When You Feel Stuck, Try This

Originally posted on GoodTherapy.org on October 23, 2019 • By Danielle Matthew, LMFT

It can be an awful feeling to feel stuck. You may feel like you can’t forge ahead, or you might not know how to move forward. When you feel stuck, it may seem that others have their lives together while you don’t.

Common areas for feeling stuck include marriage or relationships, jobs, low self-esteem, lack of personal satisfaction, and a loss of ambition.

When you feel stuck, it’s often a sign that something needs to change in your life. However, fear and helplessness are two common states that can keep you stuck for longer.

HOW TO GET ‘UNSTUCK’

When you’re stuck, your thoughts may cloud with frustration and other uncomfortable emotions. But, it’s important to try not to feel discouraged. What you consider “stuck” can be a holding place for new growth, strength, and information before moving forward.

Although you may feel like you’re at a permanent standstill, you can get “unstuck” with the right focus and mindset. Sometimes, that’s the only change that’s needed.

Here are some additional tips for getting unstuck:

• Take time to evaluate your current circumstances. As hard as it may be, it’s necessary to assess your situation. It can be helpful to spend at least 15 minutes a day reflecting on your circumstances with an honest and open mind. Try to consider why you feel you can’t move forward. It’s also important to recognize any excuses you may be hiding behind and to journal any thoughts or realizations that come to mind. Taking ownership of your choices makes you accountable for your actions. While this can be very difficult, it can also be incredibly empowering. Others can’t prevent you from moving forward.
  
• Embrace your current state. Embracing your circumstances is the first step to moving beyond your current state. It doesn’t mean you like what’s happening. Instead, you accept that it’s taking place so that you can create a plan for moving forward. You control your journey.
  
• Consider how you’d like to move forward. While you may not know precisely how you’d like to move forward, it’s essential to consider and write down the possibilities for getting unstuck. Talking to an unbiased person can also be beneficial, as it may help you evaluate the situation from a different perspective and come up with possibilities for moving forward that you may not have considered.
  

OTHER THINGS TO CONSIDER

It’s important to realize that the time that it takes to feel unstuck can vary by individual and situation. Don’t compare yourself to others. You and your set of circumstances are not the same as someone else’s. Moving forward is a journey, not a marathon. Taking one step at a time may feel like a slow process, but it’s often the most effective.

During your daily evaluations of your current circumstances, consider the steps you’re currently working on or that you’ve already completed so that you can see the progress that you’ve made. While it’s essential to take ownership of your circumstances and plans for moving forward, it’s also crucial not to be overly critical of yourself and any mistakes that you might make. And, sometimes, you need to refocus. Daily evaluations are important, but so are regular breaks from your situation. Part of moving forward is also taking care of yourself. Practice self-care and positive self-talk.

Try not to let setbacks or unexpected hurdles discourage you. While these stumbling blocks may cause you to alter your plans for moving forward, you can still control your destination. Try to look at mistakes and obstacles as growth opportunities so that you’re even more equipped to achieve your goals.

Sometimes anxiety and other issues like attention-deficit and hyperactivity (ADHD) can prevent you from feeling like you’re moving forward. To fully become unstuck, it may help to also address anxiety and other issues.

DON’T BE AFRAID TO SEEK PROFESSIONAL HELP

Therapy can be an effective way to help you move forward–especially when, despite your best efforts, you continue to feel like you’re at a standstill. Going to therapy is not a sign of weakness, and it does not mean you’re “crazy.” Start here to find a licensed and compassionate mental health professional in your area.

© Copyright 2019 GoodTherapy.org. All rights reserved.

A Parent’s Guide to Dealing with Sibling Rivalry

Originally published on GoodTherapy.org on August 27, 2019 • By Zawn Villines

Sibling rivalry can take many forms—from good-natured demands to know a parent’s favorite to aggressive fighting, punching, and biting. It’s one of the most common problems families face and one of the biggest sources of parenting stress.

Siblings may have very different personalities, and they are thrown together and forced to work out their disagreements for years. This presents a great opportunity for them to learn communication and conflict resolution skills. It can also be deeply frustrating to both parents and their children. Sometimes, sibling rivalry constitutes a unique form of bullying that can affect a child for many years. Knowing how to deal with sibling rivalry can make parenting less stressful and help parents provide a safe and supportive environment for all their children.

WHAT CAUSES SIBLING RIVALRY?

Living with another person can be difficult. There are often possessions to fight over, and children may argue over limited resources. Just as some bickering among roommates who did not choose one another is inevitable, so too is some level of disagreement between siblings.

Although most parents of multiple children report some degree of sibling rivalry, the roots of said rivalry can differ between families. Most analysts suggest a competition for parental love and approval often play a central role. Some factors that may increase sibling conflict include:

• Perceived or actual parental favoritism.
• Differences in temperament and personality.
• The need to guard resources, such as when a child worries their younger sibling will steal their favorite blanket.
• Jealousy over parental love, such as when an older child envies a new baby for the attention the infant gets.
• Parental modeling of conflict resolution, such as if parents model an aggressive or hostile conflict management style.
• Lack of conflict resolution skills, since young children rarely have the complex skills necessary to manage the challenges of living with another person.
• Behavior that normalizes or reinforces aggression, such as when parents ignore physical conflict or laugh when one child teases another.
• Viewing the sibling as a competitor rather than a collaborator.
• Being a twin or multiple, since this increases competition and raises the probability that parents or other adults will compare the children.

Some research suggests that younger children may engage in sibling rivalry more often than adolescents. Children between the ages of 3 and 7 have high rates of conflict, disagreeing an average of 3.5 times an hour.

HOW SIBLING RIVALRY AFFECTS KIDS AND PARENTS

Sibling rivalry can be a chronic source of frustration for parents, as they may feel that they spend most of their time mediating conflicts. This increases the stress and exhaustion of parenting. Constant conflict can also make it difficult to spend meaningful time with children, either together or separately. Some parents struggle to remain calm or patient in the face of intense rivalry. Others worry that the rivalry will negatively affect their children at school, with friends, or in adulthood.

The effects of rivalry on children vary. In the moment, an argument with a sibling can be stressful and frustrating, particularly when a child feels that a parent favors their sibling or does not care about their needs.

Sometimes sibling rivalry becomes a form of abuse. A 2013 study that analyzed data from the National Survey of Children’s Exposure to Violence found that sibling assaults are common. Rates of violence were highest among children who were less than 2 years apart. Among this group, 40.9% reported being physically assaulted during the past year, and 7.7% reported either being assaulted with a weapon or being injured.

Chronic physical violence, particularly when one child is usually the victim and the other child is usually the perpetrator, can be traumatic. Chronic sibling violence may increase a child’s risk of posttraumatic stress (PTSD), depression, anxiety, difficulties at school or with friends, and relationship problems in adulthood.

Conversely, sibling rivalry also confers some benefits. Siblings teach one another social skills. Early conflict resolution skills can prepare a child for the many conflicts of adulthood, as well as the challenges of living with other people, such as roommates or spouses. A 2013 study found that fifth graders without siblings had more social skills deficits, even five years after entering school. This trend suggests managing conflicts with siblings continues to confer significant social benefits even after a child enters school and spends daily time with other children.

HOW PARENTS CAN PREVENT SIBLING RIVALRY

Sibling rivalry is common, but not all forms of sibling rivalry are normal or healthy.

“While many parents tend to overlook it as ‘normal’ when siblings treat each other poorly, sibling rivalry can have a negative impact on mental health that can last a lifetime. Sibling rivalry should be viewed by parents as being potentially as harmful as ‘bullying,’” explains Kathy Hardie-Williams, MEd, MS, NCC, LPC, LMFT, a family therapist in Oregon who often works with families to manage sibling rivalry and other conflicts.

“One thing parents can do is make ‘needs’ rather than ‘fairness’ the foundation for decisions,” Williams continues. “We tend to think of fairness as treating everyone the same, but in fact, fairness is treating everyone based on what they need. Parents would be serving their children well to teach this concept.”

A 2012 study of a novel intervention for sibling rivalry echoes these sentiments, pointing to the importance of fostering a collaborative relationship between siblings. That study tested 12 after-school activities that taught siblings how to communicate in a collaborative, positive fashion. By encouraging siblings to see themselves a part of a team, researchers were able to improve how siblings felt about each other.

Some other strategies that may help include:

• Preparing young children for the arrival of a new baby by talking to them about the baby and helping them feel like an important part of the process.
• Not making sudden changes in a child’s life following the arrival of a new baby.
• Consistently enforcing rules in an age-appropriate way. Siblings are more likely to behave abusively toward one another when such behavior is rewarded. For example, a child who can get what they want by stealing from a sibling is more likely to continue doing so.
•  Intervening in conflicts that are one-sided or physically aggressive.
•  Not showing favoritism or comparing children. Don’t urge one child to be more like the other. Don’t make negative gender or appearance-based comparisons. Don’t force twins to wear the same clothing or expect they will behave the same.
•  Spending meaningful alone time with each child. This makes it easier for parents to recognize and nurture each child’s unique personality and talents.
  

WHEN KIDS ACCUSE YOU OF HAVING A FAVORITE

Children who accuse a parent of favoritism often feel genuinely distressed about the experience. So parents should not dismiss their concerns—even if the parent does not have a favorite. Instead, focus on what the child is feeling and how you can help ease those emotions.

Some questions to ask include:

• Why do you feel like I have a favorite?
• What could I do that would help you feel more loved?
• Do you feel like you get enough time with me?
• What could I do to improve your relationship with your sibling?
• How can I help you and your sibling better manage conflict?

Some strategies for managing allegations of favoritism include:

• Being mindful of your own biases. Sometimes parents are more compatible with one child than another. A parent who loves sports and rough play may have trouble relating to a child who prefers to spend quiet time reading a book. Plan activities together, and encourage your child to share their interests.
• Noticing each child’s unique personality and talents. Compliment children not just for the achievements that matter most to you, but for those that matter most to them. An aspiring artist may care more that you notice the comic book they drew than that you reward them for good grades.
• Focusing on a child’s feelings rather than the truth of any accusations they make about favoritism. Love isn’t an easily measurable emotion, so it is next to impossible to “prove” that you like each child equally. If you can make your child feel more loved, then they will likely feel less need to compete with their sibling for your affection.
  

WHEN SHOULD YOU CONSIDER FAMILY THERAPY?

Family therapy can help families manage many forms of sibling rivalry. It’s never too early or too late to give therapy a try. Therapists can help even with minor sibling rivalry. Some signs that a family should consider therapy include:

• Sibling rivalry is a chronic source of stress to the parents or children.
• The parents have tried multiple strategies to improve the siblings’ relationship, but none have worked.
• There is bullying or physical abuse.
• One or more children have special needs that complicate sibling rivalry.
• There has been a recent change or loss in the family, such as a divorce or death.
• The parents have trouble relating to one or more children, triggering allegations of favoritism.

The right therapist can help each family member talk about their feelings. They can then support the family to develop a sibling rivalry management plan that everyone can live with. GoodTherapy can help you find a family therapist here.

References:

1. Children and sibling rivalry. (2019). Retrieved from https://www.betterhealth.vic.gov.au/health/healthyliving/sibling-rivalry
2. Ciciora, P. (2019, January 15). Siblings play formative, influential role as ‘agents of socialization.’ Retrieved from https://news.illinois.edu/view/6367/205739
3. Downey, D. B., Condron, D. J., & Yucel, D. (2013, November 7). Number of siblings and social skills revisited among American fifth graders. Journal of Family Issues, 36(2), 273-296. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/0192513X13507569?journalCode=jfia
4. Feinberg, M. E., Solmeyer, A. R., Hostetler, M. L., Sakuma, K-L., Jones, D., & McHale, S. M. (2012). Siblings are special: Initial test of new approach for preventing youth behavior problems. Journal of Adolescent Health, 53(2), 166-173. Retrieved from https://www.jahonline.org/article/S1054-139X(12)00402-8/fulltext
5. Fry, S. M. (2019, May 1). Sibling rivalry—lifelong relationships, lifelong effects. Retrieved from https://www.greatschools.org/gk/articles/sibling-rivalry-lifelong-relationships-lifelong-effects/
6. Tucker, C. J., Finkelhor, D., Shattuck, A. M., & Turner, H. (2013). Prevalence and correlates of sibling victimization types. Child Abuse and Neglect, 37, 213-223. Retrieved from https://pdfs.semanticscholar.org/d295/389249a7206c2cc0815d2073895d7ca49cd3.pdf

© Copyright 2019 GoodTherapy.org. All rights reserved.

When Family Relationships Become Toxic: The Trauma of Enmeshment

Originally posted on GoodTherapy.org on October 16, 2019 • By Zawn Villines

Psychotherapist Salvador Minuchin developed the concept of enmeshment to characterize family systems with weak, poorly defined boundaries. The entire family may work to prop up a single viewpoint or protect one family member from the consequences of their actions. In these family systems, individual autonomy is weak, and family members may over-identify with one another. For example, a child may be unable to see their own interests as distinct from their parent’s and may defend that parent’s interests even when doing so is harmful.

Enmeshment inevitably compromises family members’ individuality and autonomy. It can also enable abuse. Abuse within an enmeshed family system is a unique sort of trauma. Some survivors of such trauma may not recognize their experiences as traumatic and may even defend their abusers. Because boundaries are weak in these family systems, family members who correctly identify their experiences as traumatic may be ostracized or even labeled as abusive.

CHARACTERISTICS OF ENMESHED FAMILIES

Most healthy families are loyal to one another and may share certain values. In an enmeshed family, this loyalty and shared belief system comes at the expense of individual autonomy and well-being. For example, the entire family might support the idea of the father as a wonderful parent or great leader, even though he is physically abusive.

Some characteristics of enmeshed family systems include:

• Each family member fills a specific role. In most cases, these roles enable dysfunctional behavior from other family members. For example, the family peacemaker may smooth over conflicts the family abuser creates or might guilt other family members for attempting to build healthy boundaries.
• Enmeshment often begins when one family member has a mental health condition or substance abuse issue. Enmeshment normalizes harmful behavior and can be a way to avoid treatment.
• Enmeshed families often view dissent as betrayal.
• Enmeshed families may demand an unusual level of closeness even from adult children. For instance, an adult child with children of their own may be expected to spend every holiday with the family. If they spend a holiday with in-laws or with their own family, the enmeshed family may shun or otherwise punish them.
• Family members’ emotions are tied up together. It can be difficult to discern where one person’s emotions begin and anther’s end.
• There may be unspoken family norms that family members take for granted. Outsiders may rightly view these norms as unusual or dysfunctional. For example, an enmeshed family may have a norm of never calling the police on a family member who abuses their partner.

Some people also use enmeshment to refer to covert, or emotional incest. This is when a parent or other caregiver treats a child as a partner or equal. The parent may rely on the child for support and unconditional love rather than filling these basic needs for the child.

HOW ENMESHMENT ENABLES ABUSE

Enmeshment does not always lead to abuse, but it is a potent tool for shielding abusers from the consequences of their actions. Enmeshed family members may be reflexively defensive of one another and view even deeply harmful behavior as normal and good.

Enmeshment can make it difficult for a person to form close relationships with other people. Without these relationships, it is very difficult for enmeshed family members to recognize that their family’s relational style is not healthy.

Even when enmeshed family members do form outside relationships, their enmeshed family may intrude on these relationships. Alternatively, the enmeshed person may view their family as normal and their partner as the problem. For example, an adult who gets married may still prioritize their childhood family over their spouse or may expect their spouse to defer to family members or accept abusive behavior.

THE TRAUMA OF ENMESHED FAMILIES

Enmeshment itself can be traumatic, especially when enmeshment normalizes abuse. In other cases, though, enmeshment is the byproduct of trauma. A serious illness, natural disaster, or sudden loss may cause a family to become unusually close in an attempt to protect themselves. When this pattern persists well beyond the initial trauma, enmeshment loses its protective value and can undermine each family member’s personal autonomy.

Enmeshed family systems are often dismissive of trauma. A parent might dismiss their drunken night of abuse as a normal reaction to a child’s bad grades. In adulthood, siblings may defend a parent’s abuse by insisting that the parent was under immense stress or that the abuse was actually the children’s fault. By dismissing trauma as normal or deserved, enmeshed family systems make it difficult for family members to understand their emotions and experiences. In this form of gaslighting, a family might consistently substitute the family’s collective judgment for an individual’s feelings. Over time, the individual family member may struggle to distinguish their own emotions from the emotions the family insists they should have.

TRAUMA BONDING AND ENMESHMENT

People who experience trauma or intense emotions together may bond in unusual and unhealthy ways. Patrick Carnes developed the concept of trauma bonding to characterize these relationships.

With trauma bonding, the cycle of abuse tightly binds family members, creating intense emotional attachments. In abusive relationships, the abuser may become abusive and frightening, then apologetic and extremely loving. Some abusive parents attempt to compensate for their abuse with gifts, special outings, or intense love. Many survivors of abuse report that, when their parents were not abusive, they were extremely creative, dynamic, and loving.

This intermittent reinforcement of love and affection can be very difficult to escape. The longer it persists, the more difficult it may become for a person to leave. Abuse survivors may truly love their abusers and believe that their abusers love them, too.

Even when survivors correctly identify the abuse and establish boundaries or leave the relationship, trauma bonding and enmeshment can affect future relationships. The cycle of abuse can feel normal in these situations, as an intermittent schedule of love and affection becomes the person’s point of reference for a relationship. This may cause trauma and enmeshment survivors to seek out and remain in abusive or enmeshed relationships. It can also make it easier for their family to pull them back into the abuse and chaos.

People who grow up in dysfunctional family systems may ignore their own emotions. They may question their memories, wonder if their trauma really happened, or believe that they deserve to be abused. Even when a person is able to see their family through a more objective lens, establishing boundaries can prove difficult. Holidays, family vacations, and other times of intense family closeness can trigger old habits and lead to new trauma.

Therapy can help a person draw clear boundaries, take their emotions seriously, and move beyond enmeshment. A therapist is also an outside voice who can help a person understand that the behaviors their family normalized are not healthy and that they do not have to remain trapped in their usual family role forever.

To begin your search for a compassionate therapist, click here.

References:

1. Carnes, P. J. (1997). The betrayal bond: Breaking free of exploitative relationships. Deerfield Beach, FL: Health Communications, Inc.
2. Green, R., & Werner, P. D. (1996). Intrusiveness and closeness-caregiving: Rethinking the concept of family enmeshment. Family Process, 35(2), 115-136. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1545-5300.1996.00115.x
3. Trauma bonding. (n.d.). Retrieved from http://www.abuseandrelationships.org/Content/Survivors/trauma_bonding.html
4. 
   

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Covert Narcissism: The Quiet Counterpart to Narcissistic Personality

Originally posted on Good Therapy on August 22, 2019 • By Crystal Raypole

Even people without an extensive knowledge of mental health concerns have likely heard of narcissistic personality disorder (NPD), or narcissism, as it’s commonly called. The term “narcissist” is often used casually to refer to people who don’t necessarily have a diagnosis of narcissism if they appear to have some narcissistic traits, such as grandiose delusions, low empathy, arrogance, and a need for admiration.

Portrayals of characters with narcissism in movies and television have also increased the condition’s notoriety. While depicting characters with mental health issues in the media can help increase awareness, it can also create problems. In the case of narcissism, much of what’s seen in popular culture rests heavily on stereotypes associated with grandiose and malignant narcissism. If people with narcissism aren’t portrayed as outright villains, they’re typically portrayed as toxic or harmful individuals.

If you’ve had a close relationship with someone who has NPD, you might agree that many of these stereotyped traits have truth to them. Still, it’s important to recognize that NPD can occur in varying degrees of severity, occurs on a spectrum, and can present in different ways. As a result, you may not always recognize someone has narcissism, especially if they live with a less-known subtype such as covert (vulnerable) narcissism.

COVERT VS. OVERT NARCISSISM

Covert narcissism is also known as shy, vulnerable, or closet narcissism. People with this subtype tend not to outwardly demonstrate arrogance or entitlement. Instead, they might put themselves down and seem anxious about what others think of them, rather than exuding charm or confidence. Other people may describe them as quiet and sensitive, especially to criticism.

Similarities between subtypes may become more evident with closer exploration of symptoms and feelings. People with overt narcissism generally seek attention outwardly and put themselves forward as superior. They might show patterns of exploitative or manipulative behavior that relate to a personal sense of entitlement and need for recognition.

Covert narcissism often involves a more internalized experience. People with these traits still feel unappreciated, need admiration, have contempt for those they consider inferior, and believe they should get special treatment. But instead of displaying outward grandiosity, they may privately fantasize about having their special qualities recognized or getting revenge on people they believe have slighted or wronged them in some way.

SIGNS OF COVERT NARCISSISM

Not every person with some or all of the listed traits will have any type of NPD, but the following characteristics may help identify covert narcissism in people who meet criteria for NPD.

• A reserved or self-effacing attitude
• Humility or a tendency to put themselves down
• Smugness or quiet superiority
• Passive-aggressive behavior
• Envy of others and/or feeling that they deserve what other people have
• A lack of empathy for the feelings or situations of other people
• A tendency to step in and help others out of a desire for recognition
  

Narcissistic traits usually show up in all of a person’s relationships and interactions, but they might manifest in slightly different ways depending on the situation.

• In parents: Parents may seem to prioritize their child’s needs and feelings and make sacrifices to ensure their child’s success. But these behaviors generally result from the desire to be the “best” or perfect parent and achieve recognition and admiration from others. Not receiving this recognition may lead to anger or self-pity. Parents with covert narcissism may also use guilt to manipulate children who attempt to claim some independence.
• In the workplace: People with covert narcissism may feel superior to coworkers or supervisors, believe they’re the most intelligent or best at what they do, and harbor fantasies of being elevated above others. They may envy peers who do receive recognition, believing others don’t understand or appreciate them. This may contribute to interpersonal difficulties or subtle bullying.
• Among friends: Friends may offer admiration and respect, and it’s common for people living with narcissism to manipulate others in order to get sympathy, support, or attention. People with narcissism don’t always completely lack empathy for the difficulties of others, but the empathy they can offer tends to be limited to what they’ve experienced themselves. They tend to feel neglected or rejected when they’re not getting the attention they feel they deserve, so they may try to bring every conversation back to them—but this may be done in less obvious ways.
  

COVERT NARCISSISM AND RELATIONSHIPS

Recognizing covert narcissism in a loved one may be more difficult than recognizing grandiose or malignant narcissism. Some people living with narcissism may function well in society and maintain romantic relationships without causing their partner distress. But it’s very common for partners of people with NPD, especially untreated NPD, to experience gaslighting, neglect, and manipulation.

Some common experiences include:

• Lack of empathy from your partner
• Passive-aggressive attempts to get your sympathy
• Dismissiveness or contempt from your partner
• Feeling controlled or belittled

Covert narcissism involves a high level of sensitivity, so your partner might take things you say as criticism, rejection, or personal attack. They might act as if you bore them and show disinterest in your emotions and experiences. It’s important to reach out to a therapist if you feel manipulated, neglected, or otherwise distressed as a result of your partner’s actions. Couples counseling may help in some instances, but it won’t work unless your partner wants to change. Individual therapy, however, can help you get support.

COVERT NARCISSISM AND MENTAL HEALTH

According to 2015 research looking at the diagnostic and clinical challenges associated with narcissism, people often seek treatment for co-occurring mental health conditions rather than narcissism itself.

People with covert narcissism may be more likely to have anxiety or depression than people with other subtypes. Non-suicidal self-harm is also not uncommon, and people with covert narcissism often experience feelings of emptiness or low self-esteem that can contribute to suicidal ideation.

Treating narcissism can be difficult, since many people living with the condition never seek or want help. The stigma associated with narcissism can make it even more difficult to get help. Receiving messages like “narcissists are evil” and “narcissists can’t change” may discourage even those who do want to seek help from trying.

Like other personality disorders, narcissism involves a long-standing pattern of emotions and behavior that may not seem unusual to someone living with the condition. Because of this, people who have covert narcissism, or any NPD subtype, will probably seek treatment for a co-occurring mental health issue. A therapist who recognizes traits of narcissism may then be able to help a willing individual begin working to change problematic patterns of behavior.

Some therapies show particular promise in helping address NPD. Schema therapy and psychodynamic therapy are two approaches considered most helpful. Therapists who offer compassion, validation for negative emotional experiences, and empathy for distress may be able to help clients uncover reasons for their vulnerability and address problematic behaviors, which may lead to change. People with covert narcissism may do better in therapy than those with malignant narcissism, which is often characterized by manipulative and sadistic behavior.

It’s generally accepted in the mental health field that people who want to change can improve if they seek support and are willing to make an effort. If you’d like to seek support for yourself or a loved one, begin looking for a compassionate counselor at GoodTherapy today.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition.Arlington, VA: American Psychiatric Association.
2. Behary, W. T., & Dieckmann, E. (2011, July 20). Schema therapy for narcissism: The art of empathic confrontation, limit-setting, and leverage. In W. K. Campbell and J. D. Miller (Eds.), The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments. Hoboken, NJ: John Wiley & Sons.
3. Caligor, E., Levy, K. N., & Yeomans, F. E. (2015, April 30). Narcissistic personality disorder: Diagnostic and clinical challenges. American Journal of Psychiatry, 172(5), 415-422. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14060723?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
4. Dickinson, K. A., & Pincus, A. L. (2003). Interpersonal analysis of grandiose and vulnerable narcissism. Journal of Personality Diosrders, 17(3), 188-207. Retrieved from https://pdfs.semanticscholar.org/8db5/d181e5ec85fd61de162d3c43e70611eaf4a4.pdf
5. Jauk, E., Weigle, E., Lehmann, K., Benedek, M., & Neubauer A. C. (2017, September 13). The relationship between grandiose and vulnerable (hypersensitive) narcissism. Frontiers in Psychology, 8. doi: 10.3389/fpsyg.2017.01600
6. Luchner, A. F., Mirsalimi, H., Moser, C. J., & Jones, R. A. (2008). Maintaining boundaries in psychotherapy: Covert narcissistic personality characteristics and psychotherapists. Psychotherapy, 45(1), 1-14. doi: 10.1037/0033-3204.45.1.1
7. Mayo Clinic Staff. (2017, November 18). Narcissistic personality disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662
8. Poless, P. G., Torstveit, L., Lugo, R. G., Andreassen, M., & Sutterlin, S. (2018, March 12). Guilt and proneness to shame: Unethical behaviour in vulnerable and grandiose narcissism. European Journal of Psychology, 14(1), 28-43. doi: 10.5964/ejop.v14i1.1355
   

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