Narcissistic Personality Disorder: Rethinking What We Know

by suzinne barrett | October 21, 2012 10:43 PM EDT

Know Narcissistic Personality Disorder up close and personal my mother being a textbook case. She was a horrible mother, and in her mind she was perfect and I needed fixing. Her personality had all your standard traits: grandiosity, envious, arrogant. When you get down to it she was downright delusional. And I do believe there is a genetic component as remarked by Beth. My mother's father was exactly the same way. Actually, my mother was probably a combination Narcissistic Personality with Borderline because intense anger was her defining feature and also is the defining feature of BPD (which I'm unlucky to suffer with myself). So yes, from personal experience this is passed on genetically.

by Giancarlo Dimaggio | October 01, 2012 1:13 AM EDT

Dear Beth,
thank for your very kind words. Congratulations for having survived to such a marriage ;)
As regard genetic, there is no consistent evidence for a heritable component in NPD, some studies say there is some basis, others say that is doubtful. To the best of my knowledge no genetic marker for narcissism have been identified. Things may become even more complex in the future, because the DSM 5 prototype includes the covert (hypersensitive) narcissism, which may feature a different temperament than the overt (grandiose) type, thus yeilding correlations with a different pattern of underlying traits. That said, my opinion is that parenting and culture make a difference, and narcissism is likely either a direct mirror of parental and cultural expectations, or a reaction to poor parenting, with the caregivers unable to provide empathy, attention, support, example of appropriate (pro)social behavior and respect for the child needs.

by Beth Clements | September 30, 2012 11:54 PM EDT

I wonder if there is evidence to support a genetic component in the disorder. The debate of nature vs. nurture could be made, but when you see this in members of a family who weren't raised by the same parents, it does make you wonder. Married to a classic NPD for 3 years and can tell you your discussion is one of the best descriptions of the complexities of the disorder I've ever read. Thank you for bringing NPD out of the closet and into the discussion!

by Giancarlo Dimaggio | September 05, 2012 2:02 AM EDT

Dear Shirin,
1) NPD patients do not avoid relationships, and they do form attachment bonds. It is simply that the attachment pattern they endorse is one of denying attachment! They derogate feelings of closeness and tenderness and often are spiteful toward their partners, but they depend on the (stable) presence of the other. That said, the admiring/admired pattern you describe is likely to exist but... don't trust what you see. You should spend time in the house of this couple and see what happens when the camera is off. Moreover, the admiring/admired pattern usually doesn't last for long. The admiring person starts asking for recognition, and to be cared for, which usually ignites poisonous interpersonal cycles.
2) The super-adapted NPD do exists! Simpy you don't seem them in your consultation room! Also, though they may be labelled as narcissists, it is quite likely they also display antisocial or paranoid features. In any case, they don't seek for help, unless for related problems (e.g. drug-dependence or severe mood disorders). Then, the large majority of persons with NPD lead lives below their capacities, because NPD related features, as inability to bear frustration of sustaing cooperative bonds make their work functioning poor.

by Giancarlo Dimaggio | September 05, 2012 1:54 AM EDT

NPD may have quite different characteristics than Asperger. For one, guilt is far from being absent in persons with NPD, unless they have comorbid antisocial traits. These persons conceal deep guilt feelings, which often makes impossible leave a happy life because they fear if they are happy or succeed others will suffer because of this (survivor guilt). As a result they react with anger when blamed by others, mostly because of avoiding to fall into unbearable pain. Even most pronounced may be the presence of shame - I don't know if such a feeling is present in Asperger, but I guess that as in any form of autism the emotional experience is constricted -.
Then NPD persons may largely differ from one another; while some may resemble to the Asperger profile (again, maybe the ones with antisocial features), others are better functioning. This can be easily seen during succesfull psychotherapies: after having realized others have less power in hampering their goals, and after having them made less reliant on the judgement of others and less sensitive to slights and criticism, they are more cooperative and sometimes display excellent theory of mind skills (which Asperger does not possess as far as I understand the disorder). During therapy many patients of mine and the colleagues I supervise become excellent parent, with fully-fledged abilities to understand their children, play with them and take care of them.
Then the patients with forms of NPD more resembling to the fragile/covert type, fall closer to Avoidant Personality Disorder than Asperger. They constantly seek for admiration but feel criticized and as a result avoid contact, but not because they are not interested, just because it hurts too much.
In sum, I acknoweldge that some with NPD may resemble the Asperger profile and in that case it may well be that two different diagnostic lables are used for describing the same personality: those persons are mostly characterized by severe difficulties in understanding the mind of the others and attune with them, even after therapists' struggles to make them feel validated and understood.
The majority of NPD patients instead display quite a different profile, with a wide array of capacities for relationship and social contact still intact.