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These lead to a structural weakness of the personality buy cheap cialis 10 mg line, which develops a deficient and/or dysfunctional stimuli-filtering mechanism generic 20mg cialis otc. The ability of the individual to maintain a basic narcissistic homeostasis of the personality is damaged order cialis 2.5 mg on line. Such a person suffers from diffusive narcissistic vulnerability. A disturbance occurring later in life - but still pre-Oedipally - affects the pre-Oedipal formation of the basic mechanisms for controlling, channelling, and neutralising drives and urges. The nature of the disturbance has to be a traumatic encounter with the ideal object (such as a major disappointment). The symptomatic manifestation of this structural defect is the propensity to re-sexualise drive derivatives and internal and external conflicts, either in the form of fantasies or in the form of deviant acts. A disturbance formed in the Oedipal or even in the early latent phases - inhibits the completion of the Superego idealisation. This is especially true of a disappointment related to an ideal object of the late pre-Oedipal and the Oedipal stages, where the partly idealised external parallel of the newly internalised object is traumatically destroyed. Such a person possesses a set of values and standards, but he is always on the lookout for ideal external figures from whom he aspires to derive the affirmation and the leadership that he cannot get from his insufficiently idealised Superego. Video and chat interviews with Sam Vaknin, self-proclaimed narcissist and expert in narcissism and narcissistic abuse. Extensive collection of videos on narcissism, Narcissistic Personality Disorder (NPD) and the narcissist. Sam Vaknin, author of Malignant Self Love: Narcissism Revisited provides comprehensive information on narcissism and the narcissist. Get insight into what makes the narcissist tick, the different types of narcissists, the Narcissistic Personality Disorder diagnosis, narcissism and coexisting psychiatric conditions. Click on any of the arrows to start the video then mouse-over the bottom black bar to see the selection of videos. This playlist contains the following videos:What is Narcissistic SupplyThe Cult of the NarcissistThe Narcissist and the SuperegoClinical Features of NarcissismThe Narcissist and his Relationship with GodCommon Professions of the NarcissistDead Parents of the NarcissistDiagnostic Criteria of Narcissistic Personality DisorderNarcissist False and True SelfIs the Narcissist Legally Insane? Other playlists with videos by Sam Vaknin:We have 2510 guests and 3 members onlineHTTP/1. From kudos like the ones below, to suggestions, bug reports, and even odd anecdotes, the people who use our service are the focus of why we strive for excellence. If you have your own success story to share, please This e-mail address is being protected from spambots. I love this site and I really think you have a wonderful chat site. The people are very kind and supportive and I get a lot of positive information. My husband was diagnosed as a Manic Depressive in April. His boss shared with me how the job is very stressful, so stressful that many other employees were suffering from depression because of the job. I have received only a couple of your depression newsletters and already you have helped!! I kept this one (issue #10) on the screen while I proceeded to relieve my stress by "starting small" and clearing up a specific messy pile of papers. I am so glad to have been told about this site because I am recently widowed and am grieving badly and need all the help I can get. I wish information like this was available 5 years ago. Please include me in your weekly anxiety-panic newsletter. I just wanted to tell you that I have been a subscriber for the past few months and I really enjoy your home page and the newsstand. Having a mental illness, I am particularly interested in what you have to say each week and I find many things relevant to what is going on today. I just want to thank you all for being caring and supportive. Thank you so much for writing and informing me of all the latest news on depression and eating disorders. I have struggled for two years now with both problems. I think your web site is really wonderful and I would recommend it to anyone. It has been very helpful and I have told friends about it (those who have OCD, as I do). Being a sufferer of an ED (eating disorder), I want to thank you for offering so many resources during ED awareness week. It seems as though no one really understands the gravity of an ED, but your site, truly do. Your abuse issues newsletter is something I look forward to! And the information in your abuse issues community is extremely helpful. It is educative information and I look forward to hearing from you again. I want to thank you for all the work you do in helping people deal with mental health issues. It is because of people doing work like you, that mental health is getting some respect in society as a health issue. If we ever get insurance to treat mental health on the same footing as physical health, we will be a much wiser and healthier society. I take advantage of your chat room on a regular basis. And people there try to lift others out of the doldrums. I read a transcript from a conference you had with Dr. I have issues dealing with that area and have visited her weekly chat sessions and it helps to understand relationships and the areas of sexuality. I was surfing one night looking for intelligent conversation, which seems hard to find, and came across an individual who said your site was one she chatted in most often. 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I liked self-injuring because it provided me with a sense of relief discount 2.5mg cialis otc. Of course cialis 20 mg generic, that relief did not last very long at all and then I had large medical bills to deal with purchase cialis 5 mg overnight delivery. I will say that most people injure by cutting themselves. Robin8: How did you get the courage to enter into recovery? I had lost so many relationships due to my self-injury behaviors and I almost lost my job over it. I knew I needed help because my life was one big mess. I hated myself and everything in my life and I knew the only way I could go, was up. As they learned more about self-injury, self-mutilation, I was very fortunate to have a very supportive family. David: Did you just come out and tell them, or did they discover what was going on, on their own? Keatherwood: Did you find that you were treated badly at the hospitals, when you had injured yourself? Emily J: No, I was fortunate to have doctors that, at least, used numbing medication! Other self-injurers have not had such good experience with doctors. Of course, a couple of times it was obvious I was lying, but I was never questioned about it. Emily J: Well, people have to want recovery for themselves, not for their families, friends, etc. David: Emily has been "fully recovered" for about a year. Alternatives treatment program (Self-Abuse Finally Ends). Click the link to read the transcript from our conference with Dr. Alternatives program so you can find out more details about that. Emily, can you tell us about your experience with the program. They helped me when years of therapy, hospitalization and medications could not. They gave me the formula for a successful recovery, but I did the work. The program was extremely intense: they taught me how to feel, how to challenge myself, set boundaries and they taught me that self-injury was just a symptom of a larger problem. Emily J: Many years of pain that I did not deal with. David: How long were you in the self-injury recovery program? Emily J: It is a thirty-day program, but I petitioned to stay an extra week, so I was there for a total of thirty-seven days. David: Can you give us a brief summary of your typical day? Emily J: There were at least five support groups a day. Each support group covered a variety of issues such as trauma group, art and music therapy, role playing, etc. There were a total of fifteen assignments that we had to complete. Each patient had their own psychologist, psychiatrist, social worker, medical doctor and a primary, who was a staff member who reviewed the writing assignments with us. Emily, what was the toughest part about the recovery, stopping self-injuring? Emily J: Learning to deal with my emotions instead of running and injuring. There were these things called impulse control logs - whenever I felt like injuring I had to fill out one. Emily J: Building a healthy support network of friends and family; finding a healthy hobby and pursuing that. Talking to peers, talking to staff, and listening to music were some of my alternatives. To be honest, I still had urges for quite a while after coming home. ZBATX: Can you talk a little about separating thoughts from feelings? Emily J: I used to say things like I feel like crap. I knew self-injuring was ruining my life but I was powerless to stop it. Without insurance I would say roughly $20,000 but my insurance, and many others have paid for all of it. First, I went to my therapist, and one of the program directors called my insurance company and said they could either pay for this one-time program, or continue to pay for every visit indefinitely. For those that simply cannot attend the program, I recommend the book " Bodily Harm " by Karen Conterio and Wendy Lader. What do you do then when you have no one to turn to? Emily J: I think you have to be honest with yourself. Do you want to spend the rest of your life mutilating yourself? Some examples would be attending a church with a large population of people your age, or something like that. David: Here are a couple of audience comments regarding "paying for treatment": Montana: From my experiences, the insurance would not pay the emergency room visits because it was obvious that it was involved with self harm. If any one knows of any insurance company that will insure post traumatic stress disorder (PTSD), let me know! Emily J: They have an aftercare group for people who live in the Chicago area, but I live nowhere close to Chicago so I had to build my own support here, after I got back. That was a big step for me, because I was very attached to my therapist in a very unhealthy way.

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In mice purchase 5 mg cialis mastercard, these doses are 26 to 520 times or 2 to 35 times the maximum 10 mg human dose on a mg/kg or mg/m2 basis order 20mg cialis amex, respectively cialis 2.5 mg free shipping. In rats these doses are 43 to 876 times or 6 to 115 times the maximum 10 mg human dose on a mg/kg or mg/m2 basis, respectively. No evidence of carcinogenic potential was observed in mice. Renal liposarcomas were seen in 4/100 rats (3 males, 1 female) receiving 80 mg/kg/day and a renal lipoma was observed in one male rat at the 18 mg/kg/day dose. Incidence rates of lipoma and liposarcoma for Zolpidem were comparable to those seen in historical controls and the tumor findings are thought to be a spontaneous occurrence. Zolpidem did not have mutagenic activity in several tests including the Ames test, genotoxicity in mouse lymphoma cells in vitro, chromosomal aberrations in cultured human lymphocytes, unscheduled DNA synthesis in rat hepatocytes in vitro, and the micronucleus test in mice. In a rat reproduction study, the high dose (100 mg base/kg) of Zolpidem resulted in irregular estrus cycles and prolonged precoital intervals, but there was no effect on male or female fertility after daily oral doses of 4 to 100 mg base/kg or 5 to 130 times the recommended human dose in mg/m2. No effects on any other fertility parameters were noted. Normal adults experiencing transient insomnia (n = 462) during the first night in a sleep laboratory were evaluated in a double-blind, parallel group, single-night trial comparing two doses of Zolpidem (7. Both Zolpidem doses were superior to placebo on objective (polysomnographic) measures of sleep latency, sleep duration, and number of awakenings. Normal elderly adults (mean age 68) experiencing transient insomnia (n = 35) during the first two nights in a sleep laboratory were evaluated in a double-blind, crossover, 2 night trial comparing four doses of Zolpidem (5, 10, 15 and 20 mg) and placebo. All Zolpidem doses were superior to placebo on the two primary PSG parameters (sleep latency and efficiency) and all four subjective outcome measures (sleep duration, sleep latency, number of awakenings, and sleep quality). Zolpidem was evaluated in two controlled studies for the treatment of patients with chronic insomnia (most closely resembling primary insomnia, as defined in the APA Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-). Adult outpatients with chronic insomnia (n = 75) were evaluated in a double-blind, parallel group, 5 week trial comparing two doses of Zolpidem tartrate and placebo. On objective (polysomnographic) measures of sleep latency and sleep efficiency, Zolpidem 10 mg was superior to placebo on sleep latency for the first 4 weeks and on sleep efficiency for weeks 2 and 4. Zolpidem was comparable to placebo on number of awakenings at both doses studied. Adult outpatients (n = 141) with chronic insomnia were also evaluated, in a double-blind, parallel group, 4 week trial comparing two doses of Zolpidem and placebo. Zolpidem 10 mg was superior to placebo on a subjective measure of sleep latency for all 4 weeks, and on subjective measures of total sleep time, number of awakenings, and sleep quality for the first treatment week. Increased wakefulness during the last third of the night as measured by polysomnography has not been observed in clinical trials with Zolpidem tartrate tablets. Studies Pertinent to Safety Concerns for Sedative/Hypnotic DrugsNext-day residual effects: Next-day residual effects of Zolpidem tartrate tablets were evaluated in seven studies involving normal subjects. In three studies in adults (including one study in a phase advance model of transient insomnia) and in one study in elderly subjects, a small but statistically significant decrease in performance was observed in the Digit Symbol Substitution Test (DSST) when compared to placebo. Studies of Zolpidem tartrate tablets in non-elderly patients with insomnia did not detect evidence of next-day residual effects using the DSST, the Multiple Sleep Latency Test (MSLT), and patient ratings of alertness. Rebound effects: There was no objective (polysomnographic) evidence of rebound insomnia at recommended doses seen in studies evaluating sleep on the nights following discontinuation of Zolpidem tartrate tablets. There was subjective evidence of impaired sleep in the elderly on the first post-treatment night at doses above the recommended elderly dose of 5 mg. Memory impairment: Controlled studies in adults utilizing objective measures of memory yielded no consistent evidence of next-day memory impairment following the administration of Zolpidem tartrate tablets. However, in one study involving Zolpidem doses of 10 and 20 mg, there was a significant decrease in next-morning recall of information presented to subjects during peak drug effect (90 minutes post-dose), i. There was also subjective evidence from adverse event data for anterograde amnesia occurring in association with the administration of Zolpidem tartrate tablets, predominantly at doses above 10 mg. Effects on sleep stages: In studies that measured the percentage of sleep time spent in each sleep stage, Zolpidem tartrate tablets have generally been shown to preserve sleep stages. Sleep time spent in stages 3 and 4 (deep sleep) was found comparable to placebo with only inconsistent, minor changes in REM (paradoxical) sleep at the recommended dose. Zolpidem tartrate tablets are available as follows:5 mg: pink, film-coated, round tablets, debossed either "93" or "TEVA" on one side and "73" on the other. Store at 20` to 25`C (68` to 77`F) (See USP Controlled Room Temperature). Dispense in a tight, light-resistant container as defined in the USP, with a child-resistant closure (as required). Generic Name: armodafinilNuvigil^ (armodafinil) Tablets [C-IV]Armodafinil is a drug that promotes wakefulness that is available as Nuvigil used to treat sleep apnea, narcolepsy, or shift work sleep disorder. Armodafinil is the R-enantiomer of modafinil which is a mixture of the R- and S-enantiomers. The chemical name for armodafinil is 2-[(R)-(diphenylmethyl)sulfinyl]acetamide. The molecular formula is CS and the molecular weight is 273. Armodafinil is a white to off-white, crystalline powder that is very slightly soluble in water, sparingly soluble in acetone and soluble in methanol. NUVIGIL tablets contain 50, 150 or 250 mg of armodafinil and the following inactive ingredients: croscarmellose sodium, lactose monohydrate, magnesium stearate, microcrystalline cellulose, povidone, and pregelatinized starch. The precise mechanism(s) through which armodafinil (R-enantiomer) or modafinil (mixture of R- and S-enantiomers) promote wakefulness is unknown. Both armodafinil and modafinil have shown similar pharmacological properties in nonclinical animal and in vitro studies, to the extent tested. At pharmacologically relevant concentrations, armodafinil does not bind to or inhibit several receptors and enzymes potentially relevant for sleep/wake regulation, including those for serotonin, dopamine, adenosine, galanin, melatonin, melanocortin, orexin-1, orphanin, PACAP or benzodiazepines, or transporters for GABA, serotonin, norepinephrine, and choline or phosphodiesterase VI, COMT, GABA transaminase, and tyrosine hydroxylase. Modafinil does not inhibit the activity of MAO-B or phosphodiesterases II-IV. Modafinil-induced wakefulness can be attenuated by the ~a1-adrenergic receptor antagonist, prazosin; however, modafinil is inactive in other in vitro assay systems known to be responsive to ~a-adrenergic agonists such as the rat vas deferens preparation. Armodafinil is not a direct- or indirect-acting dopamine receptor agonist. However, in vitro, both armodafinil and modafinil bind to the dopamine transporter and inhibit dopamine reuptake. For modafinil, this activity has been associated in vivo with increased extracellular dopamine levels in some brain regions of animals. In genetically engineered mice lacking the dopamine transporter (DAT), modafinil lacked wake-promoting activity, suggesting that this activity was DAT-dependent. However, the wake-promoting effects of modafinil, unlike those of amphetamine, were not antagonized by the dopamine receptor antagonist haloperidol in rats. In addition, alpha-methyl-p-tyrosine, a dopamine synthesis inhibitor, blocks the action of amphetamine, but does not block locomotor activity induced by modafinil. Armodafinil and modafinil have wake-promoting actions similar to sympathomimetic agents including amphetamine and methylphenidate, although their pharmacologic profile is not identical to that of the sympathomimetic amines. In addition to its wake-promoting effects and ability to increase locomotor activity in animals, modafinil produces psychoactive and euphoric effects, alterations in mood, perception, thinking, and feelings typical of other CNS stimulants in humans. Modafinil has reinforcing properties, as evidenced by its self-administration in monkeys previously trained to self-administer cocaine; modafinil was also partially discriminated as stimulant-like.

However order cialis 20 mg mastercard, changing some of the negative thoughts that lead to self-injury is possible and important purchase cialis 5 mg without a prescription. Some questions to think about might be:How accurate are my thoughts surrounding self-harm? Handling those thoughts can be tricky but there are techniques used to challenge buy cialis 10mg amex, stop and alter negative thoughts of self-harm. If you find yourself in a spiral of negative thoughts, think (or even shout) stop and change your thoughts to something else. A therapist can help you with more self-harm stopping techniques. Self-mutilation alternatives can keep you physically safe even when overwhelmed with the urge to self-harm. Self-injury alternatives include:Punching a pillow or a punching bagSqueezing ice cubes; putting your face in a bowl of ice waterEating chili or other spicy foodTaking a very cold showerDrawing on your body instead of cutting itOf course, the best self-harm alternative is likely to reach out and talk to someone about how you are feeling. Self help for self-injury does exist and can be effective in curbing self-harm behaviors. Learn more about self-harm, self help coping skills. Most people who self-harm want to stop hurting themselves and they can do this by trying to develop new ways of coping and communicating. However, some people feel a need not only to change their behavior but also to understand why they have resorted to harming themselves. This list is not exhaustive - different people find different things useful in various situations. You might also find these suggestions become more effective if you are getting professional self-injury treatment ; working with a mental health professional. Stop and try to work out what would have to change to make you no longer feel like hurting yourself (take our self-injury test for insight)Count down from ten (nine, eight, seven)Point out five things, one for each sense, in your surroundings to bring your attention on to the presentBreathe slowly - in through the nose and out through the mouth. Realize that this is not about being bad or stupid - this is about recognizing that a behavior that somehow was helping you handle your feelings has become as big a problem as the one it was trying to solve in the first place. Find one person you trust - maybe a friend, teacher, minister, counselor, or relative - and say that you need to talk about something serious that is bothering you. Get help in identifying what "triggers" your self-harming behaviors and ask for help in developing ways to either avoid or address those triggers. Recognize that self-injury is an attempt to self-sooth, and that you need to develop other, better ways to calm and sooth yourself. Here are some alternatives to self-harm (aka self-injury, self-mutilation ). These tools are designed to relieve the desire to self-injure the next time you feel like self-harming. If you can get to the root of the problem, you can find alternative methods to absolve the pain and ways to avoid getting into a similar situation in the future. Go ahead, examine your emotions the next time you feel like self-injuring and try one of the following suggested alternatives to self-harm instead. Violence is the key, as long as it is not directed at a living thing:As an alternative to self-harm, you can rip up or punch a pillow, scream your lungs off, jump up and down, or cut up a soda bottle or some other miscellaneous, irrelevant item. Do you feel Depressed, Down, Sad, generally Unhappy? Wash your problems away with a soothing bath is another good alternative to self-injury. A slow, relaxing dip in a warm tub filled with bath oil or bubbles is a good idea. Relaxing is the best way to alleviate feelings of unhappiness. You can curl up in bed with a book and escape to an alternate reality or light some incense and just kick back listening to calming music. Eat yummy snacks and spend the evening watching TV or surfing the web. Hurt yourself in a relatively harmless way, like holding ice, or rubbing ice on the spot you would normally cut or burn. Chew up a hot pepper or rub liniment under your nose. Another good alternative to self-harm, take a cold bath. Focus on something, like breathing or your heart beat. Working on something is a good way to focus your mental and physical energy. Do something on the computer, like playing Tetris writing a computer program, or creating a personal homepage. You can also pursue any other hobby you may have that is fulfilling and requires concentration. Weigh it in your hand, feel it, look at the little details of it, including the texture. You could also choose any object in the room and examine it. Then write a detailed description of it, including size, weight, texture, shape, color, uses, feel, etc. Choose a random object and try to list 30 different uses for it. This can get your mind going and give you a new project to work on. Pour red food coloring over the area you want to cut. This self-injury alternative may be more effective if you warm it up first. About the author: Vanessa, is a self-injurer and started the self-injury website, "Blood Red. Examine your mind and why you feel the need to self-injure. If you feel the need to self-injure, try asking yourself these questions first. Write them down so you can refer to them later and really analyze your reasoning. What other paths have I pursued to ease my pain before now? Can I avoid the problem that has driven me to this point? Your insights into why you self-injure and how you feel about self-injury could prove very helpful in your self-injury treatment and recovery.

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