Category: <span>Stress</span>

Reader’s Question

Over the years I have suspected my sister has Narcissistic Personality Disorder. Now in her late forties, her need for sexual attention is becoming more of a problem; her firm belief in her eternal sexual appeal is causing more inter-personal problems for family and friends. Knowing that any attempt to approach the problem will provoke an outburst of anger and abuse, I try to respond to her excessive behavior as I would with a child who is throwing tantrums if she doesn’t get what she wants — by largely ignoring it. However, I am beginning to realize that as she gets older, and has now been single for over six years, the same behaviors of the past seem more delusional.

Every conversation centers on her past pain, her stress, or her fear that she won’t succeed. She drinks excessively and spends beyond her means.

She has always been competitive with myself and my two brothers. She seems to want to follow career paths we choose and then becomes bored and changes direction. Recently she met my partner of three years for the first time, as we live in different parts of the country. She flirted with him openly, and now texts him constantly, imagining there is a soulmate bond — she has no idea how obvious it is, and how very embarrassing for me and my partner.

If anyone challenges her, she cuts them out of her life: she divorced her kind and patient husband six years ago because she was in love with a married man whom she considered more her intellectual equal, dismissing her husband as beneath her. She tried to seduce that married man and was rejected; when his marriage later failed due to the entanglement with my sister, my sister decided he had used her, and was no longer interested in the possibility of a relationship. When her closest friend tried to challenge her on her choice in potential partners, my sister cut her out of her life too.

When a younger man smiles at her on the street, she talks it up as proof that she is still attractive to younger men; yet whenever a man her age shows an interest, she laughs at their foolishness in thinking they are “in her league”.

After the chaos she has caused in her own personal life, she has managed to secure a part time job in the media industry, but despite being unable to handle the pressures of a professional job, she is embarking on a new course of study, hoping for a high level senior position once she graduates.

Will ignoring a sibling’s excessive attention seeking behavior just create more problems for our family?

Psychologist’s Reply

It sounds as if this has been a difficult situation for everyone in the family, and that you and your brothers (and now your partner) are at the end of your ropes in trying to manage the uproar that happens in some interactions with your sister. What I’m hearing is that you have tried ignoring her bids for attention but wonder whether that strategy could create more problems. Ignoring is certainly one way to set a boundary, and it may be worth experimenting with if it fits for you. If the ignoring is difficult to do, or isn’t working, however, some other alternatives may be worth exploring.

First, to answer your question about her behavior and a possible diagnosis, it can be helpful to try to determine a loved one’s diagnosis in an effort to help them (and yourself). I hear that you have observed the inflated sense of self, the pattern of elevating and then denigrating someone, and the interpersonal pain as possible indicators that your sister may have Narcissistic Personality Disorder. However, finding a mental health professional to meet with your sister (or with you) to better determine a diagnosis (and rule out alternatives) as well as provide treatment recommendations may be most beneficial for her as well as for your family in learning how to interact more effectively with her.

Some personality disorders share similar features. For example, there are similarities among Narcissistic Personality Disorder, Borderline Personality Disorder and Histrionic Personality Disorder. All three of these disorders are marked by longstanding patterns of interpersonal difficulty and maladaptive ways of managing interpersonal anxiety. What you describe may be more histrionic: attention seeking (particularly sexual in nature) and believing relationships to be closer than they actually are. The grandiosity and inflated sense of self may also fit with personality traits in that same cluster. However, if your sister is also having sleep disturbances along with the hypersexuality, inflated sense of self (grandiosity), substance abuse (excessive drinking) and excessive spending, she may also fit criteria for a mood disorder that is bipolar in nature. If your sister has a mood disorder (such as Cyclothymia or Bipolar II), medications can help her functioning. A licensed mental health professional can help determine a more accurate diagnosis and form a treatment plan.

Second, from what you describe, it sounds as if many friends and family have confronted or challenged your sister, and her response has been to cut them off to manage her own anxiety or pain. When a loved one pushes our boundaries, makes us uncomfortable, and can’t tolerate much confrontation, there are two things that are important to remember to do:

• Take care of yourself as well as your loved one by setting clear, consistent boundaries, and
• validate her pain and needs while also expressing your worry, love, and desire to help things get better.

Many individuals who meet criteria for a personality disorder (as well as individuals who experience bipolar disorder) respond much better when other people in their lives set clear and consistent boundaries on their time, energy, and what discussions or behaviors they will tolerate. Some examples of achieving both might go something like this:

I hear how much stress and pain you’re experiencing. I care about you and will support you emotionally in the hopes that things can get better. Sometimes, I don’t know what to say or how to help, though. I wonder if talking to someone else who isn’t a friend or family member who knows how to listen might make things better.

I’m so glad you finally met my partner and are interested in him as a person. Like you, he’s also busy with work, and doesn’t have much time to answer texts. He is glad to have met you, too, and looks forward to visiting with you when we are all together, but not to individual texts.

As you continue to navigate ways to stay connected to your sister and not feel angry with your sister, you (or anyone in a similar situation) may find it helpful to read Harriet Lerner’s Dance of Connection [Amazon-US | Amazon-UK].