To recognize the clinical presentation of adult ADHD as well as the associated challenges of assessment and treatment. This continuing medical education activity is intended for psychiatrists, psychologists, primary care physicians, physician assistants, nurse practitioners, and other health care professionals who seek to improve their care for patients with mental health disorders.
CME Credit (Physicians): This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of CME Outfitters, LLC, and Psychiatric Times. CME Outfitters designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit™. Surprisingly, to the eyes of many experts, DSM-5 better captures the essence of narcissistic personality disorder (NPD) than previous versions did. Prototypical persons with NPD present with many interpersonal problems and comorbid disorders, such as depression and bipolar disorder, with consequent increases in risk of suicide, alcohol and substance abuse, and eating disorders.1,2 Romantic relationships are typically shallow, and narcissistic persons build and maintain them with difficulty.
The draft of DSM-5 gives hints of what persons with NPD experience and, most importantly, provides a snapshot of a complex set of their self-experiences and disturbed mental processes.
Feelings of grandiosity and fantasies of power and success are certainly important but are not the core theme in a narcissistic stream of consciousness. NPD manifests as anger triggered by feelings of social rejection and tendencies to derogate those who give negative feedback.
There is no consensus on the causes of NPD, although lack of parental empathy toward a child’s developmental needs may bear some responsibility. Another trigger for NPD may be that the child is raised in a family where status and success are of utmost importance and only qualities that lead to sustaining a grandiose self-image are valued while other behaviors are disregarded or punished. Other factors, such as an externalizing personality and the role of culture (the narcissistic society) in paving the way to narcissism, should also be explored. NPD features unrelenting standards for maintaining a sense of self-worth and personal goals valuable enough to be pursued. Many neurological disorders can be debilitating and significantly limit your ability to perform normal day-to-day activities.
Migraines and cluster headaches can be extremely painful, irritating, and in some cases debilitating. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, or PANDAS, is a pediatric condition that affects many children throughout the world, and accounts for 70% of our patients. ADHD is another common disorder that can affect a child’s development, particularly when it is undiagnosed. Often times, students with ADHD or ADD have problems concentrating in class and while studying, so they may fall behind. We offer ADHD and ADD testing, treatment, and work with you to improve your child’s ability to focus, and also to ensure that they have the appropriate accommodations to succeed in school. Our neurology office provides treatment for an array of neurological disorders and injuries affecting the brain. Whether you’ve suffered a blow to the head, are having problems with motor skills, or have just started experiencing some of the symptoms above, the office of Dr. CME Outfitters, LLC, is accredited by the ACCME to provide continuing medical education for physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
It is not assumed that these relationships will have a negative impact on the presentations.


The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices. Many clinicians (myself included) were dissatisfied with the descriptions of NPD in earlier versions of DSM. Conflicts at work are the rule rather than the exception, as are problems with commitment when faced with negative feedback.
This description, though it may not be complete, is consistent with much of what we know from clinical experience and personality research about both NPD and narcissistic traits in the general population. The DSM-5 prototype notes how self-appraisal can swing from hypervalued to self-derogation along with fluctuations in self-esteem.
Persons with NPD often feel hampered in pursuing goals and blame others for being inept, incompetent, or hostile. The main schema is the “self” who desires to be recognized or admired and the “other” who is dominant and critical.
In the context of disturbed attachment, parents may fail to appropriately recognize, name, and regulate the child’s emotions, particularly in cases of heightened arousal.8 The developing child is therefore left with intense affects that receive no appropriate recognition or appropriate responses, which leads to affect dysregulation.
Another possibility is that overt grandiosity is a reaction to slights and humiliation, a sort of armor used to avoid subjugation. Although studies on causation are scant, Tracy and colleagues9 summarize some recent findings in which parenting styles, such as mixtures of overt praise and coldness, lack of supervision, corporal punishment, and authoritarian parenting, predicted future narcissism. Understanding that underlying feelings of vulnerability, impaired self-reflection, and diminished agency are core features of the disorder may lead to refined psychological treatments, keep these persons in therapy longer, and promote structural personality change. As a result, narcissism seems to include perfectionism as a trait and, after any accomplishment, the target is usually raised even higher, which results in never-ending dissatisfaction.5 Perfectionist standards are also set for others, which leads the narcissist to easily derogate others for not living up to his expectations.
It belongs to the characterization of the drugs that fall in the category of benzodiazepines.
We understand the difficulties that patients with spasticity, migraines, cluster headaches, epilepsy and other conditions face, and we share your desire to improve or eliminate the issues. Unfortunately, these severe headaches can become chronic and occur on a regular basis if left untreated. Children with Attention Deficit Hyperactivity Disorder have problems concentrating for extended periods of times, and can be hyperactive. That is why it’s crucial to have your child tested and diagnosed with ADHD sooner rather than later. Beth Latimer is here to assist in evaluating, diagnosing, and treating patients throughout Silver Spring and surrounding areas. CME Outfitters, LLC, and the faculty do not endorse the use of any product outside of the FDA-labeled indications. Persons with NPD are aggressive and boastful, overrate their performance, and blame others for their setbacks; current editions of DSM portray them as arrogant, entitled, exploitative, embedded in fantasies of grandeur, self-centered, and charming but emotionally unavailable. This is consistent with the idea that nuclear narcissistic states are not lim-ited to “being the one who sets people’s standards for the year to come,” as the disdainful protagonist of The Devil Wears Prada loved to say. States in which the self-image is extremely negative are important but are so hard to bear that fighting with others and blaming them for any personal flaws is a more suitable defensive maneuver.
In children, with their basic needs unmet, attachment becomes an issue; this translates to being attachment-avoidant in adulthood yet, at the same time, constantly striving for attention and admiration. Frequently, there are impaired romantic and professional outcomes as well as co-occurring disorders.


An agency deficit is a core characteristic of the disorder, with typical oscillations between diminished agency and hyperagentic behavior.
Other strategies for affect and interpersonal regulation are blaming others, withdrawing from relationships, adopting controlling and domineering strategies when facing problems and conflicts, and typically self-enhancing when facing others’ expected feedback. Such kinds of drugs are primarily used to treat the nervous tension that is best known as anxiety. Our office helps children, adolescents, and adults suffering from neurological conditions improve their quality of life and restore their functionality. We offer caring, compassionate, and effective treatment for these conditions so that you can enjoy a full and complete life. If you’re suffering from chronic migraines, or cluster headaches, we recommend coming in for an appointment as soon as possible.
While there is no cure for autism, it’s possible for children to grow to live healthy and productive lives with therapy and behavior management. Latimer has dedicated a large part of her focus on research and treatment for PANS and PANDAS.
One of the biggest challenges for children with ADHD is the effect it has on their schoolwork. Elizabeth Latimer, MD received her medical degree from Tufts University School of Medicine in Boston Massachusetts. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use. This portrayal of persons with NPD conveys only a minimal sense of their self-experience and misses their complexity.
When shortcomings are impossible to deny (eg, being fired from work, breaking affective bonds), persons with NPD are likely to become depressed; as they age, the risk of suicide increases. It works effectively as it helps in stabilizing the imbalance occurring in the chemicals of the brain. If you believe your child may be autistic or if they have been diagnosed with autism, we can work with you to improve their symptoms and development. We are one of the few offices in the Washington DC, Maryland, and Virginia area that offers comprehensive treatment for PANS and PANDAS. Following the lead of the psychoanalysts Kohut 3 and Modell,4 states of emptiness, emotional numbing, and devitalization are now included in NPD models.
This drug is used majorly to treat patients who suffer from anxiety disorders, to treat panic and also to treat anxiety that is caused due to depression and stress.
Such states are quintessential to the disorder, but they are not included in the current DSM-5 prototype and have been overlooked by researchers. Other prominent narcissistic states include an inability to forgive and feelings of shame, guilt, and envy at others’ successes.




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