Pride and prejudice

By on October 24, 2010
We are a Dutch/Irish family raising kids in Tokyo.  I would like to seek advice about my eldest son, 14 years of age.  We are concerned he may have a personality disorder. He is too much to handle for me and my wife.  He has a difficulty accepting blame and is always defensive, which puts me to shame when I am called by the school for his untoward behaviour.  He thinks he is superior to everyone and is too self-indulgent, which has become quite of a challenge, to be honest. What should I do?

Your description suggests that your son exhibits a high sense of pride and some grandiosity. This suggests that he does not want to feel belittled and his pride and grandiosity are a defense against this feeling. This itself is not enough to diagnose a personality disorder.

Grandiosity can be seen in a narcissistic personality style, in a manic state that may be the first episode of manic-depression (bipolar disorder), induced by drugs such as speed, or other conditions. It may also just be the start of an exaggerated adolescent striving to show he is like an adult.

First, we need to know when this started, if he has any associated physical symptoms such as a decreased need for sleep or rapid speech as may be seen in a manic state or drug use. You also mentioned “untoward behaviour” in your question but we do not know the details. If he has been hyperactive and/or impulsive over the years and this is giving him trouble in school, it could be attention deficit hyperactivity disorder (ADHD), but differentiating this from manic-depression requires a longer discussion than we have room for here. Knowing whether there is a family history of a psychiatric condition and the family relationship dynamics are also important.

Finally, making a definitive judgment on the cause of behavioral changes in children and adolescents is fraught with problems because we don’t yet have a longitudinal course of seeing the person through adulthood. That would tell more clearly whether it was just adolescent strivings, a personality problem, or a psychiatric illness like mania, ADHD, etc.

Personality disorders would not likely have any of the physical symptoms described above, and are very difficult to diagnose in early adolescence which is a time when many changes in behavior may be seen that are just temporary. What ever the cause, you are describing a problem that is currently causing significant social impairment at home and in school and he should be evaluated by a psychiatrist as a start.

Doug Berger, M.D., Ph.D
The Meguro Counseling Center
provides mental health care for individuals, couples, and families, in both English and Japanese.


The discussions herein are meant as general information and advice only. Each person needs to make their own personal life decisions and to contact a mental health professional for consultation if deemed appropriate.


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