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Well....I'm not sure if we take this as our answer....or what. I've mentioned here several times that we were preparing to ask FIL's primary for an initial cognitive assessment. Brief history - he is a raging narcissist - and I know there are some here that think that term is overused. In his case - this is not an exaggeration - this is 100% truth. He is an abusive narcissist and always has been. This is not new behavior.


Recently, he needed to sign some paperwork and was asked to provide a doctor's note stating that he is of sound mind. His primary doctor has provided this. Not only provided it but used the words "perfect cognition" His primary did not perform any cognitive assessment - even the initial basic stuff. He has been his primary for a number of years and his portal documentation always basically says the same thing after his visits - patient is pleasant and neurologically aware. However, in most of his appointments most of the talking is between the doctor and whomever attends the appointment with FIL, with the doctor addressing FIL only when needed.


So we are now concerned that we have hit a brick wall. And we are second guessing ourselves. Is it possible that a personality disorder could skew his decision making skills so much that it could look like dementia to us? His doctor has rarely if ever seen that side of him. He is 100% able to keep up the image of sweet little old man for the amount of time it takes to see his doctor for less than an hour. He has never seen the abusive narcissist that we see.


Have we been so far off base?


Some examples just for context.
- Is it his narcissistic mind that leads him to answer unknown numbers and engage with scammers - thinking he can outscam them? Even though we have told him that they are potentially voice printing him, even though we have told him there is literally no reason to answer unknown numbers, HE tells us he can fix them.
- He will sell his soul for free stuff - my SIL has walked in to hear him giving out his home address for free stuff - because - again we have told him a million times - that they aren't going to do it - but in his mind he is the ONE person they are going to give the free stuff to.
The list goes on and on - ad nauseum of things that we have thought were poor decision making due to age related cognitive decline or potential dementia - but now with this we are second guessing ourselves. Could it really be the narcissism? Seriously? I'm having so much trouble wrapping my head around it. We know he is an over the top narcissist - he literally checks every box - but is that really what we are dealing with?


Or are we overreacting to a form letter with no actual assessment behind it and should we still pursue getting him assessed anyway?


I'm just so confused now.

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BEG, your sister is going to have to learn to let things go.

If he isn't doing anything except talking to the scammers, let him talk.

If he is giving out the home address, install some security cameras. This is fairly inexpensive to do nowadays, like 8 cameras that record and have audio for less then 500.

If all of you stopped jumping when he barked, you would all be able to deal better.

He gets his needs met and he can stuff his wants. If he complains, ignore him or tell him to stop.

It is a real advantage that he is immobile, what's he going to do if you walk away? Yell? So what, let him yell. Call the police? So what, call the police, maybe that would pull the trigger on placement.

He is a complete jerk, doesn't matter why, NPD or dementia. Knowing doesn't make the behavior easier to deal with, I know.

My husband told me to treat everything with my dad as his dementia. It didn't really help me, he was still a jerk to deal with.

Help her learn to say no. Help her to not jump because he hollers. Help her to learn that she isn't his personal doormat and it is okay to stand up. Help her to understand that her dad is a horses backside and he will never appreciate her, even if she sets herself on fire to keep him warm, he will be a jerk. She or none of you can change him but, you can change how you respond to him. Cover each others back, create a united front and just start providing his needs and then disconnect physically and emotionally. Don't tell him what's up, if he says anything, ignore it, don't respond no matter how nasty he gets. It may actually get his attention, if not, you guys aren't being abused by him.

You know that he thinks he doesn't need any of you and he is the one doing a favor. So give him what he thinks the reality is.
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My now deceased narcissist mutha was seen by a geriatric psychiatrist so I could get documentation to place her.
They met with her then called me in alone.
They documented she’s a schizophrenic and told me blatantly to “have nothing to do with your mother! She hates you and voiced it with a grin.”
They saw through all her BS.
They more trained to draw it out.
I did place her, and HER attorney told me to pay myself (keep a journal) $50.00/hr. ✅
I was glad for $25.00/hour, but I wasn’t going to argue.
I popped in to give checks for her hair to get done and other needs, but kept my emotional well-being away from her.
Geriatric psychiatrist 👁 will set you free-
Hugs to you and I mean it-
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Yes, you are overreacting to a form letter with no actual assessment behind it and you should still pursue getting him assessed, if possible. It's mind-boggling to me how many 'doctors' love to assess a patient being 'perfect' or of 'sound mind' without doing ONE single cognitive assessment test on them! What gives this doctor the RIGHT to make such an assessment? It's like saying the patient absolutely does not have cancer w/o running tests on him! Then the patient drops dead of cancer and the doctor scratches his head??? What??? That analogy is spot on, too. Some doctors believe they're all that and a bag of chips, forgetting they're ONLY as good as the evidence they're able to produce thru TESTS. Everything else is guess work, plain & simple.

And don't believe people here on this site who tell you that the word 'narcissist' is overused and blah blah. THEY haven't been dealing with YOUR FIL, so unless they have firsthand experience with him, they have no way of knowing what PD he suffers from or doesn't suffer from. The thing about NPDs is that they're so very charming to others and devilishly horrid to their own family members. Covert is their middle name, which is how they've been getting away with murder for so long. Not all of us have sweet little old ladies & gents for parents. Snicker.

Wishing you the best of luck getting to the bottom of this dreadful situation.
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Ask for a referral to a geriatric physician who doesn't have any familiarity or history with your FIL; this person will be better equipped to recognize cognitive issues.
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I'm the one who has a problem with the overuse of narcissim. That's because too many family members are self-appointed psychiatrists with nothing but the internet to back up their diagnoses.

I merely advocate for people to get an actual medical diagnosis done by a qualified psychiatrist.

A general practioner is about the last person qualified to make that diagnosis, but I suppose it's a place to start if necessary. Have you shared your concerns directly with the doctor? Have you asked his doctor privately to do a cognitive assessment? Have you documented his behavior with videos you can share with him?

When my mother was alive, I would send an email to the doctor with a list of things we were concerned about, so she was prepared when the appointment came. I'd do it a few days in advance to ensure she received the information in time. HIIPA laws prevent the doctor from discussing his medical business with you, but it doesn't prevent you from bringing up concerns with him.
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helenb63 Jan 2022
I see your point about overuse of the term 'narcissism', but when I described my mother's lifelong behaviour on this forum and it was suggested that I look at books on NPD, of which I had at that point never heard, I was honestly amazed to find my life experience with my mother documented in detail and in full. I did not wish it to be the case, but the evidence just seemed too strong to refute. I don't see myself as a 'self-appointed psychiatrist', merely a mature, intelligent-enough person able to look at evidence and make deductions.

I don't think my mother would agree to see a psychiatrist and it's probably too late now anyway; dementia is now more of a problem for her than the narcissism.

What we ought to be focusing on, surely, is why so many (usually but not always) women of that generation are suffering from this disorder and what can be done to help them and prevent it from affecting others.
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When a new doctor (and staff at a rehab) finally saw and verbalized that my mother was not competent to make her own decisions without family help, I just about fell to my knees with relief. But it took her life being completely in disarray and finding her in a very bad situation that sent her to the hospital for this to happen. I had called APS years ago and no one (not her friends, not her regular primary, not APS) could see what I was seeing. I was the problem - not her - she did her best to discredit anyone that really knew her. I believe that my mother also has mental illness layered with dementia. She had everyone fooled for many years. It is a frustrating situation for sure - I feel your pain. And you are right that they can hold it together for the short time they see their regular and familiar doctor. Her friends and some of the people she saw on a regular basis (hairdresser, shopkeeper, etc) thought she was quirky and funny. Meanwhile her family was suffering and she was a notorious liar. And I just had to wait until a crisis came about before any action could be taken.

My mother now has advanced dementia with multiple health issues. But it was her failing health that brought her to the hospital where the dementia was initially identified. I also think the there was no one that wanted to take the responsibility for saying the “D” word and it took a staff that was skilled in treating dementia to identify and provide proper support and treatment.

If you could get him assessed, then by all means do so. Having that piece of paper in hand won’t make managing his affairs much easier. He will still be the mean cruel person you always knew and maybe worse. You will still go through periods of self doubt and questioning your decisions. You will feel guilty. But just go with your gut and stay strong. You will need to be the bad guy. My mother made many bad financial decisions that I am now cleaning up. I am still the target of her anger and violence - that will never change. My mother always made stupid and bad decisions so I can’t say whether the mental illness or dementia brought about bad decision making. Right now it doesn’t matter.

Knowing what I know now, I would be deciding what your personal goals are in the role of his caregiving and managing his affairs, and how much you can realistically handle emotionally and physically. I would consult an elder care attorney to get some basic advice. The consultation fee is worth it. Dealing with a cruel narcissist is draining. I have said before that if I had known, I would have let a state guardian take over the role. Good luck with this very challenging situation.
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Can you discreetly film him when he is exhibiting the abusive narcissistic symptoms? And show that to his dr. so he understands what you are talking about?
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Sarah3 Jan 2022
Excellent idea, bc they often manipulate doctors - video him in a moment that demonstrates clearly the real him
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If he really has narcissistic personality disorder then most definitely it is one of the most difficult personality disorders to interact with and typically the person has it from their teens to early twenties and it is not something people snap out of, it’s more of a lack of character and conscience than it is mental illness.

One example re the phone calls - yes bc narcissists exist on the attention of others - it’s like their life blood to find abd create ways to obtain it so whenever the phone rings he sees it as an opportunity to gain attention - important to note this isn’t the normal need that all people have done human contact and connection- narcissists require almost a constant stream of attention and when it’s not they will stir up abd manufacture conflict, pretend to be sick etc to get it.

Narcissists memory and cognition isn’t affected - they’re very calculated abd aware of what they’re doing although they’re manipulative so they can present themselves as if they don’t know what they’re doing or play dumb or pretend not to remember etc
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I have seen this happen over and over again - how do these people put on such a good act. They are two people in one body and no will believe you. Document every incident and try to get witnesses. Get a hidden camera, etc. And most importantly, immediately look for a new highly experienced doctor who is better qualified. In the meantime, set down very strict boundaries with this man and do NOT let him get away with anything without consequences. Get all the legal papers you need to take over - check with a good eldercare attorney. This man is not only a controlling narcissist he has dementia or the beginnings of it. Why do you care for him and why is he not in a facility. Keep this up and he will destroy you and your life and sanity, Get tough and place him and intervene at once or before he does crazy stuff.
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Riley2166 Jan 2022
I can't stress enough - with people who have physical and mental problems, not all of us can be caretakers and if we are and do, it will eventually destroy us and our way of life. NEVER, EVER ALLOW ANOTHER HUMAN TO DO THAT TO YOU.
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BlueEyedGirl94: Imho, since his primary care physician did not do any cognitive test, he needs to see a neurologist.
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