Narcissistic Personality Disorder: How Low Self-Esteem Masquerades as Grandiosity by Nina Bingham
INTRODUCTION: This report will define clinical Narcissistic Personality Disorder (NPD), and focus on how childhood fantasies of a perfect world combined with low self-esteem caused by a parent (s) who was indifferent or unresponsive leads to arrogance, grandiosity, and envy. I will briefly summarize Freud and Adler’s opposing opinions of why NPD occurs, views of Kohut and Kernberg, the two most prevalent forms of NPD, the “person-who-needs-to-be-superior” (Adler, 1956), and the “baby” (Mosak, 1977). Millon and Davis (1996) described four types of narcissists that I will touch on: the unprincipled narcissist, the amorous narcissist, the compensatory narcissist, and the elitist narcissist. I will review methods in which the narcissist attempts to confirm her grandiose value in the world, and I will present reasons why Narcissistic Personality Disorder is difficult to treat in psychotherapy. I will review commonly utilized methods of psychotherapy, and narcissistic behavioral patterns in therapy. I will also present a case study; a member of my family who is undiagnosed but classically symptomatic, and I will use her narcissistic behavior to illustrate the researcher’s findings:
Narcissism is a personality disorder that affects a person’s perspectives, personality, character, values, choices, and interpersonal relationships. At its worst it is an all-pervasive, all-encompassing psychological disorder that can have lasting, devastating affects on the sufferer as well as her family, friends, and lovers. The personality defects cannot be treated with psychiatric medication, because it is not a biochemical, neurotransmitter problem. It is a perceptual problem, a cognitive and behavioral problem. Therefore, clinicians agree that psychotherapy is the most appropriate solution, and often, because of the resistive nature of NPD to change or criticism, progress is typically slow, or the client abandons therapy altogether because their superior attitude and fragile self-esteem won’t allow transference and counter-transference to occur. Co-occurring morbidities such as alcohol and drug addiction, anxiety, depression, or eating disorders may lead them to seek help. More comments on treatments will be made at the conclusion of this paper.
Freud aptly coined the word narcissistic to describe this malady; the myth of Narcissis who rejected all lovers and fell in love with his own reflection in the forest pool portrays narcissistic personality, because it involves destructive self-centeredness, and a contemptuous attitude towards others. The Diagnostic Systematic Manual characterizes NPD as, “having superiority and a sense of entitlement. Narcissistic personalities need to feel unique. They rely on an unrealistic view of their talents, and may dream of unlimited fame, power, and ideal love. In their eyes, their problems and needs are extraordinary and deserve priority. They demand attention and admiration and expect special favors as a right.” What are the roots of these distorted perceptions? Psychology agrees that thoughts of perfectionism, grandiosity, superiority and low self-esteem are fostered in early childhood. “The grandiose self is formed in early childhood as a defense against early frustrations…this unrealistic (perception) brings about the experience of grandiose self-significance, entitlement, and specialness; such (unreality) becomes an inner shelter that, mostly through fantasies of ones own greatness, obtains protection from the frustrating reality” (Svakic, 190). Freud described the narcissist as “His majesty the baby.” Freud saw NPD as a regressive attempt to return to the safety of infancy. Adler felt the opposite; that babies were not self-focused; they always reached out for their mothers in an attempt to achieve union. Therefore, Adler saw narcissism as an attempt to exclude others. For a diagnosis of NPD the symptoms have had to exist since adolescence to early adulthood, and must interfere with functioning. Because of the stark difference between an ideal, glorified identity of the inner world and the disappointment of reality, the narcissist thinks in terms of “black and white.” The situation is either “all good” or “all bad.” The narcissist’s superego is “underdeveloped…the process of maturation of the superego is interrupted; hence, the internal system of values is deformed and leads primarily to a constant search for grandiosity at any cost” (Svrakic, 191). How do narcissists interact with others? Narcissistic personalities “pay little attention to other people’s feelings and wishes. They are interested in others mainly as mirrors in which they can admire their own features-the pool of Narcissis-or as instruments to satisfy their wants” (Harvard, 2004). The story of Narcissis ends tragically when Narcissis drowns, trying to embrace his reflection.
I would here like to open a case study of my own; NPD is a matter of personal concern to me, as a family member, who we’ll call Alice, seems to be suffering from it. I say “seems to be” because despite coaxing by her mother to seek therapy, she won’t go. Narcissism is consuming her life-she has severe dysfunction in her inter-personal relationships, alcoholism which began in adolescence, financial instability, and a lack of parenting skills and interest, which has lead her to the decision of surrendering her young daughter to the girl’s father who lives out of state. She displays grandiosity, low self-esteem, and envy. I am including this case for the purpose of matching a clinical diagnosis of NPD to actual circumstances where we can examine the pathological behavior in everyday life. My first “run-in” with 24-year-old Alice’s fragile self-esteem and arrogance occurred at 6:00 am on a weekday. Her mom and I shared an apartment at the time, and because she wanted to talk to her mom right then, she busted into our apartment screaming for her mom. My son was still asleep but she never considered whether her shouting would disturb anybody or not. She opened my bedroom door before I could get fully dressed, and when she saw me she fled the room. I found her in the living room, and calmly and politely asked if she would knock before she entered the apartment and our rooms so that this wouldn’t happen again. Instead of apologizing, which would have been the appropriate response, she became enraged at my request for privacy, and stormed out. She refused to visit her mother as long as I was living there. She told her mother that she hated me, and refused to speak to me. To this day she despises me. Why? Because I set a boundary and requested that she honor it. This example illustrates the thin skin of a narcissist, and hypersensitivity to the slightest criticism or disapproval. The other point here is that narcissists cannot tolerate being in the presence of anybody who would tell them what to do. Chronic envy influences the narcissist to see the authority as “better” or right when they are in the wrong. This intolerance to criticism occurs because it threatens the experience of grandiosity and intensifies the experience of inferiority. Pathological rivalry is yet another insidious manifestation of the damaged real self. Alice was heard to say in early childhood that she didn’t want her little sister to be born, and after her sibling arrived, her jealousy increased. She would purposefully ignore her and remark she wanted the baby to go away. To this day, Alice and her sister fight and put one another down, although Alice is 24 years old, and should be beyond such behavior. Alice also hated every partner that her mother had. On her mother’s wedding day, Alice, who was still in adolescence, got so drunk that the bride and groom spent their wedding night caring for Alice while she vomited. Unconsciously, I hypothesize this was Alice’s way of becoming more important than her mother’s new husband.
Other features of the narcissistic personality are Mirroring in Objects, and Object Choice. Simply stated, by identifying with the object of grandiosity, the narcissist experiences herself as grandiose. For example, Alice drives a new Mercedes Benz, lives in palatial homes (which she doesn’t own), and will only date men who are dashingly handsome, accomplished, and multi-millionaires. Because of these unrealistically high standards, Alice hasn’t dated most of her adult life. She’s waiting for the perfect husband. To date someone less than perfect would mean she is less than perfect. The longer Alice lives these grandiose fantasies, the longer she will believe that her greatness is real. Narcissists will mirror themselves in any situation; they view communication with others as an opportunity to show off and impress. Like the pool of Narcissis, others are like mirrors that confirm their specialness and significance. The narcissist is fishing for compliments and admiration because it “proves” to them that they are worthy.
In narcissistic object choice, the narcissist identifies with valuable objects, such as symbols of status or material wealth. Alice couldn’t drive just any car-she’d be ashamed to be seen in anything less than a new Mercedes. By participating in sensational situations or through associating with famous people, narcissists “grab for themselves a piece of the glitter and confirm their own greatness” (Surakic, 193). Alice, for example, recently underwent plastic surgery to enlarge her lips and breasts, and began modeling, modeling for a major beer company at the most recent Super Bowl. She frequents exclusive bars, drinks only the most expensive liquors, and chums with celebrities who give her backstage passes to concerts and greenroom privileges. The narcissist, who exaggerates all traits of the chosen objects, idealizes such high-class objects and people of desire.
Earlier I mentioned the consensus among psychologists that NPD begins in early childhood, and is a result of damaged self-esteem, and a lack of self-love. Kernberg believes these extreme defense mechanism and distorted perceptions are “a response to coldness, indifference, or hidden aggression on the part of the parent (s) who, without being truly affectionate, try to convince a child of her own importance” (Harvard, 2). As a result, “they feel they cannot be loved unless they are perfect” (Harvard, 2). For narcissists who are parents, they “cannot live up to the internal image of an ideal parent” (Harvard, 2). I am guessing this is why Alice is sending her daughter away; she clearly differentiates her high standards for parents to be different from her own reality as a parent. Kohut further states that narcissists are “unreliable parents who reject the child, or treat the child as an extension of themselves” (Harvard, 3). Because narcissists have wounded self-esteems, probably by a parent, “to defend themselves (unconsciously), they imagine themselves as perfectly lovable-a self-image which supplies the admiration not supplied by the parent” (Harvard, 3). However, “their underlying feelings of worthlessness and emptiness force them into a constant search for recognition” (Harvard, 3).
Mosak and Maniacci (2006) described the two most prevalent forms of NPD: what they called the “person-who-needs-to-be-superior” and the “baby.” Those who need to feel superior display what Adler termed a “Superiority Complex.” A normal state of confidence recognizes “while they prefer to be superior, they do not have to be so” (Maniacci, 138). And, “narcissists see others from the vantage point of who is above-or below-them. If they are not on the top, they feel grossly inferior. Others tend to feel inadequate and uncomfortable around them. Confronted with the possibility of not being superior, they blame, attack, and criticize others. They may be wrong, but others are more wrong than they are” (Maniacci, 138). What other obsessions does the Superiority Complex cause? “They are excessively concerned with their appearance through dressing well and superb hygiene, and often neglect their inner health” (Maniacci, 139). In fact, their obsession with attaining perfection leads to exhibitionism.
Narcissists want to be noticed for their superior intellect and physical attractiveness. Exhibitionism is “the infantile need to be looked at” (Svrakic, 198). Exhibitionism includes demands for constant attention, exclusivity, and an inability to form genuinely intimate relationships. Instead of sharing, these persons want to show off. The opposite side of the coin is the “baby,” who does not like to work, and wants to play continuously. “They seek comfort as a priority and look to entertain and be entertained. They can be best friends to people as long as life is exciting, fun, and busy. Boredom is a disaster for them” (Dreikurs, 1948). “Laziness, forgetfulness, and even incorrigibility are common tactics they use. “Babies”are focused upon their feelings, desires, and wishes. “Because I feel like it” is often the only reason they need to do something” (Dreikurs). They use manipulative anger to get what they want in life. “Temper tantrums are viewed as problem-solving because they can intimidate others into walking on eggshells” (Dreikurs). As Freud pointed out, narcissists act like spoiled or pampered children. His Majesty the Baby. Other general tendencies include lack of endurance or initiative, and learning difficulties caused by lack of motivation and interest only in self. Many narcissists display obsessive-compulsive tendencies or symptoms, as well as rigidity in thought and behavior. When things don’t go their way, they can become paranoid about others, thinking that people are out to get them. They can be ethically unreliable, unscrupulous, pathological liars, exploitative, egocentric, and entitled. The emotion they have the least of is empathy. Ask them how the other person might be feeling and they’ll tell you they simply don’t care. They can be inappropriately seductive, aggressive and loud, rude, and have a pathological addiction to flattery. Parasitism, distrust of others, and corruptibility can all be character flaws of the narcissist.
There are four types of narcissists which Millon and Davis (1996) discussed: the first is the unprincipled narcissist, who breaks rules and flirts with danger. They will speed dangerously, overuse alcohol and drugs, and believe the rules of life should apply for others, but not for them. They are demanding and impatient. The second type is the amorous narcissist, who is improper in their use of erotic and seductive behavior. They seek sexual conquests in order to prove their worth, and seldom settle down to monogamy. When they do, they have multiple affairs. Their partners are treated badly, often neglected or abused. They often see their partners as playthings. They will toy with your heart. The third is the compensatory narcissist, who acts superior as a way of proving to others how great they are. They have often experienced neglect or abuse, and have decided to “show them.” They have been deeply hurt, and are seeking revenge. The fourth narcissist is the elitist narcissist. They have what Adler called a “Superiority Complex.” They were superior children. Status and self-promotion are crucial to them. They can be late, rude, inappropriately dressed, and downright cruel to others, and it simply does not matter. They believe they are in a different class from others. They show little concern for others not in their “league.” My guess is that Alice is an elitist narcissist, or perhaps a blend of the elitist and the compensatory. The seeds of Alice’s pathology began when she was a young child. Her father was caught up in organized crime and drugs. Her parents divorced early into the marriage. Alice’s father stopped visiting her and communicating, treating her with indifference, and when he was scheduled to visit, he never showed. When Alice was six years old her father was murdered by the mob. At the funeral Alice was made to sit by the casket for hours while her relatives wept. As a pre-teen, Alice’s mother remarried, and her stepfather adopted Alice, but he favored his natural daughter, so once again Alice was spurned by a father. My hypothesis as to the origin of Alice’s NPD is that Alice’s self-esteem was damaged by her father’s indifference to, and abandonment of her. Further, she was a first-born child, and NPD occurs most frequently in the first-born. She was “a beautiful child who possessed talents and was fawned on” by relatives (Maniacci, 140). This early abundance of attention established in her the belief that she was special and deserving of praise. When her father abandoned her a second time in death, Alice retreated into an ideal, perfect world of her imaginings to cope with the terror of abandonment and death which she was experiencing. In her inner world, she was worthy of not just her father’s love, but also everyone’s love. She would become so perfect and lovely that no one would ever reject her again. As Alice matured her body grew but her morals, values, and perceptions of herself and the world became grossly distorted, as she was still relating to herself and others as that damaged six-year-old girl. When her stepfather rejected her, it was merely a confirmation of how she felt inside; unlovable. Unworthy. Inferior. Today, Alice is still searching for the perfect man of her dreams, one who will rescue her from ever having to be “common” again. She has discovered plastic surgery as a way to stay young and beautiful, and by identifying with status symbols and celebrities who will mirror back only what she wants to see, which is her own beauty.
What can be done to help Alice and those like her? The consensus of mental healthcare professionals is that NPD is difficult to treat. Psychoanalysis is able, over a longer duration, to “reconstruct the personality” of a narcissist, but the dilemma is that narcissists rarely admit their flaws. Mental health professionals say “these patients usually seek therapy when they can no longer sustain their high opinion of themselves. They may have lost a job, a partner, or are experiencing illness or aging that have undermined their fantasies. Psychotherapy cannot radically alter NPD, but it can (sometimes) help change thinking and behavior enough to limit its consequences. Also, narcissists may be suffering from anxiety, eating disorders, substance abuse and depression, and may be drawn into counseling for these problems” (Harvard, 3). There is also the problem of transference; normally, the client experiences a period of emotional attachment of varying degrees toward the therapist. This is to be expected, and is normal and healthy. It shows that the client is building trust with the therapist (transference), and the therapist is building trust with the client (counter transference). In the case of the narcissist who “opposes relationships outside the self due to self-preoccupation,” she “cannot, at least initially, function in analysis in an ordinary way because they cannot form an ordinary transference relationship” (Britton, 478). So what therapeutic methods are effective for this disorder? Maniacci states, “If the individual can be encouraged to see multiple perspectives, the foundation for empathy is laid. That is a major accomplishment. Psychotherapists must have tolerance for both the anger directed towards them and for the interruptions in treatment that will likely follow bouts of anger. The narcissistic rage displayed is intense and sometimes genuinely frightening” (142).
Other methods used are the psycho dynamic approach “which works by uncovering mechanisms of defense and tracing their (etiology) back to childhood” (Harvard, 3). Kohut believes by mirroring, the therapist provides a realistic reflection in which they can still admire themselves. In Twinship, Kohut recommends that the therapist become a model of emotional health for the client to (emulate). Cognitive Behavioral Therapy has been found to have some success, as it corrects erroneous perceptions by analyzing thought patterns and beliefs. To bring a person back to reality that has been living in what might be best described as a state of delusion, or at least illusion, is an extremely challenging task. The immediate goal of psycho therapeutic analysis for the sufferer of NPD is not to change that person’s distorted thinking, but to cultivate an awareness of that damaged inner child, and to encourage connection between those repressed, painful feelings and memories of the inner child to their current adult behaviors and beliefs. If she can learn to genuinely love that inner child, which is the “broken, damaged, and vulnerable” self, she may be able to relate to others in an authentic way, without façade or extraordinary defenses. There is hope that by psychotherapy narcissists will be able to see their real selves, their humanity in the mirror.
References
Svrakic, Dragan M., April 1990.The Fundamental Dynamics of the Narcissistic Personality. American Journal of Psychotherapy, Vol. XLIV, No. 2.
Maniacci, Michael P., Summer 2007. His Majesty the Baby: Narcissism through the Lens of Individual Psychology. The Journal of Individual Psychology, Vol. 63, No. 2.
Harvard Mental Health Letter, February 2004. www.health.harvard.edu
Contributing Sources: Groopman LC, et al. “Narcissistic Personality Disorder,” in Gabbard GO, ed., Treatments of Psychiatric Disorders, Second Edition. American Psychiatric Press, 1995.
Kernberg OF. Borderline Conditions and Pathological Narcissism. Jason Aronson, 1995.
Kohut H. Analysis of Self. International Universities Press, 2000.
Kraus G, et al. “The A-B-C’s of the Cluster B’s: Identifying, Understanding, and Treating Cluster B Personality Disorders,” Clinical Psychology Review (April 2001): Vol. 21, No. 3, pp.345-73.
Mruk CJ, ed. Self-Esteem: Research, Theory, and Practice. Springer, Second Edition, 1999.
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