Concept Of Relationship Foreign To Narcissists

Those who are immature or who have Narcissism don't get the concept of "relationship". They tend to think that they're entitled to any of the relationships they have, and to ownership over other people. That's one of the main reasons they don't want to do any "work" on relationships or on themselves, and why they get so upset when anyone suggests it.
Typically they get upset just talking about something that happened or something they did, and will try to divert or end the discussion.
They think that knowing someone IS all that a "relationship" requires, unless of course they want the OTHER person to change... but themselves? No way, they're already perfect, the other person is the one who needs to make any and all changes, not them.
A person with Narcissism might make little changes over time, just because it's natural for a human to change somewhat as they age and as they experience different things. But they're probably not going to ever understand the concept of a mutual relationship.

Making It To The Top

There's a very big difference between being carried to the top of the mountain by someone's helicopter and climbing it on foot. There's also a very big difference between climbing the mountain with full equipment, support, and companionship, and climbing it alone, or without expensive equipment or supplies. And there's yet another very big difference between climbing the mountain to the top in calm weather, and climbing it during a storm, during winter cold, or during an avalanche.

Just because one person made it to the top of the mountain doesn't mean they had to work nearly as hard as someone else to get there. Some people have lots and lots of help from others, and some have to fight obstacles that others don't have, and still others have to climb through obstacles all alone.
Just because one person doesn't get to the top doesn't mean they don't have the ability, nor does it mean that the top was even their goal.

Each person has a unique climb that's different from anyone else's, and the peak is not the ultimate goal, or the only place to be. To judge a person by how high they've climbed up the mountain simply shows a lack of understanding life.

Note To Counselors, Psychologists, Psychiatrists

Having a degree or even a job does not mean that one is an automatic expert at diagnosing or assessing patients, or at treating them. If I think of you as a lesser person than myself, I am not going to diagnose or treat you properly. Same if I don't like you, am bored by you, or judge you. If I'm not interested in observing the way other individuals treat you either in your family or in general, or if I judge your family member to be more worthy or respect-deserving than you, again I am not going to treat or diagnose you properly. If I judge your whole family to be some kind of lesser class of people, there's no way I'll treat or diagnose you properly. If I consider myself a world class expert, I am probably going to overlook my own bias and weakness and fail to diagnose or treat you properly. If I harbor class, race, sex, or age bias, I'm definitely not going to treat you properly. My norm is probably NOT your norm, but if I think it is, if I believe I am the picture of "normalcy", then no, I am not going to diagnose or treat you properly.

Too many difficulties? Too many hurtles? Too bad. That's how it works. Psychology professionals used to have a better grasp on why objectivity and absence of bias is so important, now there are too many who seem to consider themselves superior to their patients, or just superior in general.

The following is an article on comorbidity of AS and Bipolar, but it goes into detail about diagnostic issues and validity. Why is it relevant? Because it's become commonplace for psych. professionals to do very little observation or use objectivity when assessing or treating a patient, because there are no consequences for mistakes for them (only disasterous ones for patients and clients). This article goes into some detail regarding diagnosing and assessment that can and should be applied to any patient.

Introduction

Despite its increasing popularity as a distinct condition (included in the ICD-10 in 1993 and in the DSM-IV in 1994), the nosological status of Asperger's syndrome (AS) and its diagnostic validity remains uncertain. An astonishing 556% increase in pediatric prevalence of pervasive developmental disorders (PDD) has been reported between 1991 and 1997 [1]. This jump is probably due to heightened awareness and changing diagnostic criteria rather than to new environmental influences.

Both AS and autism persist into adulthood, but their phenotypic expression varies with age. AS may also be unrecognized in adulthood, although usually not forever. Some individuals with AS live almost normally and show good adaptation, while many can hardly cope and need supervision. Some cases are referred to psychiatric services for adults because of concurrent mental disorders or behavioral derangement, especially aggression and self-injury, rather than specific symptoms of AS. In these circumstances, the AS diagnosis is often overlooked. Since these cases appear odd and atypical in comparison with patients commonly observed in the adult psychiatric setting, they often receive several diagnoses in the course of time. The awareness of the AS diagnosis has been considered contingent on certain key professionals, who are interested in the area [2]. However, even when the correct diagnosis of AS or other PDD is made, it should not be considered necessarily exhaustive. It is of importance also to recognize comorbid psychiatric disorders, especially if successfully treatable.

Comorbid psychiatric conditions are frequent in patients with PDD. Patients with AS often present eccentricities, emotional lability, impairments in social functioning, anxiety and obsessive traits, demoralization, suicidal ideation, tempers, coldness, defiance, motor and phonic tics, repetitive behaviors, and stereotypies, that can mimic other mental illnesses [3]. The differential diagnosis with true comorbidity of schizophrenia, BD or anxiety disorders is not always easy. Children with PDD have a two-to-six-times greater risk of experiencing comorbid psychiatric conditions than their normal peers [4-6]. Awareness of the problem is increasing but available evidence on the topic is scanty. Psychiatric comorbidity of AS has been often cited but not well examined. There are very few systematic studies on psychiatric comorbidity in PDD [7-10], and only one in AS [11]. Clinicians treating children report a high comorbidity with Attention deficit hyperactivity disorder (ADHD), Oppositional defiant disorder, Depressive disorders, and Bipolar disorder [7].

Data on BD and AS comorbidity are inconsistent. McElroy [12] emphasizes that bipolarity is a marker for comorbidity, and comorbid disorders, especially multiple conditions occurring when a patient is young, may be a marker for bipolarity. However, most studies [7-9,11], evidence Unipolar depression as the most common mood disorder in patients with PDD, while only one report by Munesue et al [10] suggests that BD might be the most frequent. Several factors could account for this discrepancy.

First, as discussed by Frazier et al [13], it is difficult to ascertain the rate of comorbidity between AS and BD since the diagnosis of AS is currently used rather indiscriminately, referring to a heterogeneous group [14], and the actual incidence of pediatric BD is probably underestimated until the definition of bipolarity in children is more fully agreed upon. Second, BD often begins in childhood or early adolescence with the clinical features of unipolar depression, acute psychosis, or comorbid disorder (e.g., ADHD, obsessive-compulsive disorder (OCD), panic attack, or eating disorder), while manic symptoms appear later. As a consequence, the rate of bipolar diagnosis, can increase with the mean age of studied population. Third, the current classification of mood disorders has poor reliability and validity. According to DSM-IV-TR, the differential diagnosis between unipolar depression and BD II should be based on the lifetime presence of four days of hypomania. Information on mild symptoms overlapping with manifestations of well-being is subject to recall bias, unreliable evaluation, misinterpretation, incoherence. Furthermore, the source of information (patient, relatives, social institutions) can suggest different conclusions. Widening or narrowing the criteria for the definition of hypomania modifies substantially the ratio between unipolar and bipolar II depression [15].

Notwithstanding such gray area, growing evidence suggests that PDD and BD frequently co-occur. Unfortunately, most studies do not explicit the number of cases with AS since they predate DSM-IV [16-18]. In a clinical sample of 727 children, 52 met criteria for PDD, 114 met criteria for mania, and 14 of 52 children with PDD met criteria also for BD (2% of all referrals, 12% of children with BD, and 27% of children with PDD) [19]. In a consecutive series of adult patients referred with a diagnosis of autism spectrum disorder, 7% had BD [20]. Autism spectrum disorder, BD and Tourette syndrome were found to co-occur at a greater than chance expectation in the study of Kerbeshian & Burd [21].

Also family data suggest an etiological link between AS and BD. DeLong and Dwyer [22] found that relatives of probands with PDD had a 4.2% prevalence of BD and that the prevalence was highest among relatives of probands with AS (6.1% versus 3.3% for relatives of probands with autism). Gillberg & Gillberg [23] found that 4 (17%) of 23 patients with AS and 3 (13%) of 23 patients with autism had a family history of affective disorder. Comparing children affected by autistic spectrum disorders with and without identifiable neurological disorder that could account for their autism, DeLong and Nohria [24] found that the latter had a higher rate of family history of affective disorder. On the contrary, Piven et al [25] found that major depression, but not BD, had higher lifetime prevalence in the parents of autistic probands in comparison with the general population.

Interestingly, a family history of BD may influence the phenomenology of patients with PDD. In subjects with autism spectrum disorder and a family history of BD, many features of childhood BD have been observed, including affective extremes, cyclicity, obsessive traits, neuro-vegetative disturbances, special abilities, and regression after initial normal development. On the other hand, subjects with autism spectrum disorder and without a family history of BD showed less florid agitation, fearfulness, and aggression, and were of lower functioning [26].

In a previous series of patients, we described common clinical features of patients with AS in the emergency psychiatric setting and discussed the differential diagnosis with psychotic disorders [27]. Here, we present three subjects affected by AS and concomitant bipolar spectrum disorders that outline some clinical features of these patients and discuss some troublesome and complex problems of their management.