 Esteemed colleagues, thank you for inviting me to this stress and depression management webinar. I am honored and delighted to be here. Today I would like to present to you the latest findings with regards to a specific subtype of abuse within intimate relationships known as narcissistic abuse. It is all the hype recently. There are millions of people discussing narcissistic abuse online and it had penetrated the scholarly literature as well. My name is Sam Baknin. I'm a visiting professor of psychology in Southern Federal University in Vostov-on-Don in Russia and I'm a professor of finance and a professor of psychology in the outreach program of SEAPS, Center for International Advanced and Professional Studies. I'm also the author of Malignance of Love, Narcissism Revisited and a host of other books about personality disorders. In 1995, I coined the phrase narcissistic abuse and I felt the need to coin a new phrase because I wanted to describe a subtype of abusive behavior that was pernicious, nefarious, all-pervasive across multiple areas of life and involved a plethora, plethora of behaviors and manipulative or coercive techniques. Narcissistic abuse was not like all other types of abuse. It differed from other types of abuse in its range, in its sophistication, in its duration, in its versatility, express and premeditated intention to negate and to vitiate the victim's personal autonomy, agency, self-efficacy and ultimately well-being. And it was the only type of abuse that could be practiced either surreptitiously under the radar or overtly, openly. So very often narcissistic abuse masquerades in a variety of ways. It becomes gaslighting, becomes ambient abuse. The narcissist uses other people, which I coined another phrase to describe, I called them flying monkeys. So this type of abuse co-opts, recruits an entire community to do its bidding. It's not isolated like other types of abuse where there's a one-on-one abusive interaction, rejection, humiliation, physical abuse, verbal abuse. It's an integrated network approach to abuse. Everything becomes weaponized. Everything is used against the victim, people in the victim's life, the victim's family, friends, workplace, associations, interests, hobbies, fears, hopes, priorities, wishes. Confidential information shared in moments of intimacy. This information is weaponized as well, is used against the victim at a later stage. I keep saying victim because while in the throes of narcissistic abuse, within a shared fantasy, within a shared psychotic space, the prey is immobilized. It's like these animals in nature who first inject the prey with poison, paralytic poison, nerve agent. The prey is immobilized. It has a freeze response. It's incapable of flight, incapable of fight. It just freezes there like a deer with the headlights. Only much later, victims can become survivors. But even then, they carry the abuse with them in a variety of ways, which is the topic of today's paper. The victims of narcissistic abuse appeared at the time when I coined the phrase and was the first to describe this type of abuse. They appeared to present a clinical picture, substantially different to victims of other, more pinpointed, more goal-oriented types of abuse. The victims of narcissistic abuse were more depressed, more anxious, much more disoriented, aggressive, there was defiant reactants. They took on traits and behaviors which are typical of narcissists and psychopaths defensively. They became dissociative, so they showed all kinds of dissociative symptoms, such as depersonalization, derealization, or even amnesia. And all of them felt trapped. They felt trapped or hopeless. In other words, they have acquired learned helplessness, which was inculcated into them via intermittent reinforcement, via operant conditioning. They were in the throes of trauma bonding, the famous Stockholm syndrome. It was a kind of cultish shared psychosis or shared psychotic disorder, fully adored. Repeated abuse has long-lasting, very long-lasting, pernicious and traumatic effects, such as panic attacks, hypervigilance, sleep disturbances, flashbacks, intrusive memories, suicidal ideation, and psychosomatic symptoms. All these have been amply documented over the past at least 70 years, if not 100 years. The victims experience shame, depression, anxiety, embarrassment, guilt, humiliation, abandonment, and an enhanced sense of vulnerability. Complex post-traumatic stress disorder, complex trauma, complex PTSD, has been proposed as a new mental health diagnosis at the time by Dr. Judith Herman of Harvard University to account for the impact of extended periods of trauma and abuse. A classic PTSD is, of course, a reaction to a single harrowing, shattering external shock. Complex PTSD or complex trauma is a reaction to repeated shocks, however minor. In the article Stalking, an overview of the problem published in the Canadian Journal of Psychiatry 1998, Vol. 43, pages 473, 476, in that article, authors Karen Abrams and Gail Ehrlich, Robinson, wrote the following. Initially, there is often much denial by the victim. Over time, however, the stress begins to erode the victim's life and psychological brutalization results. Sometimes the victim develops an almost fatal resolve that inevitably, one day, she will be murdered. That's persecutory or paranoid ideation. Personal victims unable to live a normal life describe feeling stripped of self-worth and self-dignity. Personal control and resources, psychosocial development, social support, premorbid personality traits and the severity of the stress may all influence how the victim experiences and responds to their views. Victims stalked by ex-lovers may experience additional guilt and lower self-esteem for perceived poor judgment in their relationship choices. Many victims become isolated and deprived of support when employers or friends or, I add, family members withdraw after also being subjected to harassment or when they are cut off by the victim in order to protect them. Other tangible consequences include financial losses from quitting jobs, moving and buying expensive security equipment in an attempt to gain privacy. Changing homes and jobs results in both material losses and a loss of self-respect. Now this particular article deals with stalking, but many of the effects and the impacts described here are very common in cases of narcissistic abuse One could even argue that narcissistic abuse is much closer to stalking paranoid, dangerous stalking than to classic abuse. Surprisingly verbal, psychological and emotional abuse have the same effects as the physical variety. I refer you to Psychology Today, the September-October 2000 issue, page 24. Abuse of all kinds also interferes with the victim's ability to work. Abrams and Robinson wrote this in the article Occupational Effects of Stalking in the Canadian Journal of Psychiatry 2002, volume 47, pages 468, 472. They wrote, Being stalked by a former partner may affect a victim's ability to work in three ways. First, the stalking behaviors often interfere directly with the ability to get to work, for example, flattening tires or other methods of preventing leaving the home. Second, the workplace may become an unsafe location if the offender decides to appear there. Third, the mental health effects of such trauma may result in forgetfulness, fatigue, lowered concentration and disorganization. These factors may lead to the loss of employment with accompanying loss of income, security and status. Why I keep focusing on stalking is that in narcissistic abuse the victim internalizes her abuser. He becomes an introject. The abuser becomes a voice in her head. In a way, she stalks herself via the agency of her abuser. The stalking is done by the victim. The victim is her own stalker. There's no escape. And she continues to abuse herself long after a breakup, long after a divorce. She continues to abuse herself by playing and replaying the recordings of her abuser, things he had said to her, threats he had made, challenges to her self-esteem, self-confidence and sense of self-worth, gaslighting, distortion of reality in a way that makes her doubt her own sanity. All these are internalized and then integrated into a complete self-picture and she can't get rid of it. There is a pronounced element of stalking in narcissistic abuse. Still, it is hard to generalize. Victims are not a uniform lot. In some countries abuse is commonplace. It's even accepted as a legitimate mode of communication, a sign of love and caring and a boost to the abuser's self-image and to the victim's self-image. My husband loves me so much he's so jealous that he beat me up. That's proof of love. In such circumstances the victim is likely to adopt the norms of society and to avoid serious trauma. Deliberate, cold-blooded and premeditated torture has worse and longer-lasting effects than abuse meted out by the abuser in rage and loss of self-control. The existence of a loving and accepting social support network is another mitigating, important mitigating factor. And finally, the ability to express negative emotions safely and to cope with them constructively is crucial to healing. Typically, by the time the abuse reaches critical and all-pervasive proportions, ubiquitous becomes ubiquitous. The abuser had already spider-like, isolated his victim from family, friends and colleagues and meshed her in a shared fantasy and deprived her of any judgment and any opinion and any critical thinking and any reality testing. She's catapulted into a Netherlands, a cult-like setting where reality itself dissolves into a continuing nightmare. When the victim emerges on the other end of this wormhole, the abused woman, or more rarely men, she feels helpless, self-doubting, worthless, stupid and a guilty failure for having botched her relationship and abandoned her family, quote, unquote. In an effort to regain perspective and to avoid embarrassment and shame and guilt, the victim denies the abuse or minimizes it. No wonder that survivors of abuse tend to be clinically depressed, neglect their health and personal appearance, succumb to boredom, rage and impatience. Many end up abusing prescription drugs or drinking or otherwise behaving recklessly. Some victims even develop classic post-traumatic stress disorder. Again, contrary to popular misconceptions, post-traumatic stress disorder, PTSD and acute stress disorder or reaction are not typical responses to prolonged abuse. They are the outcomes of sudden exposure to severe or extreme stressors, stressful events. There is a post-traumatic stress response which encompasses PTSD and CPTSD. Yet some victims whose life and body had been directly and unequivocally threatened by an abuser react sometimes by developing exactly the symptoms. PTSD is therefore typically associated with the aftermath of extreme physical and sexual abuse in both children and adults. We can have, in other words, the morbidity of CPTSD and PTSD with elements of PTSD such as flashbacks which don't occur in CPTSD and elements like narcissistic or psychopathic behaviors or borderline behaviors which are very common in CPTSD but never occur in PTSD. And that's why another mental health diagnosis, CPTSD, that's why Judith Herman proposed this diagnosis to account for the impact of extended periods of trauma and abuse. Once or someone else's looming death, violation, helplessness, personal injury, impotence, powerful pain, they are sufficient to provoke the behaviors, the cognitions and emotions that together are known as PTSD. Even learning about such mishaps may be enough to trigger massive anxiety responses. The first phase of PTSD involves incapacitating and overwhelming fear. The victim feels like she has been thrust into a nightmare or horror movie. She is rendered helpless by her own terror. She keeps reliving the experience through recurrent and intrusive visual and auditory hallucinations, flashbacks or dreams. In some flashbacks, the victim completely lapses into a dissociative state and physically reenacts the event while being thoroughly oblivious to her true surroundings. In an attempt to suppress this constant playback and the attendant exaggerated startle response, jumpiness, the victim tries to avoid or stimulate associated however indirectly with a traumatic event. Many develop full-scale phobias like agoraphobias, claustrophobia, fear of heights, a version of specific animals, to specific animals, objects, modes of transportation, neighborhoods, buildings, occupations, weather and so on. Most PTSD victims are especially vulnerable on the anniversaries of their abuse. They try to avoid thoughts, feelings, conversations, activities, situations or people who remind them of the traumatic occurrence. These are the triggers. And these constant hypervigilance and arousal, the sleep disorders, mainly insomnia, the irritability, short fuse and the inability to concentrate and to complete even relatively simple tasks, they erode the victim's self-esteem and resilience. Utterly fatigued, exhausted, most patients manifest protracted periods of numbness, automatism and in radical cases, near-catatonic posture. Response times to verbal cues increase dramatically. Awareness of the environment decreases, sometimes dangerously so. The victims are described by nearest and dearest as zombies, machines, automata. The victims appear to be sleepwalking, depressed, dysphoric and hedonic. Not interested in anything, they find pleasure in nothing. They report feeling detached, emotionally absent, estranged and alienated. Many victims say that their life is over and expect to have no career, family or otherwise meaningful future. The victims' family and friends complain that she is no longer capable of showing intimacy, tenderness, compassion, empathy of having sex due to her post-traumatic frigidity. Many victims become paranoid, impulsive, reckless, self-destructive. Other victims somatize their mental problems and complain of numerous physical ailments. They feel guilty, shameful, humiliated, desperate, hopeless and hostile. Many of them develop somatization or conversion symptoms and become hypochondriacs. Post-traumatic conditions need not appear immediately after the harrowing experience. They can appear and often do appear after many days or many months. They're delayed. It's a delayed reaction. And they last more than one month, usually much longer. Sufferers of post-traumatic conditions report subjective distress. The manifestations are ego-dystonic. They're uncomfortable. They're functioning in various settings, job performance, grades at school, sociability, neuromantic attachments. This functioning deteriorates markedly. The criteria in the DSM 4 and 5 for diagnosing PTSD are far too restrictive even today. Even today when they had been expanded to include complex trauma and so on, they're still restrictive. The post-trauma seems to also develop in the wake of verbal and emotional abuse in the aftermath of drawn-out traumatic situations, such as a nasty divorce. And so we need to rethink trauma as a major responsive modus in many situations which either to we did not consider, such as, for example, domestic violence. Why are we limiting such responses to, I don't know, for example, natural disasters or war? Moreover, there are other phenomena associated with this. For example, consider triggering cascade. Triggering cascade is when seemingly a minor trigger results in vastly disproportional trauma. Painful memories replete with the attendant negative emotions are walled behind mental barriers, combinations of dams and firewalls, sometimes even an innocuous mishap, or a merely unpleasant event rupture these defenses in decades of hurt, like effluence of pain are released in an avalanche that at times can be life-threatened. Narcissists and psychopaths are experts in eliciting this response. They are dream records. They are particularly adept at provoking triggering cascades by aggressively and contemptuously frustrating both individual and social expectations cherished and life-sustaining hopes deeply help beliefs and ingrained fantasies and values. The lack of empathy of narcissistic or psychopathic partner the innate, goal-focused cruelty and ruthlessness, the absent impulse control and the mind-boggling recklessness create a whiplash of shock and disorientation coupled with agony and a pervasive feeling of being existentially negated. It's intolerable angst this thing. Trauma also imprints everything and everyone involved or present in the stressful event however tangentially. So there's a traumatic event or series of events and the places, the people, the smells, the sounds, the circumstances, objects, dates, categories of all the above all get imprinted and stamped with a traumatic experience. Trauma imprinting is at the core of traumatic syndromes, post-traumatic stress disorder, complex trauma and they are triggering. Triggers are places people smell, sound, circumstances, dates or objects that are reminiscent of the same classes of stressors involved in the original trauma and that evoke them. Many exposure and retraumatization therapies including most recently the treatment modality that I had developed called therapy, these treatment modalities make use of trauma imprinting to generate new, less stressful, less panic or anxiety inducing associations between external triggers and so to induce integration of the haywire emotions, the dysregulated emotions involved in the primary situation. Major traumas can lead to either of two opposing outcomes, regression into infantile behaviors and defenses in infantile state or a spurt of personal growth and maturation. It all depends how the trauma is processed. It all depends on the social network, social support network faced with devastatingly hurtful, overwhelming and dysregulated emotions, personalities with a low level of organization for example borderline personalities react to trauma with decompensation, reckless acting out even psychotic macro episodes, major depression, suicidal ideation are very common and in an attempt to restore a sense of safety the individual victim regresses to an earlier, familiar, predictable safe base phase of life. She evokes parental imagos and introjects to protect her, to comfort her to soothe and take over responsibilities in a way the trauma victim parents herself by splitting her mind into a benevolent forgiving unconditionally loving inner object mother or father and another object which is wayward defined independent and rebellious child or teen who is largely oblivious to the consequences of his or her actions. More balance emotionally regulated mature people reframe the trauma by accommodating it in a rational evidence based not fictitious or counterfactual narrative. They modify their theories about the world and the way the world operates. They set new boundaries. They generate new values new beliefs, new roles of conducts, new schemas. They process their emotions fully. They thereby rendered more self-ifications, not less so. In other words, mature people grow up having leveraged their painful losses as an engine of positive development geared towards the attainment of favorable long-term results. Abuse and attachment, trauma and bonding form parabolic relationships. Up to the vertex, the low point of the parabola one member of the pair abuse and trauma sustains and enhances the other member attachment and bonding. Beyond that point the foreman, abuse and trauma weakens and undermines attachment and bonding. The exact location of the vertex depends on individual experience, on personal history, on cultural personality social mores peer input expectations. Up to a point people, men and women are attracted to abuses. We must accept this. Abuse attracts. When the maltreatment reaches the traumatic vertex the emotional reaction flips and the heated two victims are repelled by the gratuitous cruelty and they're ejected and catapulted out of the diet the couple of the bond. This means that good guys and decent women don't stand a chance in the sexual and relationship marketplace. They always amount to distant and unattractive second rebound choices. Nice guys and solid stable girls are there to pick up the pieces relegated to the unglamorous roar of the sanitation workers of lopsided romance. They're rarely anything more than pedestrian providers and co-parents or if they lack out intimate companions in between their spouses extramarital affairs with other more abusive, less regulated more labile, more thrilling and appealing ones. Numerous studies have demonstrated this. People are attracted to dysregulation, liability pain expected hurt and abuse unconsciously subliminally. Indeed, nice girls and nice guys do end lost, unfortunately. It's time to reverse this paradigm. Thank you for listening.