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John Whitbeck:

The Mind Itself is a podcast about mental health, mental health law, and how they affect all aspects of our daily lives. By taking a deeper dive into how our society deals with mental health medically, legally, and practically, listeners gain insight and information about one of America’s most pressing and often overlooked issues that affects almost half of all adults in the United States.

John Whitbeck:

Hello there, and welcome to the first episode of Season 2 of The Mind Itself Podcast. My name is John Whitbeck, your host. I’m very excited to be back after a short hiatus, talking the most important healthcare issue of our time, in my opinion, mental health, and trying to further our mission of destroying the stigma surrounding this important issue. Joining me today is my good friend, Dr. Michael Oberschneider, a licensed clinical psychologist, who is both in the treatment world, as well as in forensics. And he’s going to help us break down today what is a really important topic, and that is personality disorder, specifically narcissistic personality disorder and borderline personality disorder. Mike, thank you so much for being here.

Dr. Michael Oberschneider:

John, thanks for having me. Pleasure.

John Whitbeck:

So today’s episode, we’ve titled My Husband’s a Narcissist and My Wife’s a Borderline. Thanks to you, Mike. I think was your idea, which is a great way to talk about this from the perspective of two issues that I absolutely run into all the time. There is an incredible amount of interest in the issue, personality disorders in my domestic relations practice. There are countless articles written, and podcasts and discussions about these topics. And I really wanted to do this for a long time, because I can’t tell you how many times a year women come into my office … And men for that matter. It’s not just men that are narcissists. They come into my office and say, “My husband’s a narcissist.”

John Whitbeck:

And I can’t tell you how many times men come into my office and say, “My wife has a borderline personality disorder.” I looked it up online, I did my research, and boy, it’s unbelievable how many of the symptoms that they meet for borderline personality disorder and narcissistic personality disorder. And half the time I have to say, look, let’s really unpack that, because these are real mental health issues. They’re not just things you say when you’re going through a bad divorce or a bad domestic relations case.

John Whitbeck:

So Mike, why don’t we start with narcissistic personality disorder? Could you just give a brief history of it and define for us what it is and what people are looking at when they’re talking about thinking that one of their spouses or someone they know is a narcissist who suffers from NPD?

Dr. Michael Oberschneider:

Sure. So when we’re talking about personality disorders, we’re talking about serious mental illness. There are actually 10 personality disorders out there that we diagnose in the mental health field, and that we see in the world. And the three most popular happen to be part of today’s discussion, BPD, borderline personality disorder, NPD, narcissistic personality disorder, and obsessive-compulsive personality disorder, OCPD. Those are the three top personality disorders in terms of prevalence, in terms of frequency of diagnosis for treatment, and even during divorce. Those are the three top ones.

Dr. Michael Oberschneider:

So when we think about NPD … And there are lots of illustrations of NPD in the literature, in film, in Netflix movies. To put it simply, it comes down to an individual having an inflated sense of self-importance, self-worth, a lack of empathy for others, and a deep and excessive need for admiration and attention. So again, we could think of all sorts of people, characters from movies that fit that description in real life. And I think what’s really important when we talk about NPD or any of the 10 personality disorders is that you’re right, your clients come into your office and they come into my office and they say, my husband has this, my wife has this. And we’re not sure, you’re not sure, I’m not sure if they do have it.

Dr. Michael Oberschneider:

It really is, again, a serious mental illness. It’s one of the most serious forms of mental illness out there. And mental illness, just to elaborate a little bit on that, it really has to do … There are two types. There’s symptoms. Someone has depression, they have symptoms, or anxiety, they have symptoms. And in anxiety disorder, they have symptoms consistent with that disorder, but the personality disorders are unique. It really doesn’t have to do with symptoms. It has to do with the fabric of who someone is. How they think, how they feel, how they behave.

Dr. Michael Oberschneider:

So when folks come into your office and my office, and they say my husband has this, my wife has that, it’s possible. And maybe even likely that they do have, or do meet criteria for the formal disorder, but even if they don’t, what that person is complaining about and beaten down by is being married to someone with a very complex personality style. That person may have the disorder, or they may haves features consistent with NPD or BPD. And bad enough that they’ve found you and they’ve found me, right?

John Whitbeck:

Right.

Dr. Michael Oberschneider:

So whether they have the full disorder or not, doesn’t matter to me as much, and it shouldn’t matter, I don’t think to you as much. These individuals who find us are clearly beaten down. There’s a process of attrition that has happened for them in their marriage and in their families where they’re worn down by the person’s complex personality style or maybe disorder.

John Whitbeck:

So some of the things that I have started looking for when someone comes in and says, my husband or my wife is a narcissist, and I, now being familiar with the science behind it. And it really is a science being that it is a real thing. It’s a real disorder. And the types of things that I look for, I’ve developed a series of questions, and a lot of it’s based on what the criteria that’s been developed over the years. And it really goes back to DSM-4, because I think in DSM-5, which is the Bible of psychology, they’ve really ranked all these personality disorders together into one discussion. Is that right?

Dr. Michael Oberschneider:

Yeah. In the literature, things are moving more toward a spectrum in a way from the descriptive labels that we used to have. Even something like autism is now viewed more on a spectrum. But yes, personalities are being … The way we see it, the researchers, the clinicians out there, there is this shifting in that direction, sure.

John Whitbeck:

So here are the nine criteria that I have looked at and that I’ve identified as part of the literature. And for those of you listening along, you can tick off each of the nine, whether someone you know has five or more of these, which I understand would be the benchmark for suffering from NPD. Is that right, Mike? In other words, five or more-

Dr. Michael Oberschneider:

That’s right. That’s right. And that’s going back to the idea of the formal diagnosis. So to meet full criteria, you have to have enough for the criteria altogether to get you there.

John Whitbeck:

So, number one, a grandiose sense of self-importance. That’s like exaggerating achievements and talents and expect to be recognized as superior without having achievements that you so consider yourself having achieved. Two, preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. Number three, believing that he or she is special and unique and can only be understood by or associated with high status people or other special people. Number four, requires excessive admiration. Number five, has a sense of entitlement. Number six, is interpersonally exploitative, meaning taking advantage of others to their own ends.

John Whitbeck:

Number seven, lacking empathy. Number eight, often envious of others and believes that others are envious of him or her. And number nine, shows arrogant, haughty behaviors or attitudes. If I’m someone who suspects that my spouse, significant other, or someone that I know is meeting the criteria for narcissistic personality disorder, is there any of those nine criteria that I just listed off that are more looked at than others, or is it an equal sharing of importance in terms of determining the criteria?

Dr. Michael Oberschneider:

I think they’re all relevant, that’s why they’re all listed. And those criteria are listed off of the research. So a lot of research goes into what the DSM-5 or the ICD-10 is reporting. We’re not guessing at this. These are the characteristics and traits consistently across tens of thousands of people assessed and evaluated. Then we lump into these categories, or we give these diagnoses to. Again, the top three, for me … Those are all relevant and those are all needed. What I’ve done is I’ve taken all that and I’ve lumped it into the top three for me, which is the self-importance, really. When I’m listening for NPD, I’m really listening closely to hear does this dad, or does this mom cross the threshold?

Dr. Michael Oberschneider:

Do they have such an inflated and exaggerated sense of self-importance? Do they consistently and pervasively lack empathy for others? And do they constantly need this excessive admiration and attention? For all 10 personality stories, the key is pervasive. Again, it goes back to fabric. These aren’t symptoms or moments like you’re at Disney World with your kids and you get upset and you appear narcissistic and reactive. Or you’re in a meeting and your coworkers see you in a meeting as being obsessively needing admiration. These aren’t moments. This is consistently who the person is all the time, again, whether they’re at home, they’re in Disney World, or at the office.

Dr. Michael Oberschneider:

And that is something that all 10 of the personality disorders have in common is the pervasive, distorted ways of thinking, feeling and behaving are there for the person. And then, of course, the wife, or husband, or kids, coworkers, friends, family members on the other side who are the receiving end of it are very negatively impacted by it, right?

John Whitbeck:

Right. Let me do a real-world application to this criteria. And I think you can do the same as you see … I’ll do it in the sense of what I see in cases that I do. And you can do it in the same treatment that you do. And I’m just going to think … Think of it this way, for those of you listening. Let’s pretend for a second that we’re trying to apply this to a divorce or a family law case, which is probably where I see this the most. Most of my mental health cases, I’m not trying to get someone committed or get them help for narcissistic personality disorder. It’s usually schizophrenia, bipolar, schizoaffective disorder, things like that. It’s really the domestic relations part of my practice this comes into being.

John Whitbeck:

So for example, a grandiose sense of self-importance. The way I see that manifests itself in divorces, if you have a spouse that just wants to control everything. They know better, they’re smarter than everybody, they should be recognized as being superior. So control, control, control. And when you take that control away from them in the domestic case or the divorce case, they react in an extreme way. And I see that a lot. One spouse is used to controlling the other, and when they separate, or the attorney gets involved and the attorney’s aggressive enough to stop, or at least halt a large part of that control, you really see the other side lash out and react if you know what I’m saying.

Dr. Michael Oberschneider:

Right. That’s absolutely right. And this is what the DSM-5 and the ICD-10 will not talk about, because those are descriptive mythologies. That’s a descriptive framework we use to check things off to make sure the person meets enough criteria or meets the threshold for enough to cross over that line toward a formal diagnosis, whether it’s depression, a personality disorder, schizophrenia, substance abuse. We descriptively diagnose off of criteria. But what you just suggested there, what you’re talking about there is so, so important. It’s what’s behind the criteria, and what drives someone, for example, with disorder, NPD, for example.

Dr. Michael Oberschneider:

And I would say this is consistent for all 10 personality disorders. The need to control. The need to control. Because really a personality disorder, again goes back to fabric, the fabric of who you are. And we know that personalities orders are caused by genetics, they’re caused by abuse, they’re caused by poor upbringing. All sorts of different factors contribute to why personality disorders happen or what will happen for the person to get there. And we know that when you have that significant mental illness, you’re compensating for a lot. And you don’t have an internal strong self. You don’t have the internal resources to manage your thoughts, feelings, and behaviors in an intimate relationship, or while raising kids, or being in a marriage, or even as an employee.

Dr. Michael Oberschneider:

You don’t have the resources to manage yourself, and you react strongly when you don’t have control. Because really what’s behind control is the perception of threat. When a spouse feels threatened or their control is threatened, that’s when you’re really going to see really the worst behavior, the worst reactions from somebody with a personality disorder. And because really they have a poorly integrated self in the world, they’re going through life as they can and control is the big part of how they roll and how they function. And so when they’re challenged, and because they don’t have those internal resources, one of the go-tos for them is to react or to try to in a way get the control back.

Dr. Michael Oberschneider:

I’ll give you a real time example for my practice from this week. I have a child patient that I treat and he’s in the middle of this storm that we’re about where the divorce has happened and now the parents are co-parenting or trying to co-parent, but the father does have NPD. And actually, he was formally diagnosed with NPD during a custody evaluation. So let me give you an example of how when a person like that isn’t in control, what can happen. So this father, because it’s his style, is dropping off the son late all the time. He’s supposed to drop off at a certain time, and he’s sometimes two or three hours late. And again he lacks empathy or the care for where his kids are, where they need to be, where his wife is, his ex-wife, that is. And so he shows up when he wants to show up.

Dr. Michael Oberschneider:

And this, of course, puts a strain on all of his relationships with his kids and his wife in that moment. And the ex-wife, and I don’t think she did anything wrong here, but she’s in a complex relationship with her ex-spouse. And she said, “Hey, listen, we have to be downtown in DC, meeting up with a group of friends with the kids and we’re running late now.” And that’s all she said. But his perception of that, because of his condition, this father’s perception was so different. And he felt challenged, and he felt threatened by her. And he felt that she was challenging his control of the moment, and he became very upset with her. He raged at her, which is common with folks with narcissistic personality disorder. They call it narcissistic rage, actually.

Dr. Michael Oberschneider:

And he raged and he tried in his own way to get control back to rationalize and justify why he was late. It’s a real time moment within my practice this week where this mom really didn’t do anything, or this ex-spouse didn’t do anything wrong. She just confronted him on his need to have things his way, which didn’t really work for her, for the kids or for the family. But from his narcissistic point of view, that challenge was too much for him. That confrontation … Really it’s more of a clarification, but he perceived it as a threat to his control, and then of course, the reactivity and the anger and the rage followed.

John Whitbeck:

That’s exactly the thing that I see when you have an NPD spouse and they lose control. Another one, I think that’s really common in domestic relations and divorce cases that I see, one of the criteria is the sense of entitlement with unreasonable expectations. Statistically, across the United States, over 90% of divorces settle. And it’s in mediation and other things help push that amount up. So that’s an old statistic, but I’d say it’s well over the vast majority of cases that actually end up settling and very small number go to trial.

John Whitbeck:

But if you have somebody with NPD traits or actually suffers from NPD and they have unreasonable expectations, the chances of you settling with them are going to get so much harder, because they think that they should be getting things in court from a judge that they have either no chance of getting, or that they’re at very little chance of getting. And they’re just not going to negotiate from a standpoint of good faith or health, even. So I see that all the time where attorneys are giving decent legal advice and they’re hearing the right thing and everybody else, but this one narcissist knows that this is what’s going to happen if it goes to court and they just won’t listen. And they drive up everybody’s costs and they end up taking the case to court and getting hit pretty hard because of their mental condition. And that’s another area I see a lot of NPD, its impact.

Dr. Michael Oberschneider:

And that goes back to the process of attrition, whether you’re a husband or a wife and you’re married. But doesn’t matter. If you’re married to someone with a personality order or you’re the child of someone with a personality order, there’s a process of attrition. You get so worn out by that person emotionally, and during divorce, yes, financially. That person, because of their perceived threat or their perceived loss of control is going to do whatever he or she can to get that control back. Even if it’s very distorted, illogical. And it really is all about emotion.

Dr. Michael Oberschneider:

And so what I often tell my clients who come in or my patients or the parents I see is I say, look, if you’re divorcing someone with NPD, or even just the traits, if the traits are bad enough, and you’re divorcing that person, you have to look at the divorce and then the co-parenting that’s going to follow. You got to look at your problem within that context. The person you’re divorcing isn’t going to change. Again, that’s just the fabric. Probably during the co-parenting, right? And a lot of parents-

John Whitbeck:

Or they’ve already changed and that’s why you’re getting divorced.

Dr. Michael Oberschneider:

Exactly. And a lot of parents, they keep saying … And what did Einstein say the definition of insanity is? Expecting the same thing over and over again, with a different outcome. A lot of parents will say to me, and I get it, and I empathize with these parents. He did this again, or he did that again, or he did this again. So I think you have to accept that that’s the person you married, that’s the person you divorced. And that’s the person you’re going to have to co-parent with for many years.

Dr. Michael Oberschneider:

But just back to the example of the father and mother and child I’m working with from this week, back to that example briefly, so what’s the solution there? The mother could call a lawyer like you, John, and say, “Hey, can you believe this, my ex-husband did this again, John. And we have to send a letter to him or his attorney. We have to file motions. He’s been late seven times.” That’s an approach, sure. But if we know that the individual with NPD is probably not going to change much, may not, or this one moment regarding pickups or drop off, maybe it gets a little better with the attorney proactively attacking it. Maybe. Or probably just moves to somewhere else, some other territory of control.

Dr. Michael Oberschneider:

So I think the better approach for that parent, for that mother in this case, is to say, well, if you know he is always to be an hour or two late, then you need to compromise in there. You need to figure out … Maybe don’t schedule something. If the drop-off is noon and you got to be in DC at 1:00, but you know he’s consistently an hour or two late, don’t upset yourself, your child, him even. Don’t schedule something at 1:00 in DC. Then cushion yourself if you know he’s going to be late. And that doesn’t mean you can’t assert yourself still and say, “Hey, listen, I really need you to be on time.” But don’t put those additional demands or pressures on yourself or your children or your ex-spouse, who for whatever reason can’t seem to drop off.

Dr. Michael Oberschneider:

And so the new approach with this family, and it seems to already be working is, hey, this is his style. It may be part of his disorder. I can continue to get upset, I can continue to call my attorney. I can continue to file motions, or I can just work with the landscape. I can work with who’s across from me. And I need to compromise probably a lot in those moments. And that’s a key for this discussion is that the non-personality disorder parent does carry the heavy load. Does carry the load to understand, accept, and let go and compromise much more than the parent who can’t.

John Whitbeck:

I think the other thing I’d add to that is when you do have unreasonable expectations, and you talked a little bit about change, I have noticed in these cases that pretty much everyone in a marriage changes over time. And they either change into someone you still love and you still want to be with, or they change into somebody you don’t love anymore or that doesn’t love you anymore. And that’s part of the reason you get divorced. And if you have a personality disorder like NPD, or you have a grandiose sense of self-importance, and you’re preoccupied with fantasies of unlimited success, those changes are going to be changes that you just don’t love anymore.

John Whitbeck:

And it really comes down to the same thing. If you get someone help in time, you can salvage relationships, you can salvage a marriage, you can salvage their life. But when things go untreated for so long, the consequences are disastrous, including a loss of marriage.

Dr. Michael Oberschneider:

That’s right. And a lot of parents understandably have a hard time hearing that and then making adjustments as needed to. Because understandably, the non-personality disorder spouse has been wronged in so many ways, probably for so many years. So it’s difficult, when I say to this mom, for example, “Hey, dig deep and try to compromise.” Well, she’s been probably doing that for a long time. And I always say, eye on the price though. Eye on the price, because if dad’s less upset at drop off and you’re less upset at drop off, guess who else is less upset? Your kid. Guess who aren’t in the middle? As much as we can, we don’t want them to be in the middle.

Dr. Michael Oberschneider:

So we know with NPD, dads and moms with NPD can be very reactive, very harsh, very angry with their children when they get triggered by their ex-spouse. So when it’s difficult, and as difficult as it must be for a non-personality parent to hear, these sorts of requests or these sorts of creative ideas around compromising around working with the person across from you, even if it’s very difficult, the price is your kid’s wellbeing. The price is really over time them understanding things. And they will. Kids don’t stay kids forever, right?

John Whitbeck:

Right.

Dr. Michael Oberschneider:

Childhood turns into adolescence, adolescence turns into adulthood. And eventually, your kids are going to see what’s what. And as much as we can during the storm of divorce and tough co-parenting that follows with someone with NPD, as much as we can, we want to protect our kids. And those creative compromising approaches are so important. And you know what, I’ll add that they work. I’ve been doing this for about 20 years and I’ll tell you … And I’m not saying that a parent should just take poor treatment, because if the treatment is bad enough, maybe they do need to call you and maybe we do need to go back to court. But if they can work withy a person across from them, who is compensating because of a disorder, who is fragile, who is reactive, that person, not all the time, but can grow, can maybe not completely change, but can soften.

Dr. Michael Oberschneider:

And we know from the research that individuals with personality disorders do soften over time as they get older. So I have seen that happen time and time again, where when the parent who can, who doesn’t have a disorder works extra hard not to trigger, not to challenge, not to confront, the other parent … Hopefully that parent is doing some therapeutic work too, parent who has the more complex personality style does start to soften. Can come around when they don’t feel so threatened, when they don’t feel the need to be in such control. So paradoxically, the compromising creative approach can bring about success too.

John Whitbeck:

Right. The last thing I’ll point out how this impacts your divorce, your domestic case. One of the things that I hear all the time is one of the criteria for NPD being lacks empathy. When you lose empathy for your spouse or even your children, God forbid, dealing with that person in a case becomes more about an enemy versus enemy than just a dispute between two divorcing spouses. And it becomes very serious. And it’s really, really serious in the sense that if you have no empathy for someone you used to love, or who at least you have children with, or at least used to like very much, there’s a lot of marriages that unfortunately didn’t start on the right foot, you’re really going to be more inclined to spend the money to fight, get your lawyer and go to war. And that’s certainly something that I see a lot of people just fighting for the sake of fighting in their divorce and using their lawyer as a surrogate for their own anger and their own lack of empathy.

Dr. Michael Oberschneider:

Right. And back to process of attrition, because by the time that mom or that dad finds you or me, oftentimes it’s not that it’s too late, it’s too late for the marriage, for sure. But that person has been through so much and they need so much support, and care, and attention just to heal. And that’s why I often tell my clients and you probably tell your clients the same, self-care is so important when being married, when divorcing, and afterwards when co-parenting with a parent with serious mental illness of any kind, not just personality disorders, of any kind. That self-care is so important, because you’re not going to be with your children all the time.

Dr. Michael Oberschneider:

That dad or that mom is going to be with your children at times. And that’s anxiety producing, that’s upsetting. That can be very triggering for the non-personality disorder parent. So that self-care is so important, and therapeutic care. Getting the attention you need and the help you need from a therapist, an attorney, psychiatrist if needed, if medications are needed. That’s very important, that self-care portion of it too.

John Whitbeck:

Is there treatment for narcissistic personality disorder?

Dr. Michael Oberschneider:

There isn’t a formal treatment and a formal solution to it, like there is for some of the other conditions. So for example, borderline personality disorder, there is a treatment for that, dialectical behavioral therapy, but there isn’t really a formal treatment for narcissistic personality disorder. But you can apply those same techniques and those same strategies. But again, in my experience … This isn’t, again, going back to DSM-5 or the ICD-10, which again are more descriptive tools that we use to diagnose. You meet criteria, you get a diagnosis, but it doesn’t really describe how it happened or what’s behind the diagnosis.

Dr. Michael Oberschneider:

In my experience when you, if you can … And it’s difficult. And the person with the personality disorder needs to be ready enough to receive help. When that person comes in and works on him or herself, and when the non-personality disorder parent and that parent are doing well enough so that the personality disorder parent isn’t getting triggered, isn’t looking for a fight, isn’t protecting his or her territory, isn’t distorting things as much via his or her thoughts or feelings, that person can get better. That person does get better with effort. And it does take a long time though, because again, we’re talking about fabric, the fabric to who someone is.

Dr. Michael Oberschneider:

Personality disorders usually … Well, they don’t. They don’t show up suddenly in adulthood. They develop over time from childhood forward. And so to fix the idea that the person will get better, that can happen with a lot of time, soft rolling things through compromise, through creative approaches, family work, if the person is going to do that. But it does take a lot of time. Compared to the other mental health disorders, like let’s say OCD. Let’s say somebody doesn’t want to get on an elevator. Well, that can be very painful, but the elevator’s there, the person’s there, the therapist is there with exposure work and with strategies, that symptom-based problem will correct.

Dr. Michael Oberschneider:

To really rework someone’s fabric takes a lot of time and a lot of effort, but I have seen individuals with NPD, BPD, OCPD get better. It’s just it takes several years to really accomplish that. And you know what else helps? It’s time. Time helps. I should mention that, because that’s important. The NPD patient will tell you, the reason I’m reacting this way is because of her, is because of him. But as the child grows out of … And maybe there is some justification at times for the feelings. Maybe not the intense reaction or the behavior, but the feelings are valid for that person, even if they’re distorted.

Dr. Michael Oberschneider:

But as that child grows out of childhood and grows into adolescence and adulthood, and as those parents don’t need to co-parent as actively, that also gives the mom or dad with the personality disorder more space, less internal pressure to work with. There’s less of a need to react. And maybe we should talk a little bit about that, how do we structure, because we can’t wait for adulthood. Somebody comes into your office, in my office and the kid’s 11 and the dad or mom has NPD, we can’t wait for adulthood to happen. We have to do certain things. So one of the things, and maybe we should talk about this, that I introduce right away is the idea of structure. And beyond acceptance, beyond managing expectations, there’s structure.

Dr. Michael Oberschneider:

Let’s say we get through this storm of divorce, what kind of co-parenting relationship can you realistically have with this dad or with this mom? And maybe it’s more of the parallel one. Not an active one with lots of texts and phone calls and get-togethers, which is more fluid. Some people can do that, but folks with personality disorders have a harder time with that fluidity, and so do the ex-spouses, and the kids. The idea of structure is so important here for this discussion. How do we communicate? Do we use is a parenting app, where everything is written down? How do we co-parent? Is it more in a parallel way, where we really don’t communicate much beyond that parenting app? And that usually is what works best is a more structured, parallel co-parenting plan.

John Whitbeck:

Right. And sometimes you just have to hire an aggressive attorney who knows this stuff to just let a judge decide, because sometimes there’s just no reasoning with them. And you often will have to come in and testify as these things that educate said judges on these things. And there’s just some cases that have to go forward because you’re just dealing with someone with such a serious personality disorder that you’re just not going to reason with them. Well, that’s a good segue, Mike into borderline personality disorder, which is another pervasive disorder that I hear a lot of people come in and talk about their spouse and assign, this is the reason for certain behaviors.

John Whitbeck:

Here’s the criteria that I … When someone comes and talks to me about borderline personality disorder, I ask them, is this what you see in them? Emotional instability, meaning really, really extreme reaction to things that happen in their life. Problems with self image or sense of self, lots of different discussion about how terrible I am and how horrible I am. Impulsive behaviors is probably the biggest one that I see, promiscuity, overspending to a level that’s chronic, reckless driving, drinking a lot. That’s the one I see the most when people are accusing their spouses of borderline personality disorder. Intense anger, temper, physical fights, things that happen, and unfortunate domestic violence situations, because a lot of times I see just really unstable and intense interpersonal relationships.

John Whitbeck:

Just really everybody around them is a threat or a reason for their bad luck in life and leading to such things as suicidal behavior, even suicidal thoughts. And just relating of stress, just exacerbating it. So when people come in and they say, “Borderline personality disorder. I researched it,” those are the big ones I look at as the criteria. Well, let’s take this to the next level. Let’s not just say that this is just you being petty about your spouse you no longer get along with. There’s some real stuff here. We really ought to have a mental health evaluation or something to it. Would you say that’s accurate, what you look for when trying to diagnose this?

Dr. Michael Oberschneider:

Oh yeah. Those are the criteria. You hit a spot on. Well, I would say unlike some of the other personality disorders like schizoid personality disorder, or more the anxious ones, or even OCPD, what BPD and NPD have in common is often those people are really initially attracted to us. And the person with BPD usually does have a very big personality, and style. They’re often described as being dramatic and intense, but they’re not stable. Dramatic and intense may be fun for five minutes, but you need to be stable in a relationship and as a parent in a marriage for it to work. I think it’s important to point out why those symptoms for both NPD and BPD can be so off putting. I get and I understand why a lot of people marry folks with personality disorders. They can look very attractive. One of my favorite examples, just back to NPD for a moment, is Gordon Gekko from Wall Street, the movie Wall Street from many years ago, with Michael Douglas and Charlie Sheen. As the movie-

John Whitbeck:

Greed is good.

Dr. Michael Oberschneider:

Greed is good, right? Gordon Gekko. So the movie unfolds and you get to watch this guy, you like him less and less, but initially, Charlie Sheen was attracted to him as he wanted a piece of the pie, he wanted what he had, that power or that wealth, that style and class. But really what was behind that really was not good, was a guy with NPD who eventually self constructed. And that’s what happens with most people with NPD or BPD is they can’t keep it together. They can’t sustain a marriage. That’s why they jump around from job to job, to job. They can’t sustain a position because of those internal compromises. But that’s the list for BPD and it’s a double edged sword to be married to someone like that. Initially, it’s attractive. It can be, but over time it becomes very painful.

John Whitbeck:

You mentioned previously that there actually was treatment for BPD. Can you expand on that a little bit?

Dr. Michael Oberschneider:

Right. And I would argue that you can use that treatment for the other personalities as well. It was really a treatment developed by Marshall Linehan. She was really a frontiers woman for this work and a leader in our field when it comes to personality disorders. And she created a treatment that really … Because again, personality disorders really have to do with a person’s fabric. The fabric is who they are. How they think, feel, and then how they behave after that. And so what dialectical behavioral therapy does is that challenges those cognitive distortions and those distorted feelings. And it helps the individual to slowly over time reframe how they experience themselves internally and in relation to others.

Dr. Michael Oberschneider:

Again, that’s a big commitment. It’s a big treatment. It takes time, but it’s very effective. It’s extremely effective. So if you have BPD or if you’re married to someone with BPD and you’re listening to this, there is treatment out there, effective treatment. The research studies have shown time and time again, DBT works a lot. Works very well for BPD. Not all at once. It does take time because the work is intensive. But there is a treatment for it, and I would argue that folks with NPD over time and with effort can get better as well.

John Whitbeck:

When you encounter young adults with either these personality disorders, and some of the traits you see them coming on. Because I think you had said that it develops over time. So it would be young adulthood when you really start to see this, I would think. Is that correct?

Dr. Michael Oberschneider:

That’s right. And technically, as mental health professionals, those in the field are not allowed to really diagnose the personality disorder before 18 years of age. That doesn’t mean there aren’t precursors to it like symptoms and behaviors and indicators that suggest that within a period of time, the person is going to meet criteria. But our field respectfully tries to give development enough time to correct whatever’s there, before going to that very big label. Because again, personality disorder is a serious form of mental illness. So once you have that disorder, if you truly have it, that’s a lifelong condition, unless you can be in that group that gets better.

Dr. Michael Oberschneider:

And let me just add this if I can, John. A person with NPD or BPD or any personality disorder is not a bad person. There’s a backstory to why they have that. We believe in part it’s genetic. We believe in part it’s upbringing. Abuse, trauma, different factors can contribute. So these kids growing up who become complicated later or where their personalities become complicated later, they didn’t sign up for that. So these people aren’t bad people, it’s the behaviors, it’s the way they function that’s bad.

Dr. Michael Oberschneider:

And I try to share that idea as much as I can with the non-personality disordered parents who come in here to try to get them to, worn out as they might be as parents or as ex-spouses, to just appreciate, to have some empathy, and to try to work creatively in the service of what’s best for their kids anyway, calm co-parenting. But it really is. What’s bad is the condition, but not the person. I actually have great empathy for people who are going through this. I don’t think anybody signs up for a personality disorder, right?

John Whitbeck:

No question. Absolutely. Mental health is mental health, and someone who is violent because they happen to suffer from schizophrenia or acts inappropriately because they happen to suffer from some of other disorder of any kind still needs help.

Dr. Michael Oberschneider:

Right. Right.

John Whitbeck:

And that’s why I wanted to do this episode, because I hear so much of this, NPD and BPD. And really make sure that there’s an understanding this is a mental health issue, and not just something that makes someone a bad person. Now, let me just close with this, Mike. My advice to someone who is … Someone comes to me and says, “My husband’s a narcissist.” It really is going to depend for me from the legal perspective, more about what the goals of the client are to accomplish how many kids there are, what kind of custody they’re looking for, what the financial part of the divorce would be.

John Whitbeck:

And I’m going to advise them subject to the fact that one of the factors I’ve got to deal with in getting the client to their goals is their spouse has narcissistic personality disorder. Similarly, if someone comes in and says, “My wife’s the borderline,” and I’m going to advise them, I’m going to advise them subject to, well, this is how your divorce will proceed. This is what the law is. This is how I think it’s going to come out, subject to there’s this other factor out there that the other side has BPD, or at least passes the criteria for it. So that’s how I handle it.

John Whitbeck:

And someone’s going to get legal advice from me that’s going to be similar to any other case, but just subject to the existence of these mental health issues. If you could to someone who’s dealing with the spouse that has one of these personality disorders or a personality disorder, what’s the best advice you could give to them for getting through it and getting to a point where they can manage their life and get through the difficulty that it brings?

Dr. Michael Oberschneider:

Well, the number one recommendation is to get your kids the help and support they need, because the most important people here are the little ones, are the kids, that didn’t sign up for this either. They’re in the middle of the storm and they don’t quite get it or are in the receiving end of someone’s mental health illness. And so getting your kids in therapy as quickly as you can is my first recommendation.

Dr. Michael Oberschneider:

My second would be to get yourself and maybe even that difficult spouse or that spouse that may have a mental health condition into therapy too. And then get a great lawyer, really, because if you’re divorcing who’s that complex, it’s not going to be an amicable divorce. If it wasn’t an amicable marriage, how’s it going to be an amicable … You’re divorcing the same person you were married to and if it was as bad as it was, you’re probably going to need a lot of help, therapeutic and legal.

Dr. Michael Oberschneider:

And you and I, John have been in the courtroom many times together and I’m always is impressed with how well … And your background is in mental health law. You have background in different areas, and you’re able to read … That’s why I say a great lawyer, and I would put you in that category, man. You are able to read these moments and to advise parents for when can we work with the dynamic without exploding things. Do we need a full blown custody evaluation? Well, sometimes you do. When the parent with a mental health issue cannot stop him or herself from behaving poorly and from harming the kids emotionally or physically, you may need to do something like that.

Dr. Michael Oberschneider:

You’re very good. You’re excellent at reading the moment and then slowly advising the parent. And then if you have to pick up speed based on problems that occur, you then adjust. But those would be the recommendations. Get therapeutic help first and get a good legal advisor to advise along the way. And those therapists and that attorney is going to adjust as needed based on how the personality disorder parent behaves, right?

John Whitbeck:

Right. Thank you for those kind words. And yes, the fact that I do a lot of cases that involve mental health is very helpful to, especially my domestic relations and divorce practice. But one of the things I would add to that is you have to be as an attorney able to work with the professionals that actually get your evidence in, which is someone like you, which is why you and I work together so much because you’re so great at testifying. And you’re absolutely down the middle. You’ve been on the other side of cases with me saying bad things about my clients and been on the same side saying good things and signing blame above.

John Whitbeck:

And that’s what you need. You need a lawyer and a mental health professional that can really do the work that needs to be done, because judges have lots of power. They get to make decisions that affect you and your children’s lives, and maybe for the rest of their lives. And you got to have those professionals behind you and working with you that can do it. And speaking of which Mike, if somebody wanted to get a hold of you, talk to you about this or any other issue involving their family or for mental condition, can you give us your contact information?

Dr. Michael Oberschneider:

No, absolutely. Thank you, John. My office number is 703-723-2999. 703-723-2999. And I’m with Ashburn Psychological and Psychiatric Services.

John Whitbeck:

What’s the website?

Dr. Michael Oberschneider:

URL is www.ashburn, A-S-H-B-U-R-N, and then psych, P-S-Y-C-H .com.

John Whitbeck:

Dr. Michael Oberschneider, thank you so much for being here. Looking forward to having you back on again as soon as possible.

Dr. Michael Oberschneider:

John, thanks so much for having me, and congratulations on all your good work and growth.

John Whitbeck:

Thank you. The Mind Itself Podcast is unique in that we look at the intersection between mental health and the law and how it impacts you. Subscribe on iTunes, Spotify, Google Play or wherever you listen to podcasts. And be sure to leave a comment, rate and review, and share with someone you know. Thanks for listening.

 

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