We all know people who are narcissistic. A narcissistic person is a person who we see as selfish and self-absorbed. They don’t seem to care about other people. There is a difference, however, between using the term narcissist colloquially and an individual who meets the diagnostic criteria for narcissistic personality disorder.
For an individual’s narcissism to rise to the level of narcissistic personality disorder they must have the following traits: sense of self-importance; preoccupation with power, beauty or success; entitled; can only be around people who are important or special; interpersonally exploitative for their own gain; arrogant; lack empathy; must be admired.
We have all met people, be they relatives or friends, who meet all these criteria. As with all personality disorders, there is no medication that will change the individual’s personality. Further, it is very hard for these people to change even if they are in therapy. Why? Because narcissistic personality disorder is adaptive, particularly in our culture. Our culture financially rewards self-centeredness and these individuals often rise to the top of organizations, or they get rich in Hollywood or on television. Why should such people relinquish their money and fame? They have lived their entire life this way and it has worked, or so they feel.
It is very hard for individuals with narcissistic personality disorder to see themselves. They often do not have the ability to reflect. They do not feel they are suffering. When someone comes to therapy suffering from depression or anxiety they are motivated by a desire for relief. Individuals with narcissistic personality disorder do not feel this way. Until they can see how their personality style causes them to suffer, they may not be motivated for change and can be difficult to treat.
If individuals with narcissistic personality disorder spend all their time focusing on themselves, then why is there a high statistical correlation between narcissistic personality disorder and depression? In narcissistic depression, the depression is not caused by genetic factors as in inherited depression, or a hormonal imbalance as in postpartum depression, or by life transitions as in adolescent depression, or by a series of losses as in elderly depression. Narcissistic depression is caused by the individual’s inability to reach outside themselves and form meaningful relationships. They might form relationships, but those relationships are only important to them as long as the relationship meets the narcissist’s needs. The moment it does not, the narcissist ends the relationship.
For example, a woman who suffers from lifelong depression may do so for many reasons, and her depression may be over determined. She may have depression because she has a genetic depression inherited from a parent who also suffered from depression. If she reports that she felt more depressed during childbirth or shortly before her cycle, there are probably hormonal factors as well. If she is elderly, she may have suffered losses which are contributing to her depression. Patients can usually accept that the reasons for their depression lie outside of themselves. It is harder for them to accept that their inability to form meaningful relationships also contributes to their depression.
What is the defensive function of narcissistic personality disorder? How does it protect the individual who holds onto it so tightly? Narcissistic personality disorder is often a defense against shallow self-esteem that is hidden behind bluster and showmanship. It is important not to try and help someone suffering from narcissistic personality disorder by taking it away from them. If you do that, all they will be left with is their damaged self-esteem. When they see how little they truly feel about themselves they may become despondent, even suicidal. You never remove a person’s defenses before you have something else to offer them.
What is the cause of narcissistic personality disorder? As with all mental health disorders, the causes are many and none are definitive. One theory is that children who are raised by narcissists have shallow self-esteem because they understood that to their caregiver, they were just an object, not a person. They did not have inherent value. To protect themselves from thinking about this, they develop a self-centered personality. However, this psychological solution, like all defensive solutions, is inadequate and maladaptive. The individual goes through life without thinking of other people and does not form any meaningful, long-lasting relationships. Consequently, the narcissist who seems to be so self-involved is intensely lonely.
It takes years of therapy for a narcissist to realize how miserable they make themselves by being self-absorbed. It is counterintuitive to a narcissist, and to many of us, that to be happy one should stop focusing on themselves. It is likewise counterintuitive why the United States, the richest and most self-absorbed country in the world, is consistently not rated the happiest. Other countries that have far less than we do materially, such as Israel, consistently rate higher.
Being a narcissist cuts you off from other people. They only exist to meet your needs.
The therapist must recognize how the NPD patient relates to him and show him slowly and tactfully how it contributes to the patient’s unhappiness. If the NPD patient feels threatened by the therapist’s insights, they may leave therapy prematurely.
Jonathan Bellin is in private teletherapy practice and is accepting new patients. He treats adolescents and adults with the full range of mental health challenges. He received his MSW from Yeshiva University in 1993. He can be reached at [email protected].
