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Manipulation Tactics of Patients with Neurotic Disorders in Everyday Life and During Therapy

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Manipulation Tactics of Patients with Neurotic Disorders in Everyday Life and During Therapy Psychiatr. Pol. 2016; 50(1): 65–76 PL ISSN 0033-2674 (PRINT), ISSN 2391-5854 (ONLINE) www.psychiatriapolska.pl DOI: http://dx.doi.org/10.12740/PP/39841 Manipulation tactics of patients with neurotic disorders in everyday life and during therapy Eugenia Mandal 1, Adam Horak 2 1 Institute of Psychology, Chair of Social and Environmental Psychology University of Silesia in Katowice 2 Dr Emil Cyran Provincial Neuropsychiatric Hospital in Lubliniec Summary Aim. The objective of the study was to examine the repertoire and intensity of manipula- tion tactics of neurotic patients in everyday life and during therapy, as well as diagnosing the intensity of Machiavellianism in neurotic patients. Methods. There were 111 study subjects: 44 patients with diagnosed neurotic disorders, 44 people from the control group and 23 therapists. The manipulation tactics were measured by means of survey methods of E. Mandal and D. Kocur and Machiavellianism was measured using the MACH-IV scale of M. Christi and F. Geis. Results. In comparison to people from the control group, the patients were more willing to use manipulation tactics such as guilt induction, threatening to break up the relationship, and self-mutilation but less willing to use supplication/begging. The intensity of tendency to undertake manipulation was higher in everyday life than during therapy. The Machiavellian- ism of patients was positively correlated with the tendency to employ manipulation tactics. Differences within the scope of general Machiavellianism between the patients and the control group were not noted. Conclusions. The manipulation tactics of neurotic patients are of morbid nature. They are related to anxiety, feeling of guilt and hostility. The tendency to manipulate correlates with Machiavellianism. Key words: neuroticism, manipulation, Machiavellianism Introduction Neurotic disorders or neuroses (situational neurosis) (ICD-10: F40–48) inclede functional disorders of the nervous system existing without any organic harm to it. In contrast to schizophrenia (F20) or borderline personality disorder (F60.31), in case of reactive neurotic disorders there does not occur any disruption of reality evaluation. Neuroses are functional mental disorders with not homogenous clinical picture usually 66 Eugenia Mandal, Adam Horak with the majority of changes in emotional processes, caused by widely understood psy- chological traumas – a variety of difficult situations of various impact and duration [1]. The prevalence of neuroses in industrialised countries amounts to ca. 10% and constitutes 5–15% of diagnoses by general practitioners and 40% of diagnoses by psychiatry specialists. Most patients are women, whose ratio to men in this regard amounts to 2:1. The axial symptom of a neurosis is anxiety, which leads to increasing difficulties in individual and social life [2–4] and is the most important element of the theory explaining the etiopathogenesis of this type of disorders. The cognitive theory explains that a neurosis is erroneous perception, processing and evaluation of hazardous facts, inducing the emotion of anxiety and then the non- adaptive attempt to escape from the stimulus that causes the anxiety. The theories of learning define neuroses as improperly learnt reactions that can reduce anxiety and its manifestation, created by means of modelling or imitating in interaction with pre-morbid personality, e.g.: egocentricity, submissiveness, tendency to dominate and aggressiveness. In the psychodynamic theories the role of unconscious intrapsychic conflicts from childhood that remained unsolved, is underlined [2]. According to K. Horney, a fun- damental anxiety that arose in that way during childhood participates in formation of neurotic attitudes “from”, “towards” and “against people” during adulthood [5]. In O.F. Kernberg’s theory, neurotic personality structure is consistent with the fixa- tion unit development at the stage of ego and superego consolidation, psychotic – at the stage of normal symbiosis autism and borderline – intermediate, acting in continuum of disorder between neurosis and psychosis [6, 7]. Neurotic disorders are transient and reactive, personality disorders are relatively permanent (character neurosis) [5]. Manipulation defines an intentional behaviour related to the manipulating person’s own benefit and creating the feeling of being in control of the situation in the manipu- lated person, while the real control is in possession of the manipulating person. It means treating the other person more like an object than a subject and it is manifested by employing manipulation tactics that aim at making the manipulated person submissive with regard to intentions and aims of the manipulating person [8–10]. A high tendency to manipulate is related to a Machiavellian personality, that is, instrumental treatment of other people according to the principle of “trampling over people” to achieve one’s aim, the principle of the end justifying the means, lack of empathy, tendency to lie and specific perception of other people as naive and cow- ardly. A manipulating person may take advantage of a high level of anxiety – when it is a state in a manipulated person, while exhibiting himself or herself a low level of anxiety – as a trait [11, 12]. It can be supposed that anxiety, hostility and the feeling of guilt – the characteristics of a neurotic personality – may facilitate undertaking manipulation of other people. At the source of occurrence of neuroses there is a fundamental anxiety caused by feel- ing of insecure as a child. The high level of anxiety, feeling of guilt and hostility may induce undertaking manipulation due to a lack of ability to satisfy social needs [13]. Hostility may be related to instrumental treatment of other people. Thus, neuroticism Manipulation tactics of patients with neurotic disorders in everyday life 67 and Machiavellianism, as well as the tendency to manipulate other people, may be closely related to one another. The studies conducted so far indicate that there is a relationship between Machiavel- lianism and the general personality disorder indicator (moderate correlation), specific scales of paranoid, passive-aggressive and antisocial personality (low to moderate correlation) [14], borderline personality (significantly lower level of Machiavellian tactics) [15] and depression (moderate correlation) [16]. Relationship between Machi- avellianism and neurotic disorders is ambiguous [17]. Aim The aim of the studies conducted with participation of patients diagnosed with neurotic disorders was: 1. to compare the intensity and repertoire of manipulation tactics employed by patients in everyday life with the intensity and repertoire of manipulation tactics employed by healthy people in everyday life; 2. to compare the intensity of Machiavellianism in patients with the intensity of Machiavellianism in healthy people; 3. to compare the intensity and repertoire of manipulation tactics employed by patients in therapy with the intensity and repertoire of manipulation tactics employed by patients in everyday life; 4. to compare the intensity and repertoire of manipulation tactics of patients in therapy with the intensity and repertoire of manipulation tactics observed by the therapists during therapy. Material The subjects were 111 people: 44 patients with diagnosed neurotic disorders (ICD-10: F40–F48), 44 people from the control group and 23 therapists. The group of patients consisted of 33 women and 11 men. Percentage of men and women in the group of patients corresponded to the proportion of 3:1 in the population of people suffering from neurotic disorders [2]. The mean age of all patients was: M = 38 years; SD = 9.0, women M = 38 years; SD = 9.5, men M = 37 years; SD = 10.07. The control group consisted of healthy individuals with no diagnosis of neurosis and psychiatric diagnosis. The health was additionally evaluated on the basis of the proper functioning of these people (work, study), which was confirmed by the circumstances in which they had been filling questionnaires (universities, libraries and other public places). The control group was similar to the group of patients with regard to sex and the mean age of the people from the control group (M = 37 years; SD = 12.00) did not differ significantly from the mean age in the group of patients (p = 0.83). The qualification for the patient group was carried out among patients of 10–12 week long therapeutic stays at day wards for treatment of neurotic disorders in: Feniks Mental Health Centre in Sosnowiec, Independent Public Clinical Hospital No. 7, Medi- 68 Eugenia Mandal, Adam Horak cal University of Silesia – Leszek Gieca Upper-Silesian Medical Centre on the basis of medical documentation according to the ICD-10 criteria (F40–48). The studied group included also 23 therapists from the Silesian, Lower Silesian, Opolskie and Greater Poland provinces (19 women (83%) and 4 men (17%)) carrying out individual and group therapy of patients diagnosed with neurotic disorders. Among the therapists there were 5 (23%) people with medical education (specialist in psychia- try), 11 with psychological education (master’s degree in psychiatry; 48%) and 7 with therapeutic education (certificate of a therapist or pending training; 30%). The mean age of therapists was M = 38 years; (SD = 10.00) and the average seniority was M = 9 years; (SD=7.00). The therapists represented almost all the therapeutic orientations. Method The following research instruments were used during the studies: 1. Manipulation tactics
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