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988 Suicide & Crisis Lifeline

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The resources and information on this page are designed to help states, territories, tribes, mental health and substance use disorder professionals, and others looking for information on understanding the background, history, funding opportunities, and implementation resources for strengthening suicide prevention and mental health crisis services.

  • About 988

    In 2020, Congress designated the new 988 dialing code to be operated through the existing National Suicide Prevention Lifeline. SAMHSA sees 988 as a first step towards a transformed crisis care system in America.

    • FY 21 Appropriations Report to Congress
    • May 24: FCC Forum on Geolocation for 988

  • 988 Partner Toolkit

    The 988 Partner Toolkit is intended to facilitate partner efforts for collaborative and aligned 988 communication planning.

    • Key Messages
    • Frequently Asked Questions
    • Logo and Branding
    • Social Media Shareables
    • End Cards for Media
    • More Resources

  • The Data

    In 2020, the U.S. had one death by suicide every 11 minutes. Suicide is a leading cause of death for people aged 10-34 years.

    • 988 Lifeline Network Performance Metrics
    • SAMHSA's National Survey on Drug Use and Health (NSDUH)
    • CDC's Suicide and Self-Harm Injury Data for the U.S. | National Center for Health Statistics

  • The Lifeline

    There is hope. Providing 24/7, free and confidential support to people in suicidal crisis or emotional distress works. The Lifeline helps thousands of people overcome crisis situations every day.

    • The Lifeline's History
    • 988 Lifeline Jobs

  • 988 Newsroom

    • Recent 988 News
    • B-roll and soundbites are available for download
    • 988 End Cards for Media

    National Media Requests about 988

    [email protected]
    240-276-2130 (press 4)

  • Partners

    • Federal Communications Commission
    • U. S. Dept. of Veterans Affairs
    • The U.S. Surgeon General
    • Centers for Disease Control and Prevention
    • Indian Health Service
    • Department of Transportation
    • 988 Partner Community

  • SAMHSA 988 Funding

    • 988 Tribal Response Cooperative Agreements Notice of Funding Opportunity
    • Cooperative Agreements for States and Territories to Build Local 988 Capacity Grant Awards
    • Lifeline Workforce and Infrastructure Grant Awards
    • Cooperative Agreement for National Suicide Prevention Lifeline Supplement
    • Track state 988 state legislation on NAMI’s website.

  • Suicide Prevention Resources

    • The U. S. Surgeon General's Protecting Youth Mental Health Advisory (PDF | 1 MB)
    • SAMHSA's Suicide Prevention Publications
    • Substance Use Treatment Locator
    • Advisory: Addressing Suicidal Thoughts and Behaviors in Substance Use Treatment (Jan. 2021)

Last Updated: 09/23/2022

988 Partner Toolkit | SAMHSA

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SAMHSA recognizes the need for governments, states, territories, tribes, crisis centers, and partners to speak with one voice to ensure there is a clear understanding about what 988 is and how it will work. We encourage you to use these communication outreach materials and build upon them with your community coalitions to meet the needs of your specific audiences.

These key messages are designed to cover the basics of 988 and provide a strong foundation from which partners can build for their audience-specific needs.

Preparing for full 988 implementation requires a bold vision for a crisis care system that provides direct, life-saving services to all in need. This leads to many questions about the transition to 988 and how 988 will work. We at SAMHSA welcome these questions. Question topic areas are:

  • FAQs about 988
  • FAQs about Federal/State Roles and Funding
  • FAQs about the Lifeline

Printable PDF handouts in English and Spanish explain the basics about 988.

988 Factsheet (English PDF | 4.5 MB)

988 Factsheet (Spanish PDF | 4.4 MB)

The 988 brand embodies the 988 Suicide & Crisis Lifeline's ideals and goals. Used as intended, the 988 brand provides a cohesive look and feel across 988 materials.

This 988 Logo and Branding provides specific information on logo and branding use and guidelines, typography and icon styles, photo choices and the color palette.

SAMHSA is providing this sample e-newsletter template to help partners with engaging your communities around the transition to 988.

Product: Sample E-Newsletter Promoting 988 Resources for Implementing Partners

Target Audience: Partner organizations and professionals who are actively engaged with delivering on or promoting 988.

Timeline: Content current for use after July 16, 2022

Subject Line: 988 Suicide & Crisis Lifeline: Resources

Download E-Newsletter Template (DOC | 395 KB)

Download Suggested Logo (JPEG | 365 KB)

These Radio Public Service Announcement (PSA) scripts to promote 988 within communities are designed to be read on-air by DJs and other radio talent. In the future, SAMHSA may provide pre-recorded audio files for use as well.

Products: 60-second, 30-second, 15-second scripts

Target Audiences: General public awareness of 988

Timeline: For airing on radio after July 16, 2022

988 Radio Public Service Announcement Scripts

  • 60-Second Script (DOC | 24 KB) (Spanish DOC | 14 KB)
  • 30-Second Script (DOC | 23 KB) (Spanish DOC | 13 KB)
  • 15-Second Script (DOC | 22 KB) (Spanish DOC | 23 KB)

This 988 Powerpoint Presentation Deck is available for partners to customize and use when talking about the transition to 988 within communities around the country.

  • Downloadable Powerpoint Presentation Deck (PPT | 4.5 MB)

This PPT is undergoing remediation for Section 508 accessibility, if you need assistance with accessibility, please contact [email protected].

These 988 operational guidance documents were created with a co-sponsorship group of partners across critical working sectors involved with 988. The playbooks are published by the National Association of State Mental Health Program Directors.

  • 988 Convening Playbook: Mental Health and Substance Use Disorder Providers (PDF | 1 MB)
  • 988 Convening Playbook: States, Territories, and Tribes (PDF | 1.2 MB)
  • 988 Convening Playbook: Lifeline Contact Centers (PDF | 1.5 MB)
  • 988 Convening Playbook: Public Safety Answering Points (PSAPs) (PDF | 1.5 MB)

These 988 printable materials have been created for use by governments, states, territories, tribes, crisis centers, and partners to educate and outreach about 988. SAMHSA provides organizations an ability to order limited supplies from the SAMHSA store. If you need larger orders than we are able to send to you, you can use the printer-ready files to make your own. For those of you who need just a few copies of an item, you can print those using the simple PDF download.

SAMHSA expects print materials to be available for ordering in late July. We will regularly update the SAMHSA Store links when products arrive.

Wallet Cards

The following business-sized wallet cards help publicize the 988 Suicide & Crisis Lifeline.

Wallet Card with Icons (2 sided, 3.5 in x 2 in)

  • Downloadable (PDF | 162 KB)
  • Printer-ready file (PDF | 618 KB)
  • Order from the SAMHSA Store

Magnets

The following magnets help publicize the new 988 Suicide & Crisis Lifeline phone number and provides access to this life-saving resource in places that are highly visible.

Square Magnet (4.75 in x 4.75 in)

  • Downloadable (PDF | 146 KB)
  • Printer-ready file (PDF | 555 KB)
  • Order from the SAMHSA Store

Stickers

These 2x2 inch stickers in English and Spanish help publicize the 988 Suicide & Crisis Lifeline.

Posters

These posters help publicize the new 988 Suicide & Crisis Lifeline and provides access to this life-saving resource. They are designed to be placed in schools, community centers, counseling offices, clinics, and other settings where people gather.

"Hope" Poster (18 in x 24 in)

  • Downloadable (PDF | 7.2 MB)
  • Printer-ready file (PDF | 11.6 MB)
  • Order from the SAMHSA Store

Safety Plan

The Safety Plan is designed to be printed as a 5”x7” pad, similar to a prescription pad, with 50 sheets of pull off plans. The intended use is for counselors, therapists, clinicians, and others working with people in need of safety plans. It is modified from Stanley & Brown.

Safety Plan (5 in x 7 in)

  • Downloadable (PDF | 96 KB)
  • Printer-ready file (PDF | 524 KB)

When news articles, entertainment programming, or other media material includes content addressing suicide, mental health, or emotional distress, please use one of the end card options to share 988 crisis supports with readers and viewers, especially those who may need help or be in crisis.

These backgrounds are available for partners to use during virtual meetings. Partners can customize these by adding their own state, territory, tribal, and organization logos to the backgrounds as well.

988 Virtual Background in Light Blue (JPG | 40 KB)

988 Virtual Background in Gray (JPG | 38 KB)

988 Virtual Background in Navy (JPG | 41 KB)

The social media messages describe the basics of 988 that apply across the U.S. These 988 shareables were designed for use as social media posts, stories and threads. You can use the videos as individual interactives on the social media platforms, or you can mash the videos together to create your own versions that make sense for your audiences.

Last Updated: 10/14/2022

Read online “Narcissus in your life. How to Claim Your Rights and Reclaim Personal Boundaries, Julie Hall - LitRes, page 2

Letting go of denial

Because you've been abused by one or more narcissists, your integrity and self-esteem may have suffered. Those elements that, when combined together, form and support you as a whole and healthy person, are under attack. If the narcissist has any power over you, then you are weakened, trapped and emotionally, and possibly physically hurt. You may tell yourself that things are not so bad and that the real abuse and neglect happens in other families and relationships, but not in yours. You may believe that the narcissist is incredibly important, special, or in need of emotional support, and therefore the truth deserves special treatment. You probably feel guilty or somehow responsible for the narcissist's behavior, repeating to yourself what they always say or mean: it's your fault and you need to change.

Denying reality can actually protect you for a while from your own feelings [5] . By brushing aside painful truths, you give yourself a chance to work through your fears and prepare for challenges. Denial is inherent and to some extent necessary for children raised in a narcissistic family. It shields us from realities we don't yet understand and protects us from dangers we don't yet know how to deal with. But denial becomes a lie when we allow it to paralyze us and fail to protect ourselves and our loved ones. Constant denial strengthens the abusers and makes us more vulnerable to them. Over time, denial itself becomes a problem that prevents us from moving on. They say that wet rain is not afraid. This position does not allow us to find shelter and keep warm. Others may look at us and wonder why we don't pay attention to the fact that we are wet and cold. They can support us and offer to go where it is dry and comfortable. But until we recognize the realities of the weather, we will get wet and cold more and more. And we will feel more and more alone.

Claiming our rights

Even when we struggle with denial, it can be difficult for us to determine what has happened to us (and perhaps continues to happen). People with narcissistic disorder project their own sense of shame onto others, constantly blaming them for their problems, and breaking emotional, psychological, and physical boundaries. Since you have been systematically shamed and blamed, and boundaries have not been respected, you are likely to experience a sense of confusion and doubts. Consciously or subconsciously, you place yourself in category "less" : less important, less deserving, less worthy, less good. And you need to remember your inalienable human rights, which all have [6] .

1. You have the right to your own thoughts and opinions.

2. You have the right to disagree with other people.

3. You have the right not to share your thoughts.

4. You have the right to express yourself freely.

5. You have the right to love or not love as you wish.

6. You have a right to your own feelings.

7. You have the right not to share the feelings suggested to you or others.

8. You have the right to equal treatment.

9. You have the right to be treated with respect.

10. You have the right to have your needs protected.

11. You have the right to protect the needs of your loved ones.

12. You have the right to privacy and dignity.

13. You have the right to defend yourself against attacks.

14. You have the right to equal legal protection.

15. You have the right to personal safety and security.

If you feel that these rules are not for you, ask yourself why. Why are you not worthy of these rules? Why does a narcissist deserve these rules and you don't? Why would you allow a narcissist to infringe on your rights?

Recognizing Narcissist Hypocrisy

Key Point: Narcissists will always put their needs ahead of yours. They suffer from a pathological disorder that distinguishes them from the average person who does not display the traits of people with personality disorders. It is extremely difficult for people without this pathology to perceive the picture of the world of narcissists. It is full of hypocrisy and contradictions that emotionally stable people cannot understand intuitively.

Narcissist:

1. Selfish, but without inner core.

2. Does not take other people's abilities and achievements seriously and exaggerates one's own.

3. Has a strong sense of shame and readily shames and blames others.

4. Hypersensitive to trifles and criticism, but tends to be overly critical of others.

5. He expects concessions, but he himself is extremely intolerant and does not know how to forgive.

6. Expects admiration, but treats others with indifference or contempt.

7. Requires loyalty and support, but he can easily betray and leave.

8. Wants to control, but is not ready to take on almost no responsibility.

9. Strives solely for himself, but expects generosity from others.

10. Disrespectful, but requires special treatment.

Overcompensation of inner emptiness and shame of narcissists manifests itself as cruelty towards other people. Narcissists are very cruel. Their double standards are unfair and irrational, but in their damaged minds they make sense. The narcissistic state is pitiful and dangerous at the same time. Cognitively they are adults, but emotionally they are small children. Would you expect an infant to understand your feelings, take care of your needs, make decisions for you, or become your parent?

Understanding our anger

When you experience narcissistic abuse, you will inevitably feel angry. However, you may not realize this because the narcissist has told you in countless ways that he had nothing to do with it - everything you feel about his behavior is wrong, unfair, and generally you yourself are to blame. Your anger may make you feel confused and ashamed because it is the narcissist's anger that he projected onto you, saying that you are the one who does not know how to manage anger. You may have sublimated that anger and directed it at yourself in the form of self-criticism and self-sabotage [7] . Or maybe they tried to drown her in alcohol, drugs, self-harm [8] , gambling, shopping and other types of compulsive behavior. It is important that you recognize your anger as adequate and justified as a response to narcissistic abuse. Anger in and of itself is a good thing. It's just an emotion and it has a right to show up. Anger can help us protect ourselves from attack and harm. It can give us the courage to stand up for ourselves and others, and to fight injustice.

But it is important to understand that your anger is based on a sense of injustice or pain. If you find their causes, then you will realize your anger in its entirety and understand what exactly causes it. Yes, anger helps in some cases, but it can paralyze us or lead to destructive behavior, which will only exacerbate the problems. Understanding your wound, the unmet need that drives anger, helps you process your emotions rather than fight them. Identifying your real needs is the first step towards meeting them.

Understanding our needs

Food and water are needs. Love, a sense of belonging, security, trust, and an understanding of purpose in life are needs. Alcohol is not a requirement. Overeating is not a need, and neither is impulsive sex. These are ways of calming yourself and gaining control over what seems uncontrollable to you. If we do not understand our feelings and needs, then in trying to feel better or gain control over the situation, we often choose counterproductive paths that create additional problems. We do this to distract ourselves from key issues that we cannot deal with. Like denial, distraction relieves pain. But this is a short-term solution, it does not allow the wound to heal and actually increases the suffering. It does not allow us to see ourselves and our situation clearly, and therefore does not allow us to help ourselves meet our own needs. Narcissists will always put their needs first, and they may actively judge and punish us for ours. But they are not going anywhere, even if we want to get rid of them. Needs mean that we are alive.

Chapter 2. Recognizing a Narcissist

Even for a professional, diagnosing a personality disorder can be difficult, and projecting it onto your situation without having the appropriate education is completely risky. People's behaviors and motives are not simple, and labels are often given in a simplistic fashion and on the basis of misconceptions. Deviant behavior and depression may resemble aspects of narcissism and also coexist with personality disorders. Unfortunately, however, in the case of pathological narcissism, you may have no options other than a non-professional "diagnosis."

Why narcissistic personality disorder is rarely diagnosed

Narcissism has an ambiguous feature: it is more often treated for the trauma the narcissist can cause to others than for the disorder itself. As they say, narcissism is a disease for which anyone but the patient is treated.

Narcissistic Personality Disorder (NPD) is often not officially diagnosed for the following reasons:

1. People with NPD are incredibly resistant to psychotherapy. The psychotherapeutic process poses a potential threat to their belief in their own infallibility and lack of control. And he encourages them to do what they hate: to reflect on their own feelings and behavior. Therefore, the vast majority of narcissists never see a therapist and are not formally diagnosed.

2. Narcissists often go to therapy only to satisfy (at least temporarily) the demands of a spouse debating a divorce or a boss threatening to fire them. Sometimes people with narcissistic disorder turn to a psychotherapist in case of depression or a broken relationship. However, narcissists who undertake such an experiment usually try to manipulate the therapist in order to maintain their illusions and/or stop psychotherapy. So they try to avoid the frightening and painful work associated with reflection [9] .

3. Many therapists do not understand or recognize NPD (or trauma caused by interaction with a narcissist) [10] .

4. Clinical professionals who deal with NPD often do not make an official diagnosis due to the associated stigma and the reluctance of narcissists to treat [11] .

It is important to note that some people with NPD do not quit psychotherapy [12] . Although the effectiveness of the treatment is debatable, some therapists report some success, and narcissists themselves claim that they are becoming more reflective and are actively working to overcome their distorted and reactive emotions and thought and behavior patterns. As with any serious mental disorder, a person suffering from pathological narcissism must be willing to work on it. Close people can support him, but he himself must have a deep motivation for change.

Recognizing what we are dealing with

If a narcissist is an important person to you, then you can be harmed significantly, if not destructively. Your best defense is awareness. People with NPD act unfairly and cruelly , satisfying their own infantile emotional needs at the expense of others. Most likely, you were used, shamed, gaslighted [13] , bullied. You were probably terrorized and, in addition to all this madness, they constantly tried to convince you that it was you who were to blame for the violence. This behavior of a narcissist, like cancer, destroys your self-esteem, health, relationships, faith, depletes financial resources. No matter how much you give to a narcissist, he will not get enough, and you will receive nothing in return.

Narcissistic personality disorder is not easy to diagnose, but without it you will not be able to get rid of the barbed wire that has entangled your life. You need a diagnosis, not them. To do this:

• recognize your own feelings of confusion and suffering;

• understand what and why you have to worry;

• don't let the narcissist brainwash you anymore;

• Help others, such as children, who have been similarly harmed;

• protect yourself from further violence.

Words of caution

Of course, you may want to give the narcissist a suspected diagnosis. But first, think about your motives and the realities of this disorder. Did this person show respect for your opinion, in particular if there was any criticism of him? Is he open to reflection, personal responsibility, or honest feedback? Did he care about your feelings and needs? If you sincerely answer “yes”, you are most likely not dealing with a narcissist. If not, then by telling about your guesses, at best, you will hurt the narcissist's pride or face indifference, and at worst, revenge and rage will fall upon you. Some narcissists like to repeat that the disorder is not really with them, but with those around them. You will see that the diagnosis you voiced is projected onto you - onto your loved ones and circle of friends.

Chapter 3 Characteristics of Narcissistic Personality Disorder

Narcissism is considered a spectrum disorder. This means that it exists on a continuum: some people show only some of its features, while others have it very pronounced. NPD is a personality disorder from cluster B [14] , which also includes borderline, antisocial, and hysterical disorders. Cluster B personality disorders are characterized by pompous, hyper-irritable and/or unpredictable thought and behavior patterns. NRL is present in 6.2% of people. It is more common in men - 7.7% compared to 4.8% of women. It often co-occurs with other personality disorders, such as those caused by substance use or those associated with anxiety and mood swings [15] .

False beliefs and facts about narcissism

Fiction

Consider some false and potentially dangerous ideas about pathological narcissism:

1. Narcissism grows out of vanity and self-love.

2. If a person is a narcissist, then he is charming, smart, good looking and / or successful.

3. Only men can be narcissists.

4. Narcissists are naturally great lovers.

5. Narcissists are "gray cardinals" who have great power.

6. A narcissist can be cured if he has the right "empathetic" partner.

7. My partner will change for me.

8. If I show my vulnerability, my narcissistic parent/partner/friend will start to trust me and open up.

9. Narcissists are evil geniuses hiding under the mask of charm.

10. Narcissists really care, they just don't know how to put it.

11. Narcissists just need to learn humility.

12. Narcissists can be reasoned with.

13. Narcissists make excellent leaders.

14. Narcissists are always plotting and looking for a victim.

15. All psychotherapists understand the essence of narcissism and are able to treat the trauma caused by narcissistic abuse.

16. Narcissists skillfully hide their true face.

17. Narcissists understand who they are.

18. Narcissism is the choice of the narcissist.

19. In fact, the narcissist loves his family and wants the best for them.

20. Narcissism is obvious.

21. If I leave my narcissistic spouse, the law will protect me and my children.

22. The media can turn you into a narcissist.

23. Narcissists have no feelings.

24. There is no cure for narcissism.

25. We are all narcissists.

Facts

Here are facts about daffodils that everyone should know:

1. Narcissistic personality disorder is a pathological and destructive condition.

2. People with NPD lack a stable self-concept and normal self-esteem.

3. Narcissists have unrealistic ideas about people and relationships.

4. Narcissists are practically incapable of empathy, including for family members.

5. Narcissism is a compensatory mechanism of the psyche based on shame.

6. Although some narcissists seek leadership, they do not strive for the greater good and are not inclined to support democracy [16] .

7. Narcissists tend to project their feelings onto others.

8. Narcissists are no smarter than everyone else.

9. People suffering from NPD are ruled by self-doubt and shame, but they hide them both from themselves and from others.

10. Narcissists' pretentiousness and sense of superiority is a fragile defense system.

11. Narcissists are usually not prone to reflection and avoid introspection [17] .

12. NPD begins to develop in early childhood.

13. Most of the world's cruel dictators are malignant narcissists [18] .

14. Sadistic narcissists enjoy making people suffer and have no remorse.

15. Although narcissists can be counted, they are mostly driven by unconscious emotions.

16. Narcissists may be aware of their narcissism but see it as a mark of being chosen rather than a set of problems stemming from low self-esteem.

17. Some therapists do not understand narcissistic abuse and the complex trauma associated with it.

18. Narcissists often act like monsters, but they are people with a mental personality disorder.

19. Narcissists view vulnerability as weakness.

20. If narcissists do not feel threatened, their company can be pleasant.

21. NPD occurs in both men and women, but is more common in men.

22. Narcissists do not treat people the way they would like to be treated.

23. Narcissists lack spiritual unity.

24. Narcissists consider hurting other people justified.

25. Narcissists are not capable of unconditional love.

Characteristics of narcissism

The American Psychiatric Association (APA) defines NPD as a condition characterized by pathological personality characteristics and impairments that exhibit "a pervasive pattern of grandiosity (whether in fantasy or behavior), a need for admiration, and a lack of empathy, beginning to manifest from adolescence and present in a variety of contexts.

According to the APA criteria published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [19] , a diagnosis of NPD is made if a person has five or more characteristics from the list:

1. Arrogant and pretentious.

2. Fantasizes about unlimited success, power, excellence, beauty, or ideal love.

3. Believes in his own uniqueness, believes that he should communicate with the same "exceptional" people and visit appropriate places.

4. Expects excessive admiration.

5. He exaggerates his rights.

6. Tends to take advantage of other people.

7. Deprived of emotional empathy.

8. Envious and thinks others envy him.

9. Arrogant and haughty.

Let's take a closer look at these criteria.

1. Arrogance and pretentiousness

Narcissists consider themselves superior to others because it protects them from deep self-doubt. They may seem attractive and influence others for praise and gain, but their incredible arrogance makes them rude and intolerant. They view others from a hierarchical position: they need to devalue the people at the bottom, beat the competition, and gain dominance.

2. Fantasies of greatness

Narcissists seek to protect themselves from failure by chasing the ideal of perfection. It is much more important for them to feel better than others than for people who just want to feel good. Therefore, narcissists can imagine themselves invulnerable and omnipotent all their lives. Depending on their interests and strengths, they may dream of the perfect result in anything, intellectual power, unearthly beauty and / or idealized romantic love.

3. Belief in one's own uniqueness

The self-concept of narcissists is built on the belief that they are chosen and that they should move in high society. They must have special occupations, institutions, and the like. All this allows narcissists to place themselves above others and strengthen their position by belittling those they see as competitors or people of lower status.

4. Seeking admiration

Narcissists are masters at hiding their insecurities from everyone, including themselves. Their inner emptiness and sense of shame are expressed in an immoderate and obsessive need for external evaluation. So they try to get a narcissistic reinforcement - confirmation of the reality of one's image from other people. This allows them to drown out the already driven deep feelings of inferiority. Without admiration, narcissists experience destabilizing emotions that can lead to confusion and depression. At home, they demand admiration with no intention of earning it or giving it back, and often instill feelings of fear or guilt in their family members to get it. And if admiration turns out to be insincere or insufficient, they fall into a rage.

5. Exaggeration of their own rights

People with NPD must convince themselves that they are more worthy than others, and in order to drown out their feelings of inferiority, they believe that they are entitled to special treatment, and without it they feel unbearably humiliated. They should have everything better and more than other people, and they do not hesitate to demand, make scenes, portray the victim or be offended if their rights are “infringed”. They believe they deserve special status and service, from the best table in the restaurant to special discounts in stores and the most responsive service at the doctor, salon or gym. If a narcissist is treated like everyone else, whether at home or anywhere in the world, he perceives this as an insult and an occasion for resentment and punishment.

In political and social matters, narcissists' rights-based beliefs are reflected in a propensity for social intolerance and a preference for a hierarchical political system. They may disregard the principles of democracy and admire authoritarian or military laws [20] .

SPECIAL RELATIONSHIP

Travis and his family often went to restaurants and traveled. His wife, Angie, said he always insisted that when they went to Chicago they book the best places, like the Ritz Hotel. “He expected to be treated like a real king,” she said. “Everyone had to bow to him, otherwise he would make scenes and yell. ” Travis hated noises and smells. He could become furious at the noise of an electric fan, a crying baby, or the smell from the kitchen. In the restaurant, he always claimed the best table and demanded to change seats until he got it, Angie said. The same was true for hotels. Wherever we stayed, he changed rooms at least once and we had to repack.”

6. Taking advantage of other people

When it comes to relationships, narcissists act without moral guidelines, use others, thinking primarily in their own interests. They use and manipulate people to cope with unstable self-esteem, and to justify themselves, they make their behavior rational. Individuals with NPD believe that the rules are not for them and try to prevail in any situation.

7. Impaired empathy

Perhaps the most dangerous of all external characteristics of NPD is the lack of emotional empathy. Yes, narcissists can rationally discern other people's opinions and positions [21] , but they rarely empathize with other people's feelings and tend to hurt those around them to make themselves feel better. They perceive other people, in particular family members, as their own extension, which can be manipulated to meet their needs, which is always a priority.

Signs of empathy:

• ability to listen;

• ability to show compassion and indifference;

• recognition of the importance of people's feelings;

• desire to sincerely apologize and take responsibility;

• interest in other people's lives;

• Respect for the needs of others, even when it causes inconvenience or difficulty.

Consistent behavior that goes against the above is called narcissistic anxiety.

IT'S ALL ABOUT ME

The day before yesterday, Joanna's mother died in the hospital, right in front of her eyes. She was ill, but her death was sudden for everyone. Joanna was walking with her father to the house when her mother-in-law, who lived in a neighboring microdistrict and passed by, broke into a vicious tirade: the car would not start. “She knew about my mother’s death, but she called about how annoying it was to wait for a tow truck and how unlucky she was, without mentioning our grief,” Joanna said. We just stood there and listened to her. Suddenly she stopped talking and said to my father, "What a pity." She didn't tell me anything. Then she drove on, continuing to mumble about her car. My father and I looked at each other in bewilderment.

8. Envy

Because people with NPD value beauty and outward signs of success, and feel they deserve more than anyone else, they tend to be jealous and think that everyone is jealous of them. They believe that everything is possible for them, and therefore they often covet other people's material values, relationships or achievements. If they want something, they can try to get it, ignoring the consequences for other people, and if their plans fail, they can go on to sabotage or punish the owner of the desired object. Believing that life is built on the principles of competition, they suspect that other people want to take what is rightfully theirs. This leads to jealousy, paranoia and false accusations.

9. Arrogance and arrogance

Narcissists are constantly seeking to elevate themselves, and therefore may be rude, competitive, lash out or try to punish others, especially if they feel threatened or lack of attention. They also tend to ridicule, brag, gossip, gloat, condescend, get annoyed, "fix", insult and/or flaunt themselves.

American Psychiatric Association Criteria Limitations

While the American Psychiatric Association's nine criteria for diagnosing NPD are indeed useful, it is important to understand their limitations. Like any organization, the APA has its own divisions, contentious issues, political and financial programs [22] , and in addition, it is under pressure from the insurance industry. Many representatives of the latter criticize the excessive simplification of DSM-5 [23] and suggest revising the criteria for NPD and personality disorders in general [24] .

The main criticism of the NRL criteria is that they are too broad and can be interpreted in different ways [25] . Since a diagnosis can be made on the basis of five out of nine characteristics, two people with this diagnosis can have only one characteristic in common, and therefore their personality profiles will be very different. Critics also point to an equal assessment of all characteristics, while in fact some are more pronounced than others. Many would argue, for example, that lack of empathy is a more important symptom of NPD than arrogance or jealousy. Another problem is mentioned: the criteria for all four Cluster B personality disorders—narcissistic, hysterical, borderline, and antisocial—to some extent overlap. This often leads to complex and confusing comorbid diagnoses such as NPD with BPD (borderline personality disorder) or NPD with APD (antisocial personality disorder). Some psychologists believe that it would be more useful to view all four disorders as different manifestations of the same underlying state, or as four dimensions on a single continuum. 0007 [26] . An alternative scaling model for diagnosing NPD has been proposed in DSM-5 [27] .

Perhaps the most important complaint about the existing criteria was voiced by one of the leading psychotherapists with clinical experience in the treatment of narcissism: these criteria do not adequately reflect the internal state of narcissists, that is, the thoughts and emotions that control their behavior [28] . By these criteria, the latent (veiled) manifestations of NPD, which are just as destructive as the exhibitionistic (overt) forms for people with this disorder and for survivors of narcissistic abuse, cannot be fully recognized as pathological either. We will look at these aspects next.

Stuck in denial? How to get off the ground. Mayo Clinic April 14, 2017. Retrieved April 8, 2019. URL: https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/denial/art-20047926.

6. Universal Declaration of Human Rights: [Approved. and proclaimed by the UN General Assembly on 10 Dec. 1948]

7. Human behavior that harms himself. It can be expressed in different forms: from procrastination to various addictions and self-harm. - Approx. ed.

8. Selfharm (from English selfharm, self-harm) - conscious attempts to harm your body, but without suicidal intentions. - Approx. ed.

9. Grinberg Elinor. "Adapting to borderline states, narcissism, and schizophrenia: the pursuit of love, admiration, and security." New York: Greenbrook Press, 2016.

Shari Stines. "Burning Labor - Treating Narcissism: A Psychotherapist's Handbook". GoodTherapy.org, 01/12/2017. Date of access: 07/14/2019. URL: https://www.goodtherapy.org/blog/arduous-work-of-treating-narcissism-therapists-guide-0112174

11. Interview with Eleanor Greenberg. Telephone interview from the author, 03/20/2017.

12. Ibid.

13. Gaslighting (from the English name of the play "Gaslight") is a form of psychological violence and social parasitism, the main task of which is to make a person suffer and doubt the adequacy of his perception of the surrounding reality through constant depreciating jokes, accusations and intimidation. - Approx. ed.

14. In the United States, mental disorders are classified according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; now in its 5th edition). The personality disorders in this manual are grouped into three clusters: A (paranoid, schizoid, schizotypal), B (antisocial, borderline, hysterical, narcissistic), and C (avoidant, dependent, obsessive-compulsive). - Approx. ed.

Stinson, Frederick S., Deborah A. Dawson, Raizo B. Goldstein, S. Patricia Chu, Boji Huang, Sharon M. Smith, W. June Ruan, Attila J. Pooley, Tulshi D. Saha, Roger P. Pickering and Bridget F. Grant. “Prevalence, proportion, disability, and comorbidities of narcissistic personality disorder in DSM-IV. Results of the 2nd wave of the national epidemiological study of alcohol intoxication and related conditions. Journal of Clinical Psychiatry (July 31, 2008. Accessed: April 8, 2019of the year. https://www.psychiatrist.com/jcp/article/Pages/2008/v69n07/v69n0701. aspx.

16. Marchlevska Marta, Kevin A. Castellanos, Carol Lucik, Miroslav Kofta, and Aleksandra Shyshok. "Own path or beaten path: Expressed narcissism and low self-esteem portend decline in support for democracy." British Journal of Social Psychology, 2018. DOI:10.1111/bjso.12290.

17. Introspection - a method of conscious self-observation, comes from the Latin word introspecto, which means to look inside. - Approx. scientific ed.

Stephanie Pappas. "Plunging into the dictator's subconscious." Journal of LiveScience, 11.02.2011. Date of access: 8 April 2019. URL: https://www.livescience.com/12842-delving-mind-dictator-mubarak.html

19. Diagnostic and Statistical Manual of Mental Disorders. 5th edition. Washington: American Psychiatric Association, 2013.

20. Marchlevska Marta, Kevin A. Castellanos, Carol Lucik, Miroslav Kofta, and Alexandra Sishoka. "Own path or beaten path: Expressed narcissism and low self-esteem portend decline in support for democracy. " British Journal of Social Psychology, 2018. DOI:10.1111/bjso.12290.

21. Baskin-Sommers, Ariel, Elizabeth Kruzermark and Elsa Ronningstam. "Empathy in Narcissistic Personality Disorder from a Clinical and Experience Perspective". Peer-reviewed American Journal of Personality Disorders: Theory, Research, and Treatment 5, No. 3 (July 2014). pp. 323–333. DOI:10.1037/per0000061 - the article has not been translated.

22. Herman, Judith Lewis. Trauma and Healing: The Consequences of Violence. From domestic violence to political terror. New York: Basic Books, 1997. pp. 117–118.

23. Kolk B. van der. The body remembers everything: what role does psychological trauma play in a person's life and what techniques help to overcome it / Bessel van der Kolk; [per. from English. I. Chorny]. - Moscow: Bombora™: Eksmo, 2020. - 460, [1] p.: ill. – (Revolution in medicine: the loudest and most amazing discoveries).

Herman Simon and Corinne E. Tsupanik. “Problems of the system for diagnosing personality disorders. Problems in the provision of psychiatric care associated with comments on the system for diagnosing personality disorders. Date of access: 04/08/2019. URL: https://www.mentalhelp.net/articles/problems-with-the-diagnostic-system-for-personality-disorders/. Herman Simon and Corinne E. Tsupanik. “Problems of the system for diagnosing personality disorders. Problems in the provision of psychiatric care associated with comments on the system for diagnosing personality disorders. Date of access: 04/08/2019. URL: https://www.mentalhelp.net/articles/problems-with-the-diagnostic-system-for-personality-disorders/. Herman Simon and Corinne E. Tsupanik. “Problems of the system for diagnosing personality disorders. Problems in the provision of psychiatric care associated with comments on the system for diagnosing personality disorders. Date of access: 04/08/2019. URL: https://www.mentalhelp.net/articles/problems-with-the-diagnostic-system-for-personality-disorders/.

27. Diagnostic and Statistical Manual of Mental Disorders. 5th edition. Washington: American Psychiatric Association, 2013. Section III. New measures and models.

28. Guide to Psychodynamic Diagnostics (PDD). Silver Spring, MD: Alliance of Psychoanalytic Organizations, 2006

Narcissistic Abuse Syndrome - IRINA KAMAYEVA

Narcissistic Abuse Syndrome

All professionals know and "love" the subject of narcissism. Malignant narcissism, narcissistic disorder, narcissism as a disease of our time, narcissism as a symptom of a pathological relationship.

If narcissism as a personality disorder is included in both the international DSM classifier and the Russian ICD list of disorders, then people who have been in a relationship with a narcissistic personality for a long time and suffer from their abuse by a narcissist are still more interesting to psi-bloggers, or are treated by specialists to other categories of people in need of help.

At best they may be seen as victims of domestic violence (although there are significant differences), at worst as masochists. In the second case, when the victim is considered from the standpoint of his own masochistic basis, the disorder itself is defined not as the result of being in a pathological relationship, but as a personal characteristic inherent in the victim himself, on the basis of which the type of assistance and recommendations is chosen, leading to a deterioration in the condition.

What do people who have been in a destructive relationship with a narcissistic personality for a long time look like?

In the vast majority of cases, these are middle-aged women, with a large number of complaints about the physical and emotional state, suffering from insomnia, all possible emotional disorders - depression, anxiety, phobias, problems with the body, weight and nutrition, sometimes with untreated physical injuries, sometimes with suicidal attempts, thoughts or intentions.

Everyone is characterized by a sense of doom, hopelessness, emptiness. They do not think about the prospects and have stopped planning for the long term. Many are anxious, inhibited or, on the contrary, fussy, sometimes seeming to be classic hysterical women - with their inherent attempts to look childishly naive, forgetting details and events “on the go”, sexualizing the situation defensively. They may seem too cheerful and laugh as if out of place, or, on the contrary, sad and detached. Their protective cognitive inhibition looks like some kind of stupidity and incompetence. They often describe their outbursts of anger at themselves and those close to them, and spend almost all of their remaining energy (which is already too little) holding themselves back and blaming themselves. They never blame others.

Experts understand (I want to believe it) that narcissism is a wide range of behavior. On a conditional scale from 1 to 10, we get 1 - healthy narcissism, strengthened ego, self-understanding, need for self-respect and respect from others, and 10 - pathological narcissism, or narcissistic disorder. Healthy narcissism will allow us to pick ourselves up when we fail, move on, be in relationships without dissolving or losing ourselves. In healthy narcissism, we are able to love someone because we are able to love ourselves.

Pathological narcissism is the other side of this healthy condition. The external picture of such a person is excessive self-love while ignoring everyone else. He is like a god, and his environment exists in order to emphasize his omnipotence, status, absolute right and power. He is out of the rules and out of competition. He has an inflated ego, most often for no reason, without the presence of at least something that would give him the right to do so. He is full of fantasies about his unlimited power. He fantasizes about the envy of everyone around him for his success. He does not sympathize, does not worry, does not understand others. He uses and exploits.

On the spectrum from 1 to 10, it is not necessary to be a 10-point narcissist in order for people nearby to become victims.

Victims of narcissists often ask themselves the question: “How did I get myself into (get stuck - according to DSM-IV, 50-75% of narcissists are men) all this, because at first everything was fine?”

In the early stages of a relationship, the narcissist is alluring. The first days of meeting a narcissist are fast, passionate and romantic. The future victim sees in him his ideal - smart, reliable, caring, generous. She falls in love "without memory" and for life. The proposal for marriage, fortunately for her, also sounds very fast. But at some point, Dr. Jekyll turns into Mr. Hyde, who at lightning speed instills in the victim fear, anxiety, insecurity, and complete confusion in relationships.

This is going to sound harsh, but we find it easier to work with victims of outright violent narcissists. Easier work does not mean better for the victims. But the victim of outright bullying is well aware of himself as a victim, whether she is ready to leave the relationship or not.

It's more difficult when someone is the victim of a narcissist who doesn't use direct physical abuse. The tactic of choosing mixed messages that simultaneously cause different emotional states in the victim is the most insidious. Talking about love, adding that “no one else needs you except me”, pointing out “wrong behavior”, “not perfect enough body”, behavior that is too sexy or not sexy enough, manipulating with threats of one’s own suicide if the victim does not do as the narcissist needs to gradually deprive her of any supportive environment, "because your mother is a fool, and her friends are whores. " After many such messages, all attempts to leave will end with returns. Because “you are fat and no one needs you”, “you are stupid and no one wants to listen to you”, “you are worthless and a beggar, and no woman but me will tolerate you.”

Brainwashing that goes on 24 hours a day, 7 days a week, 365 days a year is emotionally exhausting and makes a person completely sick and powerless.

The narcissist never uses direct messages and open communications. “If you would only do what I want from you” ... “Why can’t you make me happy in any way?” ... “What is wrong with you?” ... Or the most effective weapon is used - ignoring and silence. During this time, there is an ominous silence and tension in the house, and only one thought is spinning in the head of the victim: “What did I do wrong?”

Other characteristic manifestations in a relationship when terry narcissism flourished.

Depriving the victim of gifts for the holidays, the holidays themselves, or the most common use is to instantly stop the holiday as a punishment. When a couple or family has already gone to a restaurant, to a movie, to a concert, and suddenly, suddenly, everything stops. The narcissist can literally “throw” the victim out of the car on the go, because she looked the wrong way, turned around the wrong way, behaved the wrong way. “You yourself are to blame, but I have prepared such a holiday for you and such a gift.”

He/she may quite openly have other relationships "because you are too bad (bad)" or "not good enough (good)".

For those who see him from afar, he is always a wonderful person - a real family man, a caring parent, a wonderful friend. Helping others, a reasonable attitude to life, loudly declared correct life values, a neat appearance - all this captivates the environment. The main problem of the perception of a couple in which one of the partners is a pathological and destructive narcissist is the problem of "inverted perception". The destructive, humiliating and pathological narcissist behaves calmly and rationally, is perceived as worthy and reliable, and his mate behaves anxiously, nervously, tensely, and is perceived by others as mentally unstable, emotionally unstable, socially maladjusted.

What is the difference between a narcissist and a sadist if we don't have the terrifying "2 in 1" option?

The sadist never releases the victim. The narcissist “eats away” her, after which he throws her away, looking for a new partner - full of strength, energy and life. As he leaves, he leaves his victim emotionally shattered, "lamenting" how much she has done to destroy and ruin their once-perfect relationship. And the victim believes in his own guilt.

The narcissist himself does not change. Why change God? Why change something when others should? Only he himself knows how desperately he hates himself, and how much he wants no one to ever see the one who is hiding behind this hard outer shell.

The narcissist's victims are spouses, friends, colleagues and work partners. The hardest part is being the victim of a narcissistic mother. A relationship with a narcissistic mother is one that is almost impossible to get out of. Even after her death.

Who is at risk and is a potential victim of a narcissist? In orthodox psychology, which tends to blame the victim, the trait characteristic of a potential victim is, in fact, called victimization - the past experience of humiliating relationships and the position of the victim. But victimization is not a cause, but a consequence of being in such a relationship. A trait that can become a "trap" for a narcissist is high sensitivity to others and empathy. The desire to heal others, to help them, the sensitivity to manifestation, the tendency to care - those are the strings that the narcissist and any manipulator plays professionally.

Agree that a therapist who possesses the qualities that we habitually define as qualities needed in the profession of psychologist and therapist also turns out to be a trap for the narcissist. A classic story when a couple in which a narcissistic husband demands from his wife to understand him, pity him, accept his weakness, guarantee that she will be with him to the end, at the same time demands to be an ideal hostess, a successful woman, the owner of a super-figure, but who is not ready for any compromises for her sake, suddenly “buys” the therapist into the trap of help and empathy, and the therapist begins to act as if in the interests of the “fragile man”, calling on the wife to change in accordance with the instructions of the husband.

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