TIME mental health

How Do You Spot a Narcissist? Just Ask

Like the view? The original Narcissus and his BFF
Like the view? The original Narcissus and his BFF John William Waterhouse; Getty Images/The Bridgeman Art Library

It's not easy to diagnose most personality disorders. But narcissism is a snap—since the narcissists themselves know who they are

Narcissus got a bad rap. Sure, the guy was self-absorbed—what with all that staring at his own reflection in a stream. But once he fell in and drowned, well, lesson learned, and he wasn’t around to cause anyone else any grief. But the modern-day people who suffer from the disorder named after him? They’re a whole different matter.

Narcissists are alternately preening, entitled, aggressive, greedy, insensitive, vain, unfaithful, dishonest, lethally charming (a charm you buy at your peril) and sexually exploitative. They may represent merely 1% to 3% of the general population—but that’s only full-blown, capital-N narcissism, the kind formally known as narcissistic personality disorder. There are plenty of other people with lowercase, sub-clinical cases of the condition who can do all kinds of damage—and the odds are very, very good there are at least a few in your life.

How can you learn to recognize a narcissist at a glance? Easy, suggests a new study published in PLOS ONE: Just ask them.

Narcissism is typically diagnosed with a 40-item questionnaire known as the Narcissistic Personality Inventory, or NPI. (Take it here.) The NPI is a so-called forced choice test, one that asks people to choose between two generally contradictory statements such as “I prefer to blend in with the crowd” and “I like to be the center of attention,” or “I like to have authority over other people” and “I don’t mind following orders.” In many cases, both qualities may apply—it’s entirely possible to like to be the boss and to accept another person’s authority as well. But the “forced” part of “forced choice” means you must pick the quality that more closely describes you.

The lowest you can score on the NPI is a zero, the highest is a 40. Average in the U.S. is between 15 and 16, depending on age, gender and other variables.

The problem with the NPI is it’s time-consuming and inconvenient—hardly the kind of thing you can administer on a first date to find out if you’re getting mixed up with a charming louse before you accept a second date. But a team headed by psychologist Sara Konrath of the University of Michigan suspected that in some cases it might be possible to go at things more directly, asking people one carefully phrased written question:

“To what extent do you agree with this statement: ‘I am a narcissist.’ (Note: The word ‘narcissist’ means egotistical, self-focused, and vain.)” The parenthetical was included to ensure that all participants in the study were working from the same definition. They were then asked to rate themselves on a 1 to 7 scale, with 1 meaning “Not very true of me” and 7 meaning “very true of me.”

To a remarkable, statistically significant extent, the scores on this Single Item Narcissism Scale (SINS) correlated with the subjects’ scores on the more-complex NPI. Even with those results in hand, the researchers wanted to probe further, so they also tested their subjects on ten other personality metrics such as extraversion, agreeableness, aggression, sexual adventurousness, entitlement and more—all of which are either direct or inverse indicators of the narcissistic personality. Here too, the results lined up tidily.

The reason narcissists are so honest—a lot more honest than you’d be if someone asked you, say, “Are you a sociopath?”—is because they just don’t think their narcissism is a problem, which is perfectly consistent with people who think so highly of themselves. “Narcissists have these great mental health outcomes,” Konrath told me when I was researching my upcoming book The Narcissist Next Door. “If you’re trying to think of a group of people who are low in depression and anxiety, high in creativity and accomplishment, that’s narcissists.”

That, by itself, doesn’t sound bad at all. But narcissists often possess those good qualities to the general exclusion of others—especially social and relationship skills, a shortcoming that can hurt both them and those around them. Indeed, one of the metrics Konrath’s group looked at was whether the subjects rated primal rewards—such as a favorite food—higher than social rewards, such as seeing a friend. The friendship thing just doesn’t mean much to someone in the grip of narcissism.

“If you told a narcissist he’s not good in interpersonal relationships, he wouldn’t be any more upset than anyone else,” said Ohio State University psychologist Brad Bushman, another participant in the study, whom I also interviewed for my book. “But if you tell them they’re not smart, they get angry.”

All of this—the fragile ego, the tenuous human ties, the overweening self-regard–inevitably comes crashing down, even if less calamitously than it did for the proto-Narcissus. It’s for the narcissists themselves to recognize the dangers in the condition to which they admit so readily. And it’s for everyone else to get out of the way while they’re figuring it out.

TIME Health Care

Obamacare Leads to Surge in Mental-Health Treatment

A provision means more mentally ill young people are getting medical treatment

A provision in the health care reform law allowing parents to keep their adult children on their health-insurance plans has led to millions more young people with mental-health and substance-abuse problems getting treatment, according to a new study.

Between September 2010, when the Obamacare provision went into effect, and 2012, when the study ended, young adults between the ages of 18 and 25 who had already screened positive for mental disorders or substance abuse increased their use of mental-health treatment by 5.3% compared with a similar group of 26- to 35-year-olds who weren’t eligible for their parents’ coverage. Researchers in the study, published Monday in Health Affairs, also found that due to that same Obamacare provision, the number of mental-health visits the younger group had to pay for out-of-pocket declined by 12.4% compared with the older group.

This could be good news not only for young adults with mental-health issues, but also for their friends, families, neighbors, and parents, who often suffer most directly when their mentally ill or addicted loved ones are unable to access affordable treatment.

The findings are related to the fact that uninsured people, as well as those with bare-bones insurance plans, often rely on “community clinics and other safety net providers” for emergency mental-health treatment. They therefore have trouble affording specialized or residential treatment, or accessing individualized psychotherapy. In contrast, young adults who are able to remain on their parents’ plans often have access to a more generous range of treatment options, according to the study.

The research, which was funded by the Robert Wood Johnson Foundation, comes with a few caveats, one of which is that the study period was relatively short and spanned the financial crisis, which hit young people disproportionately hard. It’s possible that during that period, young people may have been more likely to seek mental-health treatment. The research was conducted by Brendan Saloner, an assistant professor at the Johns Hopkins Bloomberg Schools of Public Health, as well as Benjamin Le Cook, a senior scientist and assistant professor of psychiatry at the Cambridge Health Alliance and Harvard Medical School.

TIME Mental Health/Psychology

This Is the Equation for Happiness

Researchers accurately predict people's happiness

Researchers at University College London were able to create an equation that could accurately predict the happiness of over 18,000 people, according to a new study.

First, the researchers had 26 participants complete decisionmaking tasks in which their choices either led to monetary gains or losses. The researchers used fMRI imaging to measure their brain activity, and asked them repeatedly, “How happy are you now?” Based on the data the researchers gathered from the first experiment, they created a model that linked self-reported happiness to recent rewards and expectations.

Here’s what the equation looks like:

Robb Rutledge, UCL

Then, in their study published Monday in the Proceedings of the National Academy of Sciences, the researchers tested their model by having 18,420 people play a smartphone game called The Great Brain Experiment for points. They found that their equation was also accurate at predicting the gamers’ happiness.

The researchers were not surprised by how much rewards influenced happiness, but they were surprised by how much expectations could. The researchers say their findings do support the theory that if you have low expectations, you can never be disappointed, but they also found that the positive expectations you have for something—like going to your favorite restaurant with a friend—is a large part of what develops your happiness.

The fact that the researchers could accurately predict happiness was notable, but the implications are even better. Having a predictable standard for how people respond to moment-to-moment gains and losses could actually make mood disorders easier to understand by learning how someone with a mood disorder differs in their reactions to events.

TIME Crime

Slender Man Stabbing Suspect Deemed Incompetent for Trial

Enthusiasts Enjoy Comic Con As It Opens In London
Yasmin Ouard poses as Slenderman from the series Mobile Hornets ahead of the MCM London Comic Con Expo Dan Kitwood—Getty Images

A 12-year-old suspect in the stabbing linked to the fictional online character reportedly believes she has Vulcan Mind control

A Wisconsin circuit court judge ruled Friday that one of the two 12-year old girls charged with stabbing a classmate in Wisconsin is incompetent to stand trial for attempted homicide.

This May, two girls allegedly stabbed their classmate during a sleepover to prove their loyalty to the popular online fictional character Slender Man. The creepy figure has been linked to three separate acts of violence, according to ABC News.

Wisconsin law requires any person age 10 and over to be charged as an adult for severe crimes. In this case, the victim was allegedly stabbed 19 times in a nearby woods, with the blade narrowly missing an main artery near her heart. She managed to crawl out of the woods and was found by a passing biker.

Psychologist Brooke Lundbohm of the Wisconsin Forensic Unit analyzed the suspect in question this June. According to the Journal Sentinal, Lundbohm said the 12-year old claimed she could hear and see things like unicorns, the Slender Man and the Harry Potter character Voldemort. Psychiatrist Kenneth Robbins testified that the suspect believes she has Vulcan mind control and is more concerned with angering Slender Man than the prospect of a long prison sentence.

The defendant’s attorneys hope to move the case from adult to juvenile court, where the maximum sentence would be 25 years.

[Journal-Sentinal]

TIME behavior

This Blood Test Can Predict Suicide Risk, Scientists Say

Researchers report encouraging advances toward a blood test that can pick up genetic changes linked to suicide

Behaviors can’t be reduced to your genes – they’re far too complicated for that. But genes can lay the foundation for making people more or less likely to respond and act in certain ways, and suicide may be the latest example of that.

In a paper published in the American Journal of Psychiatry, researchers led by Zachary Kaminsky, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, found reliable differences in the activity of a specific gene among those who had committed suicide and those who had not. They conducted a series of tests to verify their result. First, they studied brain samples of mentally ill people and those not affected by mental illness, and revealed that a gene, SKA2—which is most abundant in the prefrontal regions of the brain that are involved in inhibiting negative thoughts and corralling impulses—was less active among those who ended up committing suicide than among those who had not. If there isn’t enough of SKA2, or if it isn’t working properly, then receptors that pull the stress hormone cortisol into cells to put a brake on the stress response also don’t work. That can lead to unchecked negative thoughts and impulsive behaviors, like a runaway car without brakes.

MORE: U.S. Special Ops Are Soldiers Committing Suicide in Record Numbers

The scientists also compared amounts of SKA2 among people with suicidal thoughts or those who had already attempted to kill themselves. Based on levels of the gene’s products in the blood, they could predict with 80% to 90% accuracy whether a particular participant had had suicidal thoughts or had tried to commit suicide.

The differences Kaminsky and his colleagues found isn’t a genetic mutation, but a change in how active the SKA2 gene is. Environmental exposures and life experiences can affect how and when genes are turned on or off. That’s what is happening with SKA2 in those who commit suicide; their gene is inhibited from doing its job of controlling their stress response and modulating it properly.

The work is just the first step in potentially developing a blood test for identifying people at highest risk of harming themselves, says Kaminsky. “We are not going to recommend screening everybody,” he says. “I don’t think that makes sense.” But among those at high risk of suicide, knowing that they also have a possible genetic tendency to react negatively to stress may help to them to get consistent support and more aggressive mental health services to help them cope with their stress and avoid more tragic outcomes.

TIME Mental Health/Psychology

The Part of Your Brain That Senses Dread Has Been Discovered

This tiny part of your brain tracks bad experiences

A tiny part of the brain can keep track of your expectations about negative experiences—and predict when you will react to an event—researchers at University College London say.

The brain structure, known as the habenula, activates in response to negative events such as electric shocks, and they may help people learn from bad experiences.

The findings, published in Proceedings of the National Academy of Sciences, marks the first time this association has been proven in humans. Earlier studies showed that the habenula causes animals to avoid negative stimuli by suppressing dopamine, a brain chemical that drives motivation.

In this study, investigators showed 23 people random sequences of pictures followed by a set of good or bad outcomes (an electric shock, losing money, winning money, or neutral). The volunteers were asked to occasionally press a button to show they were paying attention, and researchers scanned their brains for habenula activity using a functional magnetic resonance imaging (fMRI) scanner. Images were taken at high resolution because the habenula is so small—half the size of a pea.

When people saw pictures associated with painful electric shocks, the habenula activated, while it did not for pictures that predicted winning money.

“Fascinatingly, people were slower to press the button when the picture was associated with getting shocked, even though their response had no bearing on the outcome,” lead author Rebecca Lawson from the University College London Institute of Cognitive Neuroscience, said in a statement. “Furthermore, the slower people responded, the more reliably their habenula tracked associations with shocks. This demonstrates a crucial link between the habenula and motivated behavior, which may be the result of dopamine suppression.”

The study also showed that the habenula responds more the worse an experience is predicted to be. For example, researchers said the habenula responds much more strongly when an electric shock is certain than when it is unlikely to happen. This means that your brain can tell how bad an event will be before it occurs.

The habenula has been linked to depression, and this study shows how it could play a part in symptoms such low motivation, focusing on negative experiences and pessimism in general. Researchers said that understanding the habenula could potentially help them develop new ways of treating depression.

TIME politics

Montana Senator’s Plagiarism Scandal Has a Silver Lining

John Walsh
Sen. John Walsh, D-Mont., speaks during an event in the Capitol Visitor Center on the importance of the Land and Water Conservation Fund, July 23, 2014. Tom Williams—CQ-Roll Call,Inc.

Sen. Walsh's mental health may have nothing to do with lifting from other scholars, but the acknowledgement of PTSD and depression reveals a changing moment in politics.

Sen. John Walsh (D – Montana) is being accused of plagiarism for failing to properly cite the work of others in the master’s thesis he wrote while at the Army War College in 2007. Indeed, it has been widely reported that as much as a quarter of what the senator wrote—and presented as his own work—may have been the ideas and/or words of other prominent experts on Middle East policy.

When asked about this apparent transgression, Sen. Walsh stated that he believed he had done nothing wrong. He didn’t recall using sources improperly, but he is considering apologizing to scholars he failed to cite. A campaign aide for the senator acknowledged the plagiarism, but indicated that Sen. Walsh did not intend to deceive anyone and that his actions should be viewed in the context of a successful military career during which he was a highly decorated officer who served with distinction in the Montana National Guard. The aide noted that Sen. Walsh was going through a difficult period in 2007. One of the soldiers from his unit in Iraq had committed suicide during this time. The senator has acknowledged that he is being treated for post-traumatic stress disorder. He is currently taking antidepressant medication as part of this treatment.

We can’t know what Sen. Walsh intended when he failed to include citations for ideas that were not his when he wrote his thesis seven years ago. One indication of whether this act represents a flaw in the senator’s character, a lapse in judgment, or a failure to understand academic standards and practices is to look for a similar pattern of behavior—or lack thereof—across his life and career. Those on both sides of the political spectrum will be doing just that as this story unfolds.

Some are asking if there is a relationship between PTSD and plagiarism. There is none—at least not a direct one. There is, however, a clear relationship between the experience of trauma and possible impairment across a number of areas, including cognitive and emotional functioning. The relationship is even stronger if you experience repeated trauma. Imagine driving to work and having a head-on collision on the highway. Miraculously you walk away with no physical injuries, but others around you die. Imagine that this happens to you not once but several times over the course of several months or a year. You begin to have difficulty sleeping, concentrating and focusing. You might feel depressed, you might have flashbacks, and you most certainly will have guilt and possibly shame. Could this experience of repeated trauma affect your judgment or your ability to process information critical to your success in your relationships, at school, or in your career? Absolutely.

Though the consequences – if any – of Sen. Walsh’s actions in 2007 are yet to be determined, it is important that we continue to have conversations and discussions about the very real impact that trauma can have on someone’s long-term functioning. We need these discussions not because we should excuse behavior that is inappropriate, unethical or criminal, but because one in four Americans suffer from diagnosable mental health conditions, along with the trauma that often creates those conditions. Sometimes war causes these injuries, sometimes a natural disaster, or a rape, or an assault. Sometimes it is a bad role of the genetic dice that leads to significant impairment. Isn’t it better to discuss these issues openly and, by doing so, encourage appropriate care and relieve unnecessary suffering?

Perhaps one silver lining resulting from the last 13 years of war—and many tragic stories of those who have struggled upon their return from battle—is that we as a nation are becoming a bit more comfortable with the topic of mental health. Until now, few if any politicians or other public or military officials have been willing to admit they have a mental health issue, let alone suggest it may have clouded their judgment. Perhaps we are more willing to entertain the possibility that the cause of someone’s behavior just might be a bit more complicated than we think. After all, mental health is a part of the human condition. We all experience it, and sometimes the difference between being mentally sharp and healthy or not depends on whether we swerve the wrong way, are born with the wrong DNA or watch a buddy die in combat.

Barbara Van Dahlen, named to the TIME 100 in 2012, is a licensed clinical psychologist and the founder and president of Give an Hour. A notable expert on the psychological impact of war on troops and families, Dr. Van Dahlen has become a thought leader in mobilizing civilian constituencies in support of active duty service members, veterans and their families.

TIME neuroscience

A ‘High’ From Marijuana Is Really the Opposite in Your Brain

Daily Life In South Africa
A youth smokes marijuana in Soweto township, near Johannesburg, on July 2, 2013 Christopher Furlong—Getty Images

Marijuana dulls your response to dopamine

A new study suggests marijuana blunts the brain’s reaction to dopamine, making users less responsive to the chemical responsible for feelings of reward and pleasure.

In the study published Monday in the journal Proceedings of the National Academy of Sciences, the researchers studied the brains of 24 marijuana abusers — that is, people who smoked multiple times a day — and how they reacted to methylphenidate, a stimulant often used to treat ADHD and narcolepsy. Using personality tests and brain imaging, the researchers found the pot users had blunted behavioral, cardiovascular and brain responses to methylphenidate compared with control participants. Marijuana abusers scored lower on tests of positive emotional activity and higher on negative emotional reactions.

The researchers believe that pot not only dampens the brains’ dopamine reaction to stimulants but also influences the area of the brain involved in reward processing. The participants had lower reward sensitivity, higher levels of irritability, and likely more depression and anxiety.

The researchers conclude that the way pot interferes with the brain may contribute to drug cravings. And that a “high” is really the opposite in the brain.

TIME Research

Women More Likely Than Men to Seek Mental Health Help, Study Finds

And women seek help earlier

Women with chronic physical illnesses are 10% more likely to seek support for mental health issues than men with similar illnesses, according to a new study.

The study from St. Michael’s Hospital and the Institute for Clinical Evaluative Science also found that women tend to seek out mental health services months earlier than men. Researchers looked at people diagnosed with at least one of four illnesses: diabetes, high blood pressure, asthma or chronic obstructive pulmonary disease.

Of people diagnosed with these conditions, women were not only more likely than men to seek mental health services, but they also used medical services for mental health treatment six months earlier than men in any three-year period.

For the purposes of the study, “mental health services” were defined as one visit to a physician or specialist for mental health reasons, such as depression, anxiety, smoking addiction or marital difficulties.

“Our results don’t necessarily mean that more focus should be paid to women, however,” study author Flora Matheson, a scientist in the hospital’s Centre for Research on Inner City Health, said. “We still need more research to understand why this gender divide exists.”

The findings, published in the British Medical Journal’s Journal of Epidemiology & Community Health, could suggest various conclusions about the way that different sexes use mental health services. It may mean that women feel more comfortable seeking mental health support than men or that men delay seeking support. The study could also imply that symptoms are worse among women, which would encourage more women to seek help and to do so sooner.

“Chronic physical illness can lead to depression,” Matheson said. “We want to better understand who will seek mental health services when diagnosed with a chronic physical illness so we can best help those who need care.”

MONEY Kids and Money

How to Get a Grip on Your Child’s Therapy Bills

Parent and journalist Beth Pinsker explains how to get your kid the mental health treatment he or she needs without breaking the bank.

When I signed up my kids for therapy after my divorce, I made some financial mistakes. The biggest was choosing an out-of-network provider, over one who takes my insurance.

Instead of a simple $20 co-pay, I spent $150 out of pocket and get 70 percent of it reimbursed, which works out to about $1,000 more over a school year. In contrast, I have a friend whose child’s therapy sessions require no co-pays at all.

In this way, mental health coverage has a lot in common with airline pricing, where seats on the same plane may sell at many different price points.

Overall, Americans spend about $2,100 per child for healthcare, according to the Health Care Cost Institute’s report for 2007-2010. During that period, HCCI says, the use of mental health services by children jumped 24 percent.

At the same time, nearly half of all psychiatrists no longer take insurance, according to JAMA Psychiatry, with a similar portion of psychologists now only accepting private payment.

Add to that an overall shortage of providers – there are 8,700 child and adolescent psychiatrists, compared to about 50,000 for adults, according to Dr. Paramjit Joshi, division chief of psychiatry and psychology at Children’s National Health System – and you have a supply and demand problem that makes cost a real issue for parents.

Stay in-network

Finding a provider in your area may be easy enough, but finding one whose availability suits your child’s schedule could be downright impossible.

That’s why I went the private-pay route. My area of Brooklyn has no shortage of doctors on my plan, but after calling a dozen and finding that an after-school slot would entail a months-long wait, I went with a personal recommendation.

To avoid the appointment runaround, lean on your plan’s customer service department to make calls for you, says Dr. Ian Shaffer, executive medical director for behavioral health for Healthfirst, a New York health plan.

Need a therapist with a specialty? You may be able to get that provider covered if you ask, Shaffer says.

He cited a case where the family wanted a therapist who shared their ethnic heritage, and had been recommended someone who charged an eye-popping $350 a visit. Healthfirst found them another therapist with the same credentials, and covered the visits.

Reduce co-pays

My friend with the zero co-pay has insurance through the state’s child health plan, but enrolment in the plan is possible only if you don’t have access to other coverage.

Most people who are on health plans through their workplace don’t have payment wiggle room, but you can ask individual providers what they can do to help, especially if you have a high deductible.

Many private-pay therapists have sliding scales based on income; others have lower fees if you work with a trainee. Since the latter are supervised grad students, “it’s like getting two doctors for the price of one, says Clair Mellenthin, director of child and adolescent services at Wasatch Family Therapy in Salt Lake City, Utah.

Also check state resources to help pay for therapy, especially if treatment is needed for some kind of trauma following a crime. Many states have victim funds, says Mellenthin.

Mark progress

Therapy can seem like an endless process, so parents need to make sure it’s staying on track, says Mitchell Prinstein, a professor of psychology at the University of North Carolina at Chapel Hill.

After the initial evaluation, make sure you have a clear treatment plan and markers to help you figure out if your child is making progress. If there’s little improvement, get a second opinion, Prinstein says. And don’t feel bad about moving on if the therapist is not the right fit.

Fight for your rights

For ongoing treatment, it’s important to make sure the insurance company is not crimping your coverage.

Even though parity clauses in the new healthcare laws say you should get as many sessions as you need, that’s not always the case.

After a while, insurers may start saying the sessions are no longer medically necessary. This is especially true if your child has a serious ongoing problem, says Alan Nessman, senior special counsel for the American Psychological Association.

Any denial of coverage can be costly.

Joe Hoyle’s bill for one month of his daughter’s treatment for a serious illness was $125,000 after his insurance company denied the claim (he negotiated a lower payment with the hospital directly). To obtain ongoing coverage, Hoyle and his wife, who live in Virginia, got her on Medicaid.

“They say they cover things, but then they get to decide when things are ‘stable,'” he says.

Hoyle urges parents to get care early for their children to try to head off bigger problems.

“You can go along for 10 or 12 years and think your kid is just quirky, then almost literally overnight, it can go to full-blown mental illness,” he says. “You hate to talk about it, but people need to know because state governments need to do more to help people out.”

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