(The use of gender pronouns in this article reflects the clinical facts: most narcissists are men.)

Anxiety Disorders ? and especially Generalised Anxiety Disorder (GAD) ? are often misdiagnosed as Narcissistic Personality Disorder (NPD).

Anxiety is uncontrollable and excessive apprehension. Anxiety disorders usually come replete with obsessive thoughts, compulsive and ritualistic acts, restlessness, fatigue, irritability, difficulty concentrating, and somatic manifestations (such as an increased heart rate, sweating, or, in Panic Attacks, chest pains).

By definition, narcissists are anxious for social approval or attention (Narcissistic Supply). The narcissist cannot control this need and the attendant anxiety because he requires external feedback to regulate his labile sense of self-worth. This dependence makes most narcissists irritable. They fly into rages and have a very low threshold of frustration.

Like patients who suffer from Panic Attacks and Social Phobia (another anxiety disorder), narcissists are terrified of being embarrassed or criticised in public. Consequently, most narcissists fail to function well in various settings (social, occupational, romantic, etc.).

Many narcissists develop obsessions and compulsions. Like sufferers of GAD, narcissists are perfectionists and preoccupied with the quality of their performance and the level of their competence. As the Diagnostic and Statistical Manual (DSM-IV-TR, p. 473) puts it, GAD patients (especially children):

“? (A)re typically overzealous in seeking approval and require excessive reassurance about their performance and their other worries.”

This could apply equally well to narcissists. Both classes of patients are paralysed by the fear of being judged as imperfect or lacking. Narcissists as well as patients with anxiety disorders constantly fail to measure up to an inner, harsh, and sadistic critic and a grandiose, inflated self-image.

The narcissistic solution is to avoid comparison and competition altogether and to demand special treatment. The narcissist’s sense of entitlement is incommensurate with the narcissist’s true accomplishments. He withdraws from the rat race because he does not deem his opponents, colleagues, or peers worthy of his efforts.

As opposed to narcissists, patients with Anxiety Disorders are invested in their work and their profession. To be exact, they are over-invested. Their preoccupation with perfection is counter-productive and, ironically, renders them underachievers.

It is easy to mistake the presenting symptoms of certain anxiety disorders with pathological narcissism. Both types of patients are worried about social approbation and seek it actively. Both present a haughty or impervious facade to the world. Both are dysfunctional and weighed down by a history of personal failure on the job and in the family. But the narcissist is ego-dystonic: he is proud and happy of who he is. The anxious patient is distressed and is looking for help and a way out of his or her predicament. Hence the differential diagnosis.

Bibliography

Goldman, Howard G. – Review of General Psychiatry, 4th ed. – London, Prentice-Hall International, 1995 – pp. 279-282

Gelder, Michael et al., eds. – Oxford Textbook of Psychiatry, 3rd ed. – London, Oxford University Press, 2000 – pp. 160-169

Klein, Melanie – The Writings of Melanie Klein – Ed. Roger Money-Kyrle – 4 vols. – New York, Free Press – 1964-75

Kernberg O. – Borderline Conditions and Pathological Narcissism – New York, Jason Aronson, 1975

Millon, Theodore (and Roger D. Davis, contributor) – Disorders of Personality: DSM IV and Beyond – 2nd ed. – New York, John Wiley and Sons, 1995

Millon, Theodore – Personality Disorders in Modern Life – New York, John Wiley and Sons, 2000

Schwartz, Lester – Narcissistic Personality Disorders – A Clinical Discussion – Journal of Am. Psychoanalytic Association – 22 (1974): 292-305

Vaknin, Sam – Malignant Self Love – Narcissism Revisited, 6th revised impression – Skopje and Prague, Narcissus Publications, 2005

Sir Winston Churchill once observed that Americans and the British are ‘a common people divided by a common language’ …

Never was that as true as when describing the Cockneys.

You’ve certainly heard their accent, made famous in everything from movies based on Dickens and George Bernard Shaw novels to computer-generated gekkos telling real gekkos how to go forth and sell car insurance. The Australian accent has its roots in Cockney culture, as they comprised a large percentage of prisoners who were shipped there by the British when they viewed the Land Down Under as an ideal penal colony. Cockneys are the crafty characters from east London who admire those among their lot who can make a living simply by ‘ducking and diving, mate,’ which is their version of wheeling and dealing on a working-class level.

To be a ‘true’ Cockney, one must be born ‘within the sounds of the Bow bells.’ That’s a reference to the St Mary-le-Bow Church in the Cheapside district of London ‘proper.’ Their sound carries to a distance of approximately three miles, which defines the Cockney digs better than any zoning ordinance could do.

The term ‘Cockney’ first appeared in the 1600s, but its actual origins are vague. Its first known reference was related to the Bow bells themselves in a period satire that gave no reason for the association.

Some believe that ‘Cockney’ came from the second wave of Vikings, known as the Normans. These were descendants of the Northmen (‘Norman’ was the French word for ‘Viking’) who settled in that part of northern France that came to be known as Normandy when King Charles the Simple ceded it to the Vikings in exchange for ceasing their annual summer sackings of Paris. William the Conqueror was a Norman, and when he took England in 1066, a considerable amount of French influence permeated the Anglican language.

Normans often referred to London as the Land of Sugar Cake, or ‘Pais de Cocaigne,’ which was an allusion to what they saw as ‘the good life’ that could be had by living there. Ultimately, this gave rise to a term for being spoiled, ‘cockering,’ and from there, Cockney was a short derivative away.

Cockneys are famous for dropping the ‘H’ from the start of words and infamous in the mind of every grammar teacher for their coining the word ‘ain’t’ to replace the formal contraction for ‘is not.’ However, their most unique feature is their distinctive and catchy rhyming slang.

Legend has it that, during the course of their ‘ducking and diving,’ they would occasionally run afoul of the law. It was not uncommon for groups of Cockneys to be transported together to and from custody and courtroom, obviously in the company of policemen. So that they could speak openly to each other and deny the officers any ability to understand what they were saying, Cockneys devised a word/phrase association system that only the truly-indoctinated could follow. This became known as their rhyming slang.

It’s simple, really. For example:

Dog-and-bone = telephone
Apples-and-pears = stairs
Troubles-and-strife = wife

So, if a Cockney wanted you to go upstairs to tell his wife that there’s a phone call for her, he’d ask you to ‘take the apples and tell the trouble she’s wanted on the dog.’

As a general observation, their technique is that the second word of a rhyming phrase is the link between the ‘translated’ word and the first word in the rhyming phrase, which becomes the word used when speaking. Sometimes, though, to emphasize the word, the entire phrase might be used. Thus, if you are absolutely exhausted and want to make a point of it, you would exclaim, ‘I’m cream crackered!’ This is because ‘knackered’ is an English term for being tired; cream crackers, incidenally, go well with tea.

There are even dictionaries for Cockney rhyming slang, from pocket versions tailored for tourists to online listings. Two good sites for the latter are London Slang and Cockney Rhyming Slang. As with most slang, its vibrance is cause for constant expansion and/or modification of terms, so the Cockney rhymes are always a work in progress.

One note of caution: nothing sounds worse than a visitor attempting to over-Cockney their speech. If you’re thinking of touring an East End market or pub and want to pay your respects by using the local vernacular, be prepared with a few simple terms and deploy them with a smile only when the occasion permits. Otherwise, not being sure if you’re ‘taking the Mickey’ out of them or just ignorant, the Cockneys will most likely view you as a ‘right Charley Ronce’ and turn away.

Given that ‘ponce’ is common English slang for a fool — which had its origins in describing a ‘fancy man,’ now known as a ‘pimp’ in modern times — you may first need a ‘British’ translator to tell you what word the Cockney was using. By that time, you’ll no doubt agree that Churchill wasn’t ‘alf Pete Tong (ie- wrong).

In fact, he didn’t even need to refer to another country in order to be right.