A grandiose sense of self-importance. The only exercise I get is running after my kids, she told me. When do I have time to do anything else? Michelle told me that she had gained 40 pounds since she started having children. Feeling horrible about the way she looked, she skipped meals whenever she could. She almost never had breakfast, shared a peanut-butter-and-jelly sandwich on white bread with her toddler for lunch, and usually made a big, starchy family dinner. She wanted to provide good food for her family, but she also needed to stretch the budget as far as possible. After a stressful day, Michelle usually found it impossible to resist joining her husband in eating cake, cookies, and ice cream after dinner. Like most young mothers, Michelle was leading a fairly high-stress life. She worked a few afternoons a week at her local post office, leaving her children with her sister. She was also active in her church. Whatever sensations you may feel, let go of them. Let go of any attempts to control the mind. Breath by breath, forgive others. Forgive those from the past as well as those who are still around you. Forgive yourself. Accept others for what they are. Accept yourself totally. Let go and let be. Fly free.

Soar in the freedom of desirelessness. The narcissist exaggerates their achievements and talents and expects others to recognize them as superior without anything to support that belief. A preoccupation with fantasy ideals. The narcissist's fantasies revolve around unlimited success, power, brilliance, beauty, or ideal love. A belief that they are special. Narcissists believe that they have some unique and intrinsic quality apart from others, and often that they can only be understood by, or should associate with, other special or high-status people (or institutions). A need for admiration. For the narcissist, excessive admiration is necessary since it supports the mythology that they have developed. A sense of entitlement. The narcissist harbors unreasonable expectations of favorable treatment or automatic compliance with their wishes and expectations. A tendency toward interpersonal exploitation. Her husband worked two jobs so she saw very little of him--usually just a rushed dinner and maybe a hectic weekend morning. Michelle felt that she had very little time for anything fun, including sex with her husband--which I used to enjoy! she said with a sigh. I had a working hypothesis about what might be going on with Michelle's hormones, but of course I couldn't be sure without more information. So I gave her a saliva test that measured the stress hormones produced by her adrenals--a take-home test requiring her to take samples at four points during the day: morning, midday, evening, and bedtime. I also gave Michelle a blood test to evaluate her insulin levels after she had fasted for 12 hours. Then I had her eat a very sweet, starchy meal (I usually suggest pancakes with syrup) and took a second blood test two hours later. Looking at the two levels would give me more information about whether Michelle was insulin resistant. In addition, I checked Michelle's levels of thyroid hormone, which regulates metabolism.

I sometimes run a blood test to evaluate sex hormone levels as well, looking at estrogen levels on day 3 of a woman's cycle and at progesterone levels on day 25. If you eat with others who are not eating mindfully, you can still stop every once in a while and look around, breathe, and smile. Remember: most of the time, you are probably more hungry for breath than you are for food. Train yourself to breathe in and out, focusing on stopping or pausing. Breathing in and out during eating trains yourself to eat more mindfully while filling your body with oxygen. It makes the entire eating process much more enjoyable, satisfying, and peaceful. Be grateful for the elements of the meal and for where they came from. Be grateful you have food and are sharing it with others. When you simplify your communications by eliminating the irrelevant, you infuse what you do communicate with greater importance, dignity, and intention. Before you speak, remind yourself to express dignity and respect. Lying down in bed in deep relaxation mediation, as you breathe in and out, become aware of your whole body letting go. The narcissist tends to take advantage of others in order to achieve his or her own ends. A lack of empathy. The narcissist is unwilling to recognize or identify with the feelings and needs of others. A sense of envy. The narcissist tends to be envious of others and/or believes others are envious of them. An arrogant pattern of behavior. The narcissist tends toward behavior and/or attitudes that are arrogant, domineering, and contemptuous. Will someone diagnosed with narcissistic personality disorder automatically become an abuser? No.

As stated earlier, they fall somewhere on a spectrum of behavior. Alternatively, I might do a saliva test for sex hormones on day 25. Either way, I also make sure to test for DHEA and testosterone, as well as the levels of sex hormone binding globulin (SHBG), a carrier protein in the blood that binds to testosterone and estrogen. If your SHBG is high, you don't have access to your testosterone or estrogen even if absolute levels of those hormones are high, so I want to check that out as well. Finally, I gave Michelle a urine test to measure her neurotransmitters, which help determine mood, mental focus, and energy. Together these tests gave me a snapshot of what was going on with Michelle's stress hormones, thyroid hormone, sex hormones, and neurotransmitters. As I had suspected, they were all significantly out of balance. stress hormones are at the root of just about every type of problem with PMS, periods, and perimenopause, as well as having a significant effect on the hormonal issues of endometriosis, fibroids, PCOS, and premature ovarian failure. As I had suspected, Michelle's stress hormones were significantly out of balance. hormones are supposed to be at their highest levels when you wake up in the morning--in fact, they actually wake you up--and then gradually taper off during the day. But Michelle's hormones were low in the morning and high in the evening. Relax more with each natural breath in and out. Feel all the areas of your body that are touching the bed you are lying on. With each out-breath, feel yourself sink deeper and deeper into the surface, letting go of tension and worries, not holding on to anything. Send your love and compassion to your whole body. Feel gratitude for all the cells in your body. The oxygen from each in breath is nourishing them. Concentrate on quieting the breath, focusing on its rhythm. You will develop a natural, relaxing rhythm that will follow you to sleep. Persistence and diligence almost always pay off.

Artists know that diligence counts as much, if not more, as inspiration. However, as the examples above demonstrate, narcissists that meet these criteria are quite capable of extreme abuse. This can lead to what is called narcissistic abuse syndrome in the people close to them, including family members, spouses, lovers, employees, and coworkers. While the list of traits found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) is comprehensive, there are other ways of telling whether or not you are dealing with a narcissist simply by the way they interact with you. Listen to Their Stories One of the ways we open up to the people in our lives is through the telling of stories. We share our adventures in love and business, the tales of our childhood, our parents, trips taken, and our college days, all the things that had a deep impact on who we are and who we strive to be. These stories help to establish intimacy. While it's not unusual to want to emphasize the positive in all of these stories, when a narcissist tells their stories, they take on a different and often telling caste. The hallmark of true intimacy is honesty. Without it, intimacy is false because you don't really know who you are with. Furthermore, these out-of-balance stress hormones were playing havoc with the rest of her hormones. For example, Michelle's thyroid tested on the low end of normal (remember, thyroid function can be disrupted by imbalanced levels of cortisol and adrenaline). Most conventional practitioners might not have considered that score a problem, but I thought that low thyroid might be slowing Michelle's metabolism, contributing to her weight gain and occasional low mood. As happens with so many young mothers, Michelle's life was one long round of obligations, demands, tasks, and deadlines. Another key piece of the puzzle was insulin. Michelle's blood tests suggested that she was suffering from insulin resistance, a condition that can result from excess consumption of carbohydrates: grains and flour, sugar and sweetened foods, starchy vegetables, and fruits. When insulin can no longer move sugar into the cells, the insulin level in the blood rises. This creates a host of health problems, disrupting both the stress hormones and the estrogen-progesterone balance. Michelle's diet contributed to insulin resistance in two ways.