Narcissistic Personality Disorder (NPD)

Narcissistic personality disorder (NPD) is a psychiatric disorder characterized by arrogant thinking and behavior, lack of consideration for others, and excessive need for praise and admiration. At times, those with NPD are hostile, abusive, envious, manipulative, and demanding. While individuals with NPD may be perceived as “grandiose” with inflated egos, these people often suffer from a deflated sense of self, including feelings of powerlessness, humiliation, rejection, incompetence, and inferiority. The “grandiose” presentation serves to defend those with NPD from these painful feelings. In essence, the surface-level presentation of a “grandiose” self splits major parts of the individual’s personality, hindering the development of close, genuine relationships.

What Causes Someone to be a Narcissist?

Upbringing and the early childhood environment may be key factors in what causes NPD.  In order to develop confidence and reality-based self-esteem, one must have optimal and adequate availability of primary caregivers and a general sense of family harmony. These factors provide love and support that allow for the development of healthy internalized expectations, namely love for oneself rather than for one’s performance.

Parents may desire for their children to provide for them what they lacked in their own childhood. If a developing child is exposed to a selfish, depressed, or otherwise preoccupied caregiver, they will not feel loved. For example, a mother may expect her child to offer their full attention and admiration and never desert her. In this situation, the child’s possibility of love is felt only when they PERFORM adequately in a manner that will elicit the caregiver’s approval. Because love is given only in response to specific performances, it is not well integrated into the child’s sense of self.

The Perfect Self

When a developing child is deprived of empathic love or is overly gratified by a lack of clear limits, they may feel defective and unlovable. As such, the child begins seeking replacements for love, namely admiration. They subsequently develop the “Perfect Self” as a means of garnering admiration. If they can become the best (e.g., perfect, the most beautiful, the most intelligent), they will be admired and fill the gap from love.

What are the Signs of Narcissism and the Grandiose Sense of Self?

What are the Signs of Narcissism and the Grandiose Sense of Self?

Those with NPD may exhibit the following signs and symptoms:

  • a need to monopolize conversations and make everything about themselves;
  • a sense of superiority and entitlement to special favors and unquestioning compliance with their expectations;
  • gratification from belittling people perceived as inferior;
  • an inability or unwillingness to recognize the needs and feelings of others;
  • and a lack of responsibility for all errors or oversights.

A particular point to clarify regarding empathy: These individuals believe that the preservation of the grandiose self takes precedence over preservation of relationships. They believe that they do not need anything from others; however, this is a paradox. These individuals exhibit a profound dependence on others, specifically for admiration.

Can you fix a narcissist – is there a Treatment for NPD & the Grandiose Sense of Self?

In my practice NPD is typically treated with insight oriented psychotherapy or in more extreme cases a combination of psychotherapy and antidepressant medication. Narcissistic tendencies can improve with support from a compassionate, trained, and experienced therapist. Significant growth is possible if these individuals choose to remain in a consistent and ongoing relationship with a therapist. From over 20 years of practice with NPD individuals, I have learned that the most important factor is facilitating a process where the individual develops a capacity to recognize their own unique identity. This identity must be formed slowly and only when one is ready to address the narrative of grandiosity and the Perfect Self. This work of addressing perfection can be distressing, but, when things go accordingly, it typically raises a whole new set of emotions, which then must be worked through.

Call Dr. Mazzella For a Diagnosis & Treatment

If you are experiencing anything presented in this commentary, I can review your situation, formulate a diagnosis, and offer you a treatment plan to meet your needs.

You can reach me at 212-591-0152  or via the online form in my contact page.

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