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Is your teen a narcissist?

Is Your Teen a Narcissist? Learn the Warning Signs and Treatment Options
Jul 13, 2014 | Terri DiMatteo | 17 Comments

Is your teen unhappy, lacking in close friends and totally self obsessed? Is this a normal developmental stage of adolescence or do these symptoms indicate narcissistic personality disorder (NPD)? How can you tell the difference?

Firstly, don’t panic! Many teens seem totally self obsessed at some stage and most simply grow-out of their behaviors. As time passes and teens mature – and as responsibilities increase – you may notice that the worrisome behaviors diminish. Perhaps you will observe the formation of healthy interpersonal relationships and behaviors which demonstrate increased awareness, empathy and compassion.

    In effect, these egotistical adolescent ‘narcissistic’ indicators may merely represent a developmental stage in a teen’s personal growth and maturity – and nothing more.

It should be pointed out that – contrary to popular notion -- those with NPD actually do not love and adore themselves excessively rather they are void of self-love and self-worth and can be dangerous to both themselves and others.

NPD is much darker:

    Those diagnosed with NPD often suffer depression, have thoughts of suicide, and exhibit a pattern of repeated failed interpersonal relationships. A swirl of trouble and high conflict at work and at school constantly surrounds them. 

Diagnosing Narcissist Personality Disorder

The DSM-IV-TR defines narcissistic personality disorder as:

    “An all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation, and lack of empathy, usually beginning by early adulthood and present in various contexts.”1

A list of traits associated with NPD are listed below. In order for an individual to be diagnosed as NPD at least five (5) of the traits identified must be present.

    Is assuredly convinced that he or she is special, unique and can only interact and associate with other special, uniquely qualified or high-status people (or institutions).
    Insists on being treated with excessive adulation, admiration, attention and  affirmation.  Or, if not, then desires instead to be feared and viewed as infamous or notorious.
    Demonstrates a sense of grandiosity and self-importance (e.g., grossly exaggerates skills, accomplishments, talents, connections and personality traits to the point of lying; demands to be recognized as superior without demonstrating actual achievement to support the claim.)
    Exploits personal relationships focusing only on his or her own goals at the expense of others. 
    Demonstrates characteristics of at least one of the two narcissistic types: 'The Cerebral Narcissist' is driven with fantasies of boundless success, notoriety, tremendous power or omnipotence and incomparable brilliance. 'The Somatic Narcissist' is obsessed with his or her bodily beauty or sexual performance or ideal, everlasting, all-conquering love or passion.
    Believes he or she is “above the law” and all knowing (omnipresent). Behaves in a superior, invincible, immune way, and when questioned or frustrated by people he or she views as either inferior or unworthy – rages.
    The individual presents as arrogant and haughty, possessing a strong sense of entitlement and demanding full and unquestionable compliance with his or her unreasonable expectations for special favor and exemplary treatment.
    Possesses a severe lack of empathy. Cannot accept - or even acknowledge - the  needs, feelings, desires, choices, preferences or priorities of another.
    Demonstrates continuous examples of envy and jealously. Sets out to hurt and demolish the source of his or her frustration. Experiences paranoid delusions believing that others feel identically about him or her and will act in the same manner toward them.

To further determine whether or not an adolescent suffers NPD, consider these developmental and environmental factors, which are thought to contribute to NPD:

    Unreliable or unpredictable caregiving from parents
    Experiences in childhood, such as loss of a father figure
    Suffers severe childhood emotional abuse
    Excessively condescending or critical environment - Is overindulged and over-praised by her parents
    Possesses an oversensitive temperament from birth
    Learned manipulative behaviors as a way to get what she wanted

Note that chronic insomnia, over-work, ongoing exposure to high levels of stress, substance abuse, medical problems, and difficulties with family or other interpersonal relationships can exacerbate the symptoms of a personality disorder.
Treating Teen Narcissistic Personality Disorder

As teens are generally in a fragile mental state it makes it especially difficult to treat teens who suffer narcissistic personality disorder. Treatment attempts are often met with disdain making it impossible to develop the proper and necessary therapeutic therapist-client alliance. The teen’s own self-perception often interferes with this essential process.

    A therapeutic objective is to teach the teenager to value him or herself on a more realistic level and to adjust one's thinking about others' value in relation to his or her own. Exercises designed to assist the teen in developing empathy for others would be an aspect of treatment of this personality disorder.
    In general, medication is not part of the treatment plan, except in those cases where depression and anxiety emerge as the teen struggles to cope with his or her new reality of self.
    Group therapy (such as Dialectical Behavioral Therapy), somatic experiencing, anger management, sleep management, psycho-education and individual psychotherapies can help.
    Neuro-feedback techniques can also be utilized in conjunction with the other therapies.
    Holistic remedies such as yoga, meditation, acupuncture and massage therapy can support and enhance treatment and healing.
    Family therapy groups that incorporate family members and significant others into the therapeutic treatment plan are advantageous.

This combination of treatments can show good result in dealing with personality disorders.
Factors That Slow Recovery

Keep in mind, though, that:

    Narcissists rarely enter treatment and when they do they often view it as a ‘waste of time’. Depression – as well as substance abuse, specifically alcohol, marijuana or cocaine -- are prevalent among persons with this disorder and negatively impact psychological and medical treatment.
    Individuals with NPD typically have interpersonal problems with family, loved ones, classmates and co-workers – therefore, their impaired social support structure adds another layer of difficulty regarding their entrance into and continuation of treatment.
    NPD’s who are excessively impulsive or self-destructive will require more intensive therapy and resolution will come at a slower pace.

Friends and Family Can Accelerate Treatment

It may be very difficult and challenging for friends, family and loved ones to help and support because persons with NPD have great difficulties with interpersonal relationships.

    Family and friends can help by educating themselves about NPD in order to interact emphatically and with compassion for the person who has NPD.
    Family and friends are an indispensable resource when it comes to monitoring symptoms and watching for dangerous maladaptive behaviors.
    There are some treatment centers that specialize in working with individuals with NPD and friends and family can provide emotional support and financial resources.

The Prognosis

    NPD is generally a chronic life-long disturbance with periods of remission and exacerbation (worsening) dependent on changing life circumstances.
    Psychotherapy over time, coupled with sleep and stress management, and psycho-education, can address related problems.
    When a person with NPD develops depression or substance abuse, treatment becomes imperative.
    Clients who do receive effective treatment will experience significant improvement in their ability to function normally in their daily lives, with improvement in their interpersonal relationships.

References

    American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: Author.

Terri DiMatteo Terri DiMatteo
Licensed Professional Counselor
Counselor/Therapist
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Drug Testing For CPS

1923 Testing for Substance Abuse
1923.1 Detection Periods for Substance Abuse

CPS June 2010

For detection periods, see Appendix 1922.1: Detection Periods for Abused Substances.
1923.2 Diluted Samples Obtained During Testing

CPS June 2010

A diluted sample indicates that a client drank a large amount of water at some time before the drug test.

When the lab indicates that a sample is diluted, the caseworker can take one the following actions to arrive at a conclusion about the client's use:

  •  Have the client retested

  •  Request a different type of testing, such as requesting a hair follicle test instead of a urine test

  •  Rely on credible evidence obtained through observation, information from collateral sources (such as a teacher, neighbor, or family doctor), and the case history
1923.3 Instant (Swab) Tests and Court Hearings

CPS June 2010

An instant test is a swabbing of a client's oral fluids. The test is performed by a caseworker to test for recent drug use. If possible, the test results are confirmed by a laboratory.

Using the Tests in Court

Before presenting the results of instant swab tests as evidence in court, the caseworker must obtain confirmation from a laboratory.
1923.4 Using Acceptable Contractors to Obtain Test Results

CPS June 2010

DFPS accepts lab test results from physicians, hospitals, the legal system (such as the adult probation department), and providers of substance abuse treatment in order to assess safety and to assess the need for services and treatment.
1923.5 Frequency of Random Substance Abuse Testing

CPS June 2010

In general, the caseworker may conduct random drug tests when substance abuse laboratory testing is allowed under 1920 Substance Abuse Testing; that is, when:

  •  a case is scheduled for closure;

  •  reunification of the child with his or her family is contemplated;

  •  there are changes in the parent's appearance, behavior, or affect;

  •  new information is received about possible substance abuse;

  •  the client has terminated substance abuse treatment;

  •  the client shows signs of returning to seeking and using drugs, including  associating with former friends and family members who use drugs; keeping drug paraphernalia in the home; or making statements minimizing or denying having a problem with drugs or alcohol;

  •  the client refuses to create a relapse safety plan (see 1966 Developing a Safety Plan in Case a Client Relapses);

  •  the client minimizes or denies seeking and using drugs seeking and after test results come back positive;

  •  there are signs that abstinence is being threatened; for example, when a client increases the amount of alcohol consumed or begins to smoke cigarettes frequently to relieve anxiety;

  •  the client has made minimal or no effort to mitigate the substance abuse related problems that led to abuse and neglect;

  •  the client is not involved in substance abuse treatment or aftercare, even though it was recommended; and

  •  the regional substance abuse specialist recommends testing.

Hair Follicle Testing

The caseworker determines the frequency with which random hair follicle testing may be conducted, by following regional protocols.
1923.6 Situations Not Appropriate for Drug Testing

CPS June 2010

It is not appropriate for a caseworker to arrange for drug testing when a parent is:

  •  actively involved in substance abuse treatment and the treatment provider conducts random testing that is based on laboratory confirmation.

  •  randomly tested by another entity, such as a probation department or drug court, and the test is confirmed by a laboratory. The caseworker must check into the frequency of testing by the other entity, before random testing is discontinued by CPS.
1923.7 Discontinuing Drug Testing

CPS June 2010

The caseworker must discuss with the supervisor and the client's treatment provider when contemplating discontinuing routine drug testing.

The discontinuation or modification of routine drug testing may be considered when:

  •  A parent does not exhibit substance seeking and using behaviors (for example, when associating with former friends or family members who use drugs; keeping drug paraphernalia in the home; or making statements minimizing or denying having a problem with drugs or alcohol); and

  •  The parent has a consistent pattern of negative tests results.
1923.8 Assessing Test Results or Accepting an Admission

CPS June 2010

Positive Result

The caseworker must assess a positive drug test result in relationship to the child's safety and risk. The result must be discussed with the parent in a timely manner.

If a parent with a positive drug result is not engaged in substance abuse treatment and is actively parenting a child, the caseworker refers the parent to:

  •  a provider of outreach, screening, assessment, and referral (OSAR) services or

  •  a provider of substance abuse treatment.

The threshold that makes a referral appropriate is based on the definition of a child not being safe. That is, a child is not safe when:

  •  threats or dangers exist in the family that are related to substance use;

  •  the child is vulnerable to such threats; and

  •  the parent who is using substances does not have sufficient protective capacities to manage or control threats.

Client Admission

A client's verbal or written admission is accepted as a positive result of drug use; however good casework practice calls for getting the client to sign a statement of use.

Testing to Rule Out Under-Reporting

If a client admits to drug use, is not engaged in treatment, and is actively parenting children, the caseworker may consider referring the client to a substance abuse provider for screening, assessment, or treatment.

Referral may be necessary because clients sometimes under-report drug use or do not admit to all of the substances that they have used.

Clients likewise may under-report:

  •  the frequency with which they use dugs,

  •  the quantity of drugs they use, and

  •  the amount of money they spend on the drugs.

Negative Result

When the result of a parent's drug test is negative, the caseworker:

  •  notifies the parent about the result in a timely manner; and

  •  encourages the parent's abstinence and provides positive feedback.

Refusal to Test

When testing is appropriate under 1920 Substance Abuse Testing, but the client refuses to take a drug test, the caseworker must document the refusal to be tested.

If a parent refuses to take a drug test or refuses to allow a child who is an alleged perpetrator to be tested, the caseworker consults with the supervisor in a staffing meeting. The supervisor may recommend legal intervention, if the evidence raises concern for the child's safety.

For cases under court jurisdiction, the caseworker must notify the judge and attorneys about the client's refusal to test.
1923.9 Documenting Prescribed Medicine Before Offering Drug Testing

CPS June 2010

When testing is appropriate under 1920 Substance Abuse Testing, the caseworker must document any prescribed medication that the client is taking.

The documentation may be made by:

  •  completing a regional form; or

  •  entering the details in the Contact Narrative in the IMPACT system.

The caseworker must share the information about the client's medication with the lab's medical review officer (MRO).
1924 Special Situations Related to Substance Abuse
1924.1 Methadone and Prescription Medication

CPS June 2010

Methadone

If the parent tests positive for methadone, the caseworker:

  •  obtains a release (Form 2062Word Document DFPS Release of Confidential Information to DSHS/Substance Abuse Services) from the parent;

  •  verifies with the methadone clinic, that the parent has a prescription for methadone and is taking methadone as prescribed; and

  •  assesses the effect that the methadone dosage has on the parent's ability to provide consistent and safe supervision of the children.

Prescription Medicine

Similar to methadone, the caseworker must assess the effect that prescription medications have on a parent's ability to provide supervision and to keep children safe.

To determine whether the client is taking his or her medication as prescribed, the caseworker must check with the client's medical provider.

For the caseworker to obtain the information from the medical provider, the client needs to sign a consent-to-release form (Form 2062Word Document DFPS Release of Confidential Information to DSHS/Substance Abuse Services).

If the client refuses to sign the release form, the caseworker consults with the supervisor about whether to request legal intervention.
1924.2 The Infectious Client

CPS June 2010

If the caseworker is concerned that a client may have an infectious disease, the caseworker, with the supervisor's approval, refers the client to a local drug-testing facility for a urine test in lieu of an oral test.

Testing Within 48 Hours

The client must be tested within 48 hours after the contact with the caseworker.
1924.3 Drug Use During a Parent-Child Visit or FGDM Conference

CPS June 2010

A court order supersedes the following DFPS policies.

Parent-Child Visit

If a parent appears to be under the influence of a controlled substance and or alcohol, the parent-child visit must not occur.

Family Group Decision Making (FGDM) Conferences

A parent or participant who is visibly intoxicated during a family group decision making (FGDM) conference, must be excused from the conference.

The caseworker does not administer an oral test during the FGDM conference. Any required testing occurs at the end of the meeting and preferably at a location away from the FGDM immediate site.

For policy on the testing of youth, see 1951 Children and Adolescents Who Smoke Marijuana, Use Other Drugs, or Drink Alcohol.

The existence of a positive drug result in the case record does not automatically exclude a parent from visiting with the child or attending a FGDM. The caseworker needs to weigh the benefits of the visit or attendance when confronted with a positive drug reading in the case record.

If the child will not be in danger, the visit or participation may be allowed.
1924.4 The Court Testimony of the Medical Review Officer

CPS June 2010

Because of the high costs, testimony provided by technicians, medical review officers (MRO), or other personnel employed by drug testing facilities is reserved for extreme circumstances; for example, parental termination hearings in substitute care cases when a judge requires testimony in person.

Alternatives to consider before requesting court room testimony from a representative of a drug testing laboratory include:

  •  depositions at locations near the drug testing laboratory; and

  •  testimony provided via teleconference.

If DFPS concludes that court room testimony is necessary from a representative of a drug testing laboratory, the DFPS region requiring the testimony:

  •  negotiates payment rates;

  •  negotiates travel expenses;

  •  renders payment for court-related services; and

  •  renders payment for testimony provided by a representative of a drug-testing laboratory.



https://www.dfps.state.tx.us/handbooks/CPS/Files/CPS_pg_1923.asp

Arizona Child Abuse Laws

criminalize physical, emotional, or sexual abuse of minors and also require certain third parties with knowledge of the abuse to report it to the authorities. In Arizona, professionals with access to children (such as teachers and pediatricians) are required to report suspected cases of child abuse. The Arizona Department of Child Safety (DCS) investigates reports of child abuse (and neglect) in the state.

According to the Arizona DCS child abuse and neglect can occur in different forms, including:

Physical abuse -- non-accidental physical injuries such as bruises, broken bones, burns, cuts or other injuries. 
Sexual abuse -- when sex acts are performed with children. Using children in pornography, prostitution or other types of sexual activity is also sexual abuse. 
Neglect -- when children are not given necessary care for illness or injury; leaving young children unsupervised or alone, locked in or out of the house, or without adequate clothing, food, or shelter. Allowing children to live in a very dirty house which could be a health hazard may also qualify as neglect. 
Emotional abuse of a child -- severe anxiety, depression, withdrawal or improper aggressive behavior as diagnosed by a medical doctor or psychologist, and caused by the acts or omissions of the parent or caretaker. • Exploitation -- use of a child by a parent, guardian or custodian for material gain.Abandonment -- the failure of the parent to provide reasonable support and to maintain regular contact with the child, including providing normal supervision, when such failure is intentional and continues for an indefinite period.




Code Section13-3620, 8-201What Constitutes AbuseInfliction or allowing of physical injury, impairment of bodily function or disfigurement, serious emotional damage diagnosed by a doctor or psychologist, and as evidenced by severe anxiety, depression, withdrawal, or aggressive behavior caused by acts or omissions of individual having care and custody of childMandatory Reporting Required ByPhysician, resident, dentist, chiropractor, medical examiner, nurse, psychologist, social worker, school personnel, peace officer, parent, counselor, clergyman/priestBasis of Report of Abuse/neglectObservation or examination of child discloses reasonable grounds to believe minor is a victim of injury or abuseTo Whom ReportedTo peace officer or child protective services of the department of economic securityPenalty for Failure to Report or False ReportingClass 1 misdemeanor

Note: State laws are constantly changing --contact an Arizona criminal defense attorneyor conduct your own legal research to verify the state law(s) you are researching.


http://statelaws.findlaw.com/arizona-law/arizona-child-abuse-laws.html