These rapid alterations between absolute overvaluation (idealisation) to complete devaluation make long-term interpersonal relationships with the narcissist all but impossible.

The more pathological form of narcissism - the Narcissistic Personality Disorder (NPD) - was defined in successive versions of the American DSM (Diagnostic and Statistical Manual published by the American Psychiatric Association) and the international ICD (Classification of Mental and Behavioural Disorders, published by the World Health Organisation). It is useful to scrutinise these geological layers of clinical observations and their interpretation.

In 1977 the DSM-III criteria included:

• An inflated valuation of oneself (exaggeration of talents and achievements, demonstration of presumptuous self-confidence);
• Interpersonal exploitation (uses others to satisfy his needs and desires, expects preferential treatment without undertaking mutual commitments);
• Possesses expansive imagination (externalises immature and non-regimented fantasies, "prevaricates to redeem self-illusions");
• Displays supercilious imperturbability (except when the narcissistic confidence is shaken), nonchalant, unimpressed and cold-blooded;
• Defective social conscience (rebels against the conventions of common social existence, does not value personal integrity and the rights of other people).

Compare the 1977 version with the one adopted 10 years later (in the DSM-III-R) and expanded upon in 1994 (in the DSM-IV) and in 2000 (the DSM-IV-TR) - click here to read the latest diagnostic criteria.

The narcissist is portrayed as a monster, a ruthless and exploitative person. Yet, inside, the narcissist suffers from a chronic lack of confidence and is fundamentally dissatisfied. This applies to all narcissists. The distinction between "compensatory" and "classic" narcissists is spurious. All narcissists are walking scar tissue, the outcomes of various forms of abuse.

On the outside, the narcissist may appear to be labile and unstable. But, this does not capture the barren landscape of misery and fears that is his soul. His brazen and reckless behaviour covers up for a depressive, anxious interior.

How can such contrasts coexist?

Freud (1915) offered a trilateral model of the human psyche, composed of the Id, the Ego, and the Superego.

According to Freud, narcissists are dominated by their Ego to such an extent that the Id and Superego are neutralised. Early in his career, Freud believed narcissism to be a normal developmental phase between autoeroticism and object-love. Later on, he concluded that linear development can be thwarted by the very efforts we all make in our infancy to evolve the capacity to love an object (another person).

Some of us, thus Freud, fail to grow beyond the phase of self-love in the development of our libido. Others refer to themselves and prefer themselves as objects of love. This choice - to concentrate on the self - is the result of an unconscious decision to give up a consistently frustrating and unrewarding effort to love others and to trust them.

The frustrated and abused child learns that the only "object" he can trust and that is always and reliably available, the only person he can love without being abandoned or hurt - is himself.

So, is pathological narcissism the outcome of verbal, sexual, physical, or psychological abuse (the overwhelming view) - or, on the contrary, the sad result of spoiling the child and idolising it (Millon, the late Freud)?

This debate is easier to resolve if one agrees to adopt a more comprehensive definition of "abuse". Overweening, smothering, spoiling, overvaluing, and idolising the child - are also forms of parental abuse.

This is because, as Horney pointed out, the smothered and spoiled child is dehumanised and instrumentalised. His parents love him not for what he really is - but for what they wish and imagine him to be: the fulfilment of their dreams and frustrated wishes. The child becomes the vessel of his parents' discontented lives, a tool, the magic airbrush with which they seek to transform their failures into successes, their humiliation into victory, their frustrations into happiness.

The child is taught to give up on reality and adopt the parental fantasies. Such an unfortunate child feels omnipotent and omniscient, perfect and brilliant, worthy of adoration and entitled to special treatment. The faculties that are honed by constantly brushing against bruising reality - empathy, compassion, a realistic assessment of one's abilities and limitations, realistic expectations of oneself and of others, personal boundaries, team work, social skills, perseverance and goal-orientation, not to mention the ability to postpone gratification and to work hard to achieve it - are all lacking or missing altogether.

This kind of child turned adult sees no reason to invest resources in his skills and education, convinced that his inherent genius should suffice. He feels entitled for merely being, rather than for actually doing (rather as the nobility in days gone by felt entitled not by virtue of its merits but as the inevitable, foreordained outcome of its birth right). The narcissist is not meritocratic - but aristocratic.