Year : 2018 | Volume
: 6 | Issue : 1 | Page : 10--15
Deva shatru/Daitya/Asura grahonmada: Antisocial/Narcissistic/Borderline personality disorder?
Kshama Gupta, Prasad Mamidi
Department of Kaya Chikitsa, Parul Institute of Ayurveda, Parul University, Vadodara, Gujarat, India
Dr. Kshama Gupta
Department of Kaya Chikitsa, Parul Institute of Ayurveda, Parul University, Vadodara, Gujarat
Asura grahonmada (AG) is one among 18 types of bhootonmada. Deva shatru and daitya grahonmada are used synonymously for AG. Bhootonmada is a broad category which comprises of various psychiatric or neuropsychiatric problems and they are assumed to be caused by affliction of evil spirits. Till date, no studies have been conducted on AG, and it is an under-explored topic in ayurvedic psychiatry field. The present study is focused on better understanding of AG and its clinical applicability. The present study aims at better understanding of AG along with its clinical applicability. AG is characterized by Jihma drishtim (crooked/dishonest/cruel/deceitful look), Dushtaatmaanaam (deceitful/exploitative/unlawful), Krodhanam (aggressive/hostile/impulsive), Atruptam (unsatisfied/unpleasant), Sasweda gaatram (sweating), Deva, braahmana, guru dveshinam (arrogant/grandiose/envious/negative emotionality), Nirbhayam & Shooram (reckless behaviour/impulsive), Abhimaaninam (grandiosity), Vyavasaayinam (violent/unlawful/firmness/persistence), 'Rudro aham',' upendro Aham', 'skandho aham', 'vishaakho aham' bhaashamaanam (grandiosity), Vikruta vaacham (hostility/verbal aggression), Asakrit hasantam (laughing frequently/affective dysregulation), Sura amisha ruchim (fond of alcohol and meat) and Dantai, nakhai himsantam (violent/physical aggression). The clinical picture of AG shows similarity with various psychiatric conditions such as antisocial personality disorder, narcissistic personality disorder, borderline personality disorder, bipolar disorder (BD), and comorbidity among these conditions.
|How to cite this article:|
Gupta K, Mamidi P. Deva shatru/Daitya/Asura grahonmada: Antisocial/Narcissistic/Borderline personality disorder?.Int J Yoga - Philosop Psychol Parapsychol 2018;6:10-15
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Gupta K, Mamidi P. Deva shatru/Daitya/Asura grahonmada: Antisocial/Narcissistic/Borderline personality disorder?. Int J Yoga - Philosop Psychol Parapsychol [serial online] 2018 [cited 2019 Dec 10 ];6:10-15
Available from: http://www.ijoyppp.org/text.asp?2018/6/1/10/233610
Unmada is a broad term which includes various psychiatric conditions and is characterized by deranged mental functions. “Bhuta vidya” (ayurvedic psychiatry) is one of the eight specialties of Ayurveda. Bhuta vidya is a branch which deals with incantation and mode of exorcising, evil spirits, and making offerings to deva (divine beings), pishacha (class of demon fond of flesh), gandharva (class of demon fond of entertainment), yaksha (living supernatural being/ghost), and rakshasa (class of demon fond of violence) for the cure of diseases originating from their malignant influence.Bhutonmada is a psychiatric condition and is characterized by various types of abnormal behaviors. Acharya Vagbhata has described 18 types of bhutonmadas. They are deva, asura, rushi, guru, vruddha, siddha, pitru, gandharva, yaksha, rakshasa, sarpa, brahma rakshasa, pishacha, kushmanda, nishada, preta, maukirana, and vetala. Asura grahonmada (AG) is one among these 18 types of grahonmada.
There is no description of AG available in Charaka samhita.Acharya Sushruta has used the term “Deva shatru grahonmada” for AG. In Ashtanga samgraha (written by vriddha Vagbhata), “AG” is described. In “Ashtanga hridaya,” “Daitya grahonmada” term is used for AG. The description of AG in “Madhava nidaana” is similar to Sushruta samhita. AG, Daitya grahonmada, and Deva shatru grahonmada are used synonymously among different ayurvedic classical texts, and the description of these conditions is also similar.,,, AG is characterized by Jihma drishtim (crooked/dishonest/cruel/deceitful look), Dushtaatmaanaam (deceitful/exploitative/unlawful), Krodhanam (aggressive/hostile/impulsive), Atruptam (unsatisfied/unpleasant), Sasweda gaatram (sweating), Deva, braahmana, guru dveshinam (arrogant/grandiose/envious/negative emotionality), Nirbhayam & Shooram (reckless behaviour/impulsive), Abhimaaninam (grandiosity), Vyavasaayinam (violent/unlawful/firmness/persistence), 'Rudro aham', 'upendro aham', 'skandho aham', 'vishaakho aham' bhaashamaanam (grandiosity), Vikruta vaacham (hostility/verbal aggression), Asakrit hasantam (laughing frequently/affective dysregulation), Sura amisha ruchim (fond of alcohol and meat), Dantai, nakhai himsantam (violent/physical aggression), etc. features. Till date, no studies have been conducted on AG, and it is an under-explored topic in ayurvedic psychiatry. The present study is focused on better understanding of AG and its clinical applicability. The clinical picture of AG shows marked similarity with various psychiatric conditions such as antisocial personality disorder (ASPD), narcissistic personality disorder (NPD), borderline personality disorder (BPD), bipolar disorder (BD), and comorbidity among these conditions. The similarity between AG and various personality disorders is explored in the following sections.
Etiology, Pathogenesis, and Prognosis of Asura Grahonmada
There is no description of specific etiology, pathogenesis, and prognosis available for AG in ayurvedic texts. The samaanya nidaana, sampraapti, and saadhyaasaadhyata (common etiology, pathogenesis, and prognosis) explained for bhutonmada are also applicable for AG. Grahavesha (affliction by evil spirit) and prgnaaparaadha/karma (cognitive blasphemy/deeds of present or previous life) are explained as causative factors for bhutonmada. In grahonmada/bhutonmada, the symptoms occur suddenly without any visible reason. The course and prognosis of bhutonmada are unpredictable in nature.
Asura Grahonmada Lakshanas (Signs and Symptoms of Asura Grahonmada)
Compared to other ayurvedic texts, Vriddha Vagbhata in “Ashtanga samgraha” has described AG Lakshanas (signs and symptoms) in a detailed way. Various psychiatric conditions such as ASPD, NPD, BPD, and BD resemble with AG in signs and symptoms. Each and every lakshana of AG along with its similar modern psychiatric condition correlated as follows.
Jihma drishtim (crooked/dishonest/cruel/deceitful look) and Dushtaatmaanaam (deceitful/exploitative/ unlawful)
”Jihma drishtim” is considered as “Kutila darshanam” (crooked or suspicious or deceitful looks) according to “Ashtanga hridaya.” About 40%–50% of patients with BPD have brief periods of psychotic symptoms or dissociation. Typical symptoms include paranoid thoughts (suspicious looks) and auditory hallucinations. Other cognitive features that are common in BPD are depersonalization (i.e., the sensation that a person's body or self is unreal or altered in a strange way), derealization (i.e., the experience that the external world is bizarre and unreal), and illusions, which are misperceptions of existing stimuli. Characteristic features of ASPD include a pervasive pattern of disregard for and violation of the rights of others, a failure to conform social norms, irresponsibility, deceitfulness, indifference to the welfare of others, recklessness, irritability, a failure to plan ahead, and aggressiveness. ASPD patients even exhibit traits of impulsivity, high negative emotionality, low conscientiousness, and a wide range of interpersonal as well as social disturbances. Deceitfulness is indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure in one of the criteria for ASPD. NPD patients show 'interpersonally exploitative nature' and they are often envious of others. “Jihma drishti” denotes deceitfulness, exploitation, irritability, suspiciousness, and negative emotionality of ASPD, BPD, and NPD.
Aggressiveness is an important issue commonly seen in personality disorders, particularly in ASPD. Individuals with ASPD display a low frustration tolerance. Impulsivity has been variously defined as swift action without forethought or conscious judgment. ASPD is defined in DSM-IV as “a consistent pattern of disregard for and violation of the rights of others occurring since age 15.” The role of impulsivity in ASPD as defined by DSM-IV is problematic because “impulsivity or failure to plan ahead” is listed as one of the possible, but not necessary, criteria for the disorder. Patients with BPD have found that impulsivity is a key factor in the diagnosis, linking BPD to ASPD and to mania. Patients with BPD described continuous dysphoria, high emotional variability, and increased hostility. Inappropriate and intense anger is the next affective symptom of BPD and is related to affective instability. BPD is a chronic psychiatric disorder characterized by marked impulsivity, instability of mood and interpersonal relationships, and suicidal behavior. BPD is a complex syndrome whose central features are instability of mood, impulse control, and interpersonal relationships. When affective instability is monitored with standardized instruments, emotions are found to be intense but reactive to external circumstances, with a strong tendency toward angry outbursts. Impulsive symptoms include a wide range of behaviors and are central to diagnosis. “Narcissistic rage” is an easily activated destructiveness and ruthlessness, with no limits to the need for redressing the perceived grievance seen in NPD. Impulsive acting out identifies two broad categories of acting-out behavior: “self-endangering” (representing an unconscious attempt to assert omnipotence and a grandiose denial of feelings of vulnerability) and “other-endangering” (a response of narcissistic rage).Krodhanam of AG denotes aggressiveness or narcissistic rage or impulsiveness of ASPD, NPD, and BPD.
The narcissistic patient is insatiable in his or her demands from others: all limitations and frustrations, no matter how legitimate, are experienced as malicious, irrational deprivations. Narcissistic patient also feels incapable of loving or understanding others, while very little enjoyment is obtained from life other than the tributes received or from grandiose fantasies. Many individuals with NPD fluctuate between grandiose and depleted states, depending on life circumstances, while others may present with mixed features. What characterizes NPD across the spectrum is a more or less fragile sense of self that is predicated on maintaining a view of oneself as exceptional. The DSM-5 criteria provide narrow and homogeneous definition of NPD characterized by grandiosity, need for admiration, entitlement, and lack of empathy. They fail to cover core psychological features of the disorder including vulnerable self-esteem, feelings of inferiority, emptiness, boredom, affective reactivity, and distress. When narcissists self-esteem is not gratified by others or they are criticized, this can cause them to turn to anger. Gratification from achievements comes from external praise rather than an inner sense of an achievement being accomplished in NPD patients.
Sasweda gaatram (sweating)
Problems related to anger management are relatively common to paranoid, antisocial, borderline, and narcissistic personality disorders. Individuals with these diagnoses tend to react in overtly angry styles when triggered either by internal or external cues. For example, individuals with NPD often exhibit hostile behavior when confronted with interpersonal rejection or criticism. “Sasweda gaatram” of AG denotes excessive sweating which may occur due to anger/aggressiveness/anxiety commonly seen in ASPD or BPD or NPD.
Deva, braahmana, guru dveshinam (arrogant/grandiose/envious/negative emotionality)
Disinhibited, socially inappropriate behavior and emotional irregularities are seen in BPD patients due to the damage of orbitofrontal cortex. Individuals in a manic state often attempt to manipulate the self-esteem of others, exploit areas of vulnerability, test interpersonal limits, and project responsibility or blame onto others, as is often the case with patients diagnosed with BPD, with the common result of alienating the patient from others. The manic patient expresses such behavior only while in a manic state, whereas a patient with BPD does it so unremittingly. Aggressiveness is commonly seen in personality disorders, especially in ASPD. Individuals with ASPD display a low frustration tolerance. ASPD patients show pervasive pattern of disregard for and violation of the rights of others, a failure to conform social norms, deceitfulness, indifference to the welfare of others, recklessness, irritability, a failure to plan ahead, and aggressiveness. ASPD patients even exhibit traits of impulsivity, high negative emotionality, low conscientiousness, and wide range of interpersonal and social disturbances. NPD individuals show arrogant, haughty behaviors and attitudes. Patients of NPD lacks empathy and envious of others. “Deva, braahmana guru dveshinam” of AG denotes arrogance, excessive envy toward authority figures, antisocial behaviors, negative emotionality, grandiosity, etc. which are commonly found in ASPD, NPD, and BPD.
Nirbhayam, Shooram, and Vyavasaayinam (reckless, unlawful, violent behaviour/impulsive)
Impulsiveness can be defined as a behavior without adequate thought or the tendency to act with less forethought. Impulsivity can be divided into three components: (1) acting on the spur of the moment (motor activation), (2) not focusing on the task at hand (attention), and (3) not planning and thinking carefully (lack of planning). A high level of impulsivity is frequently a component of ASPD in general. Impulsive behavior, increased incarceration or arrest, addictive disorders, and suicidal behavior are characteristic for both ASPD and BD. Marked impulsivity, instability of mood, chronic feelings of anger, and disturbed interpersonal relationships are the main features of BPD. Patients with BPD described continuous dysphoria, high emotional variability, and increased hostility. Compromised empathic processing is a hallmark of narcissism. Decreased empathy (specifically emotional empathy) among individuals with NPD is characteristic. Two pathologies that have been linked to narcissism are psychopathy and BPD. Each of these syndromes appears on a continuum with NPD that highlights the patterns of impulsivity, emotion dysregulation, and self-centered, goal-focused behaviors. “Nirbhayam, Shooram, and Vyavasaayinam” of AG denotes impulsivity which is a common feature of ASPD, BPD, NPD, and BD.
Abhimaaninam and “Rudroaham,” “upendro aham,” “skandho aham,” “vishaakho aham” bhaashamaanam (grandiosity)
Individuals with NPD may be grandiose or self-loathing, extraverted or socially isolated, and model citizens or prone to antisocial activities. NPD is characterized by a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, entitlement, and lack of empathy. The grandiose, thick-skinned, overt subtype is characterized by overt grandiosity, attention seeking, entitlement, arrogance, and little observable anxiety. A group of individuals with NPD described as “high-functioning,” “exhibitionistic,” or “autonomous.” These individuals are grandiose, competitive, attention seeking, and sexually provocative while demonstrating adaptive functioning and using their narcissistic traits to succeed. Maintaining a view of oneself as exceptional is one of the characteristics of NPD. NPD patients show grandiose sense of self-importance (e.g., exaggerates achievements and a talents and expects to be recognized as superior without commensurate achievements). They are preoccupied with fantasies of unlimited power, success, brilliance, beauty, or ideal love. They believe themselves as “special” and unique and can only be understood by or should associate with other special or high-status people. NPD individuals require excessive admiration and have a sense of entitlement. Grandiosity (exaggerating talents and an unrealistic sense of superiority) has been found to be a key in discriminating NPD from other personality disorders. Grandiose narcissism is described as a pattern of arrogant, self-centered, and domineering beliefs and behaviors.Abhimaaninam and “Rudro aham,” “upendro aham,” “skandho aham,” and “vishaakho aham” bhaashamaanam (claiming themselves as rudra, upendra, skandha, and vishakha etc.) of AG denotes “grandiosity” of NPD or BD.
Vikruta vaacham (hostility/verbal aggression)
ASPD is characterized by impulsivity, irritability, aggressiveness, and recklessness. ASPD individuals may perform acts or behaviors which are unlawful and irresponsible. ASPD persons show deceitfulness (repeated lying, using aliases, or conning others, etc.) and hostility. Marked impulsivity, intense episodic dysphoria, irritability, inappropriate or intense anger, difficulty controlling anger, frequent display of temper, constant anger, and recurrent physical fights are the characteristic features of BPD. BPD individuals may display extreme sarcasm, enduring bitterness, or verbal outbursts. NPD individuals show arrogant, haughty behaviors or attitudes.Vikruta vaacham of AG denotes verbal aggression or hostility which is commonly found in ASPD, BPD, and NPD.
Asakrit hasantam (laughing frequently/affective dysregulation)
The first affective criterion in BPD is the presence of “affective instability due to a marked reactivity of mood which lasts hours to rarely more than a few days.” Persistence of affective lability throughout life is also one of the features of BPD. Moods usually shift between depression and anger, and euphoria is transient. Patients with BPD show continuous dysphoria, high emotional variability, and increased hostility compared with healthy controls. Affective instability, marked reactivity of mood, and dysphoric mood are the characteristic features of BPD.Asakrit hasantam of AG denotes mood instability seen in BPD.
Sura amisha ruchim (fond of alcohol and meat)
Alcohol and substance abuse or dependence is seen in more than 50% of patients with BPD. The combination of substance use and BPD is associated with an increased risk of completed suicide and is related to affective instability. More commonly, narcissism may be manifested in “antisocial” behavior; the “antisocial” personality as a subtype of the narcissistic personality. Addicts, including alcoholics, gamblers, and drug addicts, often develop their dependence in an effort to establish a sense of inner equilibrium and to provide a temporary sense of power against feelings of inadequacy in NPD. In BD, ASPD predicted severe course of illness, presence of substance use disorder, and suicidal behavior. Impulsive behavior, increased incarceration or arrest, addictive disorders, and suicidal behavior are characteristic for both: ASPD and BD. In case of combined disorders, these characteristics appear more severe. By considering these facts, it seems that substance abuse is common in various personality disorders such as ASPD, BPD, and NPD.
Alcohol (sura priyam) also causes a chemical imbalance of the neurotransmitters dopamine and serotonin in the brain. Dopamine directly cannot be obtained from food, but tyrosine (an essential amino acid and a dopamine precursor) is abundant in several protein-rich foods such as chicken, turkey, avocado, seeds, and nuts. By taking foods rich in tyrosine, the brain will be able to synthesize dopamine. Proteins are high in amino acids, which are necessary for dopamine production. Chicken, red meat, eggs, and dairy products all contain the amino acid tryptophan, which the body can convert into niacin. Foods such as fish, eggs, chicken, turkey, and red meat supply the body with adequate amino acids. Tryptophan poor diet produced high rates of aggressive behavior. In children, zinc and/or iron deficiencies are also related to increased aggressive behavior.
The individuals suffering with AG craves for meat which may indicate underlying deficiency of various nutrients (cravings may develop toward such type of foods which may correct the underlying nutritional deficiency). There is no confirmatory evidence related to cravings toward particular food items in various psychiatric disorders, but the latest research shows that various nutritional deficiencies might cause antisocial and offending behaviors. There is a link between poor diet and depression, anxiety, impulsivity, and aggression. Improving the nutritional status through supplementation of micronutrients improves the antisocial and offending behavior. Omega-3 fatty acids, folic acid, zinc, magnesium, and Vitamin D are the micronutrients which have been studied in relation to mood and behavior. The cravings towards meat (amisha priyam) as mentioned in signs and symptoms of AG denote underlying micronutrients, tryptophan, and/or other essential amino acids and/or Vitamin B12 deficiency. By considering all these facts, it seems that “sura, amisha priyam” of AG denote alcohol abuse (commonly found in ASPD, BPD, NPD, and BD) and craving toward to meat due to underlying various nutritional deficiencies (developed either independently or due to alcohol abuse).
Dantai, nakhai himsantam (violent/physical aggression)
Individuals with ASPD tend to be irritable and aggressive and may repeatedly get into physical fights or commit acts of physical assault including beating. These individuals also display a reckless disregard for the safety of themselves or others. ASPD individuals are indifferent to hurting others and mistreating others. They frequently lack empathy and tend to be callous, cynical, and contemptuous of the feelings, rights, and sufferings of others. ASPD individuals may spend many years in penal institutions and may commit homicides. BPD individuals may frequently express inappropriate, intense anger, or have difficulty in controlling anger. Impulsivity, irritability, dysphoria, and recurrent physical fights are common in BPD patients. Haughty behaviors or attitudes, arrogance, lack of empathy, and narcissistic rage are common in NPD.Dantai nakhai himsantam of AG denotes aggressiveness or impulsivity seen in ASPD, BPD, and NPD.
Comorbidity of Antisocial Personality Disorder, Borderline Personality Disorder, Narcissistic Personality Disorder, and Bipolar Disorder
The association between NPD and ASPD is affirmed by many studies using structured interviews. About 25% of patients who met criteria for one of these diagnoses meet criteria for the other. The conceptual, clinical, and empirical evidences of “near neighbor” status have encouraged questions of whether NPD and ASPD are distinct or are variations of a common basic psychopathology. There is an overlap of both disorders (i.e., antisocial narcissists and narcissistic antisocials). Patients with BPD have found that impulsivity is a key factor in the diagnosis, linking BPD to ASPD and to mania.
NPD is frequently comorbid with other disorders, particularly substance use disorders, BD, and other personality disorders. NPD most commonly co-occurs with antisocial, histrionic, borderline, schizotypal, and passive-aggressive personality disorders. Comorbidity with ASPD has the most profound negative impact on prognosis of NPD. Grandiose traits tend to be related to substance abuse and comorbidity with antisocial and paranoid personality disorder. The differential diagnosis for NPD includes bipolar illness, substance abuse, depressive disorders, depression, anxiety disorders, and other personality disorders. All are frequently comorbid with NPD. Two pathologies that have been linked to narcissism are psychopathy and BPD. Each of these syndromes appears on a continuum with NPD. Patients with BD suffer from comorbid personality disorders in more than 36%. Narcissistic personality, BPD, and obsessive–compulsive personality disorder are more frequent in bipolar patients. It seems that there is a high comorbidity between ASPD, BPD, NPD, and BD.
”AG” is one among 18 types of grahonmada. The signs and symptoms of AG such as Jihma drishtim, dushtaatmaanaam, krodhanam, atruptam, sasweda gaatram, deva, braahmana, guru dveshinam, nirbhayam & shooram, abhimaaninam, vyavasaayinam, 'rudro aham',' upendro aham', 'skandho aham', 'vishaakho aham' bhaashamaanam, vikruta vaacham, asakrit hasantam, sura amisha ruchim, and dantai, nakhai himsantam show similarity with deceitfulness, exploitation, antisocial, aggressiveness, impulsivity, negative emotionality, grandiosity, dysphoria, alcohol abuse, and physical violence features commonly found in various personality disorders such as ASPD, BPD, and NPD and mood disorder like BD. AG shows similarity with ASPD, BPD, NPD, BD, and/or comorbid condition among them.
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