February 11, 2025 • 34 mins
In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) delve into the complexities of narcissism and narcissistic personality disorder (NPD). We explore the historical origins of narcissism, the DSM criteria for diagnosing NPD, and the key characteristics of individuals with this disorder, including a lack of empathy and pervasive envy. Our conversation highlights the roots, characteristics, and the dual nature of narcissism, as well as the challenges in researching NPD. We highlight characteristics such as grandiose self-importance, the need for excessive admiration, and the interpersonal exploitation that can occur in relationships. We also give a preview on the vulnerable aspects of narcissism, highlighting how it can manifest as low self-esteem and social withdrawal, a topic that will be discussed in an upcoming episode!
Chapters 00:00 Intro to Narcissistic Personality Disorder 01:07 Historical Context of Narcissism 06:02 Defining Narcissistic Personality Disorder 09:32 First Symptom: Lack of Empathy 10:52 NPD vs Autism 14:24 Second Symptom: Envy 15:46 Third Symptom: Fantasies of Success, Power, Beauty 16:33 Fourth Symptom: Grandiosity 17:55 Fifth Symptom: The Need for Specialness 20:54 Sixth Symptom: Excessive Admiration 22:22 Seventh Symptom: Entitlement 24:17 Eighth Symptom: Exploitation in Relationships 26:25 Ninth Symptom: Arrogance and Haughty Attitudes 27:37 Vulnerable Narcissism
References:
- American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th edition, text revision.). https://doi.org/10.1176/appi.books.9780890425787 Blaney, P. H., Krueger, R. F., Millon, T. (Eds.). (2014). Oxford textbook of psychopathology (3rd ed.). Oxford University Press.
- Blashfield, R. K., & Intoccia, V. (2000). Growth of literature on the topic of personality disorders. American Journal of Psychiatry, 157(3), 472-473.
- Millon, T. (2011). Disorders of personality: Introducing a DSM / ICD spectrum from normal to abnormal (3rd edition). John Wiley & Sons, Inc.
- South, S. C., Eaton, N. R., & Krueger, R. F. (2011). Narcissism in official psychiatric classification systems: Toward DSM-5. In Campbell, W. K. & Miller, J. D. (Eds.), The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments (pp. 22-30). John Wiley & Sons, Inc.. https://doi.org/10.1002/9781118093108.ch3
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Episode Transcript
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(00:00):
Welcome to the Personality Couch podcast,
where we discuss all things personality
and clinical practice.
I'm your host, Doc Bok,
and I'm here with my co-host, Doc Fish.
We are both licensed
clinical psychologists
in private practice,
and today we will be continuing our
(00:20):
series on narcissism.
So we've talked about
what narcissism looks like
when it's good,
and also when it goes
sideways into pathological land.
So within pathological narcissism
is narcissistic
personality disorder, or NPD.
So while not all
(00:40):
pathological narcissism is the same
as narcissistic personality disorder,
those diagnosed with NPD
will have a heaping
dose of pathological NARCY.
So join us today as we
unpack the nine DSM criteria
for narcissistic
personality disorder, or NPD.
(01:02):
We previously discussed
where narcissism in general
came from, but where did narcissistic
personality disorder
originate?
That is a great question.
All right, so a super
brief history lesson.
The word narcissism
comes from Greek mythology,
where the god narcissus
(01:24):
was cursed to fall in love
with his own reflection.
The story contains excessive love of self
paired with lack of
empathy towards others.
Then we have writers in the late 1800s
referencing narcissism as
an erotic condition, right?
Because of this excessive self-love.
(01:46):
Kind of makes sense, doesn't it?
So there's an
impairment in the love department
because the love of self is so great
it actually impedes real intimacy.
Okay, so the self becomes the object.
So the self is
attached to and loves itself
to an extent where they're constantly in
pursuit of pleasure,
(02:06):
like in all areas, like self-love.
Right, if you catch the drift,
pleasuring the self, all of
the pleasure, you get the point.
So in the 1910s, auto-rank
linked vanity and admiration
of the self with narcissism.
Freud also picked this up
(02:28):
in the 1910s and forward,
first viewing narcissism
also as an erotic condition,
as previous theorists did,
but then expanding it into personality.
And an important note is that Freud
mentioned narcissism
can be both normal and
necessary, not just pathological.
(02:48):
He would.
Of course.
Now in 1926, Reich discussed a phallic
narcissistic character
which mirrors today's
NPD, again, how fitting.
Later, narcissism focused on achievement
and took on various names
such as the Don Juan character
in 1945 and the Nobel
(03:10):
Prize complex in 1966.
Then the big dog shrinks
like Kernberg and Kohut
to help solidify the definition of NPD
when we first had it in the DSM-3.
So that was the first
time it made an appearance.
So interestingly, it's
also important to highlight
that from about 1966 to 1995,
(03:33):
research articles on NPD
were less than 10 per year.
Wow.
So the researchers that looked into this
actually described NPD
research itself as dead for NPD.
For nearly 30 years.
My goodness.
Yes.
So this is relevant
(03:53):
because the literature on NPD
is still mostly based on clinical
experience and theory
as opposed to empirical research.
Right.
I imagine research is
hard for that population.
Calling all narcissists,
we wanna study your flaws.
(laughing)
No.
Maybe if it was marketed as like
(04:15):
whose male anatomy is the biggest,
they'd have more volunteers.
(laughing) There's a suggestion.
Calling all people trying
to find a dissertation topic.
There you go.
There you go.
All right.
So what about the books that we use
to make the diagnosis of NPD?
So let's fast forward a bit to 1980.
(04:38):
The DSM-3, as you said,
was when personality
disorders first came on the map.
Interestingly,
narcissism didn't really have
empirical research backing.
And the first iterations of
NPD had some different wording
than it does now.
But original definitions
were still based heavily
(05:00):
on psychodynamic theory,
which basically were the OG
shrinks, the original guys.
Yeah.
Now in another manual,
healthcare professional
used to diagnose the
international classification
of diseases, ICD for short.
NPD has no historical
origin until the 11th edition,
(05:22):
which is 2022.
And that's different from other
personality disorders
that showed up earlier in that.
Okay, so NPD didn't have a
presence there until 2022.
Mm-hmm.
Good grief.
Okay, so it sounds like
Narsi has been the redheaded
stepchild of empirical
(05:44):
personality research.
But don't worry, it's gained a lot of
attention even still,
and we still have a
lot to learn about it.
And I would argue
possibly need to rethink the way
that we classify it.
I agree.
But it's still
incredibly useful to understand
the diagnostic language,
which brings us to our current
DSM's definition of narcissistic
(06:06):
personality disorder.
How does someone receive such a
diagnosis, Stockfish?
Sure, like all personality disorders,
these symptoms need to be pervasive
and like widespread basically.
And it's a pattern that
begins in early adulthood
and is present in numerous contexts.
It needs to consist of kind
(06:28):
of like three main things.
One, grandiosity and fantasy or behavior.
So fantasy like it could
be imagined or dreamed of.
Now let's define grandiosity.
APA's definition states,
it's an exaggerated sense
of one's greatness,
importance or ability.
In extreme form, it may be regarded
(06:50):
as a delusion of grandeur.
Ooh, that is so interesting.
Okay, so a delusion of
grandeur is the false attribution
to the self of great ability, knowledge,
importance or worth,
identity, prestige, power,
(07:11):
accomplishment or the like.
You get the point, right?
Also, this is called a grandiose delusion
or what some might term as megalomania.
Ooh, very interesting.
Quite.
So earliest theories of narcissism
actually conceptualized
(07:31):
it more in the psychotic realm.
So syndromes out of touch with reality.
Fascinating, right?
So we have the potential erotic disorder
and the potential psychotic disorder.
And then eventually we landed on
this is a personality disorder.
Right, my goodness.
Well, going back to that
(07:52):
grandiosity definition,
the quality of seeming
impressive or important
in an artificial or
deliberately pompous way
or pretentiousness.
Sure.
It can include being
imposing or impressive
or even being more complicated or
elaborate than necessary.
Now, why?
(08:13):
Well, because there's
a need for admiration.
Exactly, exactly.
So the pursuit of being
seen as an object of esteem
with others giving them
the approval and respect
or in other words,
essentially wanting others to fawn
over you or see you as important.
(08:35):
And then of course with that,
its buddy is lack of empathy.
So empathy is putting
yourself in someone else's shoes
or like perspective taking.
It's like vicariously experiencing
what the other person is thinking or
feeling or perceiving
and maybe sitting in
someone else's pain with them
and caring for them all the while.
(08:56):
Sure, sure.
So those with NPD are so self-absorbed
that there's too much self.
There's not room for
others feelings, only mine.
Right, but that's like the framework
that we're looking at with NPD.
So now we actually
have to meet at least five
or more of the following criteria.
(09:16):
And we grouped criteria
not in chronological order
from the DSM, but with
like internal deficits first.
So internal outward.
So our first internal
deficit is really important
because it's actually
mentioned twice in the DSM.
We literally just talked
about it, lack of empathy.
So they're unwilling
to recognize or identify
(09:37):
with the feelings and needs of others.
Yep, exactly.
This one's very
important again, mentioned twice.
Kind of like BPD with impulsivity
was mentioned twice as well.
Yeah, essentially they can't tolerate
any of their own badness.
So they split it off or project it
outward and onto others.
They haven't learned perspective taking
(09:59):
and or find others
perspectives too dangerous
or irrelevant to their ego or agenda.
So they're either unaware of others
thoughts or feelings
or they just don't care.
And then sometimes empathy is rejected
because others feelings and dependency
are seen as a sign of weakness.
(10:20):
Okay, so this may be
might look like making
hurtful remarks in which they're
completely clueless about
or again, they just don't care.
So maybe bragging about
money in front of someone
they know is struggling financially,
highlighting their own
health in front of someone
who's terminally ill.
And because of this, they can
come off as emotionally cold
(10:42):
and disconnected, like
only interested in themselves
and no one else.
Yeah, yeah, exactly.
Callous, like who are you?
How could you say that to this person?
I think it's important
to note that this is like
not in an autistic type of way.
Like this is not autism.
So they just don't care, those with NPD.
(11:05):
They're too busy with their own self
and keeping up their own
image to have time for you
and your emotions versus in autism,
there's social hard wiring issues
that are rooted in development.
These are not the same thing.
Okay, as you were talking, I was thinking
(11:25):
almost like a teenager
or like a regressive form.
There's social hard wireings intact.
They just like haven't really gone
through that growth yet.
It's like still all about me.
And there's like a kind of like a
cluelessness in that,
but they're hard wiring is intact.
So research actually shows
us that there is a difference.
(11:47):
In Germany, they had a
study with three groups.
So NPD patients compared with borderline
and then also a control group.
The NPD group had less emotional empathy
but not cognitive empathy.
Oh, interesting.
So they have like some
degree of cognitive empathy.
So that means that
they're able to understand
(12:07):
another person's
perspective on an intellectual level,
but they lack the emotional empathy.
So directly feeling the emotions
that another person's feeling.
Right, okay.
So this also flies in the face of autism.
Like they can detect the
cues on a cerebral level,
but the emotional like mirroring,
that emotional feeling of understanding
(12:29):
what it's like to sit
in someone else's shoes,
that doesn't come easily.
Correct.
Which can also lead to
what's called alexithymia
or emotional blindness.
So again, not the same as autism.
Those with NPD can detect
the cues on a cerebral level.
They just don't typically
care unless it benefits them.
(12:50):
Right, and then so another study,
they actually found a
neuropsychological basis for this.
I would guess that they
found less connections
in the brain regions involved in empathy
or empathic functioning, mirror neurons,
something like that.
Exactly, exactly. Yes.
And in a third study,
(13:11):
this is super interesting.
NPD patients actually performed worse
on facial emotion recognition tasks,
specifically fear and disgust.
Oh, wow.
Those are really primitive emotions,
more like hindbrained reptilian brain.
(13:34):
Interesting, so that says
social mirroring is off,
that they don't perhaps
recognize fear or disgust in others
because it's too threatening to the ego,
so the brain doesn't register it.
So that's the
personality brain connection.
Like the body isn't registering it
(13:55):
because it's too
threatening psychologically.
It's a whole body process.
Right, so that hard wiring is intact.
There's a capacity to, but it's too scary
for the inside and the
ego, so they just deny it.
Like ignoring the
warning light on your car.
To the point where
you just don't even know
(14:15):
it's there anymore,
because you've seen it so much.
Wow, blends in with the wallpaper.
That's fascinating.
So lack of empathy
was the first criteria.
Now the second one is envy.
So they're often envious of others,
or they believe that
others are envious of them.
Of course, yep.
So they're envious of
(14:35):
others' things, achievements,
praise, believing that
they deserve them more.
So as a reaction, they may
put the other person down,
devalue them, or otherwise
undermine the other person.
They tear them down, essentially.
(14:55):
And then they desire stuff in that
pursuit of specialness.
Or think that they're so special
that others desire their stuff,
possessions, achievements, qualities,
money, power, et
cetera, you get the point.
But then they become
preoccupied with those things
because of that envy.
And as I'm even saying this,
(15:15):
I hear a hint of paranoia in that.
Ooh.
Yeah, so if you're so preoccupied
with others being jealous of you,
like wouldn't you think
that people are out to get you
and then hoard your things?
That's a good thought, yeah.
So this is internal,
but then there's also
this internal grandiosity
(15:37):
that can show up in
more external behavior.
So what you were just saying,
there's like paranoia or
maybe like being preoccupied.
And that's the third criteria actually,
is preoccupation with
fantasies of unlimited success,
power, brilliance, beauty, ideal love.
Right, because in order to
(15:58):
fill their void of emptiness
and present as superior,
they need something to fill it up, right?
So this stems from low
self-worth that is rejected.
So essentially what you
get is an overcompensation
for the emptiness.
Right, they may obsess or
(16:19):
ruminate about admiration
or maybe privilege they
think is like long overdue.
And they often find famous,
powerful, influential people
that they can compare themselves with.
Yeah, or rub shoulders with, yeah.
So this leads us to the fourth criterion.
So they have a grandiose
sense of self-importance,
(16:39):
which means they may exaggerate
achievements and talents
or expect to be recognized as superior
without the achievements that match up.
Exactly, yeah.
They've learned that
their worth is superior
and not necessarily tied to effort.
So then in an effort to disguise the fact
that nothing is there,
(17:00):
they resort to bragging,
exaggerating,
overestimating their abilities
and holding
unrealistically high expectations.
So then they come off as
boastful and pretentious
and then expect other
people to see that same reality
that they do, like the
expectation that they're going
(17:21):
to have that reality
reflected back or their greatness,
their great abilities reflected back.
And then taking the glory for themselves.
So not letting other
people have even a slice of it.
And it's all the brado though, right?
And this serves to prop up
this illusion of amazingness,
(17:42):
but there's nothing there.
Or if it is, it's not as
great as they project it to be.
But they believe that they're special.
Okay, so this is criterion five.
So they believe that
they're special and unique
and can only be
understood by or should associate
with other special or high
(18:03):
status people or institutions.
Right, it's almost like rubbing shoulders
with those that are
influential, wealthy, talented,
you know, the like, almost like
vicariously absorbing
the specialness of others.
Like these other people
have really high value.
So I have high value in their presence.
(18:24):
Like their specialness rubs off on me.
Like we're all in the special boat.
Like just like static electricity, right?
Like, oh, that rubbed
off on me, now I'm special.
Right, but they can be
devastated or surprised
when others don't
give them the admiration
they think they deserve.
Exactly, in other
words, they don't understand
(18:46):
when others don't
recognize their greatness,
even if it's like
greatness by proxy, right?
Which essentially is rubbing shoulders
with the person of status.
Like if that person of status
weren't to recognize their greatness,
they would potentially be
devastated or surprised by that.
And so we're focusing
on like status, right?
(19:07):
So it's very likely that they need the
absolute specialist,
top best person or
organization for all the things.
Like restaurants or
hotels or their hairdresser,
a teacher, a physician.
And if they're
disappointed by that top person
that they chose, they'll
devalue them and tear them down.
Yep, I'm the best, so I
(19:28):
need the best is the mentality.
Like I have to have the
best suite in the hotel,
the penthouse, right?
Oh, that wasn't good enough.
There was, I don't know, a
tiny hair on the hairdryer.
Give me a new suite.
I want a poolside penthouse view.
Like it just never ends that
voracious appetite for more.
Or I'm just thinking
of like, you know, like,
(19:49):
oh, I have a degree
from ex Ivy league school.
And then it's like, oh, but
you have a PhD from Harvard.
That's not good enough.
Like, you know, putting
down the things that are like,
are you serious?
Yeah. Are you serious right now?
That's ridiculous.
I was thinking like,
well, I'm paying you.
So I have the power and I
know better than you do,
(20:10):
even though you're
the expert in the field.
Ew, oh my.
Yeah, yeah, that can happen.
Oh, or like in business,
like someone who keeps changing
the terms of the contract in their favor.
Like again, this is
like, this is very childlike.
Like think of a kid that's
cheating at Go Fish or Candyland.
(20:31):
Like that happens.
Right, it's a thing.
And as a kid, it's like, okay, you know,
this is developmentally appropriate.
You're like teaching them not to do that.
But in business, those
with NPD can absolutely cheat
and change the terms
to be in their favor.
Yep. Right.
Okay, so now this leads us to criteria
that kind of pull on those external
(20:52):
factors to meet needs.
Okay, so criteria number six,
they require excessive admiration.
Right, so they need an
audience desperately.
Like they need applause
because that sense of self
is so fragile and
there's such deep self doubt
(21:12):
and intense self criticism.
So they pull on other
people to tell them who they are
to prop up that false image.
And then they might
ruminate also about like knowing
what others think of them.
So there's an image
protection happening there.
I have to protect my image.
What is everybody saying?
Or even like information
that someone might have on them.
(21:33):
Like this can also look like paranoia.
What are they saying?
What do they know?
Because you can't be found out.
You can't let the world
know who you really are
or who they project themselves to be.
It's like an ego hologram.
You know?
Okay, I love this quote from the DSM.
It says, "They may expect
their arrival to be greeted
(21:54):
"with great fanfare and are astonished
"if others don't covet their possessions.
"They may constantly fish for compliments
"often with great charm."
Right, like we did not
have pyrotechnics going off
when you entered the office for therapy.
So maybe that was good enough.
You're surprised.
They're devastated.
(22:14):
Oh goodness.
But yeah, on a serious
note, I have seen that
with those with high
narcissism or with NPD, yeah.
Yeah, which transitions us
to criterion number seven,
a sense of entitlement.
So like unreasonable expectations
of especially favorable treatment
or automatic compliance
(22:35):
with his or her expectations.
Again, they are super important
and then expect this unreasonable,
favorable treatment.
Like going on an excursion with a friend,
maybe taking advantage of
that friend in the process
because of that entitlement.
Like, I expected you
to taxi me to the spa
(22:57):
and to the resort and to the tanning bed
and to the shopping metropolis
for dinner at the country club.
Oh, you wanted to go in?
Like we can't have that.
Like you can't stop and use the restroom.
I have to get to dinner
or they might feel angry or confused
if not given what they expect.
Like I should be at the front of the line
(23:19):
because of who I am.
Why should I have to wait?
Or like, why is this
drive through so slow?
Why is Chick-fil-A closed on Sunday?
Like don't they know
they'd get my business?
Right.
I shouldn't have to wait in line.
Like these are the
notions of someone with NPD
because they're so important.
Right, or like I own you.
(23:40):
You need to overwork and be
completely dedicated to me.
Like you don't have a life.
I am your life.
You have to work on
holidays to show loyalty.
Like why would you be
with your loved ones?
And this can lead to knowingly
or unknowingly exploiting others.
Right, right.
Sometimes it's not even conscious.
Yeah.
It's like, yeah, they're not even trying
(24:01):
to do it on purpose.
It just is.
Yeah, versus other
times it is on purpose.
It depends on how bad the NPD is.
Yes.
So this brings us to
the external criteria.
So the criteria that
we can kind of see more.
Criterion number
eight, we just touched on,
they're interpersonally exploitative.
(24:23):
So they take advantage of others
to achieve his or her own needs.
But it's all, it's one-sided.
So then relationships
are for self enhancement
of self-esteem, emotion,
status, image, success, intellect,
financial stuff, ego cookies.
(24:43):
Like the list goes on and on and on.
It's one-sided, just like a child.
And then they can
undercut other people as well.
Like, ooh, free latte on
the counter, must be mine.
Or like in a big corporation,
forcing the algorithm
to give them a raise
versus the person who
actually deserves it.
(25:03):
And again, this can be
conscious or it can be unconscious.
They may not be aware
of what they're doing.
Right, I like this
quote from Milan's book.
So the narcissist expects to be given
whatever he or she wants and needs,
no matter what it might mean to others.
This does not include active deception,
but rather is a consequence of the belief
(25:24):
that he or she is entitled.
For example, the person
with NPD would not set out
to con a little old lady
out of her life savings.
However, if she offered
them, the NPD would accept
such a gift without
reflection of its impact on her.
So he or she will expect
great dedication over work
(25:45):
and heroic performance
from the people associated
with him or her
without giving any thought
to the impacts of this
pattern of their lives.
Wow, okay, so the thought,
like I'd never con a little old lady,
but basically if the
opportunity was there,
they absolutely would.
Or their thought of
(26:06):
self-importance and grandiosity.
I mean, it's so great, it pushes
everything else out,
including someone else's needs.
Like, what do you mean you have needs?
Mine aren't met.
Like, there's a real
infantile quality to that.
Yeah, which of course goes hand in hand
with the last criterion,
(26:26):
and that shows arrogant, haughty
behaviors or attitudes.
So the DSM specifically says
that they often
display snubbish, disdainful,
or patronizing attitudes.
Yeah, so like the notion,
like I'm not gonna talk to them
because they're beneath me.
The classic example of
(26:47):
this is like Regina George
from the "Mean Girls"
movie, like this us versus them.
Or maybe like a stereotypical Karen.
Like, what do you mean
you don't have a bidet?
Like, let me talk to your manager.
You're not important
enough, you're beneath me.
Right, right, yeah, the
us versus them snobbery.
(27:09):
So all of this is what's required
for a diagnosis of narcissistic
personality disorder,
which as we've been talking about this,
there's definitely more of a focus
on a grandiose form of
narcissism in the DSM,
the peacocking, the
extraversion, the showiness.
But I think it's important to mention
(27:31):
kind of the underbelly of that.
So while it's not in the
criteria for a diagnosis,
the DSM does give honorable mention
to other ways that it can present
that are less kind of grandiose.
Dogfish, tell me about
these honorable mentions
of how NPD presents.
Sure, okay, so it can actually present
(27:54):
in a more vulnerable form.
So maybe like low self-esteem,
very sensitive to criticism or failure,
kind of goes hand in
hand with perfectionism
because basically there's
an intense fear of exposure
to their badness, like that failure
or imperfections or
like weak emotionality
(28:14):
because it shows their humanness
and they can't handle that.
Right, so this can come
out in excessive control
and perfectionism,
like anything to cover up
the imperfections, which
you wouldn't necessarily think
of that as like a classic narcissistic
personality disorder,
but it can be, it's
kind of the underbelly.
(28:34):
And then with that, you
have the internal shame,
humiliation, hollowness,
emptiness, insecurity, envy,
kind of all of those Lego pieces
that go in all in one package, right?
These are the rejected
internal vulnerabilities.
So the person with NPD reacts
(28:55):
to these vulnerabilities with more power,
which is basically an overcompensation
for the stuff they want to cover up.
And that's where that
control can come in for that power.
I want the power back.
I have to cover this up.
Nobody can see.
And then another reaction to these
vulnerabilities though,
can actually be hiding
(29:16):
through social withdrawal.
So this is where not all facets
of narcissistic personality disorder
are shiny or extroverted.
Facing this shame and
these internal imperfections
can lead to depression
and emptiness actually.
And so this also goes
(29:36):
with impaired relationships
or a history of relationship issues,
because there's just an
overall trouble connecting
with others and keeping connections
because of self-absorption.
Exactly.
So maybe like a less extroverted type
and a more socially withdrawn person,
or the lack of
(29:56):
connection could be because
of a rejected extroverted
type that other people avoid.
Exactly.
Yep.
And also just thinking
kind of in a different domain
that sometimes those with NPD,
this can lead to like more success
and professional achievements.
So sometimes pathological narcissism,
(30:18):
kind of the umbrella term can be used
and actually be helpful
to climb corporate ladders,
social hierarchies, et cetera,
when it's matched with the actual talent
and actual abilities.
But then other times these achievements
can be interrupted by life, humanness,
things like an injury,
(30:39):
setback, expenses, aging,
that's a big one,
fluctuating views of self,
excess criticism, a major loss, like
career or otherwise,
like those are just a few examples.
But this climbing the
ladder stops working for them.
The achievements stop
or they're not as high.
(31:00):
So then other times
pathological narcissism
is not useful at all
because that internal shame
is so strong and there's
a fear of being imperfect
that it can actually keep
somebody from taking risks at all
and becoming successful.
So it can go both ways, like it can,
(31:22):
or it can really work against the person,
sometimes within the same person,
like if there's major setbacks.
But that just, that makes me think
about our favorite personality theorist,
Dr. Theodore Milan,
and I bet he has something
profound to say about NPD.
Oh, absolutely.
So in his book, he states,
(31:42):
"Where the line should be
drawn between self-confidence
"and healthy self-esteem versus an
artificially inflated
"and empty sense of self-worth is not
always an easy task.
"The healthy
narcissist should demonstrate
"in addition to the usual characteristics
"of the personality, social concerns,
"and interpersonal empathy,
(32:04):
"a genuine interest in the
ideas and feelings of others,
"and a willingness to
acknowledge one's personal role
"in problematic
interpersonal relationships."
Yes.
Where the disorder is present,
we see a persistent
insensitivity to others,
a general social exploitiveness,
(32:26):
and lack of reciprocity
in everyday relationships.
Yes.
Well, we have talked
about the brief history of NPD
with a focus on the DSM
criteria specifically.
So this is the criteria that
Doc Fish and I use to diagnose
in clinical practice.
While it is uncommon
(32:46):
that someone with NPD
would present to treatment,
sometimes they will,
especially after a major life event
or a threat that forces them
to face that inner darkness,
a major accident, job loss, divorce,
those types of things.
But another thing that I
wanna make sure to note here
(33:07):
is that the DSM criteria does favor
this more grandiose
interpretation of symptoms
that are extroverted in
nature and more in your face.
But just like we discussed,
the DSM does give a
footnote to the underside
of such vanity and grandiosity,
which is this extreme emptiness,
(33:28):
an actual lack of social adeptness,
and more like victim-y symptoms,
which we will cover those
more in an upcoming episode.
Ooh, okay.
So thank you for joining us today
on this episode of The Personality Couch.
Make sure to check out our blogs
that coincide with these episodes
(33:49):
at www.personalitycouch.com.
And as always, don't
forget to give us a thumbs up
or rate and review us on
your favorite podcast app.
And on YouTube, hit that bell
so you don't miss a single episode
in our narcissism series.
Be well, be kind, and
we'll see you next time
(34:10):
on The Personality Couch.
This podcast is for
informational purposes only
and does not constitute a
professional relationship.
If you're in need of professional help,
please seek out
appropriate resources in your area.
Information about
clinical trends or diagnoses
are discussed in
broad and universal terms,
and do not refer to any
specific person or case.
Welcome to the Personality Couch podcast,
where we discuss all things personality
and clinical practice.
I'm your host, Doc Bok,
and I'm here with my co-host, Doc Fish.
We are both licensed
clinical psychologists
in private practice,
and today we will be continuing our
(00:20):
series on narcissism.
So we've talked about
what narcissism looks like
when it's good,
and also when it goes
sideways into pathological land.
So within pathological narcissism
is narcissistic
personality disorder, or NPD.
So while not all
(00:40):
pathological narcissism is the same
as narcissistic personality disorder,
those diagnosed with NPD
will have a heaping
dose of pathological NARCY.
So join us today as we
unpack the nine DSM criteria
for narcissistic
personality disorder, or NPD.
(01:02):
We previously discussed
where narcissism in general
came from, but where did narcissistic
personality disorder
originate?
That is a great question.
All right, so a super
brief history lesson.
The word narcissism
comes from Greek mythology,
where the god narcissus
(01:24):
was cursed to fall in love
with his own reflection.
The story contains excessive love of self
paired with lack of
empathy towards others.
Then we have writers in the late 1800s
referencing narcissism as
an erotic condition, right?
Because of this excessive self-love.
(01:46):
Kind of makes sense, doesn't it?
So there's an
impairment in the love department
because the love of self is so great
it actually impedes real intimacy.
Okay, so the self becomes the object.
So the self is
attached to and loves itself
to an extent where they're constantly in
pursuit of pleasure,
(02:06):
like in all areas, like self-love.
Right, if you catch the drift,
pleasuring the self, all of
the pleasure, you get the point.
So in the 1910s, auto-rank
linked vanity and admiration
of the self with narcissism.
Freud also picked this up
(02:28):
in the 1910s and forward,
first viewing narcissism
also as an erotic condition,
as previous theorists did,
but then expanding it into personality.
And an important note is that Freud
mentioned narcissism
can be both normal and
necessary, not just pathological.
(02:48):
He would.
Of course.
Now in 1926, Reich discussed a phallic
narcissistic character
which mirrors today's
NPD, again, how fitting.
Later, narcissism focused on achievement
and took on various names
such as the Don Juan character
in 1945 and the Nobel
(03:10):
Prize complex in 1966.
Then the big dog shrinks
like Kernberg and Kohut
to help solidify the definition of NPD
when we first had it in the DSM-3.
So that was the first
time it made an appearance.
So interestingly, it's
also important to highlight
that from about 1966 to 1995,
(03:33):
research articles on NPD
were less than 10 per year.
Wow.
So the researchers that looked into this
actually described NPD
research itself as dead for NPD.
For nearly 30 years.
My goodness.
Yes.
So this is relevant
(03:53):
because the literature on NPD
is still mostly based on clinical
experience and theory
as opposed to empirical research.
Right.
I imagine research is
hard for that population.
Calling all narcissists,
we wanna study your flaws.
(laughing)
No.
Maybe if it was marketed as like
(04:15):
whose male anatomy is the biggest,
they'd have more volunteers.
(laughing) There's a suggestion.
Calling all people trying
to find a dissertation topic.
There you go.
There you go.
All right.
So what about the books that we use
to make the diagnosis of NPD?
So let's fast forward a bit to 1980.
(04:38):
The DSM-3, as you said,
was when personality
disorders first came on the map.
Interestingly,
narcissism didn't really have
empirical research backing.
And the first iterations of
NPD had some different wording
than it does now.
But original definitions
were still based heavily
(05:00):
on psychodynamic theory,
which basically were the OG
shrinks, the original guys.
Yeah.
Now in another manual,
healthcare professional
used to diagnose the
international classification
of diseases, ICD for short.
NPD has no historical
origin until the 11th edition,
(05:22):
which is 2022.
And that's different from other
personality disorders
that showed up earlier in that.
Okay, so NPD didn't have a
presence there until 2022.
Mm-hmm.
Good grief.
Okay, so it sounds like
Narsi has been the redheaded
stepchild of empirical
(05:44):
personality research.
But don't worry, it's gained a lot of
attention even still,
and we still have a
lot to learn about it.
And I would argue
possibly need to rethink the way
that we classify it.
I agree.
But it's still
incredibly useful to understand
the diagnostic language,
which brings us to our current
DSM's definition of narcissistic
(06:06):
personality disorder.
How does someone receive such a
diagnosis, Stockfish?
Sure, like all personality disorders,
these symptoms need to be pervasive
and like widespread basically.
And it's a pattern that
begins in early adulthood
and is present in numerous contexts.
It needs to consist of kind
(06:28):
of like three main things.
One, grandiosity and fantasy or behavior.
So fantasy like it could
be imagined or dreamed of.
Now let's define grandiosity.
APA's definition states,
it's an exaggerated sense
of one's greatness,
importance or ability.
In extreme form, it may be regarded
(06:50):
as a delusion of grandeur.
Ooh, that is so interesting.
Okay, so a delusion of
grandeur is the false attribution
to the self of great ability, knowledge,
importance or worth,
identity, prestige, power,
(07:11):
accomplishment or the like.
You get the point, right?
Also, this is called a grandiose delusion
or what some might term as megalomania.
Ooh, very interesting.
Quite.
So earliest theories of narcissism
actually conceptualized
(07:31):
it more in the psychotic realm.
So syndromes out of touch with reality.
Fascinating, right?
So we have the potential erotic disorder
and the potential psychotic disorder.
And then eventually we landed on
this is a personality disorder.
Right, my goodness.
Well, going back to that
(07:52):
grandiosity definition,
the quality of seeming
impressive or important
in an artificial or
deliberately pompous way
or pretentiousness.
Sure.
It can include being
imposing or impressive
or even being more complicated or
elaborate than necessary.
Now, why?
(08:13):
Well, because there's
a need for admiration.
Exactly, exactly.
So the pursuit of being
seen as an object of esteem
with others giving them
the approval and respect
or in other words,
essentially wanting others to fawn
over you or see you as important.
(08:35):
And then of course with that,
its buddy is lack of empathy.
So empathy is putting
yourself in someone else's shoes
or like perspective taking.
It's like vicariously experiencing
what the other person is thinking or
feeling or perceiving
and maybe sitting in
someone else's pain with them
and caring for them all the while.
(08:56):
Sure, sure.
So those with NPD are so self-absorbed
that there's too much self.
There's not room for
others feelings, only mine.
Right, but that's like the framework
that we're looking at with NPD.
So now we actually
have to meet at least five
or more of the following criteria.
(09:16):
And we grouped criteria
not in chronological order
from the DSM, but with
like internal deficits first.
So internal outward.
So our first internal
deficit is really important
because it's actually
mentioned twice in the DSM.
We literally just talked
about it, lack of empathy.
So they're unwilling
to recognize or identify
(09:37):
with the feelings and needs of others.
Yep, exactly.
This one's very
important again, mentioned twice.
Kind of like BPD with impulsivity
was mentioned twice as well.
Yeah, essentially they can't tolerate
any of their own badness.
So they split it off or project it
outward and onto others.
They haven't learned perspective taking
(09:59):
and or find others
perspectives too dangerous
or irrelevant to their ego or agenda.
So they're either unaware of others
thoughts or feelings
or they just don't care.
And then sometimes empathy is rejected
because others feelings and dependency
are seen as a sign of weakness.
(10:20):
Okay, so this may be
might look like making
hurtful remarks in which they're
completely clueless about
or again, they just don't care.
So maybe bragging about
money in front of someone
they know is struggling financially,
highlighting their own
health in front of someone
who's terminally ill.
And because of this, they can
come off as emotionally cold
(10:42):
and disconnected, like
only interested in themselves
and no one else.
Yeah, yeah, exactly.
Callous, like who are you?
How could you say that to this person?
I think it's important
to note that this is like
not in an autistic type of way.
Like this is not autism.
So they just don't care, those with NPD.
(11:05):
They're too busy with their own self
and keeping up their own
image to have time for you
and your emotions versus in autism,
there's social hard wiring issues
that are rooted in development.
These are not the same thing.
Okay, as you were talking, I was thinking
(11:25):
almost like a teenager
or like a regressive form.
There's social hard wireings intact.
They just like haven't really gone
through that growth yet.
It's like still all about me.
And there's like a kind of like a
cluelessness in that,
but they're hard wiring is intact.
So research actually shows
us that there is a difference.
(11:47):
In Germany, they had a
study with three groups.
So NPD patients compared with borderline
and then also a control group.
The NPD group had less emotional empathy
but not cognitive empathy.
Oh, interesting.
So they have like some
degree of cognitive empathy.
So that means that
they're able to understand
(12:07):
another person's
perspective on an intellectual level,
but they lack the emotional empathy.
So directly feeling the emotions
that another person's feeling.
Right, okay.
So this also flies in the face of autism.
Like they can detect the
cues on a cerebral level,
but the emotional like mirroring,
that emotional feeling of understanding
(12:29):
what it's like to sit
in someone else's shoes,
that doesn't come easily.
Correct.
Which can also lead to
what's called alexithymia
or emotional blindness.
So again, not the same as autism.
Those with NPD can detect
the cues on a cerebral level.
They just don't typically
care unless it benefits them.
(12:50):
Right, and then so another study,
they actually found a
neuropsychological basis for this.
I would guess that they
found less connections
in the brain regions involved in empathy
or empathic functioning, mirror neurons,
something like that.
Exactly, exactly. Yes.
And in a third study,
(13:11):
this is super interesting.
NPD patients actually performed worse
on facial emotion recognition tasks,
specifically fear and disgust.
Oh, wow.
Those are really primitive emotions,
more like hindbrained reptilian brain.
(13:34):
Interesting, so that says
social mirroring is off,
that they don't perhaps
recognize fear or disgust in others
because it's too threatening to the ego,
so the brain doesn't register it.
So that's the
personality brain connection.
Like the body isn't registering it
(13:55):
because it's too
threatening psychologically.
It's a whole body process.
Right, so that hard wiring is intact.
There's a capacity to, but it's too scary
for the inside and the
ego, so they just deny it.
Like ignoring the
warning light on your car.
To the point where
you just don't even know
(14:15):
it's there anymore,
because you've seen it so much.
Wow, blends in with the wallpaper.
That's fascinating.
So lack of empathy
was the first criteria.
Now the second one is envy.
So they're often envious of others,
or they believe that
others are envious of them.
Of course, yep.
So they're envious of
(14:35):
others' things, achievements,
praise, believing that
they deserve them more.
So as a reaction, they may
put the other person down,
devalue them, or otherwise
undermine the other person.
They tear them down, essentially.
(14:55):
And then they desire stuff in that
pursuit of specialness.
Or think that they're so special
that others desire their stuff,
possessions, achievements, qualities,
money, power, et
cetera, you get the point.
But then they become
preoccupied with those things
because of that envy.
And as I'm even saying this,
(15:15):
I hear a hint of paranoia in that.
Ooh.
Yeah, so if you're so preoccupied
with others being jealous of you,
like wouldn't you think
that people are out to get you
and then hoard your things?
That's a good thought, yeah.
So this is internal,
but then there's also
this internal grandiosity
(15:37):
that can show up in
more external behavior.
So what you were just saying,
there's like paranoia or
maybe like being preoccupied.
And that's the third criteria actually,
is preoccupation with
fantasies of unlimited success,
power, brilliance, beauty, ideal love.
Right, because in order to
(15:58):
fill their void of emptiness
and present as superior,
they need something to fill it up, right?
So this stems from low
self-worth that is rejected.
So essentially what you
get is an overcompensation
for the emptiness.
Right, they may obsess or
(16:19):
ruminate about admiration
or maybe privilege they
think is like long overdue.
And they often find famous,
powerful, influential people
that they can compare themselves with.
Yeah, or rub shoulders with, yeah.
So this leads us to the fourth criterion.
So they have a grandiose
sense of self-importance,
(16:39):
which means they may exaggerate
achievements and talents
or expect to be recognized as superior
without the achievements that match up.
Exactly, yeah.
They've learned that
their worth is superior
and not necessarily tied to effort.
So then in an effort to disguise the fact
that nothing is there,
(17:00):
they resort to bragging,
exaggerating,
overestimating their abilities
and holding
unrealistically high expectations.
So then they come off as
boastful and pretentious
and then expect other
people to see that same reality
that they do, like the
expectation that they're going
(17:21):
to have that reality
reflected back or their greatness,
their great abilities reflected back.
And then taking the glory for themselves.
So not letting other
people have even a slice of it.
And it's all the brado though, right?
And this serves to prop up
this illusion of amazingness,
(17:42):
but there's nothing there.
Or if it is, it's not as
great as they project it to be.
But they believe that they're special.
Okay, so this is criterion five.
So they believe that
they're special and unique
and can only be
understood by or should associate
with other special or high
(18:03):
status people or institutions.
Right, it's almost like rubbing shoulders
with those that are
influential, wealthy, talented,
you know, the like, almost like
vicariously absorbing
the specialness of others.
Like these other people
have really high value.
So I have high value in their presence.
(18:24):
Like their specialness rubs off on me.
Like we're all in the special boat.
Like just like static electricity, right?
Like, oh, that rubbed
off on me, now I'm special.
Right, but they can be
devastated or surprised
when others don't
give them the admiration
they think they deserve.
Exactly, in other
words, they don't understand
(18:46):
when others don't
recognize their greatness,
even if it's like
greatness by proxy, right?
Which essentially is rubbing shoulders
with the person of status.
Like if that person of status
weren't to recognize their greatness,
they would potentially be
devastated or surprised by that.
And so we're focusing
on like status, right?
(19:07):
So it's very likely that they need the
absolute specialist,
top best person or
organization for all the things.
Like restaurants or
hotels or their hairdresser,
a teacher, a physician.
And if they're
disappointed by that top person
that they chose, they'll
devalue them and tear them down.
Yep, I'm the best, so I
(19:28):
need the best is the mentality.
Like I have to have the
best suite in the hotel,
the penthouse, right?
Oh, that wasn't good enough.
There was, I don't know, a
tiny hair on the hairdryer.
Give me a new suite.
I want a poolside penthouse view.
Like it just never ends that
voracious appetite for more.
Or I'm just thinking
of like, you know, like,
(19:49):
oh, I have a degree
from ex Ivy league school.
And then it's like, oh, but
you have a PhD from Harvard.
That's not good enough.
Like, you know, putting
down the things that are like,
are you serious?
Yeah. Are you serious right now?
That's ridiculous.
I was thinking like,
well, I'm paying you.
So I have the power and I
know better than you do,
(20:10):
even though you're
the expert in the field.
Ew, oh my.
Yeah, yeah, that can happen.
Oh, or like in business,
like someone who keeps changing
the terms of the contract in their favor.
Like again, this is
like, this is very childlike.
Like think of a kid that's
cheating at Go Fish or Candyland.
(20:31):
Like that happens.
Right, it's a thing.
And as a kid, it's like, okay, you know,
this is developmentally appropriate.
You're like teaching them not to do that.
But in business, those
with NPD can absolutely cheat
and change the terms
to be in their favor.
Yep. Right.
Okay, so now this leads us to criteria
that kind of pull on those external
(20:52):
factors to meet needs.
Okay, so criteria number six,
they require excessive admiration.
Right, so they need an
audience desperately.
Like they need applause
because that sense of self
is so fragile and
there's such deep self doubt
(21:12):
and intense self criticism.
So they pull on other
people to tell them who they are
to prop up that false image.
And then they might
ruminate also about like knowing
what others think of them.
So there's an image
protection happening there.
I have to protect my image.
What is everybody saying?
Or even like information
that someone might have on them.
(21:33):
Like this can also look like paranoia.
What are they saying?
What do they know?
Because you can't be found out.
You can't let the world
know who you really are
or who they project themselves to be.
It's like an ego hologram.
You know?
Okay, I love this quote from the DSM.
It says, "They may expect
their arrival to be greeted
(21:54):
"with great fanfare and are astonished
"if others don't covet their possessions.
"They may constantly fish for compliments
"often with great charm."
Right, like we did not
have pyrotechnics going off
when you entered the office for therapy.
So maybe that was good enough.
You're surprised.
They're devastated.
(22:14):
Oh goodness.
But yeah, on a serious
note, I have seen that
with those with high
narcissism or with NPD, yeah.
Yeah, which transitions us
to criterion number seven,
a sense of entitlement.
So like unreasonable expectations
of especially favorable treatment
or automatic compliance
(22:35):
with his or her expectations.
Again, they are super important
and then expect this unreasonable,
favorable treatment.
Like going on an excursion with a friend,
maybe taking advantage of
that friend in the process
because of that entitlement.
Like, I expected you
to taxi me to the spa
(22:57):
and to the resort and to the tanning bed
and to the shopping metropolis
for dinner at the country club.
Oh, you wanted to go in?
Like we can't have that.
Like you can't stop and use the restroom.
I have to get to dinner
or they might feel angry or confused
if not given what they expect.
Like I should be at the front of the line
(23:19):
because of who I am.
Why should I have to wait?
Or like, why is this
drive through so slow?
Why is Chick-fil-A closed on Sunday?
Like don't they know
they'd get my business?
Right.
I shouldn't have to wait in line.
Like these are the
notions of someone with NPD
because they're so important.
Right, or like I own you.
(23:40):
You need to overwork and be
completely dedicated to me.
Like you don't have a life.
I am your life.
You have to work on
holidays to show loyalty.
Like why would you be
with your loved ones?
And this can lead to knowingly
or unknowingly exploiting others.
Right, right.
Sometimes it's not even conscious.
Yeah.
It's like, yeah, they're not even trying
(24:01):
to do it on purpose.
It just is.
Yeah, versus other
times it is on purpose.
It depends on how bad the NPD is.
Yes.
So this brings us to
the external criteria.
So the criteria that
we can kind of see more.
Criterion number
eight, we just touched on,
they're interpersonally exploitative.
(24:23):
So they take advantage of others
to achieve his or her own needs.
But it's all, it's one-sided.
So then relationships
are for self enhancement
of self-esteem, emotion,
status, image, success, intellect,
financial stuff, ego cookies.
(24:43):
Like the list goes on and on and on.
It's one-sided, just like a child.
And then they can
undercut other people as well.
Like, ooh, free latte on
the counter, must be mine.
Or like in a big corporation,
forcing the algorithm
to give them a raise
versus the person who
actually deserves it.
(25:03):
And again, this can be
conscious or it can be unconscious.
They may not be aware
of what they're doing.
Right, I like this
quote from Milan's book.
So the narcissist expects to be given
whatever he or she wants and needs,
no matter what it might mean to others.
This does not include active deception,
but rather is a consequence of the belief
(25:24):
that he or she is entitled.
For example, the person
with NPD would not set out
to con a little old lady
out of her life savings.
However, if she offered
them, the NPD would accept
such a gift without
reflection of its impact on her.
So he or she will expect
great dedication over work
(25:45):
and heroic performance
from the people associated
with him or her
without giving any thought
to the impacts of this
pattern of their lives.
Wow, okay, so the thought,
like I'd never con a little old lady,
but basically if the
opportunity was there,
they absolutely would.
Or their thought of
(26:06):
self-importance and grandiosity.
I mean, it's so great, it pushes
everything else out,
including someone else's needs.
Like, what do you mean you have needs?
Mine aren't met.
Like, there's a real
infantile quality to that.
Yeah, which of course goes hand in hand
with the last criterion,
(26:26):
and that shows arrogant, haughty
behaviors or attitudes.
So the DSM specifically says
that they often
display snubbish, disdainful,
or patronizing attitudes.
Yeah, so like the notion,
like I'm not gonna talk to them
because they're beneath me.
The classic example of
(26:47):
this is like Regina George
from the "Mean Girls"
movie, like this us versus them.
Or maybe like a stereotypical Karen.
Like, what do you mean
you don't have a bidet?
Like, let me talk to your manager.
You're not important
enough, you're beneath me.
Right, right, yeah, the
us versus them snobbery.
(27:09):
So all of this is what's required
for a diagnosis of narcissistic
personality disorder,
which as we've been talking about this,
there's definitely more of a focus
on a grandiose form of
narcissism in the DSM,
the peacocking, the
extraversion, the showiness.
But I think it's important to mention
(27:31):
kind of the underbelly of that.
So while it's not in the
criteria for a diagnosis,
the DSM does give honorable mention
to other ways that it can present
that are less kind of grandiose.
Dogfish, tell me about
these honorable mentions
of how NPD presents.
Sure, okay, so it can actually present
(27:54):
in a more vulnerable form.
So maybe like low self-esteem,
very sensitive to criticism or failure,
kind of goes hand in
hand with perfectionism
because basically there's
an intense fear of exposure
to their badness, like that failure
or imperfections or
like weak emotionality
(28:14):
because it shows their humanness
and they can't handle that.
Right, so this can come
out in excessive control
and perfectionism,
like anything to cover up
the imperfections, which
you wouldn't necessarily think
of that as like a classic narcissistic
personality disorder,
but it can be, it's
kind of the underbelly.
(28:34):
And then with that, you
have the internal shame,
humiliation, hollowness,
emptiness, insecurity, envy,
kind of all of those Lego pieces
that go in all in one package, right?
These are the rejected
internal vulnerabilities.
So the person with NPD reacts
(28:55):
to these vulnerabilities with more power,
which is basically an overcompensation
for the stuff they want to cover up.
And that's where that
control can come in for that power.
I want the power back.
I have to cover this up.
Nobody can see.
And then another reaction to these
vulnerabilities though,
can actually be hiding
(29:16):
through social withdrawal.
So this is where not all facets
of narcissistic personality disorder
are shiny or extroverted.
Facing this shame and
these internal imperfections
can lead to depression
and emptiness actually.
And so this also goes
(29:36):
with impaired relationships
or a history of relationship issues,
because there's just an
overall trouble connecting
with others and keeping connections
because of self-absorption.
Exactly.
So maybe like a less extroverted type
and a more socially withdrawn person,
or the lack of
(29:56):
connection could be because
of a rejected extroverted
type that other people avoid.
Exactly.
Yep.
And also just thinking
kind of in a different domain
that sometimes those with NPD,
this can lead to like more success
and professional achievements.
So sometimes pathological narcissism,
(30:18):
kind of the umbrella term can be used
and actually be helpful
to climb corporate ladders,
social hierarchies, et cetera,
when it's matched with the actual talent
and actual abilities.
But then other times these achievements
can be interrupted by life, humanness,
things like an injury,
(30:39):
setback, expenses, aging,
that's a big one,
fluctuating views of self,
excess criticism, a major loss, like
career or otherwise,
like those are just a few examples.
But this climbing the
ladder stops working for them.
The achievements stop
or they're not as high.
(31:00):
So then other times
pathological narcissism
is not useful at all
because that internal shame
is so strong and there's
a fear of being imperfect
that it can actually keep
somebody from taking risks at all
and becoming successful.
So it can go both ways, like it can,
(31:22):
or it can really work against the person,
sometimes within the same person,
like if there's major setbacks.
But that just, that makes me think
about our favorite personality theorist,
Dr. Theodore Milan,
and I bet he has something
profound to say about NPD.
Oh, absolutely.
So in his book, he states,
(31:42):
"Where the line should be
drawn between self-confidence
"and healthy self-esteem versus an
artificially inflated
"and empty sense of self-worth is not
always an easy task.
"The healthy
narcissist should demonstrate
"in addition to the usual characteristics
"of the personality, social concerns,
"and interpersonal empathy,
(32:04):
"a genuine interest in the
ideas and feelings of others,
"and a willingness to
acknowledge one's personal role
"in problematic
interpersonal relationships."
Yes.
Where the disorder is present,
we see a persistent
insensitivity to others,
a general social exploitiveness,
(32:26):
and lack of reciprocity
in everyday relationships.
Yes.
Well, we have talked
about the brief history of NPD
with a focus on the DSM
criteria specifically.
So this is the criteria that
Doc Fish and I use to diagnose
in clinical practice.
While it is uncommon
(32:46):
that someone with NPD
would present to treatment,
sometimes they will,
especially after a major life event
or a threat that forces them
to face that inner darkness,
a major accident, job loss, divorce,
those types of things.
But another thing that I
wanna make sure to note here
(33:07):
is that the DSM criteria does favor
this more grandiose
interpretation of symptoms
that are extroverted in
nature and more in your face.
But just like we discussed,
the DSM does give a
footnote to the underside
of such vanity and grandiosity,
which is this extreme emptiness,
(33:28):
an actual lack of social adeptness,
and more like victim-y symptoms,
which we will cover those
more in an upcoming episode.
Ooh, okay.
So thank you for joining us today
on this episode of The Personality Couch.
Make sure to check out our blogs
that coincide with these episodes
(33:49):
at www.personalitycouch.com.
And as always, don't
forget to give us a thumbs up
or rate and review us on
your favorite podcast app.
And on YouTube, hit that bell
so you don't miss a single episode
in our narcissism series.
Be well, be kind, and
we'll see you next time
(34:10):
on The Personality Couch.
This podcast is for
informational purposes only
and does not constitute a
professional relationship.
If you're in need of professional help,
please seek out
appropriate resources in your area.
Information about
clinical trends or diagnoses
are discussed in
broad and universal terms,
and do not refer to any
specific person or case.
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