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Doctor Blake
Doctor Blake , Psychologist
Category: Mental Health
Satisfied Customers: 146
Experience:  Ph.D., Ed.S., NCSP Clinical Psychologist; 15+ years of experience; dual licensure
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I suspect my younger sister has a narcissistic personality

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I suspect my younger sister has a narcissistic personality disorder and severe OCD. This does not bother me as I can ignore her however she is getting increasing abusive towards my mother and appears to have a relationship with her husband which borders on co-dependent and abusive. Recently they where both incredibly abusive towards my mother and I could do with some advice to help her deal with my sister ( I am the oldest then I have middle sister and she is the youngest 11 years younger than me). My family before she was born travelled as my family is from a Forces background but any mention of this previous life before her (including living in the far east) will induce a horrendous hissy fit from her. Almost to the point now we are afraid to mention it in her presence or alluded to it in conversation. I can as I said ignore this but its upseting me to see my parents particuly my mother so abused. Thank you for any advice.
Submitted: 6 years ago.
Category: Mental Health
Expert:  Doctor Blake replied 6 years ago.

Good morning.


I'm afraid I'll need to ask some clarifying questions, just so we can provide a more targeted response.


#1. Is you sister currently involved in therapy or has been formally diagnosed with any mental illnesses? What treatment is she receiving?


#2. Is your goal to get your sister treatment or to get her to stop/change her behavior toward the family?


#3. Has there been any legal involvement up to this point?



Customer: replied 6 years ago.
My sister has not had any medical input or therapy, its just that am trying to help my Mother understand my sisters attitude as she is so abusive.

I think it would help my parents understand her better and ask her to consider treatment before she alienates both my other sister and myself permanently

No there is no legal involvement
Expert:  Doctor Blake replied 6 years ago.

Thanks for your speedy reply.


First - it would be inappropriate (and unethical) for me to make a diagnosis over the internet (and across the Atlantic Ocean). Please understand that this information is not diagnostic in nature - but just some initial steps.


If you believe having a diagnosis would be helpful (and it *is* the first step in moving toward treatment), then I highly recommend that your sister see a Licensed Mental Health Professional (LMHP). Given the complexity of the problem you describe, I might recommend she see a psychologist - who would employ extensive diagnostic protocols to better understand your sister's functioning.


That being said... you should know that Narcissistic Personality Disorder (NPD) is somewhat controversial. You should know several things about the field of psychology/psychiatry:

1. The "big book" used for diagnosing mental disorders is the Diagnostic and Statistical Manual of Mental Disorders... and has undergone a number of revisions and changes over the years.

2. While there are still discussions and arguments about the material contained in the DSM, none is more controversial than those disorders located on Axis II (so-called "Personality Disorders").

3. You should understand that there are licensed mental health professionals who do not believe in the concept of "personality" and do not, therefore, believe that a personality can be disordered.

4. Even for those who find sufficient evident for "personality," the disorders listed on Axis II can be controversial. Besides difficulties with diagnostics, if personality is an immutable trait of an individual - how can one treat it? If one were to diagnose an individual's entire personality as "disordered," what could one do to "re-order" it?


Obsessive Compulsive Disorder (OCD) is a complex Anxiety Disorder that involves, as it suggests, obsessions and compulsive behaviors. Someone who obsesses about the past or "gets stuck" thinking about something isn't necessarily OCD. Unlike NPD, OCD is an Axis I disorder.


Research has consistently demonstrated that treatment plus medication is more effective than medication alone or treatment alone for a majority of Axis I disorders. Further research has shown that Cognitive Behavioral Therapy (CBT) is the most effective form of psychological treatment/intervention.


A licensed psychologist/psychotherapist with specific training in CBT modalities would be able to address your concerns. I would encourage you to find a licensed mental health professional with whom to work, employing CBT. Referring to a psychiatrist for medical treatment is appropriate if you are interested in pursuing this approach.


Again, the mantra of years of research says: medication or treatment alone is not as effective as both working in tandem. Some research has also indicated that insight-oriented talk therapy is counter-productive with some forms of Axis I disorders... it actually exacerbates the condition(s). So, seek out a CBT therapist who will provide targeted, efficient, and effective therapy - not someone who signs you as a "lifer." If you're going to a therapist for years, something about the therapy isn't working.


SO: I will return to an adage I learned during my residency... "If you hear hoof beats bearing down upon you, it's far more likely to be a horse than a zebra that's coming..." The same is true with mental health disorders. NPD is highly controversial, very rare (if it exists at all), and some would argue, untreatable. A host of other disorders (that *are* treatable with good prognoses) could explain the very same behaviors used to describe NPD.


Finally, the reason I asked about legal involvement is only this: you may be able to get your sister into treatment, but that does not mean that it will necessarily get her to stop her untoward behavior in your family. If you are SERIOUSLY concerned that her behavior is harmful to herself or others, or that she is violating the rights of others, then you should call the police and begin the process of legal involvement.


Diagnosis can help understand behavior we find uncomfortable or dangerous. Treatment can help change or reduce behavior we find uncomfortable or dangerous. But if you really want it to STOP - you make have to involve the court system. I realize that this will be very painful for everyone involved - but if her behavior is rising to such a level that you fear for the safety of others - it's time to involve the police.


Thanks. I hope you're well and that this was helpful.


* FEEDBACK ENCOURAGED. Please contact me prior to leaving negative feedback so that we can resolve the matter. I am eager to work with all JA clients to provide them with useful/helpful answers. Thanks again.

Doctor Blake, Psychologist
Category: Mental Health
Satisfied Customers: 146
Experience: Ph.D., Ed.S., NCSP Clinical Psychologist; 15+ years of experience; dual licensure
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