Narcissistic Personality Disorder
Interest in the topic of narcissism and its clinical variant, narcissistic personality disorder (NPD), has grown dramatically in recent years. Research on this topic was traditionally found in the fields of social-personality psychology (trait narcissism) and clinical psychology and psychiatry (NPD). More recently, however, work on narcissism has made its way into industrial-organizational (I-O) psychology, developmental psychology, decision making, organizational behavior, criminology, educational research, and political science. Narcissism is examined as a variable of interest in research on many cutting-edge topics, such as behavior on the World Wide Web, corporate leadership, ethics and criminality, and celebrity.
DSM-IV Diagnostic Criteria for Narcissistic Personality Disorder
Source: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Copyright 1994), American Psychiatric Association.
DSM-IV Diagnostic Criteria
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) Has a 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 or high-status people (or institutions)
(4) Requires excessive admiration
(5) Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
(6) Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her 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 believes that others are envious of him or her
(9) Shows arrogant, haughty behaviors or attitudes
Narcissistic Grandiosity and Narcissistic Vulnerability
To the layperson, the construct of narcissistic personality disorder is most often associated with arrogant, conceited, and domineering attitudes and behaviors, which are captured by the term narcissistic grandiosity. This accurately identifies some common expressions of maladaptive self-enhancement associated with pathological narcissism. However, our definition of narcissism combines maladaptive self- enhancement with regulatory impairments leading to self-, emotional-, and behavioral dysregulation in response to ego threats or self-enhancement failures. This narcissistic vulnerability is reflected in experiences of anger, aggression, helplessness, emptiness, low self-esteem, shame, avoidance of interpersonal relationships, and even suicidality. Evidence for the two phenotypic themes of narcissistic grandiosity and narcissistic vulnerability come from clinical theory, social/personality psychology, and psychiatric diagnosis; and in recent years, recognition of both grandiose and vulnerable themes of narcissistic dysfunction has increasingly become the norm.
Freud and Narcissistic Personality Disorder
In Freud’s original conceptualization, narcissism related both to a mental, psychological pattern of thoughts and interactions, and to drives and the economy of energy. The description of narcissism as the libidinal investment or cathexis of the self and the choice of self as a libidinal object has since remained fundamental but also controversial. For the purpose of clarification, cathexis refers to the attachment of psychic energy to an object, a representation of the self, a person, a part or an idea, or to affects, which enables the individual to remember and feel feelings. Libido, an energy stemming from the sexual instinct (drive), represents the mental side or the dynamic manifestation of the sexual instinct. In a similar way, as is discussed further, aggression is stemming from the destructive or death instinct (drive).
Although primarily focused on the role of libido in relation to narcissism, Freud mentioned the large amount of aggressiveness in libidinal narcissistic personality types (1931). Narcissistic aggression can take self-destructive turns into suicide. Rosenfeld noticed the sense of superiority and self-admiration when such patients identify with the destructive narcissistic part of the self, and pursue suicide with an idealized view of death. An extreme form of hatred expressed in suicide. “The self is identified with the hated object and self-elimination is the only way to destroy the object as well”. In patients with malignant narcissism, chronic suicidal preoccupation may be accompanied by cold, sadistic, vengeful satisfactions, and the development of secret means, including suicide, for exercising power and control.
Various disruptions and distortions can happen. When the child is missing the function of a structuring object that can be internalized to contain an experience of the self and of the other (the parent), both narcissistic reactivity as well as the potential for narcissistic personality disorder occur. P. Kernberg (1998) described gaze aversion in children who experience themselves as functions of the parent’s needs or expectations. What they have seen in the parent’s eyes is not a reflection that promotes their self-identity but an image of a parental expectation that does not correspond to their own sense of self. Avoidance of eye contact serves in such cases a self-protective function. P. Kernberg also mentioned separation anxiety in children who experience having an impact on the parent’s self-esteem or self-regulation; that is, they exist in the service of the parent but not as an autonomous being (p. 111). The child is assigned power or ability that supports an illusion of his or her grandiosity, perfection, or invulnerability. In both cases the self-development is compromised due to an imbalance between the external (unrealistic) assignment and the age-appropriate needs for realistic self-reflection and self-evaluation. Also in adulthood, the meaning of gaze, seeing and being seen, takes on a narcissistic function that can be either protective or devastating.
The psychoanalytic theory on trauma recognizes two types: the real external trauma (abuse, terror, torture, etc.) and the internal, intrapsychic trauma that involves loss or distortions of ideals and meanings. The latter is of specific importance for understanding the narcissistic personality disorder. In object relation terms, the intrapsychic trauma is caused by a change in or loss of bond between the subject and a good object on which the ideals are based. The trauma causes damage or destruction of the idealized object as well as of the idealized aspects of the self-associated to the object. The trauma is leaving an empty space where the idealized, protective, and supportive functions of the object previously had been. Anxiety overwhelms the ego and weakens or damages its ability to recognize and adapt. Trauma causes a false ego organization, with specific efforts to handle the loss of ideals, including various narcissistic strategies such as denial, omnipotence, invulnerability, and limitlessness. It also produces fantasies but the fantasies are separate from and do not correspond to the trauma. Through repetition compulsion there is a tendency, especially when facing negative experiences, to repeat a trauma, in particular those aspects of the traumatic experience that could not be symbolized or assigned a specific meaning.
Freud outlined the “narcissistic libidinal type” (1931). He wrote:
“The subject’s main interest is directed to self-preservation; he is independent and not open to intimidation. His ego has a large amount of aggressiveness at its disposal, which also manifests itself in readiness for activity. In his erotic life, loving is preferred above being loved. People belonging to this type impress others as being “personalities”; they are especially suited to act as a support for others, to take on the role of leaders and to give a fresh stimulus to cultural development or to damage the established state of affairs.” (p. 218)
Freud noted the negative description of this narcissistic personality type, with a lack of tension between ego and superego and a preoccupation with themselves. Because of their libidinal detachment from objects and the outside world Freud believed narcissistic personalities to be incapable of forming a transference relationship and therefore unable to benefit from a psychoanalytic treatment.
Narcissistic Personality Disorder Treatment
The question may not primarily be whether the narcissistic individual is reactive to protect and enhance self-cohesiveness or whether he or she has an underlying brittleness that calls for more protective, defensive, or avoidant maneuvers. Instead, the attention ought to be on the balance between these two positions. In terms of self-esteem regulation, the question is how the individual manages experience ranging from superiority and control to inferiority and powerlessness. From an affect regulation perspective, the question of whether the narcissistic individual is more motivated by shame or by anger may in a similar way be answered by looking at the predominance and balance in between both of those affects.
The developmental conditions for normal versus disordered narcissism are indeed individual, resulting in specific internalizations of early representations of self and others, and in accompanying clusters of narcissistic strategies (internal as well as interpersonal), which are interacting with the external life conditions that takes on subjective narcissistic meanings. The phenomenological presentation of narcissistic individuals can therefore only provide hints of what can be central in their intrapsychic functioning.