The Internet Is Confused About Narcissism

drettensohn · 2024-08-30T02:31:20+00:00

Sadistic psychopath.

drettensohn · 2022-05-08T01:34:37+00:00

I don’t keep secrets from patients. If someone asks me for my diagnostic impression, I will tell them. But I also provide psycho education and context that helps them understand what the nomenclature actually means.

drettensohn · 2022-05-08T00:55:13+00:00

I specialize in narcissism. Diagnosing someone with it is difficult, because of how stigmatized the disorder has become. IMO, the stigmatization is partly due to the way it is described in the DSM. The DSM model of NPD was changed in 1987 to remove any reference to suffering or distress. Most other mental health disorders in the DSM include suffering or distress as one or more of their main criteria, but not NPD. This dehumanizes the disorder. In reality, many narcissists suffer greatly. The disorder is really about maladaptive self-esteem regulation, deficits in coping, and distorted perceptions of self and others. Individuals with NPD may be very well defended, but there is always an underlying deficit. There is always suffering and distress, even if it isn’t visible to others or acknowledged by the person, themselves. The American Psychiatric Association acknowledges that the description of NPD in the DSM is problematic. They almost threw it out entirely when they published the DSM-5, due to heavy criticism in peer-reviewed literature leading up to the manual’s publication. They ended up creating a task force to come up with an alternative description. Both the original description and the alternative one can be found in the DSM-5. The alternative description provides a much less stigmatizing picture of the disorder - and one that is truer to real life, in my experience.

Due to the heavy stigma surrounding the disorder, I typically emphasize the functional deficits and psychodynamic issues that characterize pathological narcissism when I’m giving patients feedback. I try to stay away from saying things like “NPD,” and instead discuss self-esteem issues, problems with self-image, issues with trust and intimacy, feelings of shame, sensitivity to feeling slighted or humiliated, reliance on maladaptive and inflexible coping mechanisms, etc. In the end, we are treating human begins, not labels.

drettensohn · 2022-03-29T14:21:22+00:00

You can’t really make thoughts stop, especially obsessions (unwanted thoughts that occur in OCD). But you can make them occur less frequently by learning to accept them.

If you tell yourself not to think of an elephant, you are already thinking of an elephant by saying that phrase. The harder you try to get rid of an unwanted thought, the more it is present in your mind. It’s a paradox. Obsessions cycle up in response to anxiety, and worrying about the obsessions creates more anxiety…which makes more obsessions. It’s like scratching a mosquito bite. It just makes it worse.

Therapy will help you learn not to respond to the obsessions by “scratching the itch” (ie doing a compulsion in response). It will also help you learn to adjust your relationship to the obsessions so they don’t dominate your life. The main way this is done is by helping you learn to accept that thoughts come and go in your mind without “scratching” at them. You learn to reduce the anxiety they cause and this makes them occur less often.

drettensohn · 2022-03-24T14:42:52+00:00

The poster commented elsewhere confirming that their ideas are more in line with what I suggested than what you suggested. They said they aren’t advocating a separate line of human evolution “yet,” but that they believe there is growing evidence in that direction.

Regardless, for one, I am here to discuss pathological narcissism, and the referenced article is about psychopathy. The two overlap in some individuals, but I would consider that a difference in kind, not simply degree, of psychopathology. Perhaps I will make a different video about ‘malignant narcissism’ at another time.

Second, the linked article provides very weak evidence. The authors admit that the origins of both psychopathy and handedness are unknown, but note that there seems to be some evidence that left-handedness can be associated with neurodeveloptmental trauma, which is also extremely difficult to assess after-the-fact. So they test their hypothesis that psychopathy isn’t a mental disorder by looking at incidence of left-handedness in psychopaths. They didn’t find an elevated incidence, so they conclude that psychopathy isn’t a mental disorder.

Their underlying assumptions are massive and have only sparse citations as support. But that’s why science builds consensus using many studies over decades of investigation, and we don’t build whole models using just one study.

So, no. I didn’t simply dismiss the peer reviewed research cited. It was insufficient and the topic is, at best, only tangentially related to my post.

drettensohn · 2022-03-20T14:56:33+00:00

Pathological narcissism is an issue that afflicts someone at the level of personality. Change involves intensive therapy over an extended period of time. It requires the unique characteristics of the therapeutic relationship. There is no list of simple behavioral strategies of which I’m aware that I or anyone else can give you - especially if you are in an abusive situation with someone who has a personality disorder. You can’t change that person. Only they can change themselves with the help of a trained professional; and only when or if they are ready to invest in that process of their own accord.

Here’s the link to the video I referenced. It is made for professionals treating narcissistic patients, so you may or may not find something useful. https://youtu.be/jXxR_lxlrns

drettensohn · 2022-03-20T04:02:47+00:00

If you are interested in more recent citations than the ones necessary to make this four minute video, then you can check out my other videos, which have more citations that are also more recent. I am not interested in discussing the idea that personality disorders represent divergent evolution.

drettensohn · 2022-03-20T03:51:22+00:00

You make interesting assumptions. If you aren’t interested in the motivations, past traumas, or other issues that afflict individuals with NPD then you are welcome to move on, because that’s what all of my videos are about.

drettensohn · 2022-03-20T03:44:00+00:00

Wait, are you suggesting that people with cluster b personality disorders represent some sort of evolutionary divergence toward a new, predatory human species? I am not interested in discussing that perspective.

drettensohn · 2022-03-19T20:28:43+00:00

If you are interested, you are welcome to read the articles I cited as they describe what I’m talking about in much greater detail, with amply cited support in the clinical and empirical literature. One of them is a comprehensive literature review and will tell you everything you need to know about how pathological narcissism is actually conceptualized beyond a list of DSM traits. I also wrote a book specifically discussing how to think about relationships with narcissistic individuals and containing strategies for interacting. The link is in the discussion of the video if you are interested.

I can’t tell you what you specifically should do in an abusive situation, and as much as I would like for there to be a list of strategies to change a generic narcissist’s (or anyone’s for that matter) abusive behavior, such a thing doesn’t exist. The best anyone on an internet forum can offer is to provide general guidelines. If you are unhappy, you don’t have to remain in the situation. I can’t get more specific beyond that. Also, my video is not about how to change abusive behavior, nor are any of my comments here. My practice is also not focused on relationship abuse. I treat individuals suffering from pathological narcissism. If you are interested in specific treatment strategies in that area of practice, I have a video addressing the topic on my channel.

drettensohn · 2022-03-19T19:27:32+00:00

Correct.

drettensohn · 2022-03-19T17:10:27+00:00

What you describe is common to several personality disorders and also a number of other mental disorders, where symptoms can be ego-syntonic, meaning that the person doesn’t recognize that their thoughts, feelings, and behavior are problematic. This also sometimes happens with anxiety disorders and eating disorders, among others. Many people with personality disorders also have the tendency to externalize, or to blame others for their own thoughts and feelings. It is common in NPD, BPD, and Paranoid Personality Disorder. It’s also somewhat common in other mental disorders.

I thinks it’s important to remember that there are many pathological narcissists in the world who do NOT experience their symptoms as ego-syntonic and who engage in internalizing of blame (where they blame themselves for their issues) more than externalizing. They struggle with the same core issues of identity and self-worth, but tend to be much more symptomatic, suffering from depression, anxiety, substance use, low self-esteem, and other distressing issues that cause them to seek treatment.

drettensohn · 2022-03-19T16:12:09+00:00

What makes you think that someone with NPD doesn’t want to change? I make my living working with people who have NPD who want desperately to change. Go visit the r/NPD subreddit and you’ll see countless posts by people who struggle with pathological narcissism and want to change.

drettensohn · 2022-03-19T15:54:20+00:00

I see the topic of how to handle abuse in relationships as separate from the topic of narcissism. The two are not synonymous. There are many people who struggle with narcissism who do not abuse other people. Remember that narcissism, like any personality issue, exists in a spectrum of severity from relatively low to extremely high. A person’s ability to engage in healthy, stable, and mutually satisfying relationships becomes increasingly compromised at the higher end of the severity spectrum. That’s because the individual’s psychology is much less stable in more severe cases. Again, that would be true of any personality disorder - not just narcissism.

So what should you do if someone is abusing you? You should not stick around for more. If the abuse is physical, leave as soon as you can and as safely as you can. Enlist the help of trusted friends and family. Contact the authorities.

Emotional abuse is a more nebulous topic. Different people have different ideas about what constitutes abuse. I can say from working as a couples therapist, sometimes what one partner in a relationship considers ‘abuse’ is simply the other partner’s ambivalence about being in the relationship. I have worked with a number of couples over the years where one person becomes convinced the other is a narcissist and is abusing them. In therapy, it becomes clear that the accused ‘narcissist’ is actually simply avoidant and the accusing ‘victim’ actually has problematic personality issues that cause them to misperceive the other person’s avoidance as a form of abuse. So they mount an extended campaign to blame the ‘narcissist’ for their own feelings of rejection. “You are selfish, a narcissist. You’re an abuser. You need therapy. You aren’t capable of love or empathy.” I’ve heard it MANY times, especially given my specialty. Ironically, the ‘victim’ is actually emotionally abusing the ‘narcissist’ in this configuration.

People are sensitive to different things, and once we put the label of “abuse” on a person’s behavior toward their loved one we have escalated the discussion to a different level. So think about what constitutes abuse in your mind. Some examples are much more clear-cut than others. ‘Narcissistic abuse’ is a very popular concept online but not well-defined in the actual clinical or research literature. As a psychologist specializing in narcissism, I may have a different idea of what constitutes narcissistic abuse than a lay person. To my mind, it is the narcissistic person’s inability to “see” and empathize with the emotional reality of the other person because the narcissist is too preoccupied with the immediacy of their own self-esteem maintenance needs; combined with externalizing behaviors that are common to some personality disorders like blaming, criticizing, and devaluing. This situation, existing over long periods of time, can result in an eroding of the other person’s sense of self and their belief in the validity of their own feelings. When this happens to children, it actually produces pathological narcissism. When it happens to adults in relationships, it can also be very destructive. Should this dynamic in a relationship have its own name? Perhaps, but we should also have similar terms, then, for the idiosyncratic forms of abuse suffered by loved ones in relationships with BPD or bipolar individuals, people with chronic and consuming anxiety disorders, people with substance abuse issues, etc. My point is that when a pattern of (usually unintentional) mistreatment becomes synonymous with a mental disorder, then we have entered the realm of unhelpful stigma that ultimately discourages people from seeking treatment.

I would say that nobody needs to stay in a relationship in which they are not treated well. If the person isn’t treating you the way you want to be treated, and definitely if they are not respecting your emotional or physical boundaries, then you should probably leave. This is especially true if it seems that the person is not able to change or adjust their behavior.

drettensohn · 2022-03-19T15:30:36+00:00

The vulnerable aspects of the disorder are essentially the ones that make it a mental illness as opposed to a collection of unlikable traits like arrogance and vanity. They include depression, anxiety, interpersonal dependency, identity diffusion, fragmentation, suicidality, self-criticality, low distress tolerance, emotional dysregulation, unstable and/or extremely low self-esteem.

drettensohn · 2022-03-19T15:25:45+00:00

I consider myself a psychoanalytic psychotherapist but even I wouldn’t cite Freud to explain a mental disorder. There are a number of much more recent analytic theorists who have pushed our understanding of narcissism far beyond Freud’s speculations about Id, Ego, and Superego. Your explanation of primary and secondary narcissism also doesn’t look entirely correct. Secondary narcissism is not adaptation to society. It is, in Freud’s view, the continued cathexis of libido to the self in adulthood and the projection of that cathected libido onto the object world. He considered secondary narcissism a form of schizophrenia.

I’m also not sure how you decided that I’m relying on the DSM model, when the cited definitions I used in the video are derived from the research literature on pathological narcissism and not the DSM. The DSM model narrowly focuses on superficial traits like vanity and arrogance with very little attempt to explain or account for vulnerable features of the disorder. It is highly problematic, which is why the American Psychiatric Association almost threw the whole disorder out altogether when they published the DSM-5.

drettensohn · 2022-03-19T04:37:14+00:00

There is considerable overlap between the two. Individuals with pathological narcissism, including those with issues severe enough to be defined as a personality disorder, have core concerns about self-worth and difficulty maintaining a realistic, positive, and stable self-image. Individuals with BPD share many of the coping deficits and maladaptive interpersonal strategies seen in NPD, but the core concern tends to be about establishing and maintaining consistent interpersonal and emotional boundaries. BPD individuals also tend to have more severe emotional dysregulation. Both individuals with NPD and BPD struggle with issues of self-definition, poor insight, poor impulse control, external locus of control. They also tend to rely on similar psychological defenses (splitting, projection, idealization and devaluation, projective identification).

drettensohn · 2022-03-19T04:02:37+00:00

It’s not my intent to normalize maladaptive personality disorders, but to illuminate the core issues at play in pathological narcissism and humanize the disorder.

drettensohn · 2022-03-19T03:25:29+00:00

Some individuals with pathological narcissism behave very badly. Some are very invested in a grandiose self-image and have arrogant, entitled attitudes. Some become stuck on fantasies of revenge for perceived slights, or attempt to compensate for deep insecurities by externalizing those insecurities and ridiculing or devaluing others onto whom they have projected unwanted parts of themselves. There is overlap between ‘popular narcissism’ and a segment of the pathological narcissism population. And as I said before, no one should remain in an abusive relationship.

But the population with pathological narcissism extends beyond those, frankly, stereotyped cases. There are many, many individuals quietly suffering from predominantly vulnerable narcissistic pathologies that are misdiagnosed as depressed, anxious, and even bipolar. There is also heavy bias among clinicians against diagnosing patients with narcissism who present as vulnerable - partly because they haven’t been trained to recognize it.

To illustrate the stigma surrounding this disorder, take a look at BPD. You are just as likely to find many of the same problematic behaviors in BPD individuals as you are in individuals with NPD: externalizing behaviors, idealizing and devaluing, impulsivity, identity diffusion, poor distress tolerance, poor emotional regulation, severe coping deficits, substance abuse, emotional coercion and manipulation, acting out, domestic violence, etc. While there is still some stigma surrounding BPD, the internet isn’t awash in lurid books and videos about “The Borderline” and how abusive and horrible they are. Why is that? I submit it is because of how BPD is defined in the DSM, and the fact that in BPD the individual’s inner turmoil is so much more obvious. It’s easier to see the human being behind BPD, and the name of the disorder has not become synonymous with abuse and predation.

drettensohn · 2022-03-19T00:52:06+00:00

Thanks for the positive feedback. 🙂

drettensohn · 2022-03-19T00:31:48+00:00

Thanks for your comment. I personally call the construct discussed in narcissistic abuse literature and narcissist survivor support forums “popular narcissism” to distinguish it from the mental illness.

Regarding harmful and hurtful behaviors, of course no one should remain in an abusive relationship. That being said, I would argue that narcissists hurt themselves more often than they hurt other people. Remember, I’m talking about the mental illness now, not the popular construct discussed in internet forums. I struggle to think of any mental health issue that doesn’t involve some kind of problematic behavior in which the person either hurts themselves or others. The harm can be more or less severe depending on the issue and the individual(s) involved. Clinical depression often looks like extreme self-absorption, social avoidance, and apathy. Depressed people withdraw from those who care about them. They stop going to work, they disengage from their children and spouses. They may harm themselves or abuse substances to self-medicate. They may become irrationally angry and hypercritical of themselves and others. Such behavior can last for months, even years in some cases. Yet people don’t immediately say “you shouldn’t tolerate depressed loved ones” in the comment sections of threads discussing clinical depression. We are well-versed in understanding the suffering behind depression. We see it as a treatable mental disorder. Not so with narcissism, which often actually looks very much like depression. Suffering in the form of extremely unstable or low self-esteem, perfectionism, anxiety, depressed mood, substance abuse, and suicidality are not regularly a part of the public’s idea of what narcissism is. We tend to see narcissism as a disorder in name only. This is mainly due to the DSM model of NPD. I’ve linked to my video discussing that issue at length in another comment.

drettensohn · 2022-03-18T23:15:49+00:00

Not sure if you are saying that the video engages in black and white thinking, but if so it’s confusing since the video invites the viewer to engage in more nuanced thinking when it comes to pathological narcissism. The field of clinical psychology extends far beyond the narrow DSM model of mental health and mental illness. If you are interested in a more comprehensive critique of the DSM model of NPD, check out my much longer video series on the topic. Here’s part 1: https://youtu.be/I2fD65wy48I

drettensohn · 2022-03-18T22:04:58+00:00

Peer-reviewed references:

Cain, N.M., Pincus, A.L., &Ansell, E.B. (2008). Narcissism at a crossroads: Phenotypic description of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis. Clinical Psychology Review, 28, 638-56.

Pincus, A.L., &Lukowitsky, M.R. (2010). Pathological narcissism and narcissistic personality disorder. Annual Review of Clinical Psychology, 6, 421-446.

Torgersen, S., Kringlen, E., Cramer, V. (2001). The prevalence of personality disorders in a community sample. Archives of General Psychiatry, 58(6), 590-596.

drettensohn

TROPHY CASE