 Okay, so that we have a coherent presentation. My name is Sam Vaknin. I'm a professor of psychology in Southern Federal University of Stov-on-Don, Russia, and a professor of finance and psychology in CSCAPS, Center for International Advanced and Professional Studies. As team colleagues, today I would like to discuss a much neglected topic in the psychology of personality disorders and that is the connection between trauma including an external shock such as the pandemic and reactance, in other words, disproportionate reactions to daily triggers or small triggers. First of all, in my work in the past few years, I am trying to reconceive of personality disorders as post-traumatic conditions. All personality disorders, at least in cluster B, which are the erratic or dramatic personality disorders, all of them start as trauma and abuse in early childhood. Narcissism, psychopathy, borderline, histrionic, all these people have experienced some form of trauma and abuse when they were children and these are the pathological dysfunctional reactions to trauma and abuse. So why not recast, reconceive, reconsider these personality disorders as post-traumatic conditions? One of the things that characterizes all these personality disorders that I've mentioned, because they are dramatic and because they are erratic, they are also disproportional. There is a phenomenon called reactance or total reactance. Psychopaths, borderlines, victims of trauma, by the way, people who had developed post-traumatic stress disorder or complex post-traumatic stress disorder, complex trauma, all these people react disproportionately even to the smallest irritation, to the tiniest provocation. They perceive everything as insults and slights, they're hyper-vigilant, they scan other people and their environment to find where have they been wronged, where have they been discriminated against, they are hair-trigger, they are irritable and so they develop over time mood disorders and impulse control issues. They escalate every conflict, every conflict, however minor, however imaginary, they take it full course, they take it to the level of a nuclear, apocalyptic, all annihilating warfare and they make disproportionate use of every weapon they have simultaneously. Reactance includes elements such as defiance, contumatiousness, hatred of authority, posturing, hostility, aggression, recklessness, abuse, all these are elements of reactance and these pitched battles happen again and again and again, they are recurrent, all bridges are burned, all relationships are shattered, hurtfully, irrevocably, people, these people, psychopaths, borderlines, narcissists, histrionics, they sometimes lose their jobs, they lose their families, they destroy their marriages, they end up with in horrible relationships with everyone, their children, their loved ones, all because they can't control their impulses and so the issue of reactance is a critical issue because the pandemic has been going on for five months now, many people have been socially isolated, many people have been settled from the daily lives, from the social support networks, many people are unable to practice the habits that they had developed over decades to control their impulses, to restrict and restrain their reactance and so today many, many people are deteriorating, degenerating if you wish, into these conditions. In contrast, the reactions of healthy people in healthy environments, these reactions are differential, these reactions are in kind, they're incremental, they build up, they are proportional, people weigh the consequences, people correct course, every step of the confrontation, they don't go from zero to hero overnight or within a second, patients with borderline personality disorder react to abandonment and rejection, real or imaginary or anticipated or feel, they react to neglect, to abuse, to being ignored, they react with, in this way, disproportionately, narcissists react to narcissistic injuries and narcissistic modification this way and psychopaths and people with histrionic personality disorder, they react to frustration this way, they are goal oriented, if they can't obtain the goal, if there are obstacles on the way to the goal, they react explosively, they destroy everything and everyone in their path. Now all these total reactants, all these disproportionality has to do, of course, with trauma, it's a post traumatic behavior. What is a trauma? Painful or ego dystonic memories, everyone has them, but if they are seriously hurtful, if they are life threatening, if they threaten one's self image in a substantial fundamental way, if they are ego dystonic, in other words, if they are exceedingly unpleasant, these memories replete with the attendant negative emotions and cognitions, these complex of memory, cognition, emotion that are bad, that are unpleasant, they are walled off, they are isolated from the normal stream of consciousness from the day to day cognitive and emotional functioning, these memories are put in an enclave, they are secluded, they are walled behind mental dissociative barriers, combinations of dams and firewalls. We all have these, we all have these very small reserves where we forget things, we forget unpleasant experiences, we repress them, we deny them, we reframe them, we tell ourselves narratives that somehow soothe, we self soothe, we solve our wounds and one of the major tools to do this is simply by forgetting, and we often forget, but when forgetting becomes pathological, when forgetting becomes extensive or pervasive ubiquitous, when forgetting is exclusively associated with negative emotional and cognitive content, with negative memories, we talk with that we are discussing then we are dealing with actually pathology, pathology that is very common in narcissistic personality disorder and even more so in borderline personality disorder. Sometimes even an innocuous mishap or a merely unpleasant event rupture these firewalls, rupture the fortress, break down the defenses and then there's an avalanche, a tsunami of pain and hurt and this tidal wave is released in a traumatic manner and this sometimes can be life-threatening. Trauma, when we are traumatized the trauma imprints everything, it puts its stamp, it puts a signature on everything and everyone involved or present in the stressful event however tangentially. So if you experience a trauma the places, the people, the smells, the sounds, the circumstances, the objects, the dates, categories of all the above, your thoughts at the time, your emotions at the time, all these things will get imprinted with the trauma, will get stamped with the traumatic experience. From that moment on these things will be able to re-trigger your trauma, will be able to force you to experience the trauma again and trauma imprinting is the core of post-traumatic stress disorder and complex trauma. It is also the mechanism behind triggering. What are triggers? Triggers are places, people, smells, sounds, circumstances, dates, objects that are reminiscent of the same classes of stressors, same classes of stress-causing events involved in the original trauma and consequently they evoke, they bring to the surface the original trauma and that's precisely the problem with this pandemic. This pandemic has touched upon absolutely every dimension of existence. Everything, the workplace, the family, loved ones, life and death, places, smells, images, everything has been imprinted with this massive external life-threatening shock. It will be very difficult to recover from this. There are four forms, four ways to release trauma, four ways we cope with trauma. The first one is cognitive release. We catastrophize. When we are traumatized, we tend to see only the negativity, only the horrible apocalyptic nuclear end result. We tend to anticipate the worst and so catastrophizing is an integral part. It's a cognitive fallacy of course. It's a cognitive deficit in a way. Catastrophizing is intimately involved in the cognitive release of trauma. In very extreme cases, we have flashbacks. Flashbacks are cognitions coupled with emotions, coupled with memories, in a way that is so vivid that actually the trauma victim re-experiences, relives the trauma. He believes himself to be back physically and mentally in the trauma and in this sense, re-traumatization or flashbacks are technically a psychotic experience. We intervene in these cases by using controlled catastrophizing via imagery. Then there is emotional release. Emotional release involves a triggering cascade. It's when seemingly minor triggers result in vastly disproportional trauma All the emotions erupt volcanically, uncontrollably. People's emotions become dysregulated. Traumatized people are overwhelmed by their emotions. Not only they cannot control the emotions, but they drown in them. They feel suffocated. And so we deal with this via a variety of techniques, chair-based techniques, chair-work dialogues, mindfulness, reframing in cognitive behavioral therapy, dialectical behavioral therapy, especially in the case of borderline, Gestalt, Schema therapy, and so on and so forth. All these therapies involve an attempt to control emotions by forcing cognitions upon the emotion. Essentially an emotion is a reaction to cognition or the continuation of cognition by other ways, by other means. So we use cognition to try to control the emotions. The third way the trauma is released is behaviorally, behavioral release, and that is what the total reactance that I mentioned at the opening of my presentation. Total reactance, this disproportional, explosive, uncontrolled, impulsive, defined, anti-social very often. Behavior, reckless, addictive. These behaviors are forms of releasing the trauma. And these behaviors characterize psychopaths, borderlines, trauma victims, people with mood disorders, people within impulse control issues. As I said, they escalate every conflict and so on and so forth. And so the total reactance is the behavioral form of releasing trauma. And we intervene in this by trying to create a therapeutic alliance with a patient if it is possible. With a narcissist it's very difficult because narcissism is an infantile defense and there is a regression to early childhood and it's very difficult to create an alliance with a narcissist. It's equally difficult to do it with a psychopath because the psychopath lacks basics such as empathy and respect for contracts and agreements. It's difficult to do it with a borderline because she's dysregulated and she has mood liability. It's very difficult to alliance with these type of patients. We try to encourage self-efficacy by leveraging actually some pathological elements. For example, we leverage the narcissist's grandiosity We challenge the narcissist to become more self-efficacious, more controlled, more goal-oriented in a good way, leveraging his grandiosity. We try to encourage agency, in other words, control over one's life. We use positive reinforcement, rewards, we reward socially acceptable or sublimated behavior. And we involve sometimes other people, other patients for example, in group therapy. These are the interventions for behavioral release and finally there is somatic release. Many people with traumas have what we call, what used to be called conversion symptoms. They somatize the trauma. They use their bodies to express the trauma. There are effects on motility, mobility, motor functioning, sensory motor functioning, sensor intake. There are effects on autonomous functions such as heart rate, sweating. So the body expresses the trauma very often unconsciously and involuntarily and seemingly unconnected to the trauma itself or any of its elements. So we use classic psychoanalytic techniques like dream work. We use psychodynamic psychotherapies. This requires somatization, requires deeper work, depth, psychology. Narcissists and psychopaths not only have experienced trauma as children, border lines, people with histrionic personality disorder. First of all today we consider all these personality disorders as elements or emphasis on a single underlying personality disorder. And second thing, many of these personality disorders are actually gender specific manifestations of the other. So for example, borderline personality disorder can be easily reconceived as secondary psychopathy in women. Narcissism seamlessly glides into psychopathy. Psychopaths are very grandiose, so they are all narcissistic. So there's a lot of commonality and a lot of comorbidity between these disorders. All these disorders are not only victims of trauma and abuse in early childhood, but they carry forward this trauma and abuse. They propagate it. They move it on intergenerationally if you wish. They are conveyor belts, their production line of trauma and abuse. And so they are dream records. They are particularly adept, these people with personality disorders. They are particularly adept at provoking triggering cascades by aggressively and contemptuously frustrating both individual and social expectations, cherished and life-threat sustaining hopes, deeply held beliefs and ingrained fantasies and values. They challenge all these things. They destroy all these things with their behavior. And all these disorders have an innate lack of empathy or truncated empathy, what I call cold empathy. They have goal focused cruelty and ruthlessness. They have absent impulse control, mind boggling recklessness. And when you put all these things together, they create a whiplash of shock and disorientation in other people. They inflict agony and a pervasive sense of being existentially negated in their nearest and dearest and intimate partner. To be with a narcissist or a psychopath or a borderline, create intolerable angst. That's the inevitable outcome. It's as though they infect, as though they are contagious. They infect other people with their internal chaos, low level of organization, pain, hurt, trauma and the abuse they had suffered. They share it with other people. They bring other people into their own near psychotic state. And so we need to reconceive of personality disorders as reactions to massive shocks. And if we do this, we will understand the real risk in this pandemic. The real risk in this pandemic is that in its wake, once we have solved the virus issue, once there is a vaccine, once there is a cure, the pandemic will have left behind millions upon millions of people whose trauma had been so extensive, so massive, so intolerable, so dysregulated that they will develop personality disorders. We are in for a secondary pandemic of mental health. And in this, in this ugly dystopian landscape of mental health issues that is awaiting us, there's depression, there's anxiety, of course, but there's also, there's also a tidal tsunami wave of personality disorders coming our way. Many people will have been rendered narcissistic, psychopathic, dysregulated, labile and histrionic by this pandemic. The question remains only one. Are these effects reversible? Are they situational? Are they the artifacts of complex trauma? Or will these people remain scarred for life and will become a new harbor, a new focus, a new epicenter of pain, trauma and abuse for other people? Thank you.