Disturbing the Disturbed: Reflections on Narcissism

Greetings! I will first apologize for how late this post is – things happened. But that aside, this week we talk about Narcissism in its three main forms: narcissism, narcissistic personality disorder, and malignant narcissism. I will warn you now that this post will be very, very long.

Firstly, narcissism is not Histrionic Personality Disorder. The laconic version is that Histrionics desire attention, while Narcissists desire admiration. Histrionics are characterized by excessive emotionality and attention-seeking, including a need for approval and inappropriately provocative behaviour, typically beginning in early adulthood. Other possible qualities include being easily influenced, over-dramatization of difficulties, egocentric, self-indulgent, in possession of good social skills, yet a tendency to be manipulative.

OK, before we decide that most teenagers suffer from HPD there are other symptoms that distinguish it. They tend to view their relationships as a sort of do-or-die deal, with many seeking counselling for depression when they end. They may go through multiple jobs due to becoming easily bored and having problems dealing with frustration. They are also thrill seekers and hence can end up in risky situations simply for the novelty.
The interesting thing about HPD is that its combination of symptoms actually put sufferers at greater risk of developing depression.

A useful way to remember the main traits of Histrionic Personality disorder is the mnemonic PRAISE ME. Both the Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR and The World Health Organization's ICD-10 lists reflect some combination of these symptoms.

• P - provocative (or seductive) behavior
• R - relationships, considered more intimate than they are
• A - attention, must be at center of
• I - influenced easily
• S - speech (style) - wants to impress, lacks detail
• E - emotional lability, shallowness
• M - make-up - physical appearance used to draw attention to self
• E - exaggerated emotions – theatrical

Others not covered above include, exhibitionist behaviour, constant seeking of approval/reassurance, extreme sensitivity to criticism, low tolerance for frustration or delayed gratification, rapid shifts in emotional state to the point of appearing superficial, rashness in decision making, extreme resistance to all change, and having Somatic symptoms and using these symptoms as a means of garnering attention.

HPD is more often found in women as men with similar symptoms tend to be diagnosed with narcissist personality disorder. The cause of HPD is unknown but the trigger events include things like deaths in the family, divorce, illnesses in the family which provoke constant anxiety, and perhaps genetics.

Millon also has subtypes for HPD – these are:

• Theatrical histrionic - especially dramatic, romantic and attention seeking.
• Infantile histrionic - including borderline features.
• Vivacious histrionic - synthesizes the seductiveness of the histrionic with the energy level typical of hypomania.
• Appeasing histrionic - including dependent and compulsive features.
• Tempestuous histrionic - including negativistic (passive-aggressive) features.
• Disingenuous histrionic - antisocial features.

Note that we do not see anything that features Narcissistic Personality Disorder – this is because histrionic has symptoms similar to NPD but also piles on some more while detracting from others: you’ll see that later that the inverse is not true.

Now that that’s over we can start on Narcissism. So, what is narcissism? Let me ask you a riddle: “without it you will crawl, with it you will stand tall, too much and you will fall” – what is it?
The answer is pride and this is where we meet narcissism in its “garden variety” form – a personality trait, rather than a personality disorder. And just like any other personality trait, moderation is the key.
“Healthy” narcissism is the thing that gives you self-confidence – a highly valuable trait on leaders according to management theory. “Destructive” narcissism is when that confidence goes overboard. Self confidence is good – believing others inferior is not. Enjoying power is ok – pursuing it at all costs is not.
Basically, moderation is the key difference between healthy and destructive narcissism

Now, just because a person is narcissistic, it doesn’t mean they suffer narcissistic personality disorder – people are perfectly capable of being arrogant without having to blame it on a mental disorder.

Narcissistic personality disorder

Now, pathological narcissism can be put into a spectrum based on severity. The most extreme form is NPD. While usually I don’t go into the theories of causation, mainly because they hand-wave it as genetic or something, here I will discuss a few suspected causes.

Theories:

A sufferer of NPD believes that they are flawed in a way that makes them unacceptable to others. This belief is so deep in their conscious that they don’t even know they think it. So, to protect themselves from this belief and the horrible rejection it would entail, they try to control how others view them. Hence why they rage when people criticize them, and desire people to fear/admire them. This sort of thing, coupled with an inability to tolerate setbacks, makes them hard to work within a team environment.

A 1994 study by Gabbard and Twemlow reports that histories of incest, especially mother-son incest, are associated with NPD in some male patients.

The cause for NPD is still unknown but there are a lot of theories about it. I shall list some of them as these were observed in patients by many researchers according to Groopman and Cooper.

• An oversensitive temperament at birth is the main symptomatic chronic form
• Being praised for perceived exceptional looks or abilities by adults
• Excessive admiration that is never balanced with realistic feedback
• Excessive praise for good behaviors or excessive criticism for poor behaviors in childhood
• Overindulgence and overvaluation by parents
• Severe emotional abuse in childhood
• Unpredictable or unreliable caregiving from parents
• Valued by parents as a means to regulate their own self-esteem

In this list you can see that they could fall under two categories for the most part, in a way that links to the theories of psychiatrist Glen Babbard. He believes that NPD can be broken down into two subtypes: “Oblivious” and “hypervigilant”.
The “oblivious” are grandious, arrogant, and thick-skinned –which could be the result of overindulging parents– and wish to be admired and envied in order to protect the weaker internalized self. The “hypervigilant” is very sensitive to criticism, easily hurt, and ashamed and consequentially views devaluation as unjust – a possible consequence of overcritical or neglectful parents.

This is further backed by the psychological concept of “splitting”. This is the idea that NPD sufferers use splitting as a defence mechanism. To quote the psychoanalyst Kernberg:

“the normal tension between actual self on the one hand, and ideal self and ideal object on the other, is eliminated by the building up of an inflated self concept within which the actual self and the ideal self and ideal object are confused. At the same time, the remnants of the unacceptable images are repressed and projected onto external objects, which are devalued.”

Basically NPD sufferers merge the idea of their inflated self and their actual self, and other people are either an extension of the sufferer’s self (the givers of admiration) or are worthless (those who disagree with the NPD sufferer’s inflated view).

But enough of the theory, let’s see the symptoms!

Symptoms

The main thing about a narcissist is that they are preoccupied with issues of personal adequacy, power, prestige, and vanity. So, their symptoms tend to include the following:

• Reacts to criticism with anger, shame, or humiliation
• May take advantage of others to reach his or her own goal
• Tends to exaggerate their own importance, achievements, and talents
•  Imagines unrealistic fantasies of success, beauty, power, intelligence, or romance
• Requires constant attention and positive reinforcement from others
• Easily becomes jealous
• Lacks empathy and disregards the feelings of others
• Obsessed with oneself
• Mainly pursues selfish goals
• Trouble keeping healthy relationships
• Is easily hurt and rejected
• Sets unreal goals
• Wants "the best" of everything
• Appears as tough-minded or unemotional

It can be easily seen how these symptoms can be similar to the traits of people who have a high-self esteem, confident or even arrogant, but the fact is that the underlying psychological structures of why they react this way is considered pathological.
While a narcissist believes that they “are all that” they are very susceptible to criticism and actually have a fragile self-esteem and will lash out by belittling in order to back up their own self-worth. In layman’s terms, the expression “Blowing out another’s candle won’t make yours glow any brighter” has little bearing here. This is the defining trait of sufferers of NPD – the need to back up their own idea of their self-worth with reasons why others aren’t as worthy.

(Author’s note: So basically, the minds of NPD sufferers are so broken that they don’t even know or aren’t capable of accepting the idea that they’re broken.)

While usually I reference the World Health Organization’s ICD-10 lists for clarification of the symptoms, they only have NPD listed under “other specific personality disorders”. So, this time I will reference symptoms from the Diagnostic and Statistical Manual of Mental Disorders. Note that it has to satisfy this criteria as well as the list of general personality disorder criteria (which has been retroactively added to my original Disturbing the Disturbed post).
Firstly, the individual must have a pattern of grandiosity (in fantasy or behaviour) everywhere, a need for admiration, and a lack of empathy. These symptoms begin in early adulthood and are present in a variety of areas. They must also have five or more of the following symptoms:

1. A grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
2. 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. Sense of entitlement, i.e., unreasonable expectations of especially favourable treatment or automatic compliance with their expectations
6. Interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
7. Lacks empathy: is unwilling/unable to recognize or identify with the feelings and needs of others
8. Often envious of others or believes others are envious of him or her
9. Arrogant, haughty behaviors or attitudes

Millon also has subtypes for NPD, these being:
• Unprincipled narcissist – including antisocial features. Iis a fraudulent, exploitative, deceptive and unscrupulous.
• Amorous narcissist – including histrionic features. Is erotic, exhibitionist, acts like a Casanova.
• Compensatory narcissist – including negativistic (passive-aggressive), avoidant features.
• Elitist narcissist – variant of pure pattern.
• Fanatic narcissist – including paranoid features. Self-esteem was severely arrested during childhood, usually displays major paranoid tendencies, and holds on to an illusion of omnipotence. They are fighting delusions of insignificance and lost value, and trying to re-establish their self-esteem through grandiose fantasies and self-reinforcement. When unable to gain recognition or support from others, they take on the role of a heroic or worshipped person with a grandiose mission.
There are actually lots of theories as to subtypes of narcissist. Alexander Lowen has some too, but I like to stick to Millon as they show how the disorders can relate to each other. As you can see the histrionic adds a more sexual side to the narcissist’s pride.

NPD occurs in less than 1% of the general population and is seen more frequently in males than females. Narcissistic traits are very common in adolescents, however, most adolescents grow out of this behaviour – those who don’t, if the behaviour intensifies, become diagnosed with NPD. It’s common for successful people to become narcissistic but this doesn’t mean they suffer from NPD: only when the behaviour is “distressing or disabling” does it become grounds for seeking a diagnosis.

Malignant narcissism

As for this section, there are a few problems. The first problem is that most psychologists have not actually recognized this as a term. The second problem is those who do recognize it can’t seem to decide whether it’s psychopathy, another name for NPD, or a disorder all on its own. As a friend noticed, the term “malignant narcissist” is rather emotionally loaded, so I’m inclined to believe that someone decided to get fancy with their dislike of NPD by using a word that sounds really nasty that they can fall back on the secondary meaning of “likely to spread” when they get accused of bias.
Therefore, I am forced to skip this disorder at least until somebody gives me an official health site that has it. This annoys me on many levels and I apologize for being unable to find more information on it.

Author's Notes:

Now for miscellaneous information I found while searching the net. Or, more appropriately, misinformation. I won’t go into specifics but some sites have claimed things like the “common expressions of a narcissist”, which is logically flawed. Things like “I had them eating out of my hands” were taken as a subconscious expression of their belief that manipulating people is the best way to get things. For starters, you don’t have to be a narcissist to be good at or enjoy manipulating others. Secondly, if we’re going to take that expression as such a serious thing then a lot of kids should start calling the cops when their parents say “I brought you into this world, I can take you out of it” because clearly they wish to murder them.
I will admit that turns of phrase can help reveal what a person is actually thinking, basing an entire diagnosis on whether someone calls you a control freak is beyond ridiculous. Also it kind of strikes me as a cop out for those who are actually control freaks (or other insult) to just say that the person who says them is a narcissist.
Think about it, when you insult someone are you insulting them to prop yourself up, because the insult actually applies, or because you’re angry and words are just flying? Are you so willing to assume the first, even though so many of us are just doing the second two options?

For the sake of full disclosure, I have not included every piece of information I have read. Mainly because they either disagreed with the medical documents, were stand-alone (or crackpot) theories, or were written as though they were describing a supervillain. The last one especially... just because someone is an abuser it doesn’t make them mentally ill, and just because someone is mentally ill it doesn’t mean they are an abuser. A lot of sites tend to be dedicated to supporting the victims of “bad” NPD’s and spend a lot of words vilifying the NPD. I’m not blaming the victim, but I don’t think the solution is to create a concentrated ball of hate against the entire demographic that the abuser just happens to fall under. Also, there tends to be the implication that all abusers can be classified as psychopaths, sociopaths, or narcissists – I will dedicated a later post to statistics proving this implication wrong. Statistics are fun like that.
After all, we know from last week’s post that “sane” people are just as capable of being indifferent to suffering.

Now, obviously I can’t stop you from reading this and then deciding that “OMG I know an undiagnosed narcissist!” but hey I’m going to try. Are you a psychiatrist/psychologist? If you answered yes then you already knew all this. However, if you answered no then you do not have the technical know-how to do this.
So if you think that someone is up themselves then just stop there – that’s all they have to be. Don’t go off and decide that clearly they need to be insane too.

 

I will not be doing a Disturbing the Disturbed post (at least not one of the usual structure) next week as I have a major assignment to get done as well a cosplay costume to sew. Depending on the assignment I may not be able to post until the week after that. However, rest assured we will be continuing with (Spoilers sweetie!) Antisocial Personality Disorder and Psychopathy.

See you in a week or two!