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Narcissism: The Basics This edition’s featured theme is divided into two articles. In this article, we explore the concept of narcissism and how it manifests in individuals. You will also be introduced to Narcissistic personality disorder (NPD), including its epidemiology, symptoms and diagnostic criteria. Introduction During the week of pre-wedding festivities and at the wedding itself, Clifford – the groom – was the life and soul of the party. He had agreed that the wedding could be held in the native country of his fiancé, Carlotta. His few family members and friends flew in for the week of gatherings. With a new ensemble each night, Clifford looked magnificent for all the events, and particularly so at the wedding itself, where he was resplendent in a kilt. He flashed his beautiful smile and gave eloquent speeches, declaring his love for Carlotta with expressive words and gestures (although he was publicly critical of Carlotta’s sister: without reason, Carlotta thought). Carlotta’s nephew exclaimed that he wanted to be “just like Clifford” when he grew up. Both sets of parents looked on approvingly, happy that their children could look forward to a wonderful new life together. But things seemed to change when Carlotta and Clifford returned, after their expensive honeymoon, to Australia. Clifford quickly seemed to lose awareness of his new wife and her feelings, doing things like bringing business associates home to dinner with no notice and overriding her wishes on nearly all household decisions, even though Carlotta brought in as much money as he did. Clifford’s style of lovemaking seemed to be only for the purposes of satisfying himself, and he displayed increasingly sour moods, to the point that he would not even acknowledge the presence of Carlotta’s friends or her family members who came to visit. As Clifford insisted on “nothing but the best”, the couple was soon beset by huge debts, including the mortgage for their beautiful house in an exclusive suburb. As Clifford sank deeper into his ugly moods, began a series of affairs, and then withdrew completely, Carlotta wondered what happened to all the romantic promises he had made. If Clifford’s behaviour seems similar to that of someone you know, you are probably already familiar with the personality disorder of narcissism. Definition and a few facts Narcissistic personality disorder (NPD) is a disorder in which individuals seem to have an inflated sense of their own importance and an unrealistically deep need for admiration. A person with NPD is majorly preoccupied with issues of power, personal adequacy, prestige, and vanity. He or she lacks empathy and exudes a sense of superiority, but beneath the mask of super-confidence rests an extremely fragile self-esteem. Individuals with NPD are insensitive to others’ feelings, but crumple at the slightest hint of criticism to themselves. Heinz Kohut formulated the construct of narcissism in 1968; it was called “megalomania” before then. The condition is similar to egocentrism (Mayo Clinic, 2011; Wikipedia, 2012). Epidemiology The lifetime prevalence of NPD is estimated at 6.2 percent in the general population, 9.4 percent among people age 20 to 29 (Miller & Campbell, 2010), and up to 16 percent in clinical populations. Fifty to 75 percent of those with the NPD diagnosis are men (Groopman and Cooper, 2006). Studies conducted in 2009 (Twenge and Campbell) suggested that the incidence of NPD has more than doubled in the US in the last 10 years. Symptoms/ Diagnostic criteria The DSM – IV (replaced in 2013 with the DSM – V) talks about NPD as “a pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five or more of the following: - Has a grandiose sense of self-importance, exaggerating achievements and skills and expecting to be recognized as superior without commensurate achievements
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- Believes that he or she is “special” and unique and can only be understood by, or should associate with, other high-status people (or institutions)
- Requires excessive admiration
- Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
- Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
- Lacks empathy; is unwilling to recognize or identify with the feelings and needs of others
- Is often envious of others or believes that others are envious of him or her
- Shows arrogant, haughty behaviours or attitudes.” (American Psychiatric Association, 2000, p 294).
Copyright © 2012 Mental Health Academy This article is an extract of Mental Health Academy’s “Narcissism: The Basics” course. The aim of this course is to acquaint you with the basics of narcissism as it is understood by clinicians and researchers. Click here for more information about this course. References: American Psychiatric Association. (2000). Quick reference to the diagnostic criteria from DSM – IV – TR. Washington, D.C.: American Psychiatric Association. Groopman, L. C., and Cooper, A. M. (2006). Narcissistic personality disorder. Armenian Medical Network. Retrieved on 11 September, 2012, from: https://www.health.am/psy/narcissistic-personality-disorder/ Mayo Clinic. (2012). Narcissistic personality disorder. Mayo Clinic. Retrieved on 11 September, 2012, from: https://www.mayoclinic.com/health/narcissistic-personality-disorder/DS00652 Miller, J. D. & Campbell, K. (2010). The case for using research on trait narcissism as a building block for understanding Narcissistic Personality Disorder. Personality Disorders: Theory, Research and Treatment. 1 (3), 180 – 191. Join our community:
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Helping Clients Deal with Narcissists This follow up article focuses on how practitioners can assist clients in dealing with narcissists. You will be introduced to some of the “positive traits” that make narcissists attractive at first sight. You will also learn the criteria for Self-Defeating Personality Disorder (SDPD) and get a range of “survival tips” to help clients deal with narcissists in their life. Introduction In the short term, and when everything is going their way, narcissists can be charming, charismatic, compelling, and entertaining. It was probably during this early period of acquaintance that your client succumbed to their persuasions. By the time a person calls a mental health professional to deal with a relationship damaged by narcissism, however, the ugly side of the disorder is fully manifested. The client sitting in your office with tears streaming down her face has probably been emotionally abused, possibly severely, by the relationship that she now wonders how to cope with. If your client’s description of the intolerable behaviour seems like NPD, you should, of course, go over the DSM – IV diagnostic criteria (see previous article) to see if they “fit” what she is experiencing. But we also include here behaviours described in non-clinical, everyday language that the narcissist may be displaying: the behaviours which sucked your client into his exploitative vortex in the first place. Your client will then realise just how compelling a narcissist can be – and what, therefore, they must deal with. The seductiveness of the skilled narcissist If you have you ever met someone who seemed amazing at first, but later on showed a very hard, uncaring side, the person might be narcissistic. Back, Schmukle, and Egloff (2010) conducted studies in which people judged each other on the basis of brief self-introductions. They found that narcissists were significantly more popular at first sight (“zero acquaintance”, p132) than non-narcissists. Moreover, it was one of the most maladaptive dimension of narcissism (that of “exploitativeness/ entitlement”) which proved to be most attractive at first sight. Psychotherapist Lopez de Victoria (2011) identifies – in somewhat scathing tones – some of the less well-known characteristics of these “impressive little gods”. Throughout this discussion, we refer to the client as “she” to differentiate her from the narcissist, whom we refer to as “he”. Charming: Charm inspires a delightful attraction to someone or something, evoking a sense of being fascinated or drawn in. The charmer is not necessarily drop-dead gorgeous (although many narcissists are quite attractive), but he will have the ability to offer her a sense of instant, deep mirroring: that reflecting back to her of what feels like her “true” self. It creates a sense of deep connection and feeling instantly “safe”. It’s as if the narcissist has discovered her secret playlist of favourite songs, and is playing them all for her, one after the other. More savvy: An astute person is someone who figures out the most unique and impressive angle of a situation – quickly. It will be an angle that few have thought of. Skilled narcissists are able to outsmart most people, and your client may sense that they are always four steps ahead of her. This means that if the relationship sours with such a narcissist, she must be very careful. The narcissist will do everything in his considerable power to humiliate and destroy her, most of it thought through before he even flew at her in narcissistic rage. Great storyteller: Naturally, being the life and soul of the party requires some storytelling skills. A skilled narcissist is also a skilled weaver, integrating threads of circumstances, statistics, events, and quotes with seeming effortlessness. Those who have witnessed their impressive performances often acknowledge learning a lot, although they also say that the narcissist is not above rewriting history in the recounting. Often their claims are exaggerated, designed to enhance their status and position. Believable: The NPD-in-action is a paragon of credibility. They work hard at coming up with information that is believable; it helps usher your client into their “lair”. One strategy they use is to appear magnanimous: as if they are noble, giving, and forgiving. The advice is not to get sucked in; the ultra-credibility is just a set-up to hook her in and/or destroy her. The stereotype here is of the used-car salesperson, who will tell someone anything about the car of interest in so that he can make a sale. Of course, not all used-car salespeople are dishonest, and of those who are, not all are narcissists, but you get the idea. In the telling of the tale, the narcissist will be very smooth. Able to cover tracks: Dating two women and able to convince each that his ongoing disappearance from relationship is just “an emergency business trip” or “just a trip back to my home town to check on my sick mother” is not beyond the scope of an advanced narcissist. Expect accomplishments to be exaggerated, and false online identifications are not beyond the pale. Even if it turns out to be true that the narcissist does indeed work for the prestigious firm, the claimed senior position may not be true. Innovations or other achievements may belong to others in the company, not the narcissist. In the interpersonal arena, narcissists cover their tracks by making the other person in the relationship look like the “bad” one, whether the context in which they do this is the therapy room or the police station. Among the greatest actors in the world: Thespian skills are not a nice-to-do for serious narcissists; they are life-saving, as the various roles, masks, and disguises that the person takes up help them to keep up the façade of power, brilliance, charm, and success. Yes, the skills are to help the wounded child underneath compensate and survive. Yes, they are used to intimidate. And, yes, it is easy for your client to believe that what she is seeing is the “real deal”; this is not only because they often are so skilled, but also because narcissists themselves believe that they are the self-representation, the persona that they are taking up, be that bikie gang member, lovable good guy, or sexy siren. Some narcissists have been known to acknowledge that they don’t know who they are (Lopez de Victoria, 2011). The anchor in your client After your client has stopped weeping over the terrible maltreatment by the narcissist and is ready to engage the serious work of changing the relational dynamic, you may wish to bring forward the question of what the “anchor” is in the client which allows the abuse. Clinicians and theorists have long observed that narcissists often end up in relationship with those who have Self-Defeating Personality Disorder (SDPD) (Benjamin, 1996). Included in the DSM III–R, the diagnosis was dropped in the DSM – IV. The controversy surrounding it related to the possibility that it could stigmatise women. The arguments are valid that (1) the diagnosis represents males’ stereotyped view of women and (2) that women suffer from socially reinforced pressure toward self-sacrifice and submission without the avenues of escape available to men (Kass, 1987). Yet it is unfortunate not to have the syndrome included in the DSM because it shows the precise complementarity with NPD. Self-Defeating Personality Disorder: The criteria The diagnostic criteria for SDPD are as follows. - A pervasive pattern of self-defeating behavior, beginning by early adulthood and present in a variety of contexts. The individual may often avoid or undermine pleasurable experiences, be drawn to situations or relationships in which he or she will suffer, and prevent others from helping him or her, as indicated by at least five of the following:
- Chooses persons and situations that lead to his or her disappointment, failure or mistreatment even when better options are clearly available to him or her
- Rejects or renders ineffective the attempts of others to help him or her
- Following positive personal events (e.g., new achievement), responds with depression, guilt, or a behavior that brings about pain (e.g., an accident)
- Incites angry or rejecting responses from others and then feel s hurt, defeated or humiliated (e.g., makes fun of spouse in public, provoking an angry retort, then feels devastated)
- Turns down opportunities for pleasure, or is reluctant to acknowledge enjoying himself or herself (despite having adequate social skills and the capacity for pleasure)
- Fails to accomplish tasks crucial to his or her personal objectives despite demonstrated ability to do so (e .g. helps fellow students write papers, but is unable to write his or her own)
- Is uninterested in or rejects people who consistently treat him or her well (e.g. is unattracted to caring sexual partners)
- Engages in excessive self-sacrifice that is unsolicited by the intended recipients of the sacrifice
- The behaviors in A do not occur only in response to, or in anticipation of, being physically, sexually or psychologically abused.
- The behaviors in A do not occur only when the individual is depressed. (Kass, 1987)
Although SDPD is no longer included in the DSM, it is a construct that is clinically useful. If you have a client wondering what to do about her painful relationship with a narcissist, the first stop on the therapeutic journey is to check how many of the above behaviours she may be engaging. Even if the client is not manifesting five (the minimum for a diagnosis of SDPD), there may be several problematic behaviours in her repertoire. It is your job as therapist to help identify these, and the context in which they occur, in order to devise a treatment plan. Below are some guidelines for your clients and others dealing with narcissists. Coping with narcissism in relationships If you and your client do discover any self-defeating traits in her, she may need additional skills training in order to be a match for the clever but aggressively opportunistic narcissist. Some of the interpersonal skills that your client should seriously consider enhancing – whether in session with you or in separate courses – are those of: assertiveness; negotiating skills; communication skills; conflict management and; coping with difficult people. In session, a worthy therapeutic goal is that of identifying when she is not “stepping up to the plate” to receive her just due, and then working with feelings of guilt, shame, or unworthiness to claim it. A self-defeater in relationship with a narcissist always has the disadvantage of being made to feel “less than”: less deserving, less worthy to receive entitlements, and more “the victim”. The therapeutic work may usefully go back to childhood roots of the problem, and almost certainly will explore how the person does relationship generally: with herself as well as others. In cases of intractable, full-blown narcissism, your client may ultimately decide there is no hope for the relationship and in this case will need to have her capacity for leaving – and being alone – strengthened. Quick tips for survival For the short and medium-term, here are some strategies and action points for your client’s consideration. Get support: Have your client build up her support networks. It is wonderful that she has come to see you; she should be encouraged to come for regular sessions, working to the contexts described above. It is also imperative for her to develop strong social support links with family, friends, group members, colleagues, and others. Their perspectives may be useful to get a “reality check” or early warning signal if she continues to be abused. Find out how bad it is: Narcissists can come in all intensities, from a few tendencies in that direction, to having narcissistic traits or defences, to having the full disorder. Some people may only be acting that way because of trauma. She can work with you to discern just how serious his condition is. He should be going to therapy, too, but may not see anything wrong that merits attendance at a session. This may ultimately be a deal-breaker for your client. Set boundaries: Remind her that narcissists always believe, through the entitlement and grandiosity, that their needs are more important than others’. He may expect her to drop whatever she is doing to be at his beck and call, and be equally imposing upon her space, time, and resources (financial and otherwise). Help your client to make clear boundary statements about what she will and will not do, and what he may and may not do. He needs to know the consequences of pushing the boundaries. Keep the promise made: Establishing the limits is only half the battle. Your client must learn to consistently maintain them. Drawing a line in the sand is to a narcissist a challenge: he wants to see how he can cross it, testing the boundaries. If your client says that she will go without him if he is late, she needs to keep that promise. Keep cool: Calm confrontation with narcissists works better than getting visibly upset because the latter response can see things escalate. Narcissists are good at “pushing buttons” and usually incapable of believing that they have done anything wrong, so your client’s anger will just provide ammunition to the narcissist. Calm is better. Trust feelings: If the narcissist is telling your client something and your client’s insides are churning for no explicable reason, your client needs to learn to take a step back and evaluate the situation, even if what she is being told seems quite reasonable (reference: the point about NPDs being credible, above). Don’t get caught up in the drama: Narcissists love theatre, and turn most things into a drama. That may be the NPD’s choice, but ask your client if she wants to have her whole life embroiled in the narcissist’s various dramatic creations. Remind her that allowing herself to get caught in it is a way of allowing the narcissist to control and manipulate her. Even trying to make progress in therapy (say, couples therapy) can be a way of gaining attention and control. Lower expectations: Without being disparaging, ask your client to recognise that most narcissists are not likely to change. As far as they are concerned, they are fine the way they are. Setting boundaries and following through on consequences may cause the narcissist to change some behaviour, but he will be doing it because it is beneficial to him, not to your client. Appealing to his empathy or higher nature will not generally be successful. The earlier your client can recognise that, the better. Evaluate the relationship: Encourage your client to probe with you into why she got into the relationship, and what need(s) she believes it is fulfilling. Was it a way for her to distract, punish, or ignore herself? What has kept her with someone so self-involved? And what else could she be doing with her time, money, and love? What is all the drama replacing? Remind her that, while relationships do require work, they shouldn’t hurt. For her to feel abused and completely unappreciated is wrong. Do not make his narcissism a pet project: It will be easy for her to have all the session time about him, all the conversations with her friends about him, and all her reading time books and articles about how to deal with narcissism. Get her to recognise the co-dependence in this, and steer clear. She should be focusing on her own self-worth, boundaries, and consistent demands for equal treatment and resources. Know when to walk away: Psychotherapists regard narcissism as a “failure of relationship”. In other words, the NPD failed at relating before he ever knew your client. It is possible to change, but it is hard. Your client should think long and hard about whether the rewards are worth the heartache, and be willing to walk when she realises that she can no longer pay such a high emotional toll. This may be necessary not to punish him but to protect herself. (ehow, 2012; Michelle, 2012) Copyright © 2012 Mental Health Academy This article is an extract of Mental Health Academy’s “Treating narcissism in and around your clients” course. This course is geared for working mental health professionals with clients who either are showing signs and symptoms of NPD themselves or are being victimised by someone else's pathological narcissism. Click here for more information about this course. References: Back, M.D., Schmukle, S.C., & Egloff, B. (2010). Why are narcissists so charming at first sight? Decoding the narcissism-popularity link at zero acquaintance. Journal of Personality and Social Psychology, 98 (1), 132 – 145. Benjamin, L.S. (1996). Interpersonal diagnosis and treatment of personality disorders. New York: The Guilford Press. eHow. (2012). How to treat narcissistic personality disorder. Ehow health topics. Demand Media, Inc. Retrieved on 18 September, 2012, from: https://www.ehow.com/how_2088472_treat-narcissistic-personality-disorder.html Kass, F. (1987). In response: New controversial diagnoses: Self-Defeating and Sadistic Personality Disorders. Jefferson Journal of Psychiatry, 92 – 96. Lopez de Victoria, S. (2011). The incredibly seductive pull of a very skilled narcissist. World of Psychology. Psych Central. Retrieved on 25/9/2012 from: https://psychcentral.com/blog/archives/2011/11/07/the-incredibly-seductive-pull-of-a-very-skilled-narcissist/ Michelle, J. (2012). How to cope with narcissistic personalities. eHow: Relationships and family. Demand Media, Inc. Retrieved on 18 September, 2012, from: https://www.ehow.com/how_5631696_cope-narcissistic-personalities.html Join our community:
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Many students of the Diploma of Counselling attend seminars to complete the practical requirements of their course. Seminars provide an ideal opportunity to network with other students and liaise with qualified counselling professionals in conjunction with completing compulsory coursework. Not sure if you need to attend Seminars? Click here for information on Practical Assessments. Below are the remainder seminars dates and locations for 2012. You can also access this information and seminar pre-requisites via our website: www.aipc.net.au/timetables.php. 2013 seminar dates and locations will be posted soon. BRISBANE DPCD Timetable Communication Skills I - 01/12 Communication Skills II - 03/11 The Counselling Process - 24/11 Counselling Therapies I - 08-09/12 Case Management - 10-11/11 Counselling Applications - 16/12 CDA Timetable Communication Skills I - 01/12 Communication Skills II - 03/11 The Counselling Process - 24/11 Counselling Therapies I - 8-9/12 Legal & Ethical Frameworks - 17/11 Family Therapy - 15/12 Case Management - 10-11/11 GOLD COAST DPCD Timetable Communication Skills I - 17/11 Communication Skills II - 15/12 The Counselling Process - 01/12 Counselling Therapies II - 23-24/11 CDA Timetable The Counselling Process - 01/12 Communication Skills I - 17/11 Communication Skills II - 15/12 Counselling Therapies II - 23-24/11 MELBOURNE DPCD Timetable Communication Skills I - 03/11, 01/12 Communication Skills II - 04/11, 02/12 The Counselling Process - 23/11, 14/12 Counselling Therapies I - 10-11/11, 8-9/12 Counselling Therapies II - 17-18/11, 15-16/12 Case Management - 24-25/11 CDA Timetable The Counselling Process - 23/11, 14/12 Communication Skills I - 03/11, 01/12 Communication Skills II - 04/11, 02/12 Counselling Therapies I - 10-11/11, 8-9/12 Counselling Therapies II - 17-18/11, 15-16/12 Case Management - 24-25/11 NORTHERN TERRITORY DPCD Timetable Communication Skills I - 01/12 Communication Skills II - 08/12 The Counselling Process - 10/11 Counselling Therapies I - 17-18/11 Counselling Therapies II - 15-16/12 Case Management - 24-25/11 CDA Timetable The Counselling Process - 10/11 Communication Skills I - 01/12 Communication Skills II - 08/12 Counselling Therapies I - 17-18/11 Counselling Therapies II - 15-16/12 Legal & Ethical Frameworks - 03/11 Case Management - 24-25/11 SOUTH AUSTRALIA DPCD Timetable Communication Skills I - 10/11 Communication Skills II - 11/11 The Counselling Process - 09/12 Counselling Therapies I - 24-25/11 CDA Timetable The Counselling Process - 09/12 Communication Skills I - 10/11 Communication Skills II - 11/11 Counselling Therapies I - 24-25/11 Legal & Ethical Frameworks - 08/12 SUNSHINE COAST DPCD Timetable Communication Skills I - 10/11 Communication Skills II - 11/11 Counselling Applications - 03/11 CDA Timetable Communication Skills I - 10/11 Communication Skills II - 11/11 SYDNEY DPCD Timetable Communication Skills I - 15/11 Communication Skills II - 30/11 The Counselling Process - 03/11, 26/11, 13/12 Counselling Therapies I - 23-24/11 Counselling Therapies II - 14-15/12 Case Management - 06-07/12 Advanced Counselling Techniques - 17/12 Counselling Applications - 18/12 CDA Timetable The Counselling Process - 03/11, 26/11, 13/12 Communication Skills I - 15/11 Communication Skills II - 30/11 Counselling Therapies I - 23-24/11 Counselling Therapies II - 14-15/12 Legal & Ethical Frameworks - 19/11 Family Therapy - 20/11 Case Management - 06-07/12 TASMANIA DPCD Timetable Communication Skills I - 16/12 Communication Skills II - 04/11 The Counselling Process - 25/11 Counselling Therapies I - 17-18/11 Counselling Therapies II - 01-02/12 Case Management - 10-11/11 CDA Timetable Communication Skills I - 16/12 Communication Skills II - 04/11 The Counselling Process - 25/11 Counselling Therapies I - 17-18/11 Counselling Therapies II - 01-02/12 Legal & Ethical Frameworks - 09/12 Case Management - 10-11/11 WESTERN AUSTRALIA DPCD Timetable Communication Skills I - 08/12 Communication Skills II - 09/12 The Counselling Process - 03/11, 01/12 Counselling Therapies I - 24-25/11 Counselling Therapies II - 15-16/12 Case Management - 10-11/11 Counselling Applications - 04/11 CDA Timetable The Counselling Process - 03/11, 01/12 Communication Skills I - 08/12 Communication Skills II - 09/12 Counselling Therapies I - 24-25/11 Counselling Therapies II - 15-16/12 Case Management - 10-11/11 Important Note: Advertising of the dates above does not guarantee availability of places in the seminar. Please check availability with the respective Student Support Centre. Training Courses
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