Narcissism is a painful issue that’s often misunderstood. Let’s get beyond the stereotypes to look at the key traits, causes and treatments...
Sometimes, it can feel as if we’re living in an image-obsessed culture of social media selfies and celebrity worship. We seem to be becoming a ‘me-first’ society, one with a huge focus on self-satisfaction and very little on self-sacrifice. Yet for this reason, it’s all too easy — and even a little bit fashionable — to bandy around terms like ‘narcissist’. We might use it to describe an attention seeking movie star, a selfish ex or an egotistical boss.
Yet while lots of people can show some degree of narcissist traits (and in moderation, these can even be healthy), this is quite a different thing from narcissism as a mental health issue. In fact, clinical narcissism is a complex medical condition that can cause a lot of pain for the person dealing with it, as well as those close to them. Most importantly, clinical narcissism doesn’t always look the way you might expect it to — in fact, some people with the issue might not remotely fit our stereotypical idea of a ‘narcissist’.
This is because narcissism is an entire way of thinking, being and relating that can prevent a person from ever experiencing true connection with others. Clinical narcissism goes beyond vanity and self-absorption to a whole constellation of ways of thinking, being, relating and self-protection.
Other hallmarks can include a lack of empathy, an inflated sense of self-importance, a sense of entitlement, an excessive need for attention, troubled relationships and grandiose fantasies. For this reason, people close to an individual with a narcissistic personality can experience intense stress, suffering and even abuse. Yet it is also a devastating condition for the person themselves, for a whole host of reasons.
So let’s start by looking at what clinical narcissism actually is, what causes it and which therapies might help. And perhaps most importantly, let’s eliminate some of the stereotypes about this condition.
Narcissism is actually a continuum that includes individuals with a few narcissistic traits at one end and the diagnosable condition of Narcissistic Personality Disorder (NPD) at the other. NPD is a label given to people with a high level of dysfunctional narcissism that might be causing pain, havoc and instability in their lives. In order to meet the criteria for NPD, the person would have at least five of the following nine traits:
However, when looking at the above traits, it’s important to remember that because people can have different combinations of the five, clinical narcissism can take many forms. This means that there are a variety of expressions of the condition. Also, some people can have some of the above characteristics but hide them very well, presenting quite a different image to the world. This is why the stereotype of the bold, brash and flashy narcissist — although true in some cases — can also be unhelpful when trying to understand if you or a loved one have the condition.
In fact, narcissistic personalities can often fly under the radar as they don’t always look how we expect them to look. Could that quiet and withdrawn person actually be quite narcissistic? Or the devoted pastor who works around the clock? As a matter of fact they could, as there are various different expressions of narcissist personalities. This is why narcissism is often split into various sub-types and while there is no solid consensus on what these are, here are some of the main ones often discussed:
These individuals can be close to sociopathic in their behaviour, however what separates them from sociopaths is that they can still experience some level of remorse. They tend to be manipulative and Machiavellian, using people for their own gain, playing systems brilliantly and often rising to the top of corporate and organisational ladders as a result.
These individuals are often our stereotypical idea of the narcissist — bold, confident, charming, polished and charismatic. They can often be the life and soul of the party but might also have the effect of ‘sucking the air out of the room’, as they need all attention to be on them. They are often very superficial, choosing friends and even romantic partners based on appearance and social status, rather than on real emotional connections.
This quieter form of narcissist can come across as shy, reserved and even self-deprecating on the surface. They could seem negative, depressed or low in self-esteem, or fragile, vulnerable and a perpetual ‘victim’ who needs to be ‘rescued’ or to receive ‘special’ care. Yet underneath this facade they might secretly believe that they are an undiscovered genius that the world hasn’t recognised and has somehow passed by. They can also express anger and resentment in less obvious ways, through passive aggressive behaviours or the silent treatment.
These individuals can appear highly devoted to charity work, activism or a religious organisation. They might devote themselves to a worthy cause around the clock, passionately fundraising and raising awareness of it. Yet it is worth noting that they tend to need a lot of validation and recognition for their activities. For instance, they might post regular selfies on social media of them volunteering or throw glittering charity balls. Or they might be the church leader who seems to thrive on the rapt attention of a huge congregation each Sunday. They might also have a sense of themselves as being a kind of ‘saviour’ with special qualities that allow them to rescue others.
Yet while narcissistic individuals can have different outward expressions, their underlying way of thinking, perceiving and relating is generally the same. They tend to be driven by feelings of being ‘special’, ‘superior’ or ‘entitled’, even if these attitudes aren’t obvious on the surface.
As mentioned, one big block to healing from clinical narcissism is the set of psychological ‘coping mechanisms’ that shield people from becoming aware of their issues — or even dealing with the consequences of them. In fact, one of the most tragic aspects of this issue is that the person is often in complete denial that anything is wrong with them. This is because clinical narcissism creates a worldview filled with blind spots, illusions and fantasies.
In fact, one of the hallmarks of the condition is that the person usually thinks that everyone else around them is the problem, not them. You could think of them as the ‘king or queen of the castle’, with the walls and battlements being their various psychological defences against reality. This is why it is still fairly unusual for highly narcissistic people to become self-aware and seek therapy, or stick to it long term if they do enter it (that said, growing awareness of the condition via the internet may be changing this). In the words of Wendy T. Behary, author of Disarming the Narcissist, ‘...for a narcissist, saying a simple “I’m sorry” is like saying, “I am the worst human being on earth”.’
Yet it is important to note that pathological narcissism is more than just a desire for attention or a tendency to be too self-absorbed. Instead, it is a condition that completely distorts a person’s way of seeing the world, their place in it and their relationships with others. Even if their outward life looks totally different, in their heads they exist in a warped reality with themselves at the centre, high on a pedestal. And even if they have a spouse, children and plenty of friends, they can still suffer from a gnawing sense of emptiness that they often repress.
In fact, narcissism is a paradox — the person may project an air of specialness, superiority or superhuman drive, but underneath it all their self-esteem can be extremely fragile. And while validation from others can seem like the air that they breathe, they can never be truly close to anyone.
So how can we make sense of these contradictions? Probably the best way is by looking at where they might have been formed — in the person’s childhood.
According to Heinz Kohut, a psychoanalyst and leading theorist in the field of narcissism, we all go through a necessary developmental stage as children when we are ‘egocentric’. This just means that our main focus is to get attention from adults around us in order to be protected, comforted and guided. One of our key needs at this stage is for our parents to attune to us and reflect back our emotions to us. And when they do us, we can start to both understand and regulate those emotions.
If our needs are met at this 'healthy narcissism' stage, then we develop a sense of self-worth and identity. This is why it is so crucial for our parents to guide us through it and help us develop a balance between respecting our needs and the needs of others. However, for reasons that we will explore, some people get stuck at this stage and develop narcissistic personality traits.
One theory for why this happens is that narcissistic people had parents who were cold, distant or demanding (or even narcissistic themselves). However, those parents might not have presented this way publically and could even come across as very loving. Some people who develop clinical narcissism can even appear to have been ‘spoiled rotten’ in childhood, yet beneath the surface there could have been a lack of real, deep and accepting love.
Children from this kind of family learn early on that love is conditional and dependent on achieving certain things, projecting an ideal image, or meeting the needs of a parent. For instance, being the ‘top of the class’, ‘most beautiful girl’ or ‘sports star’. In essence the child is treated like an object and a source of validation for their caregivers. They are not loved for who they are or even taught that their emotions are valid. In fact, this family dynamic is actually its own form of abuse and can cause deep psychological trauma, even although it might not be outwardly obvious to others.
In the words of narcissism expert, Professor Frank Yeomans: ‘A narcissist has never felt loved and appreciated for who they are, for just being. Anything they got in terms of love and approval was from performance...they have a sense that if they aren’t performing then they are just nothing.’ And ‘performing’ could mean anything from being the funniest person at the party, to having the most dramatic ‘woe is me’ tale, to being the most hard working church volunteer.
And according to psychoanalyst Otto Kernberg, if a child has cold, distant or demanding parents then they may never fully emotionally develop and reach adult levels of maturity. This is because they eventually disconnect from their inner emotional selves as they come to believe that this part of them isn’t important (and they may even see it as painful or inconvenient). Instead, they focus on developing their outer selves, believing that any talent they have is like a ‘superpower’.
However, it is worth noting that the causes of clinical narcissism are still being debated. Some theorists think it might be caused by trauma in general, including physical, sexual or emotional abuse. Others believe that it could be related to over-protective ‘helicopter’ parents, or conversely, caregivers who are too lenient and set few boundaries. Excessive praise from parents could also be an issue, as could having one parent who was overly close while the other was overly disant or critical.
But whatever the specific causes, narcissism seems to arise from a lack of attunement between children and parents. As a result, the child who doesn’t feel safe accepting the more vulnerable part of themselves and instead, learns to identity with an idealised outer self that becomes their whole identity.
This means that when the child is faced with uncomfortable emotions such as fear, pain or shame, they don’t know how to process them as they were never shown. Instead, they deny their inner state, disconnecting from it and never really growing into an integrated person. Dr. Kernberg describes this process as ‘splitting’ and the age when it begins may be the age that the person gets stuck emotionally in adulthood. This is often why narcissistic people can seem charmingly ‘Peter Pan’ at best and dangerously immature at worst.
With splitting, vulnerable feelings like shame aren’t processed inwardly — instead, they are directed outwards and expressed as rage at others. However, after the rage attack the child might feel ashamed again and become stuck in a vicious cycle. So the only way to cope with this is to deny and bury the act of rage, because if it never happened then you don’t have to deal with the shame. This is known as ‘compartmentalisation’ and explains why family members of narcissistic people can be bewildered when the person explodes at them in the evening then gets out of bed whistling the next morning. It is also why someone can be charming and funny at a dinner party then scream at their partner in the car home.
As well as splitting and compartmentalisation, narcissistic individuals use another unconscious tool known as ‘projection’. Because they cannot admit to flaws, weaknesses or vulnerabilities within themselves, they project those qualities onto others. To them, everyone else is ‘difficult’, ‘weak’ or ‘crazy’ and also entirely to blame for any conflict or argument. And by projecting aspects of themselves that they feel uncomfortable with onto those around them, they never have to deal with them.
Together, splitting, compartmentalisation and projection protect the person with NPD from ever having to process their emotions, admit to any wrongdoing or face their true flaws. They have created a false identity in their minds, a person who is more special than the imperfect individuals around them. They exist in an endless lonely hall of mirrors, where their own distorted version of reality is reflected back at them.
The trouble with this narcissistic ‘false self’ is that it is incredibly fragile. In fact it is little more than smoke and mirrors, without the weight or substance of a core inner identity. It is a mask (or series of masks) that the narcissist wears in everyday life — a paper-thin covering, delicate and without substance, always at risk of tearing or dropping. That mask might be ‘career high-flyer’, ‘devoted charity worker’ or ‘tragic victim’ — what matters is that they need it to navigate their reality.
It’s true that we can all wear masks at times and have different personas in different situations, yet for a clinical narcissist, this works on a whole other level. Because they disconnected from their true inner self in childhood, they have to maintain the illusion that the mask is real (for both themselves and other people). Yet the only way to do this is by getting continuous reinforcement from others that this is the case. In fact, a narcissist person has a deep unconscious terror that if they don’t get this reinforcement then they will vanish, or just stop existing. And this reinforcement — known as ‘narcissistic supply’ — can come in many forms, including attention, admiration and emotional reactions from others.
The hunt for narcissistic supply is the reason why some narcissistic people can seem to have a constant need for validation. They might dominate conversations with long-winded monologues, dress in dramatic ways or exaggerate their achievements. Even quieter or more covert narcissists can find a way to get ‘supply’ through excessive complaining, passive aggressive behaviour or bids for sympathy.
And it is worth noting that not all attention has to be positive, admiring or sympathetic. Behind closed doors, narcissist personalities can use more destructive means to seek ‘supply’, behaving in ways that provoke fear, anger or frustration in others. Because from their perspective, if a person is reacting to you by shouting or crying, then they are still reacting — it is much better than being ignored (and it is also better than the ‘humdrum’ harmony found in more stable relationships). Yet although their behaviour can drive people out of their lives, the poignant truth is that they are absolutely terrified of abandonment or rejection.
In some ways this reliance on supply can be seen as a form of addiction. The narcissistic person craves it, they chase it and they can even seem to unravel when it is taken from them (for instance, when a partner leaves them). Yet unlike with a ‘typical’ addicted person, clinical narcissism can’t be cured with a twelve-step recovery programme. This is because there is a deeper problem at work — the person’s complete disconnection from their inner self. As a result, they don’t have any internal resources to draw upon to conquer their ‘addiction to attention’.
This need for supply can be the driving force behind a lot of narcissistic behaviours such as grandstanding or playing the victim. The sad truth is that if a narcissistic individual feels unseen, unheard or unloved, then it can feel like an annihilation. Because without other people around them to reassure them that their false self is real, how can they be sure that it is? And if it’s not, then what is left?
Pathological narcissism is a devastating issue, both for the person themselves and the people that they are in relationships with. Even if the person seems confident and charming on the surface, there is a deep well of emptiness and isolation hidden beneath. And because this condition shapes their entire identity and perceptions, there are no quick fixes. In fact, one of the biggest challenges with narcissism is getting a person to recognise that they have a problem in the first place. This is because people with this issue have created an entire framework to shield them from feeling shame, so acknowledging that they have something they need to work on can trigger the very feelings that they are burying.
However, If you think that you or someone close to you has this condition, then there is hope. Therapy can help, although there are no quick fixes. Healing clinical narcissism is hard work that can take years, yet it can also be an enriching and rewarding journey.
Therapies that can help people with strong narcissistic traits include Psychodynamic Therapy, Cognitive Analytic Therapy (CAT) and Schema Therapy. Psychodynamic Therapy uses the therapeutic relationship to provide a ‘corrective experience’, in other words, help the person to experience the bonding and emotional attunement they missed out on when younger. This can be done through empathy, by gently ‘mirroring’ the individual and by recognising their need for acknowledgement and praise. Over time they can internalise these experiences with the therapist and develop a more robust sense of self-worth. This can also help them feel safe enough to tolerate bringing other parts of themselves into awareness without being overwhelmed by shame.
CAT helps narcissistic individuals to understand their distorted patterns of relating to others (which tends to involve one person being admiring and the other admired, or one being contemptuous and the other contemptible) The therapist will help to explore the ways in which the person tries to protect themselves from feeling the core pain of being at the undesirable end of these ‘poles’. For example, through striving for power, success or admiration, or being the one who instructs or cares for another person. In these ways, the narcissist makes other people ‘hold’ their own buried feelings of weakness and vulnerability that feel so shameful to them. And by beginning to understand these patterns in therapy, ways to break out of them can be considered. This can lead to more authentic and meaningful connections with others, as well as the development of true self-worth.
Finally, Schema Therapy helps individuals to understand the impact of not getting their needs met when they were younger. It can also help them to identify the protective mechanisms they developed in order to cope. This has likely led to a lonely, dependent or spoiled ‘inner child’ that they continue to carry within themselves, as well as ‘coping modes’ that are now causing difficulties for them (for example pushing others away, preventing emotional connection and depending on others to fill the emptiness inside with narcissistic supply). These coping modes might manifest as a side that can be a bully, a show off or someone who relies on substances to soothe emotions. Schema Therapy raises awareness of this and helps the person learn alternative ways of getting needs met that do not damage themselves or their relationships.
If you think that you might have issues with narcissism, then you are not alone. Not having all your needs met in childhood is not your fault, yet you do have the power to do something about it. It’s possible that you feel exhausted and confused right now, but it doesn’t always have to be this way. Big issues don’t have quick fixes but they do have first steps.
And if you are being affected by someone who might have narcissistic traits, therapy can also help you to think about your needs and how to navigate the relationship. It can also be helpful in overcoming the impact of growing up with narcissistic parents as well as exploring any patterns you might have of choosing narcissistic partners.
However you are being affected by narcissism, there is a way forward. And by taking that first step towards understanding your situation better, you can eventually find a peace, happiness and self-awareness that you might never have experienced before.
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