Other abusers have a personality disorder such that he or she is unable to see the world through the other person's eyes. We call this a lack of empathy and this can occur in varying degrees, ranging from narcissistic personality disorder or NPD on the mild end of the spectrum to antisocial personality disorder or ASD on the other end. NPD is characterized by entitlement (I deserve it but you don't), grandiosity (I'm more special than most everyone else), and a limited capacity for empathy. More severe deficits in empathy may result in a person believing that their person, race or culture is better and justify abuse, genocide, family feuds, murder, etc. Other perosnality disorders such as borderline personality disorder or BPD and obsessive compulsive personality disorder or OCPD can be associated with abusive behavioral patterns. BPD is best understood as a disorder of loss and abandonment. BPD patients are very needy, fragile and demanding, and go into states of emotional storm with rages, tantrums and irrational thoughts and behaviors over minor frustrations. OCPD is diffent from OCD which is obsessive compulsive disorder. OCPD is a more pervasive condition affecting the way a person looks at the world and at others. OCPD patients are enslaved to their needs for punctuality, orderliness, symmetry, color coordination, moral righteousness to name a few. This is perfectionism to the extreme. High levels of anger and anxiety result when their excessive needs are frustrated. Personality disorders are generally resistant to medications and to therapy. Treatment for ASD and severe NPD involves training the people they live with to set firm consistent limits with them and enforce consequences for poor choices as well as modeling respect, kindness and empathy. BPD takes years of work with a therapist to show improvement. Dialectic behavioral treatments show promise. OCPD can be helped by medications and psychotherapy. Certain psychiatric conditions can be associated with abusive behaviors: Bipolar mood disorder, if untreated can cause periods of agitition, irritable euphoria, excessive talkativeness, poor judgement with impulsivity and transient loss of contact with reality alternating with periods of depression. This has become a fad diagnosis lately and anyone with mood swings or moodiness seems to get diagnosed bipolar which is unfortunate because the treatment involves use of some higher risk medications such as Depakote (or valproic acid), lithium or Tegretol (or carbamazepine).
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© Copyright 1995-2004
Robert Shubinski, MD ; All rights reserved.