By: THEODORE MILLON
et al.
The narcissistic
personality disorder is frequently experienced by others as obnoxious, grandiose, and un-empathic. Narcissists’ immense
arrogance, their belief that they possess unsurpassed intelligence and
celebrity, and their degradation of the mere mortals who inhabit the planet make
them insufferable as family members, partners, and coworkers.
Several
normal-range variants of the narcissist exist, such as Oldham and Morris’s (1995) self-confident style and Millon’s (Millon et
al., 1994) asserting pattern; these possess traits that are actually assets when trying to
get ahead in a capitalist society. At the disordered level, however, self-confidence and
healthy assertiveness turn into grandiose self-regard; complete disregard for other
people’s strengths, talents, and feelings; and extreme haughtiness.
Several subtypes
also exist that combine aspects of these personalities with the narcissistic.
The unprincipled narcissist combines elements of a sadistic personality with the narcissist’s skills of social influencing but few
internalized moral prohibitions. Amorous narcissists are focused on erotic seduction
with multiple partners. Compensating narcissists have some elements of the
avoidant and negativistic personality. The elitist narcissist is full of aggressive
confidence.
Narcissistic
characteristics can be traced throughout historical literature, from Greek mythology to the Bible, but it wasn’t until almost the
twentieth century when it was given explicit psychological
meaning by Haveloch Ellis, an English psychologist. The psychodynamic history
of the narcissistic personality disorder is extensive and convoluted, but
over time it has changed
from Freud’s purely intra-psychic model of narcissism as self-cathexis to the
idea that narcissism is a pathology of early relatedness. Horney, Reich,
and Kernberg all
contributed to this change. Grandiosity, rationalization, and fantasy are
the most common defense
mechanisms used by narcissists; in classical analytic terms, they are the ego ideal
incarnate. Developmentally, psychoanalysis proposes that the narcissists’
parents loved them for imaginary qualities instead of for their true selves.
Further, Kernberg proposed that narcissists fail to develop integrated
conceptions of self and other object images.
Interpersonally,
narcissists are noted for their sense of entitlement and subsequent lack of empathy toward others. This makes intimate
relationships nearly impossible, as others are seen only as appendages of the narcissist’s
ego, not as a partner. Narcissists often make a good first impression, but soon others
regard them as arrogant and snobbish because of their seeming calm and
confident nature. They are also extremely sensitive to perceived slights and
often seek a close circle of admirers who will worship them. Benjamin suggests that
developmentally, narcissists’ parents failed to disclose their own needs, instead
worshipping the infant. As a result, the child failed to learn that others are separate beings with their own desires.
Cognitively,
narcissists substitute imagination and daydreams for reality. Their past, present, and future are colored by these imaginings,
all adding to their glory. Other cognitive processes protect narcissists’
vulnerabilities, such as their refusal to test hypotheses, because their ideas
must be innately correct. They are also prone to black-and-white thinking and focus on small
differences between themselves and others.
Biophysical
hypotheses concerning narcissistic patterns are still unclear, although some observations may be noted in terms of mood and
temperament. Under most circumstances, narcissists are possessed of a carefree
mood and a positive outlook, enjoying an unusually relaxed demeanor. However,
changes taking the form of edginess and irritability or dejection characterized by feelings of
emptiness, worthlessness, or humiliation may quickly become their baseline if
their sense of superiority is penetrated.
From an
evolutionary perspective, the narcissist is passively self-oriented. Narcissists believe they are worthy of unconditional praise and
tribute for just being themselves, with no actions or responsibilities required to earn
rewards. Oddly, there seem to be two developmental pathways to narcissistic personality
disorder: One is overly indulgent parents; the other is neglectful or authoritarian
parents.
Narcissists share
surface similarities with histrionic, antisocial, paranoid, and sadistic personalities.
Although not linked systematically to any Axis I disorders, narcissism certainly colors any that do occur. Narcissists
experience fewer anxiety disorders than many other personalities but still may develop social
phobias and obsessions. They are also resilient against many depressive disorders but
may experience low-grade depressive symptoms. Substance abuse is frequently a
problem; for narcissists, it is a way to numb their awareness of events that intrude on their
sense of self-worth.
Most narcissists
strongly resist psychotherapy. For those who choose to remain in therapy, there
are several pitfalls that are difficult to avoid, including the therapist’s
being too reinforcing of the
narcissist and, subsequently, the narcissist’s never wanting to leave
therapy. Interpretation
and even general assessment are often difficult to accomplish. For
successful treatment,
there must be a strong working alliance established, and confronting the narcissist’s
behaviors and patterns must be timed properly. A combination of interpersonal and cognitive
strategies may prove the most effective treatment to decrease sense of entitlement and
increase awareness of others’ feelings.
References
Personality Disorders in Modern Life, second edition, 2000,
2004 by John Wiley & Sons, Inc.
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