)
Brief Answer:
its difficult to predict

Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.

As we are not aware about the truth of his ex whether she is really the mother of his children or just he is making excuses to not to come for therapy.

Other than than we do not know, how the person reacts to him, even if they have connection.
It is difficult to predict behavior of someone without knowing the environmental factors and ground reality.

At this stage I can state that if he is rejected in a way which does not suit his personality needs, he can be dangerous to anybody.

I hope this answers your question.

If you do not have any clarifications, you can close the discussion and rate the answer.
Wish you good health.
With best regards
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Dr. Ashok Kumar Choudhary

Psychiatrist

Practicing since :2000

Answered : 3354 Questions

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Suggest Treatment For Narcisstic Personality Disorder Along With Anti-social Personality Traits

Brief Answer: There is low likelihood of engagement in therapy Detailed Answer: Dear XXXXXXX Thanks for using Healthcaremagic and posting a detailed query. Regarding diagnosis I do not have any doubt after going through your query but whatever the number of criteria present, For me he is first Narcisstic personality disorder with anti social personality traits. I may be wrong as still the mental status examination, most important tool for diagnosis can be carried out. To make it easy he is suffering and making others to suffer with cluster B personality disorder. Regarding therapy as these patients do not have awareness about their condition and till confronted in proper way, find very hard to engage in therapy. But the most important factor is to way of confrontation and I hope the therapist in your city is well equipped to do that. As these patients are very impulsive and involve in risk taking behavior, they become threat to close ones if not handled properly. Rejecting him is not a solution and we need to be more optimistic. In recent years there is lot of success report in patients with various personality disorders and Cluster B is no different. Hope I am able to answer your concerns. If you have any further query, I would be glad to help you. If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback. Thanks and regards