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By F. Osko. Columbus State University. 2018.

The narcissist stimulates his self habitually in order to derive pleasure and gratification 120 mg viagra extra dosage. The narcissist prefers fantasy to reality order viagra extra dosage 200mg amex, grandiose self-conception to realistic appraisal buy discount viagra extra dosage 150mg on line, masturbation and sexual fantasies to mature adult sex and daydreaming to real life achievements buy discount viagra extra dosage 200 mg online. Carl Gustav Jung (1875-1961) pictured the psyche as a repository of archetypes (conscious representations of adaptive behaviors) buy discount viagra extra dosage 200 mg. Fantasies are a way of accessing these archetypes and releasing them. In Jungian psychology, regressions are compensatory processes intended to enhance adaptation, not methods of obtaining or securing a steady flow of gratification. Introversion is indispensable to narcissism, while extroversion is a necessary condition for orienting to a libidinal object. Freud regards introversion as an instrument in the service of a pathology. Jung, in contrast, regards introversion as a useful tool in the service of the endless psychic quest for adaptation strategies (narcissism being one such strategy). Nevertheless, even Jung acknowledged that the very need for a new adaptation strategy means that adaptation has failed. So although introversion per se is by definition not pathological, the use made of it can be pathological. Jung distinguished introverts (those who habitually concentrate on their selves rather than on outside objects) from extroverts (the opposite). Introversion is considered a normal and natural function in childhood, and remains normal and natural even if it dominates later mental life. To Jung, pathological narcissism is a matter of degree: it is exclusive and all-pervasive. Heinz Kohut said that pathological narcissism is not the result of excessive narcissism, libido or aggression. It is the result of defective, deformed or incomplete narcissistic (self) structures. Kohut postulated the existence of core constructs which he named: the Grandiose Exhibitionistic Self and the Idealised Parent Imago. Children entertain notions of greatness (primitive or naive grandiosity) mingled with magical thinking, feelings of omnipotence and omniscience and a belief in their immunity to the consequences of their actions. Without the appropriate responses, grandiosity, for instance, cannot be transformed into adult ambitions and ideals. To Kohut, grandiosity and idealisation are positive childhood development mechanisms. Even their reappearance in transference should not be considered a pathological narcissistic regression. Kohut says that narcissism (subject-love) and object-love coexist and interact throughout life. He agrees with Freud that neuroses are accretions of defence mechanisms, formations, symptoms, and unconscious conflicts. But he identified a whole new class of disorders: the self-disorders. These are the result of the perturbed development of narcissism. Self disorders are the results of childhood traumas of either not being "seen", or of being regarded as an "extension" of the parents, a mere instrument of gratification. Such children develop to become adults who are not sure that they do exist (lack a sense of self-continuity) or that they are worth anything (lack of stable sense of self-worth, or self-esteem). Horney said that personality was shaped mostly by environmental issues, social or cultural. Horney believed that people (children) needed to feel secure, to be loved, protected, emotionally nourished and so on. Horney argued that anxiety is a primary reaction to the very dependence of the child on adults for his survival. Children are uncertain (of love, protection, nourishment, nurturance), so they become anxious. Defenses such as narcissism are developed to compensate for the intolerable and gradual realisation that adults are merely human: capricious, unfair, unpredictable, non-dependable. Defences provide both satisfaction and a sense of security.

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The self is dependent upon the unconscious generic 120 mg viagra extra dosage free shipping, which exerts a constant influence on all mental functions generic 130 mg viagra extra dosage overnight delivery. Pathological narcissism order viagra extra dosage 150 mg with mastercard, therefore generic viagra extra dosage 200mg on-line, reflects a libidinal investment in a pathologically structured self and not in a normal purchase 200mg viagra extra dosage fast delivery, integrative structure of the self. The narcissist suffers because his self is devalued or fixated on aggression. All object relations of such a self are distorted: it detaches from real objects (because they hurt him often), dissociates, represses, or projects. Narcissism is not merely a fixation on an early developmental stage. It is not confined to the failure to develop intra-psychic structures. It is an active, libidinal investment in a deformed structure of the self. Franz Kohut regarded narcissism as the final product of the failing efforts of parents to cope with the needs of the child to idealise and to be grandiose (for instance, to be omnipotent). Idealisation is an important developmental path leading to narcissism. This exerts an enormous and all-important influence on the processes of re-internalisation (the processes in which the child re-introduces the objects and their images into his mind) in each of the successive phases. Through these processes, two permanent nuclei of the personality are constructed:The basic, neutralising texture of the psyche, andBoth of them are characterised by an invested instinctual narcissistic cathexis (invested energy of self-love which is instinctual). As he grows, he begins to notice their shortcomings and vices. He withdraws part of the idealising libido from the images of the parents, which is conducive to the natural development of the Superego. This is largely true until the "child" re-internalises the ideal parent image. Also, the very construction of the mental apparatus can be tampered with by traumatic deficiencies and by object losses right through the Oedipal period (and even in latency and in adolescence). The same effect can be attributed to traumatic disappointment by objects. Disturbances leading to the formation of NPD can be thus grouped into:Very early disturbances in the relationship with an ideal object. These lead to a structural weakness of the personality, which develops a deficient and/or dysfunctional stimuli-filtering mechanism. The ability of the individual to maintain a basic narcissistic homeostasis of the personality is damaged. Such a person suffers from diffusive narcissistic vulnerability. A disturbance occurring later in life - but still pre-Oedipally - affects the pre-Oedipal formation of the basic mechanisms for controlling, channelling, and neutralising drives and urges. The nature of the disturbance has to be a traumatic encounter with the ideal object (such as a major disappointment). The symptomatic manifestation of this structural defect is the propensity to re-sexualise drive derivatives and internal and external conflicts, either in the form of fantasies or in the form of deviant acts. A disturbance formed in the Oedipal or even in the early latent phases - inhibits the completion of the Superego idealisation. This is especially true of a disappointment related to an ideal object of the late pre-Oedipal and the Oedipal stages, where the partly idealised external parallel of the newly internalised object is traumatically destroyed. Such a person possesses a set of values and standards, but he is always on the lookout for ideal external figures from whom he aspires to derive the affirmation and the leadership that he cannot get from his insufficiently idealised Superego. Video and chat interviews with Sam Vaknin, self-proclaimed narcissist and expert in narcissism and narcissistic abuse. Extensive collection of videos on narcissism, Narcissistic Personality Disorder (NPD) and the narcissist. Sam Vaknin, author of Malignant Self Love: Narcissism Revisited provides comprehensive information on narcissism and the narcissist. Get insight into what makes the narcissist tick, the different types of narcissists, the Narcissistic Personality Disorder diagnosis, narcissism and coexisting psychiatric conditions.

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Benzodiazepines ??? these tranquilizers are often prescribed for short-term treatment of acute anxiety symptoms order viagra extra dosage 120mg overnight delivery. Long-term use is often a concern due to increasing tolerance and dependence on the drug generic 200 mg viagra extra dosage free shipping. Common benzodiazepines include alprazolam (Xanax) and lorazepam (Ativan) viagra extra dosage 130 mg lowest price. Anticonvulsants ??? this antiseizure medication buy generic viagra extra dosage 150mg line, like pregabalin (Lyrica) cheap viagra extra dosage 200 mg otc, may be given long-term for anxiety disorder treatment. Antipsychotics ??? antipsychotics are often used in conjunction when other medications alone are not sufficient. Examples include risperidone (Risperdal) and aripiprazole (Abilify). Antihypertensives ??? this medication can lower blood pressure and reduce the physical symptoms of an anxiety disorder. This may be particularly useful in post-traumatic stress disorder (PTSD). Antianxiety agents ??? one medication, buspirone (BuSpar) is considered, specifically, an antianxiety medication. Therapy treatments are not cures for anxiety disorders either, but they can be very useful in eliminating anxiety disorder symptoms and changing anxiety-related thought patterns. Several types of therapy are used including:Cognitive behavioral therapy (CBT) can be delivered in-person of even via a computer program (known as FearFighter). CBT is particularly useful in panic and phobia disorders. Behavioral therapy has also been shown useful in clinical studies in treating anxiety disorder. Psychodynamic (talk or insight) therapy is rarely used as a standalone therapy for anxiety disorders unless there are complicating factors such as a history of abuse. Lifestyle changes may not cure an anxiety disorder but they can go a long way to relieving some of the anxiety disorder symptoms. Lifestyle changes are best used in conjunction with other treatments to attain their full benefit. Lifestyle changes that help rid someone of anxiety disorder symptoms include:Dietary changes such as avoiding caffeineGetting more exercise and proper restLearning to meditate, practice mindfulness or do relaxation exercisesLearning skills with which to better handle stressA list of anxiety medications includes several types of medication including antidepressants, antipsychotics, beta blockers and benzodiazepines. The antianxiety medication list below includes all drugs approved by the FDA for the treatment of anxiety disorders as well as those commonly prescribed off-label. Only one drug is of the antianxiety medication class: Buspirone (BuSpar). This drug is approved for anxiety disorders (in general). Antidepressants are typically the first choice treatment for anxiety. A list of common, modern antidepressant anxiety medication that works on the brain chemicals serotonin and norepinephrine includes: Citalopram (Celexa) ???off label for panic disorder, social phobia and trichotillomaniaDuloxetine (Cymbalta) ??? approved for generalized anxiety disorder (GAD)Escitalopram (Lexapro) ??? approved for GADFluoxetine (Prozac) ??? approved for OCD and panic disorderFluvoxamine (Luvox) - approved for OCD in children (8-17 y) and adultsParoxetine (Paxil) ??? approved for obsessive-compulsive disorder (OCD), panic disorder, social phobia, GAL and posttraumatic stress disorder (PTSD)Sertraline (Zoloft) ??? approved for panic disorder, PTSD, social phobia and OCDTrazodone (Desyrel) ??? off label for panic disordersVenlafaxine (Effexor XR) - approved for GAD, panic disorder and social anxiety disorder in adultsAn older type of antidepressant called a tricyclic antidepressant is also sometimes used to treat depression. Tricyclics act on more chemicals in the brain and are more likely to cause side effects so they are not typically a first choice treatment. A list of tricyclic antidepressants used to treat anxiety includes: Clomipramine (Anafranil) ??? approved for OCDDesipramine (Norpramin) ??? off label for panic disorderDoxepin (Sinequan) ??? off label for GADImipramine (Tofranil)- off label for panic disorderList of Monoamine Oxidase Inhibitor Drugs for AnxietyAnother powerful, older class of antidepressants is also used to treat anxiety. These monoamine oxidase inhibitors (moai) are not first choice treatments but may be useful where other treatments have failed. A list of monoamine oxidase inhibitors used to treat anxiety includes: Isocarboxazid (Marplan) ??? off label for social phobiaPhenelzine (Nardil) ??? off label for panic disorders and social phobiaSelegiline (Emsam) ??? off label for social phobiaTranylcypromine (Parnate) ??? off label for social phobiaBenzodiazepines are commonly used to treat short-term anxiety or for acute anxiety episodes. They are not typically used long-term due to concerns about benzodiazepine tolerance, dependence and abuse. A list of benzodiazepines includes: Alprazolam (Xanax) ??? approved for GAD, panic disorder; used off-label for agoraphobia with social phobiaChlordiazepoxide (Librium) ??? approved for anxiety (in general)Clonazepam (Klonopin) ??? approved for panic disorder; used off label for anxiety (in general)Diazepam (Valium) ??? approved for anxiety (in general)Lorazepam (Ativan) ??? approved for anxiety disorders (in general)Oxazepam (Serax) ??? approved for anxiety (in general)While considered investigational, some anticonvulsants (antiseizure medication) are being used to treat anxiety. A list of anticonvulsants used to treat anxiety off label include: Divalproex (Depakote, Depakote ER)These drugs are known as antihypertensive medication because they lower blood pressure. Beta-blockers and others reduce the physical symptoms of anxiety.

Key items on these instruments that appear to differentiate children with autism from other groups before the age of 2 include pointing and pretend play generic viagra extra dosage 130 mg without prescription. Screening instruments do not provide individual diagnosis but serve to assess the need for referral for possible diagnosis of ASD buy discount viagra extra dosage 130mg online. These screening methods may not identify children with mild ASD discount viagra extra dosage 150mg mastercard, such as those with high-functioning autism or Asperger syndrome buy viagra extra dosage 120 mg online. During the last few years purchase viagra extra dosage 200mg visa, screening instruments have been devised to screen for Asperger syndrome and higher functioning autism. These tools concentrate on social and behavioral impairments in children without significant language delay. The second stage of diagnosis must be comprehensive in order to accurately rule in or rule out an ASD or other developmental problem. This evaluation may be done by a multidisciplinary team that includes a psychologist, a neurologist, a psychiatrist, a speech therapist, or other professionals who diagnose children with ASD. Because ASDs are complex disorders and may involve other neurological or genetic problems, a comprehensive evaluation should entail neurologic and genetic assessment, along with in-depth cognitive and language testing. In addition, measures developed specifically for diagnosing autism are often used. These include the Autism Diagnosis Interview-Revised (ADI-R)and the Autism Diagnostic Observation Schedule (ADOS-G). The ADI-R is a structured interview that contains over 100 items and is conducted with a caregiver. The ADOS-G is an observational measure used to "press" for socio-communicative behaviors that are often delayed, abnormal, or absent in children with ASD. Still another instrument often used by professionals is the Childhood Autism Rating Scale (CARS). It is suitable for use with children over 2 years of age. The examiner observes the child and also obtains relevant information from the parents. Two other tests that should be used to assess any child with a developmental delay are a formal audiologic hearing evaluation and a lead screening. Although some hearing loss can co-occur with ASD, some children with ASD may be incorrectly thought to have such a loss. In addition, if the child has suffered from an ear infection, transient hearing loss can occur. Lead screening is essential for children who remain for a long period of time in the oral-motor stage in which they put any and everything into their mouths. Children with an autistic disorder usually have elevated blood lead levels. The team will then meet with the parents to explain the results of the evaluation. Although parents may have been aware that something was not "quite right" with their child, when the diagnosis is given, it is a devastating blow. At such a time, it is hard to stay focused on asking questions. But while members of the evaluation team are together is the best opportunity the parents will have to ask questions and get recommendations on what further steps they should take for their child. Learning as much as possible at this meeting is very important, but it is helpful to leave this meeting with the name or names of professionals who can be contacted if the parents have further questions. When your child has been evaluated and diagnosed with an autism spectrum disorder, you may feel inadequate to help your child develop to the fullest extent of his or her ability. As you begin to look at treatment options and at the types of aid available for a child with a disability, you will find out that there is help for you. It is going to be difficult to learn and remember everything you need to know about the resources that will be most helpful. If you keep a notebook, you will have a foolproof method of recalling information. Learn everything you can about special programs for your child; the more you know, the more effectively you can advocate.

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