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Narcissistic Personality Disorder

SAGUI: Have you ever done any kind of psychotherapy?

Dr. Vaknin: Yes, twice. Once as an adolescent and once in jail. Oops! Forgot a third time, after I broke up with my first girlfriend. None of them went anywhere. I co-opted (bribed, bought off) and then devalued one of the three, discussed psychiatry with another (hence "Malignant Self Love") and became the therapist of the third ... LOL.

Very few therapists know the first thing about pathological narcissism and NPD. The disorder has been classified as a separate mental health category only as late as 1980 (DSM III). Freud did some groundbreaking work and so did Kohut and, later Millon and Kernberg. But these were "lab" types and didn't filter down to practitioners. Additionally, the boundary between NPD and other personality disorders (such as Borderline Personality Disorder, Histrionic Personality Disorder, or Antisocial Personality Disorder) all in the infamous Cluster B - is very blurred.

David: How long were you in therapy (total time) and did you get anything positive from it?

Dr. Vaknin: Well, as I said, no. I didn't derive any discernible benefits, except that I was able to label myself, finally. All therapies were short (the longest was six months) and rather erratic. But labeling myself has helped me get to know myself and, so, maybe it wasn't all in vain. One should not confuse, though, self-knowledge with healing. To heal, one must experience insight and it's emotional correlates. KNOWING is not FEELING and there is no healing (transformation) without the latter.

David: Is there a difference between male and female narcissists?

Dr. Vaknin: Not really. This is why I keep using the politically incorrect male voice ("he", "him", etc.). Still, 75% of all diagnosed NPDs (1% of the population) are MALES. Females tend more to Histrionic Personality Disorder (which, in my book, is another form of NPD where the narcissistic supply is sex and the physical).

David: Here are some more audience questions.

Forgetful: What would be the best way to relate to someone with NPD?

Dr. Vaknin: What do you want to achieve? Who is the narcissist? A boss, a lover, your kid, the neighborhood bully?

Forgetful: A friend and a co-worker.

Dr. Vaknin: If you wish to preserve and maintain the relationship, do not criticize or disagree with the narcissist. Provide him or her with ample and recurrent narcissistic supply (adulation, admiration, attention, affirmation, applause). Never give advice unless explicitly asked to and, even then, make it seem like the narcissist found it by himself. Never remind him that he is weak, sick, unknowledgeable, in need of help, or otherwise beholden to someone or something. Do not threaten to abandon him, do not pose conditions, or impose. Do not intrude, or micromanage his life. Stay away until summoned. Be there only when requested. Do not have a full-fledged existence, being, needs, or wishes of your own.

David: How does one recognize a narcissist (and I'm talking about someone who has an untrained eye)?

Dr. Vaknin: FAQ #58 is dedicated to that, and it is a long one. The narcissist is a master of disguise. He is a charmer, a talented actor, a magician and a director of both himself and his milieu. It is very difficult to expose him as such in the first encounter. But here are a few signs:

  1. displays haughty behaviour
  2. has a tendency to humiliate, criticize and belittle others
  3. has a tendency to exaggerate, small, unnecessary lies
  4. has a tendency to fantasize about unlimited success
  5. brags incessantly, to ignore you, not to listen
  6. has a tendency to idealize you much beyond the call of courtship
  7. makes promises which are incommensurate either with the event, or with his ability to fulfill them
  8. has haughty body language

David: But there are also people, as you describe, who are "genuine" in nature. So, I'm assuming that by the time one finds out they are involved with a narcissist, it may be too late to dodge the hurt, if it comes.

Dr. Vaknin: I don't know what you mean by "genuine". Anyone who is "genuinely" like I described is a genuine narcissist. Invariably, you feel something wrong on your first encounter with a narcissist. There is something fake, cheap, not authentic, two dimensional in his behaviour, even in his looks. Everything is bigger than life. If he is polite, then he is aggressively so. His romantic nature will tend to schmaltz. His promises outlandish, his criticism violent and ominous, his generosity inane. Something doesn't fit. But we all want to find the right one, prince charming, the savior. It is sad. It is the fear of our loneliness which drives us into a hell much worse than any solitude.

David: I was referring to the "talented and charming" part of the person. Here's an audience comment and then we have a question someone emailed in.

rainmaker: Sam, I spoke to you over two years ago about my NPD fiance and after evaluating the situation, you advised me to immediately throw in the towel and move on. It took me two years to heed your advice and escape the long shadow of the NPD. You were totally right. NPDs can't change as their emotional wiring harness cannot be accessed by mortals. Your advice is so sound: "Just work on changing yourself and trying to understand why you are drawn to a person with Narcissistic Personality Disorder in the first place." You gave great advice.

Dr. Vaknin: Thank you. I am glad I could be of help.


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Last Updated: 11 April 2017
Reviewed by Harry Croft, MD

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