In recent years, there has been a great deal written about mothers and spouses or partners with narcissistic traits. What if sometimes those apparent “traits” were actually symptoms of another mental illness? How might that impact the identified patient as well as their loved ones? And how might commonalities of family distress experienced by loved ones of those with so-called more socially accepted major medical diseases shed light on the struggles of family members of people with more stigmatized mental illnesses?
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders,1 defines Narcissistic Personality Disorder, NPD, “as a pervasive pattern of grandiosity (in fantasy or behavior), a need for admiration, and a lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following 9 criteria:”
1. Has a grandiose sense of self-importance.
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3 Believes that they are ‘special’ and unique and can only be understood by, or should associate with,
other special or high-status people or institutions.
4. Requires excessive admiration.
5. Has a sense of entitlement.
6. Takes advantage of others to achieve their own needs.
7. Lacks empathy.
8. Is often envious of others or believes that others are envious of them.
9. Shows arrogant and haughty behaviors or attitudes.
People with Bi-polar and Alcohol Use Disorders can, at times, appear grandiose.1 Those struggling with Alcohol and other Substance Use Disorders may appear to lack empathy or even, on occasion, take advantage of others1.
Family members report periodic hostile comments from loved ones who may be suffering from Post Traumatic Stress, PTSD, and Bi-polar Disorders1 With untreated Post Traumatic Stress, Bi-polar and Alcohol Use Disorders interpersonal difficulties can become increasingly more frequent.
The on-going stigma of mental illnesses and other barriers to seeking experienced help can significantly delay the accurate diagnosing and appropriate treatment of these illness, as well as loved ones accessing supportive services.
Family distress frequently results from loving someone with a serious chronic disease
It’s emotionally painful when a loved one experiences any major health problem. Pain can turn to distress when the illness is chronic, has a greater effect upon behavior and may be more challenging to initially diagnose.
With prolonged distress, individual and/or family resources can be stretched to or beyond apparent limits. This can include emotional, physical and financial resources, social supports, and others. Feelings of excessive guilt, fatigue, and anger as well as having difficulty concentrating are common.2, 3
Earlier in my career, when I was Director of Family Services at Beech Hill Hospital, Dublin, NH, my staff and I were charged with screening adolescents for a new inpatient substance abuse treatment program. My increasing frustration in dealing with many of their parents made me realize I was ineffective in responding to the parents’ needs during the initial phone contact and in-person intake session.
I decided to arrange a site visit at the renowned Joslin Diabetes Center in Boston, Massachusetts to learn about their experiences with parents whose children and teens were hospitalized for assessment, stabilization and education about their illness. It was there that I first learned about family distress.
I was amazed about how many of the comments I heard from various staff, including a psychiatrist, a social worker and a nurse, which they attributed to parents of their diabetic patients, sounded word for word like comments I heard from parents and spouses of patients at our alcohol and drug treatment hospital.
When we began to approach each parent as an individual, without preconceived expectations, and focused on their own needs as well as the those of each patient, what we previously had labeled as resistance or pathology quickly dissipated.
They also were more able to respond to our attempts to help them decrease their distress and partner with us to better understand their loved one’s illness and how it was affecting each of them. This led me to a continued review of literature on distress experienced by parents and other family members affected by more than a dozen chronic illnesses or disabilities of loved ones.
In a more recent study, researchers4 interviewed 133 family members of patients with 137 medical and seven mental health conditions. The top four themes identified were: 92% of family members were emotionally affected by the patient’s illness, with 35% of those reporting worry, 27% reporting frustration, 15% reporting anger and 14% reporting guilt as the most common emotions.
Ninety one percent reported a negative effect on day -to-day living as a result of having an unwell relative. Sixty nine percent reported family relationships being affected with increased stress and tension and 67% cited sleep loss caused by worrying about their loved one.
“This study has identified the major ways in which family lives can be affected by disease and the commonality of issues across all diseases. This is the first study to identify the similar experiences of family members of patients across the whole of medicine …4” Understanding that distress is common with major illnesses can help shift the focus from the individual being the cause of your pain to the disease being the cause.
I often say to my clients who are concerned about a loved one that I don’t know how to make dealing with major mental health or medical illnesses easy and that they are not imagining things. This is difficult. But by focusing on what you can control, how you respond as well as continuing to seek experienced help and support, you can learn to reduce its impact on yourself.
I also tell them that we refer to mental illnesses as illnesses because they are illnesses, not because we are trying to be kind and supportive. When we treat mental illnesses as the illnesses they are, treatment outcomes significantly improve and distress experienced by family members decreases.
Many family members find self-help groups to be invaluable, not only in lessening the effects of coping with a loved one’s major mental health illness (National Association of Mental Illness, https://nami.org,) alcohol use disorder (Al-Anon Family Groups, https://al-anon.org) or drug use disorder (https://www.nar-anon.org) but also in learning practical examples of how to more effectively respond to their loved ones.
Participation in self-help groups is free, confidential, empowering and provides hope.
In addition to experiencing significant emotional pain and distress from interacting with a loved one with a major mental illness, there may be other factors contributing to your struggles. An experienced clinician can work with you to assess for a possible major depression, anxiety disorder, identify a history of trauma or other concerns that may or may not be related to your struggles with a loved one’s illness.
When is the last time you saw your primary care physician? Often, we can be so focused on what we think a loved is doing or not doing what we think they need to be doing to take care of themselves that we neglect our own self-care. Neglect of self-care can significantly add to distress.
Treating mental illnesses as we would any other illness, without blame or shame, can provide patients and their loved ones with earlier opportunities for appropriate treatment and support.
1. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition, DSM-5, Arlington, VA, 2013.
2. DeSantis PhD, Richard P., Manney, Gerald J., MS, Parental Distress: Moving form Reaction
to Response, Adolescence, July, 1993: 29-31.
3. Golics, Catherine Jane, Basra, Mohammad Khurshid Azam, Salek, Sam, Finlay, Andrew
Yule, The impact of disease on family members: a critical aspect of medical care, J R Soc Med.,
2013, Oct., 106 (10): 399-407.
4. Golics, Catherine Jane, Basra, Mohammad Khurshid Azam, Salek, M. Sam, Finlay, Andrew
Yule, The impact of patients’ chronic disease on family quality of life: an experience from 26
specialties, Int. J Gen Med., 2013; 6: 787–798.
Gerald J. “Jerry” Manney is a Licensed Alcohol and Drug Counselor and family therapist in private practice in Massachusetts. He presented on parental distress and chronic disease at three Joint Meetings on Adolescent Treatment Effectiveness (JMATE) national conferences in Washington, DC. He has taught undergraduate and graduate courses at colleges for 17 years. Follow Jerry at twitter.com/Jerry_Manney.