In the second of this two part series with Dr. Mark Hagwood of Turning Point Counseling, Mark and the hosts discuss Narcissistic Personality Disorder (NPD), Borderline Personality Disorder (BPD) and Bipolar Disorder in the context of marital dysfunction.
This episode was recorded at the office of Robertson + Easterling on January 22, 2020 by Blue Sky Media.
- Turning Point Counseling
- Dr. Mark Hagwood
- Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder
- Minnesota Multiphasic Personality Inventory
- Karpman Drama Triangle
- Narcissistic Personality Disorder
- Borderline Personality Disorder
- Depression in Bipolar Disorder: What You Can Do
- Dialectical Behavior Therapy
Matt: We are back with our two-part podcast with Dr. Mark Hagwood. If you did not listen to part one yet, stop, go back. I think you will really enjoy it. We have already talked about Marks childhood, his experience with addiction, both personally and professionally, his blended family and the story of surviving divorce. Today’s episode, we want to talk more about Mark’s professional work with Turning Point Counseling and his experience with different personality disorders and issues that a lot of people have and something that our listeners will want to listen to today. Mark, Thanks for coming back!
Mark: It is good to be here.
Craig: So, let’s just jump right in, Mark. There are buzz words in my practice, and we hear words like narcissism, borderline, bipolar, and in my experiences, you know it when you see it. Give us a definition if you will of narcissistic personality disorder. Describe that for our listeners.
Mark: Narcissistic Personality disorder, the real disorder, is a long-standing approach to life that suffer from that, they tend to be very self-absorbed. They think mostly of themselves without really thinking or understanding how their behavior impacts others. One of the key characteristics that I look for is the lack of empathy. They just do not connect emotionally with other people. They do not understand emotions very well.
Matt: Narcissistic personality disorder, is that something that develops in a person over time or is it nature or nurture?
Mark: Yes, so when you are talking about nature or nurture you are talking about whether it is genetically based or do we pick it up somehow in the environment. Depending on what research you are looking at, there appears to be evidence of some genetic components to a lot of our behavior, not just narcissistic personality disorder or other things. It is an interesting field of genetics that indicated that we can actually turn genes on and off to behavior and environmental factors. So, let’s just open that can of worms. Let us say that yes there are genetic correlation to narcissism or borderline personality disorder, we still have to have environmental things like trauma, abuse, sexual abuse. For narcissism, it can come from overindulgent parents giving a lot of praise to a child passed what is reasonably in life. Then there is the other part of that that people with narcissistic personality disorder, they have had a lot of abuse and trauma and neglect in their childhood. I think it is both because they have identified clinically, not from a diagnostic standpoint, two basic types of narcissistic personality disorder. You got the overt which is kind of the typical expression that you would think of, angry, very controlling, play a lot of mind games with their spouse, and then there is vulnerable covert narcissistic is hypersensitive to criticism. They fall into periods of pity, not self-reflection but self-pity, then that spurs their anger and they lash out from there.
Matt: I’d be interested to know, I have no idea what the science says, I know that in my practice over the last two years, almost every one of my clients believes that they are married to a narcissist. What does the science say about how prevalent narcissism is in our society? Is it one in ten, is it one in twenty, what percentage of our population are actually narcissist?
Mark: Thankfully, it is not a huge number. Prevalence rates depends on the study you are looking at. I would just say from the combination of reading I’ve done, maybe 5%. Some are like.5 and others are 8%. I do not believe that it is that high but that is true narcissistic personality disorder, not narcissistic characteristics.
Matt: So, if I am hearing you right, a large number of my clients, some of them may be married to narcissist but a lot are just married to jerks?
Mark: Yes, however, I think that you guys and people that come to my office, our prevalence rate that we see, because we are dealing with people that are in crisis. So, we get a higher level of people that show up that may have a mental disorder or an emotional disorder because they are hard to live with.
Craig: Now a disorder is not the same thing as having those characteristics, for example, one of the diagnostics for NPD is a grand sense of self-importance. Well, that describes a lot of people and so preoccupied by fantasies of limited success. Some might say our president falls into that category. So, there are lots of, people have tendencies and then there is a full-blown disorder which is not necessarily the same thing.
Mark: That is correct.
Craig: So, lets talk a little bit about borderline personality disorder or BPD and how is that different than narcissism? Because my experience, it feels like they are almost first cousins.
Mark: There is so much when you start talking about personality disorders that your average listener is going to be 100% forward with. So, I am trying to skip some of that but there is a lot about NPD and BPD that are similar. It is not uncommon to find someone that has NPD that marries somebody with BPD and that is a much bigger conversation, but Narcissistic personality disorder is different from borderline personality disorder in a couple key ways. One is that NPD, they have no empathy. Borderline personality disorder, those people do not have a lot of self-identity. So, when I am looking at somebody in my office and they do not have empathy, I am thinking one thing. Somebody that comes into my office and they have a chaotic life, they talk about how they get easily upset with people in their life, I am thinking borderline personality disorder.
Craig: When I think of borderline, I think “I hate you don’t leave me”.
Mark: Right, go away but come here. I mean that is typical borderline behavior. What that looks like, let us say you are dating somebody right? And they send you a text message and you are super busy. You cannot get back to them for a couple of hours. When you call them, they are raging at you because they are ignoring your text message that you clearly do not care and is just tirade. For most people they are like “wait a minute that doesn’t match what is going on”. Those are kind of the ways that sometimes borderline personality disorder is expressed. It is a real or perceived abandonment that spins these people up.
Craig: And these things are hard to diagnose. It really takes a therapist sitting with someone for an extended period of time before there would be a diagnosis and my understanding is that most people who have those types of characteristics do not walk into a counselor’s office anyways.
Mark: Well first of all, these are complex disorders and they do take somebody that is trained over a period of time sitting with somebody in order to be able to diagnosis. Stress, trauma, crisis, unresolved trauma can create behavior that looks like any kind of disorder. It takes a while to diagnose.
Craig: We work with people in the most intimate parts of their life and the most intimate communications, you mentioned the situation with text messages a minute ago and that is something that would be really, over a long period of time, wear a person out because we are a fault based divorce system in Mississippi, those types of nuances can make a marital relationship just impossible to continue in and are often times in a court room type settings it is very difficult to explain. That is one thing but when it happens five times a day and is consistent, that is where our clients have difficulty because they know what they are experiencing but not everybody can articulate how that impacts them. You are smiling because I know you want to say something that you are trying to not say.
Mark: There is so much there. I heard someone describe as being married to a borderline as being sucked through a keyhole. You never know what is coming. There is a book about this called “Walking on Egg Shells”. So, you do not every know if you are going to walk in and your spouse be all about you or you are going to walk in, and they are going to lash out at you. It does take a toll. It is complex trauma. If we are married to somebody that we don’t know where they are emotionally and there is this sense of anxiety throughout the day, there is this sense of how am I going to manage this next interaction with this person, so instead of having a home life that is secure and attached and safe, there is this underlying anxiety and fear that no matter what I say, it is not going to be right. They don’t know how to express what is going on because if I say one thing today and the same thing tomorrow, I could get different reactions.
Craig: That is breeding ground for codependency. The way that I see codependency, the way I understand it, if I look over at my spouse in the morning and say “Honey, how am I feeling today? Am I feeling good? Okay great let us go throughout the day now!”
Matt: You talked about the affect that people with these personality traits have on their spouse. Their ability to communicate is being undermined through that relationship so it makes it harder for them if they go through that divorce process to have confidence in what it is, they are going to say. They do not know how to communicate. I am asking them, “How does this make you feel?” and their feelings have been undermined for so long, they don’t have a real confidence in the way they express it so it makes it even harder to communicate those effects.
Mark: So, I see spouses of people who are married to someone with NPD or BPD and they are the ones that think they are crazy. They will come in like I am losing my mind and ill get the spouse in there and they will confirm it. They are like you really have to fix her.
Craig: We call that gaslighting. Sounds like that is what you are describing.
Mark: Absolutely, gaslighting is a term you find in addictions a lot because when an active addict is on their role, they are trying to make everybody else think that they are okay. The only way to do that is by saying someone is crazy. People with personality disorders do the same thing because they really believe that it is everybody else.
Matt: So, I am curious to know, a lot of my clients they believe they are married to a narcissist or someone that has borderline personality disorder, they want us to push through the divorce process for a psychological evaluation, how easy is it for someone who maybe is a narcissist or has BPD to mask those things through a psychological evaluation? Are they smart enough to know how to answer questions?
Mark: So, I would say it depends on the psychological evaluation. There are some instruments out there like the MPI2 that you cannot fake it. I don’t know what it would take for someone to take that test, that’s more of a legal question but some of the instruments that people take, they give to hundreds of thousands of people, if they try to fake it, it is going to be clear that they are lying. But if they are honest, it will pick up on their disorder.
Craig: This sounds nerdy lawyer stuff and maybe it is but when you are working with mental health professionals sometimes you have to differentiate the roles. Is that person a therapy provider or an evaluate and in my experience, the therapy provider is going to be very resistant to label their client and I understand that because the idea is to build rapport and build relationship and to build trust and to work through that. When you start labeling people then it undermines that process.
Mark: That is true. With my clients, I move away from diagnostic labels because a diagnostic label is just shorthand for communicating a cluster of behaviors found within an individual. So, I do not typically say you have NPD, I want to get to the causes and conditions and try to help this person function better in life. Psychological evaluating, like a clinical psychologist or others in that area, will administer test that will be able to get them the written results.
Craig: Let’s introduce one more little buzz word into the equation of our discussion today and that is Bipolar. If I have heard it once, I have heard it a hundred times, I mean she is just bipolar or he is just bipolar and it seems like that is the kind of catch it all term but for me, bipolar is that roller coaster ride. Mania, high intensity, down to the lower part, which is I am depressed, drinking too much, I can’t feel. When I think of bipolar, I think of a roller coaster. When I think of narcissism, I think of lack of empathy. When I think of borderline I think, “I hate you, don’t leave me”.
Mark: One of the things with borderline I would throw out there is there is chaos. It is a very chaotic individual inside and outside. Bipolar disorder has some very specific criteria that is unimportantly out there. Other than to talk about your typical expression of bipolar, there would be a mania phase. I look at these things as a continuum. The far outcome of bipolar disorder, those are pretty obvious. You can have hallucinations and think that you are talking to angels. You can think that God is giving you certain powers. When you are in that mania phase, that person really really believes it. Then they sink into that depressive stage. They don’t necessarily 100% believe it but there is always that thought in the back of their head like “maybe I am kind of special. Maybe I was talking to angels” so that is on the far end of your continuum. Now, if you back out of that, not all bipolar is that high level for the psychotic features. You can have people that go into the mania phase and they have more energy. They clean the heck out of the house and they act out sexually and they spend a whole lot of money buying time shares in Guatemala and then they come out of there and say “What the heck was I doing?”
Craig: Mark are you saying there is something wrong with timeshares in Guatemala?
Mark: I mean if that is your thing but if you buy 14 in a week, I say that is a problem.
Craig: Okay, that is fair.
Mark: So, it is a different expression. I think sometimes people confuse bipolar with borderline because some of the behaviors are similar. Borderline is sort of an ongoing chaotic. There is not a lot of order or a pattern. This person is really up for a week, had 3 or 4 sexual partners, spend a lot of money. That is the bipolar swing. Borderline is that their world is defined by external relationships with people. So, they will have chaotic intrapersonal relationships that are romantically based. All their relationships have chaos involved. They will act out sexually in order to feel okay about themselves. They spend money or shop because they are trying to gather information about who they are. Bipolar is a result of that mood instability. That euphoria phase followed by the downcycle.
Matt: So, with bipolar, if someone in your life has bipolar, you can see that they are moving through this manic arch and then can predict that there will be this sort of dip. With borderline it is just all over the place.
Craig: It sounds like borderline is more relational a well.
Mark: Borderline personality is externally triggered. Something in the environment triggers the reaction. Now, it is not always as clear what that event is. Now with bipolar, the mania triggers the behavior, or the depression triggers the lack of behavior.
Matt: So, it is internal triggers.
Craig: We are not going to try and teach a course in abnormal psychology today but let’s complicate a little more because when you start adding in alcohol and drugs, then you get real right.
Mark: Oh yeah great time.
Craig: Because I think that is what ai think a lot of our clients experience is “yeah craig all of that you just said but he drinks a lot too” and when you add those things, you have a recipe for chaos and misery.
Mark: It is hellish really. One of the confusing factors and it takes a trained person to work through some of this, let’s say that I’ve got active chemical addiction. Well if I am doing cocaine one day like a three day run on cocaine or meth or Adderall and then I switch over to inzos and Xanax and alcohol, my behavior is going to mimic bipolar because I am up and running three days straight and then I crash and burn for a week.
Craig: You know I represented a guy many many years ago and he was a great guy and had a great heart but he suffered a traumatic accident and he had a lot of pain and there were financial pressures so he had to work even though he was disabled. TO be able to work, he would take a handful of Minithins. He would work through the pain and do his job and then after he had worked his 12 hour shift, he’d drink the beer to comedown off of the minithins and when you process that type of chemical in your body for a long period of time, things start falling apart in your world.
Mark: There is a physical response to drug and alcohol abuse for sure.
Craig: Our listeners are thinking this and thinking oh my gosh I’m married to a narcissist, or I need to google borderline. Let’s talk about some hope. Obviously, there is divorce but when you have children with somebody, you are going to be divorced from somebody with NPD or BPD or bipolar, so what do we need to do. We have talked about these complex issues, so now what are they supposed to do?
Mark: Well, fortunately today, we understand these disorders better than we ever have. So, there are treatments. There is a very good treatment for borderline that for years most people thought these diagnoses were hopeless. For this behavior, therapy has shown wonderful results when people suffer from borderline personality disorder. I would say get involved in a therapeutic process with a therapist that understands the complex dynamics of these personality disorders or even bipolar. You have the people suffering from it and then you have the people and the family. A lot of times, what I find helpful for the spouse and children is get an understanding of what is going on.
Craig: With Bipolar, there are certain medications that have had success in helping people live normal lives. Is that true?
Mark: Oh absolutely. Bipolar, if you find the right medical substitute, it becomes very controlled. We can give or psychiatrist can give medications that treat borderline, but it will only get to anxiety and depression of it. It doesn’t treat the problems.
Matt: If is good to hear you say that some of these personality disorders can be improved or helped through treatment but I know one thing that I hear form my clients a lot is “well if I can just get my husband into counseling or my wife” is it not true that it takes the person with the disorder willingness to go?
Mark: It takes an absolute dedication from the person with the narcissistic personality disorder to even begin to get better and what I mean by that is that particular disorder, their thinking is so distorted that it doesn’t really change very well over time. There really is something about them.
Craig: I think what I heard you say was it is really awareness. The listeners are hearing these terms that are about their family and it really takes awareness to understand. Understanding yourself and then you can make a decision about whether the relationship is even something you can continue in. I am not afraid to say it because if there is NPD or anything, the only option is to move away very quickly.
Mark: Yeah there is some truth in that.
Craig: There is a lot of bravery in that.
Matt: For anybody who thinks they are married to somebody who has one of these disorders and they are not quite ready to walk away from the relationship, do you have any advice on what would be the best way to approach their partner about going to therapy.
Craig: They should trick them right?
Mark: Yes. A lot of times people will come into therapy because one of the spouses has sort of gotten in the position where there is an ultimatum laid out. We are going to go to therapy, or we are getting a divorce. So, I have had many clients show up and say their husband has narcissistic disorder. So, the wife comes in initially because she is losing her mind. She is being abused physically or emotionally and the husband will come in sometimes just to make sure I am getting the complete story and so that is common and if you can get those guys hooked in, we may be able to make some traction. My first goal is to be able to establish a safe relationship for the spouse because that spouse is being abused. Not the kind of abuse that is going to be easy to prove in court but the psychological and emotional impacts that are tremendous. I have had clients that suffer from unresolved traumas that gets expressed physically. They develop lower back pain or anxiety, or the immune system gets jacked up so living in this chaos is very difficult for the spouse.
Craig: And I think one of the meanest things that an abuser can say is you are not valuable; you do not matter. As matt said earlier, they start to believe it and they get into that cycle of negative self-talk and sometimes it takes a third party giving them feedback that they aren’t stupid. I think that is unfortunate but there is hope and there are lots of people who can help you. If you feel like this is your life or your role, I would ask if you consider reaching out to someone else or a friend to get this stuff into the light. We have talked in the past about someone living in a basement that is filled with broken bottles and garbage and bones and mold but all they see is their flashlight and as long as their little bitty light is okay and they can point it in the direction it needs to go but when they flip the lights on in the room they think “oh my gosh I can’t believe I am here”.
Matt: Well you know for the most part I usually characterize divorce as being a destructive process but every now and then when you are dealing with somebody that you have been married to who has this personality disorder, divorce can become very impowering and where they learn that they do have self-worth and I can live without him or I can live without her and I can do this and I am smart. That really is a beautiful thing to watch someone grow from feeling insecure and weak to being independent. I tell people all the time that one of my favorite things is to bully bullies. It is great watching someone who has been trampled on to finally stand up to someone who has been beaten on.
Mark: Not only that, which is hugely freeing, but I watch women who are married to some of these guys, they have to come first to the realization that they are not crazy. When you are working with a narcissist, I mean I have had great sessions with narcissistic clients where they seemed to have insight. It is light a light bulb moment and what I do is so important and then two days later when I see the spouse, you need to talk to him every day. He was great for 48 hours and by 48 hours we were both nuts.
Craig: We didn’t even talk about the drama triangle and whoever is listening to this can google drama triangle, but these conditions that we have been discussing, they are perpetually in that place. They are either the victim, rescuer, or persecutor and when you are in relationship with a person with NPD, BPD or bipolar, then you feel like there is a never-ending drama triangle which you are engulfed.
Mark: That is because there is.
Craig: In closing thoughts mark, lets give hope. If you could speak to those who have landed in your office or come to see you or if it is to far gone and they think it is maybe time to have a consultation with an attorney, what encouragement would you give?
Mark: I have seen some very miraculous things in my office and so if you are dedicated to getting better, that is one of the best motivating powers that I have seen. Just because you are desperate today does not mean that it is going to consume you, but it means that it will drive you and being driven, we can become free. Whether the relationship heals or not, you can have freedom.
Matt: Mark, thank you so much for being here today and educating me. I know I have learned a lot. Tell our listeners where they can find you if they think they are in relationship with someone like this?
Mark: The easiest way to get in touch with me is to go to our website which is www.turningpointms.com and there is contact information there.
Craig: Thanks for being her man. Thank you for your knowledge and we are very grateful.