The word ‘Narcissism’ is frequently used throughout today’s world, being often prescribed as a label for those that appear to be boastful, power-hungry or manipulative. It is a word that is employed as a pejorative for anyone who on occasion, fails to adhere to pro-social values, displays excessive self-centredness, and has no problem in throwing others into harms way to get what they want. These individuals are often labelled “narcissists.” Unfortunately, due to the widespread popularity of the word in the modern lexicon, the psychological meaning of the term, what it entails and how it can manifest, has been completely lost.
It is important for us to understand the origins of the term, that stem from the Greek mythological figure ‘Narcissus.’ The story of Narcissus goes on to state that he was an attractive male figure who rejected the advances of many potential lovers. However, upon rejecting the proposal of a nymph by the name of Echo, he is cursed by the gods to fall in love with his own reflection. As a result, Narcissus sits next to a pool of water, forever in love with his own reflection. When he realises that the object of his love cannot love him back, he slowly withers away and dies, admiring his own reflection. It is interesting to note that even though this story is over a thousand years old, it aptly captures the features of dysfunctional or ‘pathological’ narcissism that may manifest in affected individuals. Before we delve into what makes narcissism pathological, it is important to note that narcissism is a personality trait that exists on a spectrum. It denotes an individual’s healthy investment into the self. If manifested in healthy amounts, it enables a person to invest into themselves, and appropriately invest in others so that individuals can have a stable sense of themselves. Thus, Narcissism in healthy amounts allows us to have confidence in ourselves, and above all, it empowers us to navigate the world with its disappointments. We become inspired to have dreams, to love others, to be self-confident and above all, to face failure. All of these desirable qualities characterise the term, “healthy narcissism.” Thus, in psychological terms, healthy narcissism is a personality trait that we all aspire to have.
On the other hand, Narcissistic personality disorder (NPD) is a mental health condition that results in an individual having pathological levels of narcissism, which dominates the individual’s perception of themselves, and how they interact with others. One word synonymous with NPD is grandiosity, that means to say that affected individuals often have an excessive, unrealistic perception of themselves. This can manifest in the form of seeking to be idealised and admired to disproportionate extents, to manipulate others to satisfy one’s own needs, and being unable to tolerate criticism, often responding with extreme rage, or disappointment. Combined with this, is an inability to appropriately care for, and have empathy for others. This may lead to a pattern of relationships that may be characterised by one-sidedness, domination, or neglect. Patients with this disorder often have unrealistic expectations of themselves and of others, and in that sense, the grandiosity is pervasive to their detriment. To simply put it, patients with NPD can come across as bold, charming, extraverted but at the same time display excessive self-centredness, a constant need for admiration, a sensitivity to criticism, along with difficulty regulating their emotions, and manipulativeness.
At the same time, not all patients with NPD present in this manner. There is a subtype of patients with the disorder, who can present with features of introversion, a tendency to avoid confrontation, an apparent humbleness, but with an attitude of grandiosity which seems to suggest that ‘the world has done me wrong, I am special and people don’t know it yet.’ When we traditionally think of narcissism, we are attuned to think of the first subtype, and not the second. In fact, affected individuals can often fluctuate between these two states of ‘grandiosity’ and ‘vulnerability.’ There is a complex relationship and a commonality between these two. While many of us may have encountered people displaying these features, it is important to note that all of us are capable of, and probably have shown certain aspects of what is described above. That is because these are universal emotions, and can be seen in normal individuals as well. What matters is their intrusiveness and persistence in all aspects of life, that separate NPD from normal human behaviour. An accurate diagnosis can, and should be made only by a mental health professional.
As is common for mental health conditions, there is no single cause for NPD. One important factor to consider is that we must not judge affected people based on their behaviours, but understand where they stem from. In the story of Narcissus described above, one thing not mentioned is that narcissus is born from a childhood traumatic experience. Impressively, clinical studies have shown a consistent pattern of adverse childhood experiences seen in adults with the disorder, such as physical or emotional abuse and neglect. These factors, combined with biological (genetic) and socio-cultural factors cluster together to result in what we may see in an affected person. It is important to note that NPD does not merely entail rude, self-obsessed persons who manipulate others, but instead an entire cluster of symptoms which involve a difficulty in managing one’s self esteem, that stem from an inability to deal with and accept oneself for who they are. It is surprising to hear, that NPD presents with a substantially higher risk of developing depression, substance-use, and a tendency towards self-harm and suicide, especially when a person faces a major setback, leading their fluctuating self being unable to cope with a normal failure of life. Coupled with the fact that the disorder involves having a fear of, and predominance of negative emotions, such as guilt, shame, loss, and setting unusually high standards to the point that the person may be setting themselves up for failure.
It may be a revelation to note that although patient’s with this disorder can be destructive towards others, the greatest harm they cause is often in their own lives. This does not mean that there is no hope, in fact it is far from it. It may be difficult for all of us, but rather than blaming someone with this disorder, we must try to empathise with them. One major factor shown to alter the course of the disorder, is treatment. Often, patients with the disorder are referred after ultimatums by friends and family, face an acute failure in life, have relationship failures, or to cope with associated mental health conditions. As professionals in the mental health field, it is important for us to build alliances with these patients, help set realistic goals, and attend to their relationships and self-esteem. Developing a nurturing and accepting environment in therapy can go the extra mile to help patients tolerate distressing emotions, and manage their own expectations of themselves. It is essential to explore their motivations, and to help transform situational motivation into a long-term commitment to helping themselves. These things help them to develop a sense of agency, trust, and face self-defeating patterns. NPD is far from a sinking ship, and we must help these persons by showing them that they can help themselves, through consistency, nurturance and managing expectations.
Summary: Narcissistic personality disorder (NPD) is a mental health condition characterised by pathological levels of narcissism, with core features of difficulty in regulating one’s self-esteem, a fragile grandiose sense of self, difficulty in regulating emotions, sensitivity to criticism, excessive admiration-seeking, and manipulative behaviour. Affected individuals may also have difficulty in empathising with significant others. Grandiosity can often fluctuate with vulnerability, a second subtype of clinical presentation, where individuals present with introversion, avoidance behaviour, high levels of neuroticism, and a self-victimizing form of grandiosity. Affected individuals often fluctuate between the two states. NPD is also associated with a high rate of other mental health conditions, including depression, anxiety, substance abuse, and suicidality with self-harm behaviour. Childhood adverse experiences such as abuse, neglect are a common finding in this disorder, along with genetic and socio-cultural risk factors. NPD can be readily addressed by mental health professionals in the form of psychotherapy which focuses on establishing realistic expectations, a strong therapeutic alliance, and an open therapeutic space to nurture the patient’s wounds that often express themselves in the form of defensiveness, manipulative behaviour and rage.
