What is Pathological Narcissism?
Narcissism has become a term known among almost everyone. For example, in Woody Allan’s 2006 movie, Scoop, when asked what religion he is, he replied that he had converted to narcissism.
Narcissistic Personality Disorder (NPD) or pathological narcissism is associated with ways of thinking and feeling about oneself and others that affect how an individual functions in many aspects of life. There are several distinct types of personality disorders, of which NPD is one. The prevalence of NPD in our community is estimated to range from 0% to 6.2% and of those diagnosed with NPD, 50% to 75% are male.
NPD is characterised by a pattern of grandiosity and a less obvious pattern of vulnerability, which reflects two distinct but co – occurring states. The pervasive pattern of grandiosity (in fantasy or in behaviour), a need for admiration, and lack of empathy, often develops by early adulthood and presents in a variety of contexts.
Is there a Difference between being Narcissistic and having a Disorder?
Not all narcissism is pathological or maladaptive. However, some features of narcissism can become much more clinically relevant and severe. Any person, and often very successful people display personality traits that might be considered narcissistic. Only when these traits are inflexible, maladaptive, and persistent, and cause significant functional impairment or subjective distress than they constitute narcissistic personality disorder.
What Kind of Relationship Problems Arise with NPD?
It is often the case that narcissism is not identified through how the narcissist feels, but through how they make other people feel.
Truly pathological or malignant narcissism is often reported by others through their experience of emotional, psychological, financial, and physical abuse.
Furthermore, a person with narcissism is frequently isolated, socially withdrawn, and unable to truly enjoy the company of others.
What Kind of Emotional / Affective Problems do People with NPD Tend to have?
A person with NPD tends to fluctuate between features that fit in with the pattern of grandiosity and the pattern of vulnerability.
Narcissistic grandiosity creates difficulty in feelings and relationships such as:
- An absence of emotion
- Not understanding emotions
- Lack of empathy
- Disconnect with others
- Hot emotions like rage and aggression but can also be more controlled versus explosive
On the other hand, the person experiencing narcissistic vulnerability may seem:
- Emotional dysregulated
- Have feelings shame
- Have feelings of envy
- Experience rage and aggression
- Experience self-aggression and be very self-critical
- Depressed and anxious moods
- Intolerant of criticism and defeat
- Have a feeling of emptiness
How to communicate with someone who you think displays narcissistic behaviours?
Communicating with a narcissist can be difficult as they tend to think they’re perfect or need to be seen as perfect. Hence, they can easily respond to a request, complaint or need as a direct assault on their identity. With a narcissist, everything can be about what they need and decide. Expressing vulnerability, sharing with others, and sacrificing some of their desires to please another, can seem like a threat. A narcissist is likely to withdraw and isolate themself out of fear of feeling vulnerable.
A narcissist will often complain that they don’t get the attention or admiration they deserve and that they haven’t got enough success, fame, or money worthy of their talents. This ongoing entitlement fantasy, often results in the narcissist showing no interest or concern in anything to do with anyone else’s life, including their partner, children and friends. It can feel as if no one exists beside the narcissist.
When entering a conversation with a person with NPD, it may feel like you are being talked at, or over. A person with NPD can come across as demeaning, demanding, distrustful, unremorseful, and snobbish while constantly seeking your praise and recognition. It is too easy to become defensive and emotional, and even bored when communicating with a narcissist.
To Communicate Well with a Narcissist, there are some Important Things to Consider:
- Educate yourself – the more you understand about the disorder, the easier it is to avoid some of the pitfalls and traps that you may get caught up by.
- Create boundaries and standards – decide in advance to communicating with a person with NPD what you are willing to do, accept, agree on. The clearer you are about how you will commit to your values and principles, the less chance there is of being manipulated.
- Have realistic expectations – don’t expect a deep and meaningful conversation; don’t expect them to see your point of view; don’t expect their words to mirror their true intentions.
- Have an out – when entering communication with a narcissist, be clear about the time frame available for the conversation from the beginning.
- Stay calm – try not to react when you notice they are trying to pick a fight or gaslight you.
- Choose your words wisely – frame your needs, complaints, and desires in careful, positive ways. Practice assertive and empathetic communication skills frequently, so when communicating with someone with NPD, you are not caught off guard.
- Stay well – seek supportive counselling from a mental health professional and from your social support network to take care of your own mental health. Ongoing communication with a person with NPD can be stressful.
What to do if you feel you may be a Narcissist?
Seek Professional Support from a Mental Health Provider
Does an assessment help?
Possibly yes. A diagnosis is made by a psychologist or psychiatrist. A diagnosis for NPD typically involves structured clinical interviews, self-report measures and informant reports.
Features of pathological narcissism appears in other disorders, so the clinician will compare the symptoms with symptoms from other disorders such as depression, OCD and ADHD.
A person with an NPD diagnosis may be diagnosed with more than one mental health problem, for instance, depression, substance use disorder, and even other personality disorders.
Typically, according to the DSM-V, which is the benchmark for mental health diagnosis in Australia, the person needs to experience moderate or greater impairments in personality functioning, manifested by characteristic difficulties in five or more of 8 areas:
- Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognised as superior without commensurate achievements).
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- Believes that he or she is “special” and unique and can only be understood by, or should associate with other special or high-status people (or institutions).
- Has a sense of entitlement (i.e., unreasonable expectations of especially favourable treatment or automatic compliance with their expectations).
- Is interpersonally exploitative (i.e., takes advantage of others to achieve their own ends).
- Lacks empathy – is unwilling to recognise or identify the feelings and needs of others.
- Is often envious of others or believes that others are envious of them.
- Shows arrogant, haughty behaviours or attitudes.
A diagnosis informs the direction and approach of the treatment and patient care, and communicates to the wider team. For instance, a patient with NPD may not comply with medical treatment, and a GP can ensure continuity of care by reporting the diagnosis in their case notes.
However, the important thing is understanding the core criteria of the diagnosis which includes how the disorder influences your behaviour, identity, and relationships.
Can you get Help?
Yes, you can. There are several empirically supported therapeutic approaches which are tailored for people with NPD. These include:
- Transference focused psychotherapy
- Schema therapy
- Dialectical behaviour therapy
- Cognitive behaviour therapy
- Supportive psychotherapy
What can you Expect to Gain from Therapy?
Some positive outcomes from a genuine commitment to therapy include:
- Improved and more stable relationships
- Healthy sense of self
- Stable self-esteem
- Improved self-talk
- Being less defensive, feeling more secure
- Improved communication and social skills
- Less dependency on unhealthy coping strategies, such as substance use
- Improved mood
- Healthy attitudes and mindsets that support real growth in career, interests, and personal life
Be prepared to make mistakes and to learn and grow from them. Understanding narcissism in another person or in yourself can feel overwhelming at times. Stick to the basics. Recovering a stable personality is a journey taken one moment at a time and may feel like a lot of effort at times. Stay the course. Just as with many mental health and personality disorders, the individual has a lot of power to change the behaviours and thoughts that perpetuate the symptoms and features of the disorder. A person may have narcissistic tendencies or a diagnosis of NPD, but they are not their diagnosis.
Diagnostic and statistical manual of mental disorders : DSM-5. (5th ed.). (2013). American Psychiatric Association.
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Ross M. King, Brin F.s. Grenyer, Clint G. Gurtman & Rita Younan (2020) A clinician’s quick guide to evidence‐based approaches: Narcissistic personality disorder, Clinical Psychologist, 24:1, 91-95, DOI: 10.1111/cp.12214