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While some of these feelings may seem overwhelming buy generic sinequan 75 mg on-line anxiety 18 weeks pregnant, they are all "normal" reactions and are necessary to the process of healing so that we can eventually move on and engage in other relationships buy cheap sinequan 10 mg online anxiety symptoms 3 weeks. It may also help to talk your feelings over with someone order discount sinequan on-line anxiety knot in stomach. Speaking with a counselor or therapist can often give us perspective sinequan 75 mg otc anxiety jacket for dogs. This article explains the feelings surrounding a relationship breakup and how you can effectively deal with the end of a marriage or relationship. Loss can occur when:someone important to us dies;Loss is not a feeling. It is an event that may induce positive or negative feelings - or both. The negative: rejection, confusion, frustration, anger, rage, fury, regret, shame, hurt, remorse, sadness, depression, melancholy, desperation, anxiety, fear, betrayal, humiliation, bitterness, alienation, insecurity, loneliness, self blame, grief? The positive: relief, contentment, lightness, refreshment, aliveness, hopefulness, optimism, peace? Loss will descend on you like a wave then recede until next time. Each wave will pass and each wave helps diminish the pain. If what you are doing feels wrong or right it probably is. Even though you still feel terrible, persist in what seems right and reconsider what seems wrong. The process is made smoother if you:Accept pain is normal... Make an active decision to do something - as reluctant as you might feel (e. Browse the bookstores till you find something that seems to talk to you. Or, better yet because it is free, go to the council library. Go through the motions if necessary but avoid withdrawing entirely from the world. Distractions are okay if they do not become avoidance of the pain. Then you have to make an active decision to do something? This is not easy but sometimes its easier to act your way into positive feelings than it is to feel your way into acting positive. Beginning a new relationship before healing after the end of an old one can often lead to even more remorse and pain. Temporary distractions are fine - you do have to move on - but be careful about using other people to avoid your pain. Try to see being single as an opportunity not a life sentence. By doing this, you are beginning to assume control - not being controlled. You might choose to:Talk about what is going on with a close friend, with a counselor, with yourself. Spend time alone - Important: This is a positive, active choice not to be done when you are utterly depressed (that is when you should seek out someone to talk to). Meditate - focus on your physical feelings - identify your emotions. Rituals - using symbols in rituals can be a powerful way to let go. Rituals can mark the last stage of recovery and the first step forward. Gather together items that represent something about your relationship (letters, photos, jewelry, a book, a record. Write a "Goodbye Letter" - write to your ex and express all that you feel now. If you still feel it would be helpful to send it, do so. Preferably burn it or bury it as part of your ritual closure. Visit a place of significance to your relationship to mentally say "Goodbye. You need to replace the emptiness with positive experiences. Emptiness reminds you of the loss - go walking, jogging, bushwalking, surfing, try cooking classes, meet with friends, catch a movie, go to the museum, join a drama group. Slowly start returning to some things you have probably neglected for a while. Eventually you might discover you are looking forward to the future and not running from the past. However, if you are stuEnding a relationship can be emotional painful and hard to accept. Find out what you can do to cope with a relationship breakup. When you have been in a meaningful relationship, you and your partner have usually made an investment in the relationship and in each other. When your partner decides that the relationship is no longer working for them, that they would rather be with someone else or with no-one at all, it can be very a difficult time. Negotiating - if I do this, my partner will come back, "I promise to... People often go through a range of strong feelings, and have a lot of confusing thoughts. It is as if the jigsaw that was your life has been thrown up in the air and one significant piece is missing. Now you have to readjust and create a new life and it takes a while for the pieces to land and fit together again. Cry, punch the pillow, talk out loud, and do what you need to do. You have "lost" something important and tears are an important way for men and women to express their sorrow.
He does not normally do long term individual therapy which he believes can sometimes foster dependence buy sinequan no prescription anxiety symptoms for years. The purpose of his work is helping people to access their own Spirit so that they can learn to depend on order sinequan 10 mg anxiety symptoms wikipedia, and trust themselves sinequan 75mg with visa anxiety symptoms everyday. He specializes in small groups (maximum 4 people) which focus on changing the core relationship with self purchase 75 mg sinequan visa anxiety 12 year old boy. These consciousness expanding process groups are designed to help people on a Spiritual Path become more aligned with the healing process so that life can become an easier, more enjoyable experience. During the course of the group process individuals learn how to: get in touch with and release childhood grief which allows emotional honesty with self; get intimately in touch with both the inner child (inner children) and Higher Self; have internal boundaries, as well as external boundaries, in order to stop being at war within and start developing a more Loving relationship with self. The following paragraphs from one of his pamphlets exemplifies both the philosophy and goal of his therapeutic work:"Learn how to integrate Spiritual Truth and intellectual knowledge of healthy behavior into your experience of life and find some balance in your relationships. Knowing Spiritual Truth intellectually will not make your fear of intimacy disappear or relieve you of the shame you feel deep within. Integrating Spiritual Truth into your day-to-day life process and emotional reactions is what will set you free. It is possible to feel the feelings without being the victim of them. It is possible to change the way you think so that your mind is no longer your worst enemy. It is possible to become empowered to have choices in life at the same time you are letting go of trying to be in control. Life can be an exciting, enjoyable adventure if you stop reacting to it out of your childhood emotional wounds and attitudes. His childhood from all outside appearances was an idyllic, middle class, Norman Rockwell, all-American upbringing with both parents present and no overt dysfunction. He participated in 4-H and little league baseball and in sports, theater, and student government in high school. He became very interested in politics through the influence of his grandfather who was a long-time Lieutenant Governor and, due to the death of his predecessor, for several months Governor of Nebraska. In that freshman year, he became very involved in theater and through the influence of a dynamic French teacher made plans to study at The Sorbonne in Paris his sophomore year. There he continued his activism for a while, even serving as a delegate to the state Democratic convention, but after the trauma of 1968 with assassinations, riots, and the election of Richard Nixon, he withdrew from activism and spent his remaining college days mostly drinking and partying. He was in Air Force ROTC because of a strong desire to fly (which he later realized was about his spiritual quest and not about planes) and because of the draft. Although he was opposed to the war in Viet Nam, his low number in the draft lottery convinced him to join the Air Force rather that be drafted into the army. Robert was commissioned as an Air force officer on the same day he received his Bachelor of Arts degree in Political Science. He entered Air Force pilots training and was flying solo in jet aircraft before being medically eliminated because of allergies. He was then assigned to an Intelligence wing where he held one of the highest security clearances available. After receiving an early discharge because of the de-escalation in Viet Nam, he entered graduate school. He got involved with the American Indian Movement in the spring of 1973 during their occupation of the village of Wounded Knee in South Dakota. He left graduate school and went to South Dakota to fly an air drop of supplies but the siege ended a few days after his arrival. He remained actively involved with AIM for the rest of that year and had an extensive FBI file compiled on him for his active participation in revolutionary activities against the government. During this time more than a dozen of the people he was closely involved with were killed or went to prison. It was only through divine intervention on several occasions that he survived to return to graduate school. He completed his Masters Degree and was then hired by the U. Civil Service as a Race Relations Orientations Specialist at Edwards Air Force Base in California (a little cosmic irony here. A brief sojourn in England rekindled his love of theater and he moved to Hollywood to pursue an acting career. Over the course of more than a decade pursuing an acting career, he got very few parts of any consequence but was able to play out fully the role of the suffering artist, a perfect expression for his own particular brand of Codependence which also gave ample opportunity for him to fully pursue personal research in the area of substance abuse. He played the role to the hilt in all areas of his life including earning a living by parking cars, driving cabs, and waiting tables. Acting provided an invaluable emotional outlet to explore and express feelings that would otherwise have been unacceptable according to his childhood training and experiences. The personal research of substance abuse almost killed him. Robert was introduced to Twelve Step programs through an intervention by his family on a trip home for the holidays. He started his Twelve Step Recovery in January of 1984 and remained in Nebraska for nine months. During this time he worked first in the family care section of the treatment program which he had gone through and then at a state mental hospital where he started to again utilize his training and skills in communication and counseling. He returned to Hollywood in the fall of 1984 convinced that his new found Spiritual path would facilitate his quest for an Oscar nomination. When that did not materialize in short order, he fled to South Lake Tahoe and went to work in the poker room at a casino. The Universe however had other plans for him and ended his career at the casino so that he could go to work for the Alcoholism Council of the Sierra Nevada. It was there that he started to realize and deal with how Codependent he was in his relationships with others. When funding for his position ended, Robert returned to Southern California and gave acting one last try. It was only a short time however before he went to work in a Chemical Dependence Treatment program in Pasadena. His work as a therapist there and at a subsequent treatment program facilitated and accelerated his personal recovery process. In the spring of 1988, he had a major emotional breakthrough in his recovery and gave himself the gift of entering a thirty day treatment program for Codependence. Sierra Tucson Treatment Center in Arizona was one of the first to pioneer treatment of Codependence and it was there that he learned a great deal about the grieving process and absorbed techniques and knowledge upon which he would later expand. He also realized what a Codependent relationship he had with the romance of Hollywood and upon completion of the program promptly moved. After brief stays in Tucson and Sedona Arizona, he lived in Taos, New Mexico, for a year until his Spiritual path led him to Cambria, California. It was in Cambria that he began a private practice specializing in Codependence Recovery and inner child healing. During almost two years on the coast he became involved in a relationship a tribute to the healing he had done to overcome his terror of intimacy.
Somnolence was a commonly reported adverse event reported in patients treated with SEROQUEL especially during the 3-5 day period of initial dose-titration buy discount sinequan 25 mg on-line anxiety 24 hour hotline. In schizophrenia trials sinequan 75 mg anxiety symptoms in males, somnolence was reported in 18% of patients on SEROQUEL compared to 11% of placebo patients buy sinequan 25 mg with amex anxiety symptoms 8-10. In acute bipolar mania trials using SEROQUEL as monotherapy order cheap sinequan on line anxiety symptoms electric shock sensation feelings, somnolence was reported in 16% of patients on SEROQUEL compared to 4% of placebo patients. In acute bipolar mania trials using SEROQUEL as adjunct therapy, somnolence was reported in 34% of patients on SEROQUEL compared to 9% of placebo patients. In bipolar depression trials, somnolence was reported in 28% of patients on SEROQUEL compared to 7% of placebo patients. In these trials, sedation was reported in 30% of patients on SEROQUEL compared to 8% of placebo patients. Since SEROQUEL has the potential to impair judgment, thinking, or motor skills, patients should be cautioned about performing activities requiring mental alertness, such as operating a motor vehicle (including automobiles) or operating hazardous machinery until they are reasonably certain that SEROQUEL therapy does not affect them adversely. One case of priapism in a patient receiving SEROQUEL has been reported prior to market introduction. While a causal relationship to use of SEROQUEL has not been established, other drugs with alpha-adrenergic blocking effects have been reported to induce priapism, and it is possible that SEROQUEL may share this capacity. Appropriate care is advised when prescribing SEROQUEL for patients who will be experiencing conditions which may contribute to an elevation in core body temperature, e. Esophageal dysmotility and aspiration have been associated with antipsychotic drug use. SEROQUEL and other antipsychotic drugs should be used cautiously in patients at risk for aspiration pneumonia. The possibility of a suicide attempt is inherent in bipolar disorder and schizophrenia; close supervision of high risk patients should accompany drug therapy. Prescriptions for SEROQUEL should be written for the smallest quantity of tablets consistent with good patient management in order to reduce the risk of overdose. In 2 eight-week clinical studies in patients with bipolar depression (N=1048) the incidence of treatment emergent suicidal ideation or suicide attempt was low and similar to placebo, (SEROQUEL 300 mg, 6/350, 1. Clinical experience with SEROQUEL in patients with certain concomitant systemic illnesses is limited. Patients with these diagnoses were excluded from premarketing clinical studies. Because of the risk of orthostatic hypotension with SEROQUEL, caution should be observed in cardiac patients [see WARNINGS and PRECAUTIONS ]. Acute withdrawal symptoms, such as nausea, vomiting, and insomnia have very rarely been described after abrupt cessation of atypical antipsychotic drugs, including SEROQUEL. Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in practice. The information below is derived from a clinical trial database for SEROQUEL consisting of over 4300 patients. This database includes 698 patients exposed to SEROQUEL for the treatment of bipolar depression, 405 patients exposed to SEROQUEL for the treatment of acute bipolar mania (monotherapy and adjunct therapy), 646 patients exposed to SEROQUEL for the maintenance treatment of bipolar I disorder as adjunct therapy, and approximately 2600 patients and/or normal subjects exposed to 1 or more doses of SEROQUEL for the treatment of schizophrenia. Of these approximately 4300 subjects, approximately 4000 (2300 in schizophrenia, 405 in acute bipolar mania, 698 in bipolar depression, and 646 for the maintenance treatment of bipolar I disorder) were patients who participated in multiple dose effectiveness trials, and their experience corresponded to approximately 2400 patient-years. The conditions and duration of treatment with SEROQUEL varied greatly and included (in overlapping categories) open-label and double-blind phases of studies, inpatients and outpatients, fixed-dose and dose-titration studies, and short-term or longer-term exposure. Adverse reactions were assessed by collecting adverse events, results of physical examinations, vital signs, weights, laboratory analyses, ECGs, and results of ophthalmologic examinations. Adverse reactions during exposure were obtained by general inquiry and recorded by clinical investigators using terminology of their own choosing. Consequently, it is not possible to provide a meaningful estimate of the proportion of individuals experiencing adverse reactions without first grouping similar types of reactions into a smaller number of standardized reaction categories. In the tables and tabulations that follow, standard COSTART terminology has been used to classify reported adverse reactions for schizophrenia and bipolar mania. MedDRA terminology has been used to classify reported adverse reactions for bipolar depression. The stated frequencies of adverse reactions represent the proportion of individuals who experienced, at least once, a treatment-emergent adverse reaction of the type listed. A reaction was considered treatment emergent if it occurred for the first time or worsened while receiving therapy following baseline evaluation. Adverse Reactions Associated with Discontinuation of Treatment in Short-Term, Placebo-Controlled TrialsDepression: Overall, discontinuations due to adverse reactions were 12. Mania: Overall, discontinuations due to adverse reactions were 5. Schizophrenia: Overall, there was little difference in the incidence of discontinuation due to adverse reactions (4% for SEROQUEL vs. However, discontinuations due to somnolence and hypotension were considered to be drug related: [see WARNINGS and PRECAUTIONS ]The prescriber should be aware that the figures in the tables and tabulations cannot be used to predict the incidence of side effects in the course of usual medical practice where patient characteristics and other factors differ from those that prevailed in the clinical trials. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatments, uses, and investigators. The cited figures, however, do provide the prescribing physician with some basis for estimating the relative contribution of drug and nondrug factors to the side effect incidence in the population studied. Table 2 enumerates the incidence, rounded to the nearest percent, of treatment-emergent adverse reactions that occurred during acute therapy of schizophrenia (up to 6 weeks) and bipolar mania (up to 12 weeks) in 1% or more of patients treated with SEROQUEL (doses ranging from 75 to 800 mg/day) where the incidence in patients treated with SEROQUEL was greater than the incidence in placebo-treated patients. Treatment-Emergent Adverse Reaction Incidence in 3- to 12-Week Placebo-Controlled Clinical Trials for the Treatment of Schizophrenia and Bipolar Mania (monotherapy)Gamma Glutamyl Transpeptidase Increased1Reactions for which the SEROQUEL incidence was equal to or less than placebo are not listed in the table, but included the following: accidental injury, akathisia, chest pain, cough increased, depression, diarrhea, extrapyramidal syndrome, hostility, hypertension, hypertonia, hypotension, increased appetite, infection, insomnia, leukopenia, malaise, nausea, nervousness, paresthesia, peripheral edema, sweating, tremor, and weight loss. In these studies, the most commonly observed adverse reactions associated with the use of SEROQUEL (incidence of 5% or greater) and observed at a rate on SEROQUEL at least twice that of placebo were somnolence (18%), dizziness (11%), dry mouth (9%), constipation (8%), SGPT increased (5%), weight gain (5%), and dyspepsia (5%). Table 3 enumerates the incidence, rounded to the nearest percent, of treatment-emergent adverse reactions that occurred during therapy (up to 3-weeks) of acute mania in 5% or more of patients treated with SEROQUEL (doses ranging from 100 to 800 mg/day) used as adjunct therapy to lithium and divalproex where the incidence in patients treated with SEROQUEL was greater than the incidence in placebo-treated patients. Treatment-Emergent Adverse Reaction Incidence in 3-Week Placebo-Controlled Clinical Trials for the Treatment of Bipolar Mania (Adjunct Therapy)1Reactions for which the SEROQUEL incidence was equal to or less than placebo are not listed in the table, but included the following: akathisia, diarrhea, insomnia, and nausea. In these studies, the most commonly observed adverse reactions associated with the use of SEROQUEL (incidence of 5% or greater) and observed at a rate on SEROQUEL at least twice that of placebo were somnolence (34%), dry mouth (19%), asthenia (10%), constipation (10%), abdominal pain (7%), postural hypotension (7%), pharyngitis (6%), and weight gain (6%). Table 4 enumerates the incidence, rounded to the nearest percent, of treatment-emergent adverse reactions that occurred during therapy (up to 8-weeks) of bipolar depression in 5% or more of patients treated with SEROQUEL (doses of 300 and 600 mg/day) where the incidence in patients treated with SEROQUEL was greater than the incidence in placebo-treated patients. Treatment-Emergent Adverse Reaction Incidence in 8-Week Placebo-Controlled Clinical Trials for the Treatment of Bipolar Depression1General Disorders and Administrative Site Conditions1Events for which the SEROQUEL incidence was equal to or less than placebo are not listed in the table, but included the following: nausea, upper respiratory tract infection, and headache. In these studies, the most commonly observed adverse reactions associated with the use of SEROQUEL (incidence of 5% or greater) and observed at a rate on SEROQUEL at least twice that of placebo were dry mouth (44%), sedation (30%), somnolence (28%), dizziness (18%), constipation (10%), lethargy (5%), and nasal congestion (5%). Explorations for interactions on the basis of gender, age, and race did not reveal any clinically meaningful differences in the adverse reaction occurrence on the basis of these demographic factors. Dose Dependency of Adverse Reactions in Short-Term, Placebo-Controlled TrialsDose-related Adverse Reactions: Spontaneously elicited adverse reaction data from a study of schizophrenia comparing five fixed doses of SEROQUEL (75 mg, 150 mg, 300 mg, 600 mg, and 750 mg/day) to placebo were explored for dose-relatedness of adverse reactions. Logistic regression analyses revealed a positive dose response (p < 0. Class Effect: Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first few days of treatment. Dystonic symptoms include: spasm of the neck muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue. While these symptoms can occur at low doses, they occur more frequently and with greater severity with high potency and at higher doses of first generation antipsychotic drugs.
Gonorrhea is infectious and easily passed on through:from a mother to her baby at birthIt can also be passed from the genitals to the eyes by the fingers order sinequan 10mg overnight delivery anxiety from weed. About 50% of women and 10% of men with gonorrhoea show no symptoms at all generic 25mg sinequan overnight delivery mood anxiety symptoms questionnaire. Any symptoms that do occur may be noticed one to 14 days after infection buy 75mg sinequan amex anxiety symptoms gastro. They involve:a genital examination by a doctor or nursetaking swabs from the cervix (entrance to the womb) discount 10 mg sinequan with mastercard anxiety symptoms difficulty swallowing, urethra (tube where the urine comes out), throat or rectumEarly treatment is simple and effective and involves a single dose of antibiotics. This is followed by a second test a month later to make sure the infection has gone. If complications occur another treatment may be needed. To avoid re-infection, any sexual partners should be treated too. The highest rates of gonorrhea are seen in women aged 16-19 and men aged 20-24. Without treatment, gonorrhea can spread to other reproductive organs causing damage and serious long-term health problems. In women, gonorrhea can cause pelvic inflammatory disease. This can lead to:A mother with gonorrhea can pass an eye infection to her baby at birth. In men, gonorrhea can lead to:pain and inflammation of the testiclesinflammation of the prostate gland and infertilityA male or female condom can provide protection from most STIs if used correctly every time you have sex. Genital herpes is caused by the herpes simplex virus. There are two types of the virus which affect the mouth and nose as cold sores or affect the genital and anal areas. Be warned, though - the pictures are graphic and you may find them disturbing. Some people have one outbreak of herpes, others have repeated outbreaks. Genital herpes is passed on by direct skin contact, mainly during vaginal, oral or anal sex, or sharing sex toys. There are ways in which you can avoid passing on genital herpes:During an outbreak, the blisters and sores are highly infectious. Avoid contact with the infected area of skin at this time or during the warning signs of an outbreak. Signs and symptoms of Genital HerpesMany people show no signs of the virus. Symptoms can develop at any time after contact with the virus, but for most people it takes around three to four days. Recurrent infections are milder and symptoms clear up more quickly (within a week). They may include:taking a swab from any visible soresgenital examination by a doctor or nursewomen may have an internal examinationThe virus always remains in the body and no treatment gets rid of it completely. Antiviral tablets can be taken during the first outbreak to ease symptoms and help clear it up. However, these can be less effective if further outbreaks are experienced. People often experience early warning signs of an outbreak, such as a tingling sensation in the affected area. Self-help measures can prove useful in reducing symptoms or preventing outbreaks, such as:cutting down on smoking and drinkingavoiding direct sunlight on the affected area - including using sunbedsavoiding lycra or nylon underwearIn 2000, almost 16,800 men and women attended STD clinics in the UK with a first attack genital herpes. Before you have sex, talk to your partner about how to protect yourselves. Become familiar with how to use condoms and have a supply ready. Find out about signs and symptoms of Pubic Lice, testing and treatment. Pubic lice or crabs are unpleasant, but once diagnosed are thankfully easily treated. Here are the symptoms to look for, where to go for help and the various methods of treatment for pubic lice that are available. They live in coarse body hair, such as pubic hair, but can also live in underarm hair, on hairy legs and chests and occasionally in beards, eyebrows and eyelashes. Pubic lice are easily passed on through sexual contact, or through close physical contact. Symptoms are noticed about five days to several weeks after infection. They include:itchy skin or inflammation of the affected areablack powder (lice droppings) in underwearoccasionally, visible lice and eggsspots of blood are sometimes seen as lice feed from blood vessels close to the surface of the skinTests for pubic lice are simple and include:a physical examination by a doctor or nursea medical history being takenlice being examined under a microscopePubic lice are easily treated. Special shampoos, creams or lotions are used to kill the lice and their eggs. The itching or rash may continue after treatment and take a few weeks to clear up. However, to avoid re-infection, any sexual partners should be treated too. Sex and all close contact should be avoided until treatment has been completed and the lice and their eggs have gone. Find out the symptoms of Scabies and how to get treatment. Scabies is a common skin infection caused by a tiny mite invisible to the naked eye. The female mite burrows under the skin to lay her eggs. The scabies mites are easily passed on through close physical contact with an infected person. Scabies can occur anywhere on the body, but sometimes the signs are hard to see. Symptoms can appear weeks after first contact and include itching (especially at night), a rash and tiny spots. Be warned, though - this picture is graphic and you may find it disturbing. Tests for scabies are simple and involve:taking a skin flake from one of the spots and examining it under a microscopetaking a full medical historyTreatment for scabies is simple and involves applying a special cream or lotion all over the body. The itching or rash may continue after treatment and take a few weeks to clear up, although a calming skin lotion may help with this. To avoid re-infection, close contacts, family members and sexual partners should be treated too. Close personal contact should be avoided until treatment is completed and the infection has cleared up.
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This object of love is idealised and internalised and becomes part of our conscience (the superego in the psychoanalytic model) purchase 75mg sinequan visa anxiety symptoms even when not anxious. Growing up entails the gradual detachment from the mother and the redirection of the sexual attraction from her to other discount sinequan 10mg line anxiety symptoms treatment, socially appropriate objects order generic sinequan on line anxiety symptoms getting worse. These are the keys to an independent exploration of the world purchase sinequan without a prescription anxiety vest for dogs, to personal autonomy and to a strong sense of self. It is by no means universally accepted that children go through a phase of separation from their parents and through the consequent individuation. Scholars like Daniel Stern, in his book, "The Interpersonal World of the Infant" (1985), concludes that children possess selves and are separated from their caregivers from the very start. Childhood traumas and the development of the narcissistic personality Early childhood abuse and traumas trigger coping strategies and defense mechanisms, including narcissism. The child, fearful of further rejection and abuse, refrains from further interaction and resorts to grandiose fantasies of being loved and self-sufficient. Repeated hurt may lead to the development of a narcissistic personality. Sigmund Freud (1856-1939) is credited for the first coherent theory of narcissism. He described transitions from subject-directed libido to object-directed libido through the intermediation and agency of the parents. To be healthy and functional, the transitions must be smooth and unperturbed; otherwise neuroses result. Thus, if a child fails to attract their love and attention of his or her desired objects (e. The first occurrence of narcissism is adaptive in that it trains the child to love an available object (his or her self) and to feel gratified. But regressing from a later stage to "secondary narcissism" is maladaptive. If this pattern of regression persists, a "narcissistic neurosis" is formed. The narcissist stimulates his self habitually in order to derive pleasure and gratification. The narcissist prefers fantasy to reality, grandiose self-conception to realistic appraisal, masturbation and sexual fantasies to mature adult sex and daydreaming to real life achievements. Carl Gustav Jung (1875-1961) pictured the psyche as a repository of archetypes (conscious representations of adaptive behaviors). Fantasies are a way of accessing these archetypes and releasing them. In Jungian psychology, regressions are compensatory processes intended to enhance adaptation, not methods of obtaining or securing a steady flow of gratification. Introversion is indispensable to narcissism, while extroversion is a necessary condition for orienting to a libidinal object. Freud regards introversion as an instrument in the service of a pathology. Jung, in contrast, regards introversion as a useful tool in the service of the endless psychic quest for adaptation strategies (narcissism being one such strategy). Nevertheless, even Jung acknowledged that the very need for a new adaptation strategy means that adaptation has failed. So although introversion per se is by definition not pathological, the use made of it can be pathological. Jung distinguished introverts (those who habitually concentrate on their selves rather than on outside objects) from extroverts (the opposite). Introversion is considered a normal and natural function in childhood, and remains normal and natural even if it dominates later mental life. To Jung, pathological narcissism is a matter of degree: it is exclusive and all-pervasive. Heinz Kohut said that pathological narcissism is not the result of excessive narcissism, libido or aggression. It is the result of defective, deformed or incomplete narcissistic (self) structures. Kohut postulated the existence of core constructs which he named: the Grandiose Exhibitionistic Self and the Idealised Parent Imago. Children entertain notions of greatness (primitive or naive grandiosity) mingled with magical thinking, feelings of omnipotence and omniscience and a belief in their immunity to the consequences of their actions. Without the appropriate responses, grandiosity, for instance, cannot be transformed into adult ambitions and ideals. To Kohut, grandiosity and idealisation are positive childhood development mechanisms. Even their reappearance in transference should not be considered a pathological narcissistic regression. Kohut says that narcissism (subject-love) and object-love coexist and interact throughout life. He agrees with Freud that neuroses are accretions of defence mechanisms, formations, symptoms, and unconscious conflicts. But he identified a whole new class of disorders: the self-disorders. These are the result of the perturbed development of narcissism. Self disorders are the results of childhood traumas of either not being "seen", or of being regarded as an "extension" of the parents, a mere instrument of gratification. Such children develop to become adults who are not sure that they do exist (lack a sense of self-continuity) or that they are worth anything (lack of stable sense of self-worth, or self-esteem). Horney said that personality was shaped mostly by environmental issues, social or cultural. Horney believed that people (children) needed to feel secure, to be loved, protected, emotionally nourished and so on. Horney argued that anxiety is a primary reaction to the very dependence of the child on adults for his survival. Children are uncertain (of love, protection, nourishment, nurturance), so they become anxious. Defenses such as narcissism are developed to compensate for the intolerable and gradual realisation that adults are merely human: capricious, unfair, unpredictable, non-dependable. Defences provide both satisfaction and a sense of security. Otto Kernberg (1975, 1984, 1987) is a senior member of the Object Relations school in Psychology (comprising also Kohut, Klein, and Winnicott).