As today’s practicing pharmacist knows, unique counseling may need occur with patients who are taking anti-depressant or anti-stress medications like Lexapro (escitalopram) or other similar medications. One such unique counseling that has grown in prevalence relates to helping a patient deal with a narcissist in his or her life. Do you know a narcissist? Do you know what a narcissist is? Do you know how a narcissist plays the control game?
Narcissism is a personality disorder (NPD) and can manifest itself in different styles depending upon whether the individual is male or female. 75% who possess NPD are males (American Psychotherapy Association). The prevalence of NPD has been reported in the literature as 6% of the forensic population, in 20% of the military population and in nearly 20% of first-year medical students and other healthcare practitioner settings (nurses, pharmacists, dentists, etc.). In the USA, the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) lists six different types of personality disorders, including NPD. Psychiatrists further define NPD in three general contexts: Exhibitionists, Closet and Toxic. Most men are evaluated to be of the Toxic type while women predominantly fall into the Exhibitionists with the remainder being Closet types.
Relationships with narcissists can be risky because the narcissist lacks the ability to be objective and rational, for example, when they are angry with a partner. They cannot see the situation in the context of the relationship and tend to display only anger or a desire to dismiss the partner because they are not in control of the situation. This can occur in either a romantic, family setting or professional relationship and is emotionally draining on the individual attempting to maintain the relationship.
Often these narcissistic individuals can behave in a more passive-aggressive way, particularly with a romantic partner, and routinely set up their partner up for constant frustration. For example, they may say they will do something (ie; write a letter, answer a question) but not do it and get an endorphin rush watching the other person’s reaction. As the narcissist grows older and suffers the inevitable changes in physical, mental and daily functioning, the NPD is magnified and becomes increasingly more severe.
From a different perspective, this pharmacist will share a real life example experienced in a pharmacy setting. Please contrast the comments and experiences provided in this real world example with the traits offered above in this article. It teaches the validity of knowing a narcissistic individual’s traits.
This example, presented below, is just one of many I have experienced as a pharmacist, and involved an older age, long-time customer, who was a widower. To maintain this professional healthcare gentleman’s anonymity, we will call him Larry. Three years ago Larry met an attractive Ukraine mature female nurse practitioner (today she is 48 years old-we will call her Natalie) through an international dating site. With continued internet and social media communication and continual letters of love declaration promising life-long satisfaction(with beautiful personal photos) from this woman, Larry became overwhelmed with the possibility of this woman becoming a life companion. Larry even received correspondence from Natalie that her parents now considered him their soon to be son-in law! Larry offered in our private conversation that this emotional “charge” caused him to nickname Natalie “Osobyy Natalie”. Osobyy is Ukraine or Russian for special. She was thrilled at this offering. In subsequent correspondence “Osobyy Natalie” gave Larry the name “Lucky Larry” including a picture key chain with “My Lucky Larry, I Love You! Your Special Natalie” during their first meeting in Kiev. Larry showed me the key chain as we talked. “Lucky Larry” flew to Kiev twice to be with “Osobyy Natalie” during a 6 month period and was challenged to provide considerable money for Natalie’s dental problems and then expensive gifts during both visits as demanded by Natalie to convince Larry that their relationship would continue. The gifts Larry provided to Natalie included, among other things, fashion clothing, expensive running shoes, a new laptop, expensive prescription designer eyeglasses and even a mink coat! As the discussion continued, Larry mentioned to me he first realized he was involved with a narcissist when Natalie, on her own, ordered a $1000 camera, and told Larry they had to pick it up during his second visit…after Larry had flown to Kiev to meet Natalie and checked them into an expensive resort outside Kiev. This occurred, of course, after Larry had indicated to Natalie via email, prior to this visit, that he thought this camera purchase was too expensive and not necessary. Larry revealed to me he thought he had been used or “suckered” to maintain the romantic interlude. After this meeting and shopping and resort evening experiences, Natalie continued her pattern of not responding timely to letters Larry sent. Off and on during the next few months, following appeals for financial help, which were always preceded by Natalie’s increasing expressions of love declaration, Larry made the decision to stop providing money to the scheming and manipulative Natalie. What was the result? Natalie was very angry when Larry told her they could not meet for a third time because of money issues…Surprise? Natalie responded with numerous comments that Larry must be planning on meeting with other women instead and should take plenty of condoms! Amazing!
Larry told this pharmacist that he had spent during the past three years as much as $16,000 to maintain this international relationship which was based on, in his words, “when love is a lie”. Not surprisingly, and most recently, after Natalie had recently received financial support for special shoes to help with her gout-ridden feet, Natalie told “Lucky Larry” to stop writing her because Larry would not pay for an expensive sanatorium stay to help her regain her youth. Of course, Natalie also told Larry: “You would pay for my two week sanatorium visit if you loved me”.
As Larry finished his comments, he told me he had read many books about narcissists and each book had a recurring theme: Any relationship with a narcissist can never work. In his own words Larry confided, “I always knew she would discard me. It was a sense I could never release because I loved her so much. Your pharmacist phrase that “If I only knew then what I know now” is the truth”.
As “Lucky Larry” finished his very personal sharing of this experience I could see he was finally relieved of the emotional roller coaster and torment he had experienced during the past three years. His devotion to this Ukraine woman had not been truthfully matched by her personal commitment to match Larry’s sincere desire for a life companion. As offered by Larry as we closed our conversation at the local Saint Petersburg Florida Starbucks: “This chapter of my Life’s Book is finally complete and I am free from the Natalie narcissist’s web that had lured and trapped me three years ago. I am Ridin’ On!!”
And yes, Larry no longer takes Lexapro.
Pharmacists have the responsibility as part of their patient engagement responsibility to educate patients with NPD about the signs and symptoms of the disorder and explain to them in a supportive way their behavior is a result of many different factors. It is important to present patients with relevant reading material and online videos so they can understand how any diagnosis applies to them.