Updated: Nov 20
Narcissism and Narcissistic Personality Disorder (NPD) is one of the most difficult mental health issues any person or couple contends with. But what exactly is narcissism? How does one become “narcissistic”?
Freud originally came up with the term from a Greek character “Narcissus” who fell in love with his reflection in a pool of water and died from the longing of his image that couldn’t satisfy. Those that struggle with Narcissism often have childhoods characterized by one of a couple of issues: (1) material over-indulgence combined with emotional neglect or severe emotional neglect alone (2) Shame-based parenting or (3) When a parent uses a child to maintain their own self esteem. Sometimes parents will exploit their child’s natural talents to maintain their own self-esteem, thus becoming “narcissistic extensions” of their caregiver and later narcissists themselves. This is often classified as the “special child.” Many report growing up in a family atmosphere of constant evaluation. Some research has identified the “shamed child, spoiled child, and the special child” as precursors to pathological narcissism in adulthood. All in all, these are people who were over-indulged or under-indulged by their early relationships. They likely struggled to feel fully seen, honored, respected, or recognized as a whole and separate individuals. They served ego-functions for parents or managed childhood shame with narcissistic compensation.
NPD Criteria as outlined in our Diagnostic Manual the DSM-5: (1) Grandiose sense of self-importance (e.g. exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements) (2) Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love (3) Believes that he or she is “special” and unique and can only be understood by, or should associate with other special high status people (or institutions) (4) Requires excessive admiration (5) Has a sense of entitlement - unreasonable expectations of especially favorable treatment or automatic compliance with their expectations (6) Is interpersonally exploitative - takes advantage of others to achieve their own ends (7) Lacks Empathy; is unwilling to recognize or identify with the feelings and needs of others (8) Is often envious of others or believers that others are envious of him or her (9) Show arrogant, haughty behavior or attitudes
The result is someone whose personality is organized around maintaining self-esteem by gaining affirmation from outside of themselves. In childhood, they learn to abandon their budding true self and instead pursue actualization of a constructed, idealized, false self. That budding true self was never attended to properly by the original caregiving environment, never given fertile interpersonal soil to grow. So instead they jump ship on themselves and pursue an idealized image of who they could be, the person who, in their mind, could be worthy. It’s incredibly sad, as they are cast out of ever possessing an authentic being. Instead, they compulsively internalize the praise of others to stay afloat. This leaves others feeling a great need from them for them but also a shallow love. Psychoanalysts call this “collecting self-objects” or internalizing representations of others and their praise to maintain their fragile esteem. It is hard for those with NPD to genuinely and reciprocally relate, you can feel used for your attention and admiration. Preoccupied with how they appear to others, narcissistically organized people often feel privately fraudulent and loveless. At the core, they feel there is something missing (some extreme deficiency) from their inner lives and they oscillate between shame and envy, greatness and worthlessness. Interpersonally, the inner truth is “If I feel deficient and I perceive you as having it all I may try to destroy what you have by deploring, scorning, or ridiculing it.” They can attack impulsively and it is a cornerstone of diagnosis that they consistently lack empathy for others.
Another way people with Narcissism try to compensate for shame, whether conscious or not, is to identify with someone they see as perfect to manage self-esteem. This is usually a lover, mentor or hero but can range from a whole sports team to a single individual that they try to fuse with in order to bask in this person or groups glory and avoid the deep shame they feel inside (“I am an appendage of so and so, who can do no wrong”). In the end, image replaces substance and ones persona becomes more vivid than ones authentic personality. They develop what is called a “false self”, central to NPD. The person with NPD unconsciously abandons their authentic self for a construction of their idealized self. The result is that they often feel like full time actors to others in their lives. It’s hard to feel like there’s really anyone in there to connect to. In every vain, grandiose narcissist lurks a self-conscious, shame faced child. In every depressed, self-critical narcissist lurks a grandiose version of what the person feels they should really be. What remains and theme throughout their lives is the need for perfection, neurotic ambition, and the need for vindictive triumph.
The defenses Narcissistic people typically rely on are idealization and devaluation. They see the themselves, others, and the world in these two categories – great and awful. There is a constant ranking process that narcissistic people use to address any issue that faces them: “Who is the best doctor?” “What is the finest pre-school?” Realistic advantages and disadvantages may be completely overridden by concerns about comparative prestige. They hold themselves up to unrealistic ideals and either convince themselves that they have attained them (a grandiose narcissist) or respond to their falling short by feeling inherently flawed rather than forgivably human (the depressive outcome). They often avoid normal feelings of dependence as they see it as weakness because they build their sense of self on not having failings and not being in need. Also dependence tends to bring up a lot because the people they were dependent upon as children disappointed and instilled the NPD injury. The theme in adulthood becomes, I can’t let others in or I might feel that same childhood injury. They are often unable to tolerate real intimacy and have a profound ability to rationalize almost any action or behavior. They have difficulty accepting responsibility for their actions because they terrified that it means they are not perfect. A genuine “sorry” is often not in the cards and being “good enough” is not one of their internal categories.
There are two fundamental subtypes of NPD worth mentioning because they present and are experienced very differently. The subtypes are best categorized as grandiose narcissism and vulnerable narcissism (also called “covert” or “hypersensitive”). When most think of narcissism they typically think of the more grandiose type (Trump, Kanye, DJ Khaled, etc.). Those who fall into this category are incredibly extraverted, low on neuroticism (typically low levels of anxiety and depression) and express overt feelings of superiority and entitlement. They are true egomaniacs and megalomaniacs. They are “out there”, shameless, bold, and lead with their sense of superiority. Vulnerable narcissism, while sharing the core feature of self-centeredness, superiority, and self-absorption, express it quite differently. These are the men and women living in their parents basement, angry at being undiscovered or unjustly scorned at the lack of opportunity. They live in an ongoing state of “I’m supposed to be great, the best, etc…but….(some externality).” They are often those that navigate work and relationships with a more subtle but clear sense that they are better than you, however, unlike grandiose narcissists they fear criticism so deeply that they shy away from and even seem panicked by people and attention. They are typically highly neurotic (high levels of anxiety and depression) and are prone to overreacting emotionally to the point of being explosive. Anything that threatens to expose their hidden, negative self-image is met with narcissistic rage (overtly or with passive aggression). Any action that makes them feel shame is met with equal contempt or hatred. An example of this person might be Alec Baldwin, Matthew McConaughey, or Steve Jobs.
In relationships, those with NPD either find another NPD person to commit to – only someone they see as close to as great as themselves (think Kim Kardashian and Kanye) or they find a partner that can serve to meet their never ending and exhausting ego needs. Those in relationship with people suffering from NPD face real challenges that wear their partners out. In the beginning the idealization wins – you are the best, the most amazing, the only one, etc. but when that party is over you are met with the stark opposite. True indifference (“because there’s no way that I can really be associated with someone not as perfect as me”). What the person with NPD finds unbearable about themselves will often be projected into their loved ones and then scorned, rejected, or even hated. People report feeling like they are losing their own sense of identity as their needs, emotions, feelings, wants, thoughts, are never respected, honored or listened to by the person with NPD. They feel ridiculed, picked apart, devalued. The person with NPD doesn’t know how to be genuinely concerned about another. Their shame provokes chronic defensiveness. Even the simple task of asking questions and properly tuning into another person can feel difficult for them. The conversation usually veers back around to themselves as their obsessive need for praise, idealization, and others concern overrides any chance for mutual relating. This perpetuates the empty feeling they have. You’ll never hear “Hey, I know you had that meeting you were really anxious about today, I was thinking about you, how did it go?” It’s not in them to even think to ask.
If you are in a relationship with someone with NPD long enough then you probably have a sense of what it was like to be them as a child. You are feeling the way they were treated by a parent. Needing to perform (like they did for a parent’s needs) or expected to be perfect as they were convinced they were as children. You are likely a bottomless pit of continual validation and frustrated at not being respected as a whole, other person. Your needs are never met, and you have figured out how to live on breadcrumbs. The dynamic is characterized by gaslighting, a preoccupation with how you as a couple appear to others (even though you know what’s behind the scenes), and fear that your own self is slipping away from you. The subjugation in the relationship can be frightening and overwhelming. Feeling blamed constantly, you may begin to believe the projections of the NPD partner. You may not even recognize the person you have become – deflated, self-critical, empty (again, this is not you but what the NPD person has projected into you and you are holding for him so he can maintain his cohesive sense of self and superiority).
Therapy can help with this disorder but it takes a lot of time. As with all disorders of character, people with NPD lack insight because so much is repressed and it makes psychotherapy challenging. Those with NPD don’t often seek treatment (as you would imagine) but their significant others do. Either because the NPD person has convinced them that “the problem is you” or they have begun to sense something terrible and cult-like has overtaken their life to which they need outside help. They often come in secret, and have learned to fear the rage that might incur should they seek professional help. Those with NPD that do seek treatment often arrive with the goal to further perfect the self, seek enlightenment, use therapy to discover ways to manipulate others or avoid some crisis themselves, impress the therapist, check the box for someone, seek praise, or complain of an inner sense of deadness. However, a keen therapist helps them to understand themselves better, speak their needs, accept themselves as “good enough”, accept others nonjudgmentally and non-exploitatively, to love others/themselves as they are (without idealizing or devaluing) and to express genuine feelings without shame. It’s also a great accomplishment to help them discover the ways in which they get in their own way and to identify such patterns. These are major successes for those suffering from NPD.
A final note, NPD is an exaggerated set of normal personality features. Enjoying your accomplishments, success, appreciating your strengths, believing in yourself, etc. is not NPD this is healthy self-esteem. NPD can't even be diagnosed unless it causes impairment or distress in important areas of functioning (occupational, relationally). Although this is common, it is not always the case that there are major consequences in ones life as a result of pathological narcissism.
For more information on this topic a recent book was published called “The New Science of Narcissism” by Keith Campbell or Nancy McWilliams book “Psychoanalytic Diagnosis.” You can also check Dr. Campbell out on a recent episode of the Joe Rogan podcast. If you or a loved one are suffering from some of the issues above please reach out to us at the contact information listed below:
Keil Psych Group