Diagnosing Ramona Morganstern?

Old folklore from Eastern Europe suggests that many vampires suffered from a form of Obsessive Compulsive Disorder , being fascinated with, for example, counting.

Explanations of the disorder along with Erotomania and NPD follow below.

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Traditional Definitions & Descriptions of OCD

OCD in all of its variations is far more common than previously thought. Medical research also shows that there is a strong genetic basis for the disorder. Anxiety and worry is a prominent feature of OCD – and the compulsions are behavioral attempts to manage or control the anxiety and the distressing thoughts.

Obsessive-Compulsive Disorder

1. Obsessions are “Recurrent and persistent thoughts, urges, or images that are experienced… as intrusive and unwanted…” and cause anxiety, worry and distress (DSM-5, American Psychiatric Association). Attempts are made to ignore or suppress the thoughts.

2. Compulsions are… “Repetitive behaviors or mental acts” (like checking behavior and counting) in response to the thoughts. These behaviors are not rational or realistic, and are often excessive.

3. The thoughts and behaviors are often very time consuming and cause severe distress.

Obsessive-Compulsive Personality Disorder

1. This type of personality is rigidly and excessively focused on rules, organization, perfectionism and control (individuals with OCD, the anxiety disorder mentioned above, may not have this type of personality).

2. These individuals may be “workaholics” – they are generally preoccupied with details, lists and schedules, and excessively concerned with morality and ethics.

3. They may be “hoarders” who cannot dispose of unneeded objects without a great deal of anxiety and worry.

4. This personality may lose sight of productive goals and balance in life due to their rigid standards.

The Many Faces of OCD

o The Perfectionist – Charlene was indeed a perfectionist. She worked long hours and was never quite satisfied with the results. She told me once that when she entered a room at home she would immediately inspect the floor to see if there were specks of dirt or dust to be picked up. She rarely enjoyed her beautifully decorated home because of her “OCD”. She constantly experienced anxiety and worry about making mistakes or being seen as less than perfectly well put-together.

o The Control Freak – Charlene’s husband referred to her as a Control Freak – and she agreed with him. She washed the dishes immediately after every use and rarely used the dishwasher – the knowledge of soiled dishes in there made her nervous. She required a level of organization and cleanliness that was disturbing to her husband.

o The Worrywart – This version of OCD is similar to Generalized Anxiety Disorder, but these individuals stay in their heads with obsessive worry while they struggle to work out solutions that are evasive and usually impossible to achieve. The worrywart doesn’t discriminate – he or she worries about everything, regardless of the level of importance.

o The Fanatic – Ironically, Charlene’s husband had his own OCD tendencies. He was an admitted fanatic about politics and sports. Charlene said he was a bore. He was obsessively focused on national politics and watched hours of cable TV news shows. He knew all of the NFL players and statistics, and at social gatherings he would monopolize conversations with his knowledge and opinions. Sports and politics were always on his mind and he would become antsy if he was away from his computer or TV for more than a few hours.

o The Nag – aka The Complainer – It looks and sounds like chronic complaining or incessant nagging. But when you look below the surface, there may be OCD tendencies or traits. The Nag may be someone who struggles with anxiety and worry – and distressing obsessive thoughts that result in a compulsive need to complain.

o The Anal Retentive – This type of OCD is characterized by rigidity, a need to keep things orderly and excessively organized, and a personality that’s fussy, scrupulous, and fastidious to a fault.

OCD in Relationships

Individuals with OCD – either the formal anxiety disorder itself or a personality type – struggle with anxiety and worry that can be very distressing, even overwhelming at times. And it can be equally difficult and challenging to live with someone who suffers from OCD. Patterns of emotional reactivity can develop in this type of relationship, leading to a great deal of relationship distress. Charlene’s husband would be triggered by her anxiety and her controlling, perfectionistic tendencies. He would react with sarcastic comments and he resisted her attempts to involve him in her compulsive tendencies. Charlene felt unsupported by him, and she reacted to his frustration with anger and withdrawal. During those times when Charlene was the most anxious and obsessive compulsive, the reactive patterns and distress in her marriage became unbearable.

Couples may be unaware of the underlying causes – obsessive thoughts and beliefs; the anxiety associated with them; the controlling, complaining behavior that follows – and partners react emotionally out of frustration. On the surface, it looks like tension and arguments about the kids, money, chores, or even an affair in the past. And those can be troubling issues to be sure. However, the OCD process takes over at times, and becomes a primary source of relationship distress.

Coping Skills for OCD

o Mindfulness and acceptance – Awareness without judgement. Observe and identify the distressing, obsessive thoughts, while letting go of any negative judgments. The judgments create more anxiety and worry which exacerbates the OCD.

o Letting go of the struggle – Don’t argue with the obsessive thoughts. Don’t try to find a rational explanation. It’s like trying not to think about a pink elephant – the more you try the more it feeds the pastel beast in your mind.

o Identify and label the thought as obsessive, annoying, or unproductive (without any judgment). It’s just an annoying thought, and that’s all it is. It’s not about the content of the thought. We get lost believing in the content (my finances, my spouse and what he/she did, the problems with work, the house, the kids). But it’s not about the content – it’s about the OCD, the ruminations, and the anxiety we feel because of the thoughts.

o Thought stop and refocus – Gently tell your mind to stop it, and immediately refocus onto something manageable in the present moment. Keep repeating this process as necessary.

o Exercise and yoga – Proven to reduce anxiety and worry, along with the obsessive thoughts.

o Therapy and medication – If you continue to struggle and there’s no improvement, seek professional help. Counseling and therapy, along with certain medications when necessary, can be highly effective with all forms of OCD.

OCD Can Involve Obsessions That Revolve Around Another Person

6-8 minutes

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By Fred Penzel, Ph.D.
I recently visited my local library searching for current articles on OCD that might be of interest to my support group. The periodicals file is computerized so I conducted a search of articles on Obsessions, Compulsions and both together. I suppose a system is only as good as the knowledge of the person who programs and updates it. What I discovered under the topic headings was a mix of a few articles in the more well-known magazines, together with a group of writings which were shockingly out of place and so misleading that at first I thought I had accessed the wrong topic.  I came across such titles as “I Love You To Death,” “Crazy Love,” “A Stranger Was Stalking Our Little Girl” and “Twisted Love: A Deadly Obsession.”
To the uninformed reading these, it would appear that people with OCD are either a bunch of dangerous sweet-talkers, or delusional or violently jealous maniacs, posing a risk to anyone foolish enough to get into a relationship with them and who then want to break up. While I was aware that this misconception existed, it seemed to me to be more widespread than I had ever imagined. How could they be so ignorant? After all, these articles were from widely distributed popular magazines.  There are those with OCD who actually have obsessions which involve others. I have met and treated quite a few over the years, but they are hardly dangerous, delusional or violent. These types of OCD seem to fall into the following categories:
1. Obsessions that one will have to break up with someone they care about,
2. Obsessions that the person will want to break up with them,
3. Obsessive and doubtful questions about why one has broken up with someone,
4. Obsessive and doubtful questions about why the other person has broken up with them,
5. Obsessive doubts as to whether one has harmed, injured, insulted or embarrassed a particular person, often someone close, or
6. Obsessive questions about the other person’s past.
These types of obsessions are usually accompanied not only by compulsive rumination and analysis, but frequently by attempts to question the other person, either face-to-face, by phone, mail, or via a third party or parties. Here is where, I believe, the confusion about this type of OCD occurs. Generally, the OCD sufferer, when tortured by doubts, may repeatedly question or search for information. This may be the result of the individual with OCD being unable to process information on their particular obsessive topic, even though they might actually have enough to answer their question. Therefore, they erroneously believe that more information will solve their problem. The more they question, the more the doubts increase. Gradually, this questioning strikes the other person as strange and begins to bother or annoy the other person who is being questioned inappropriately. They may respond with annoyance, graduating to hostility and in many cases, withdrawal from the relationship and finally from all contact with the OCD sufferer. This withdrawal, of course, only serves to increase the sufferer’s distress due both to rejection by the other person, and to their source of information being cut off. If, in addition, their obsession is about losing the other person, this can really drive anxiety and distress levels through the roof as the behavior paradoxically served to make the obsession come true.
This is where some of the really desperate behavior on the part of sufferers begins to be confused by many with that of individuals who are delusional, pathologically jealous, or otherwise out of touch with reality. (None of which, by the way, have anything to do with OCD.) The person with OCD may go to great lengths to pursue the person to ask their relentless questions, and I have seen several cases where they would even manipulate to the point of threatening to harm themselves or do desperate things if their questions went unanswered. The other person may, at times, be driven to seek legal help, such as an order of protection, fearing harm from the person with OCD, not realizing the actual basis of the pursuit. The harassment here is unintentional on the OCD sufferer’s part, but it does turn out this way, unfortunately. The disorder can become so all-consuming that they may overlook the needs of others without meaning to. I have never heard of anyone being harmed by a person with such an obsession,. nor can I imagine they would do more than simply be persistent and very frustrating to talk to or deal with, at times. Naturally, when they recover, they would never dream of behaving this way. Some have described it to me as feeling “like waking up from a nightmare” to find out that you have lost relationships with friends and loved ones, sometimes permanently. Fortunately, there are also cases where the sufferer has gone back and explained what the problem was and was treated with understanding.
There is another type of non-OCD disorder called “erotomania” in which the sufferer has delusions that they have a relationship with another person, that the other person knows about, but is “keeping secret.” Sometimes the other person can be someone famous. A good example is the woman who believes she is David Letterman’s wife and keeps breaking into his house. Again, this is not OCD.
My hope is that as the facts of OCD become better known we will no longer see such articles listed under OCD as I saw in my town library. Perhaps some of you can help in this effort. Simply informing those close to you that you have a problem isn’t enough — you must make efforts to help yourself if you want others to be sympathetic. If you suffer from any of the obsessions mentioned earlier, you can get help and you can recover. Behavioral therapy and medication help a lot, but only if you utilize them. Don’t wait until you have damaged an important relationship in your life.

Fred Penzel, Ph.D. is a licensed psychologist who has specialized in the treatment of OCD and related disorders since 1982.  He is the executive director of Western Suffolk Psychological Services in Huntington, Long Island, New York, a private treatment group specializing in OCD and obsessive-compulsive related problems, and is a founding member of the OCF Science Advisory Board.  More of Fred’s work can be found on his website.  Dr. Penzel is the author of “Obsessive-Compulsive Disorders: A Complete Guide To Getting Well And Staying Well,” a self-help book covering OCD and other obsessive-compulsive spectrum disorders.

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 What is erotomania?

Erotomania is a delusional belief that a person is in love with the affected individual, despite contrary evidence.

Erotomania is an uncommon form of paranoid delusion. The affected person strongly believes that another individual is in love with him or her.

This delusion develops and persists despite clear evidence to the contrary. The condition is rare, and erotomania affects women more often than men.

Erotomania can start suddenly, and the symptoms are often long lasting. The object of the affection is typically an older, inaccessible person with a higher social status who may have had little or no previous contact with the deluded person.

Erotomania is sometimes called De Clerambault's syndrome, after the French psychiatrist who first described it as a distinct disorder in 1921. Erotomania is often related to other psychiatric disorders, but may also occur on its own.
Causes

Erotomania may be a symptom of a psychiatric illness, including schizophrenia, schizo-affective disorder, major depressive disorder with psychotic features, bipolar disorder, or Alzheimer's disease.

Erotomania is a type of delusional disorder. Other types include delusions of persecution, grandiosity, or jealousy.

Case reports have suggested that social media networks could exacerbate or even trigger delusional beliefs linked to erotomania.

Social media eliminates some of the barriers between unacquainted people and can easily be used to observe, contact, stalk, and otherwise harass people who would previously have been completely inaccessible. Social media platforms can reduce privacy, which can make stalking behavior much easier.

Some studies have suggested that delusions may develop as a way of managing extreme stress or trauma. Genetics may also contribute to the development of delusional disorders.

Symptoms

Recent reports have suggested that social media may potentially cause or exacerbate erotomania.

The key symptom of erotomania is a resolute and delusional belief by someone that another person is in love with them.

Behavior linked to erotomania includes persistent efforts to make contact through stalking, written communication, and other harassing behaviors.

This can be accompanied by a belief that the object of the affection is sending secret, personal, and affirming messages back. Paradoxically, this belief can be triggered by the targeted person making it known that the attention is unwelcome.

People with erotomania can pose a threat to their object of affection. This is often underestimated as a risk factor when assessing the condition.
Diagnosis

The diagnosis of erotomania can be challenging because it is such a rare condition. Some psychiatrists do not see cases of erotomania in clinical practice and may not even recognize the symptoms when they do encounter them.

The following conditions must be met before a stand-alone diagnosis of delusion can be made:

Delusions must involve possible events, even if they are highly unlikely.
The delusion must only apply to the relevant issue, with all other aspects of the affected person's life being functional and normal.
If low moods or manic episodes are also present, then the duration of the delusional period must be longer than the mood or manic episode.
Schizophrenia, mood disorders, and intoxication must all be excluded.

Treatment

Treatment for erotomania should be tailored personally for the individual to gain the best results. Medication and therapy are common treatments.

Treating delusional disorder can be hard because those affected are not likely, or even able, to see that their beliefs are unfounded.

Comparatively few affected people will seek treatment of their own accord, and they may find it difficult to engage successfully in therapy.

Treatment should be tailored to the needs of each affected person. Priorities should focus on maintaining social function, minimizing the risk of problematic behavior, and improving the affected person's quality of life.

It may also be helpful to provide social skills training and to provide practical help in dealing with any problems stemming from erotomania.
Management

Successful symptom management will focus on treating the underlying disorder and may include medications, therapy, and hospitalization. Any or all of these approaches can be applied, depending on the person concerned and the underlying causes.

Therapy should help the affected person to comply with an agreed treatment plan and to educate them about their illness.

Hospitalization may be needed if the affected person becomes a danger to themselves, to the object of their affection, or to anyone else.

Antipsychotic medication may control symptoms effectively and can be prescribed for the underlying disorder. Medication and psychotherapy can be used together.

The role that social media plays in any problematic behavior should be considered when developing a treatment plan.
Outlook

Diagnosis and symptom control is essential for helping a person with erotomania overcome their condition.

It is rare for erotomania to reoccur and treatment is often successful, especially for people with bipolar disorder or without other underlying conditions.
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All about narcissistic personality disorder

Narcissistic personality disorder involves a distorted self-image. Emotions can be unstable and intense, and there is excessive concern with vanity, prestige, power, and personal adequacy. There also tends to be a lack of empathy and an exaggerated sense of superiority.

Narcissistic personality disorder (NPD) is closely associated with egocentrism, a personality characteristic in which people see themselves and their interests and opinions as the only ones that really matter.
People with NPD have limited interest in the feelings of others. They lack empathy and are unable to feel or appreciate feelings that are not their own.
According to the United States' National Library of Medicine, a person with NPD has an excessive sense of self-importance, an intense preoccupation with themselves, and a lack of empathy for others.

Fast facts on NPD:

• The term comes from a character in Greek mythology, called Narcissus.
• It is characterized by an extreme sense of self-worth.
• Other features include being quick to anger and prone to irritation.
• For a diagnosis, the symptoms must be persistent and chronic.

What is narcissistic personality disorder?

Narcissistic personality disorder (NPD) is characterized by an extreme sense of self-worth.

The term comes from a character in Greek mythology, called Narcissus. He saw his reflection in a pool of water and fell in love with it.
NPD is one of a group of conditions known as dramatic personality disorders. The person will have unstable and intense emotions and a distorted self image.
An unusual love of self, an excessive sense of importance and superiority, and a preoccupation with success and power can indicate a lack of self-confidence. NPD often involves a deep sense of insecurity and a lack of self esteem.
A study carried out by the National Institute on Alcohol Abuse and Alcoholism, published in the Journal of Clinical Psychiatry, found that 7.7 percent of men and 4.8 percent of women develop NPD during their lifetime.
The researchers also found that NPD rates are much higher among black men and women, Hispanic women, younger adults, and people who either never married or became divorced, widowed, or separated.

Traits

Below are the most common traits found in people with NPD:

• An insatiable appetite for the attention of others
• Extreme feelings of jealousy
• An expectation of special treatment
• Exaggerating achievements, talents, and importance
• Extreme sensitivity and a tendency to be easily hurt and to feel rejected with little provocation
• Difficulty maintaining healthful relationships
• Fantasizing about their own intelligence, success, power, and appearance
• An ability to take advantage of others to achieve a goal, without regret or conscience
• A lack empathy, or ability to understand and share the feelings of others, and a tendency to disregard others' feelings
• A belief that only certain people can understand their uniqueness
• A tendency to consider themselves as skilled in romance
• Responding to criticism with anger, humiliation, and shame
• Seeking out praise and positive reinforcement from others
• An expectation that others will agree with them and go along with what they want
• Whatever they crave or yearn for must be "the best"

Others may see narcissists' goals as selfish ones. They may describe the person as self-obsessed, arrogant, tough-minded, and lacking emotion.

Diagnosis

A thorough range of criteria need to be met before a diagnosis of NPD can be made.

No specific lab tests exist that can diagnose NPD, but X-rays and blood tests may help rule out other conditions that may be causing the symptoms.
There are several different types of personality disorder, some of them overlap, and it is possible to be diagnosed with more than one type.
An NPD diagnosis must follow the criteria written in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the APA (American Psychiatric Association).
The following must be present for a diagnosis of NPD to be made:

• The patient's idea and importance of self is exaggerated.
• Fantasies about beauty, success, and power dominate the individual's thoughts.
• The person thinks they are special, and relate only to other "special" people.
• They need to be admired all the time.
• They believe they are entitled to most things.
• They manipulate and take advantage of others.
• They lack empathy, the ability to feel and recognize the feelings and needs of others.
• They envy other people.
• Their behavior appears haughty or arrogant.

Treatment

There is no known cure for NPD. With psychotherapy, the individual may come to understand what causes their problems and learn how to relate more positively to others.
This may bring about a change in attitudes, resulting in more constructive behavior. It can help the person build up their self-esteem and acquire realistic expectations of themselves and others.
Cognitive behavioral therapy (CBT), family therapy, or group therapy are types of psychotherapy. CBT helps the patient identify negative beliefs and behaviors, in order to replace them with healthful, positive ones.
Medication may help with some of the more distressing aspects of the condition.

Causes

It is unclear what causes NPD. It may be associated with circumstances during childhood, such as very high parental expectations, over-pampering, neglect, or abuse.
An individual may have learned manipulative behaviors from their parents or household members while growing up.
If a child learns that vulnerability is not acceptable, this may undermine their ability to tune into other people's feelings and needs.
The NewYork-Presbyterian Hospital points to recent evidence that a genetic predisposition and other biological or biochemical factors may be linked to NPD.

Complications

A person with untreated NPD has a greater chance of abusing drugs and alcohol, of having depression, relationship problems, difficulties at work or school, and suicidal behaviors or thoughts.
A study published in PLoS One found that males with NPD have higher levels of cortisol in their blood. Cortisol is a stress hormone. A person with NPD may have higher levels even when stress levels are low. High blood cortisol is linked to a greater risk of developing cardiovascular problems.

Living with somebody who has NPD

Living with someone who has NPD can be challenging.
Family members have described their loved one as:

• controlling
• egotistical
• frequently dissatisfied with the actions of others
• prone to blaming others and making them feel guilty for all their problems
• losing their temper at the slightest provocation
• turning their back and giving people the "silent treatment"
• being physically and sexually abusive

The emotional and physical impact of working with or living with a person with NPD can be severe. Learning how to become more confident and assertive can help a person cope with the effects.
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Put it all together and weigh them against her actions in the story and you end up with a centuries old vampiress who quite possibly suffers from OCD, Erotomania and Narcissistic Personality Disorder. Who also happens to have had a freaking demon in her mind/soul whispering to her and influencing her for about 432 years (Soooo, Auditory Hallucinations and Psychosis?) while being guided in her vampiric development by freaking Cecily of all people (We can speculate about that, but there's a possibility in it playing a part in Ramona's development of her sadomasochistic tendencies and fetishes; she is, after all, turned on not just by watching others get hurt, but she is also turned on heavily by the act, or even just the threat, of, death or pain caused to herself. In fact, fun little fact, normal porn doesn't get doesn't do anything for her. Her fetishes are more extreme.), you can talk to Carmella all about Cecily, all on top of the natural vampiric bloodlust and killer instincts that come naturally with being a vampire.

Not justifying her mass murders and centuries of general super-dickery of course, but I thought it was an interesting breakdown of possible disorders she could've been living with for centuries.