Excerpts from the Archives of the Narcissism List - Part 54 - Narcissism, Pathological Narcissism, The Narcissistic Personality Disorder (NPD), the Narcissist, and Relationships with Abusive Narcissists and Psychopaths

Excerpts from the Archives of the Narcissism List - Part 54

Narcissism, Pathological Narcissism, The Narcissistic Personality Disorder (NPD), the Narcissist,

and Relationships with Abusive Narcissists and Psychopaths

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1. Interview granted to Mandie Moshenzadegan

Q. When did you first know that you were suffering from narcissism, and what caused the awareness?

A. I remember the day I died. Almost did. We were in a tour of Jerusalem. Our guide was the Deputy Chief Warden. We wore our Sunday best suits - stained dark blue, abrasive jeans shirts tucked in tattered trousers. I could think of nothing but Nomi. She left me two months after my incarceration. She said that my brain did not excite her as it used to. We were sitting on what passed as a grassy knoll in prison and she was marble cold and firm. This is why, during the trip to Jerusalem, I planned to grab the Warden's gun and kill myself.

Death has an asphyxiating, all-pervasive presence and I could hardly breathe. It passed and I knew that I had to find out real quick what was wrong with me - or else.

How I obtained access to psychology books and to Internet from the inside of one of Israel's more notorious jails, is a story unto itself. In this film noire, this search of my dark self, I had very little to go on, no clues and no Della Street by my side. I had to let go - yet I never did and did not know how.

I forced myself to remember, threatened by the immanent presence of the Grim Reaper. I fluctuated between shattering flashbacks and despair. I wrote cathartic short fiction. I published it. I remember holding myself, white knuckles clasping an aluminum sink, about to throw up as I am flooded with images of violence between my parents, images that I repressed to oblivion. I cried a lot, uncontrollably, convulsively, gazing through tearful veils at the monochrome screen.

The exact moment I found a description of the Narcissistic Personality Disorder is etched in my mind. I felt engulfed in word-amber, encapsulated and frozen. It was suddenly very quiet and very still. I met myself. I saw the enemy and it was I.

The article was long winded and full of references to scholars I never heard of before: Kernberg, Kohut, Klein. It was a foreign language that resounded, like a forgotten childhood memory. It was I to the last repellent details, described in uncanny accuracy: grandiose fantasies of brilliance and perfection, sense of entitlement without commensurate achievements, rage, exploitation of others, lack of empathy.

I had to learn more. I knew I had the answer. All I had to do was find the right questions.

That day was miraculous. Many strange and wonderful things happened. I saw people - I SAW them. And I had a glimmer of understanding regarding my self - this disturbed, sad, neglected, insecure and ludicrous things that passed for me.

It was the first important realization - there were two of us. I was not alone inside my body.

One was an extrovert, facile, gregarious, attention-consuming, adulation-dependent, charming, ruthless and manic-depressive being. The other was schizoid, shy, dependent, phobic, suspicious, pessimistic, dysphoric and helpless creature - a kid, really.

I began to observe these two alternating. The first (whom I called Ninko Leumas - an anagram of the Hebrew spelling of my name) would invariably appear to interact with people. It didn't feel like putting a mask on or like I had another personality. It was just like I am MORE me. It was a caricature of the TRUE me, of Shmuel.

Shmuel hated people. He felt inferior, physically repulsive and socially incompetent. Ninko also hated people. He held them in contempt. THEY were inferior to his superior qualities and skills. He needed their admiration but he resented this fact and he accepted their offerings condescendingly.

As I pieced my fragmented and immature self together I began to see that Shmuel and Ninko were flip sides of the SAME coin. Ninko seemed to be trying to compensate Shmuel, to protect him, to isolate him from hurt and to exact revenge whenever he failed. At this stage I was not sure who was manipulating who and I did not have the most rudimentary acquaintance with this vastly rich continent I discovered inside me.

Q. What was your childhood like, and do you think narcissism can be stemmed from childhood experiences and relationship with parents?

Whether pathological narcissism are the results of genetic programming (see Jose Lopez, Anthony Bemis and others) or of dysfunctional families and faulty upbringing or of anomic societies and disruptive socialisation processes - is still an unresolved debate. The scarcity of scientific research, the fuzziness of the diagnostic criteria and the differential diagnoses make it unlikely that this will be settled soon one way or the other.

Certain medical conditions can activate the narcissistic defense mechanism. Chronic ailments are likely to lead to the emergence of narcissistic traits or a narcissistic personality style. Traumas (such as brain injuries) have been known to induce states of mind akin to full-blown personality disorders.

Such "narcissism", though, is reversible and tends to be ameliorated or disappear altogether when the underlying medical problem does.

Psychoanalysis teaches that we are all narcissistic at an early stage of our lives. As infants and toddlers we all feel that we are the centre of the Universe, the most important, omnipotent and omniscient beings. At that phase of our development, we perceive our parents as mythical figures, immortal and awesomely powerful but there solely to cater to our needs, to protect and nourish us. Both Self and others are viewed immaturely, as idealisations. This, in the psychodynamic models, is called the phase of "primary" narcissism.

(continued below)

This article appears in my book, "Malignant Self-love: Narcissism Revisited"

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Inevitably, the inexorable conflicts of life lead to disillusionment. If this process is abrupt, inconsistent, unpredictable, capricious, arbitrary and intense, then the injuries sustained by the infant's self-esteem are severe and often irreversible. Moreover, if the empathic crucial support of our caretakers (the Primary Objects, e.g., the parents) is absent, our sense of self-worth and self-esteem in adulthood tends to fluctuate between over-valuation (idealisation) and devaluation of both Self and others. Narcissistic adults are widely thought to be the result of bitter disappointment, of radical disillusionment in the significant others in their infancy. Healthy adults realistically accept their self-limitations and successfully cope with disappointments, setbacks, failures, criticism and disillusionment. Their self-esteem and sense of self-worth are self-regulated and constant and positive, not substantially affected by outside events.

Learn more here:

Narcissism at a Glance

I never was a child. I was a "wunderkind", the answer to my mother's prayers and intellectual frustration. A human computing machine, a walking-talking encyclopaedia, a curiosity, a circus freak. I was observed by developmental psychologists, interviewed by the media, endured the envy of my peers and their pushy mothers. I constantly clashed with figures of authority because I felt entitled to special treatment, immune to prosecution and superior. It was a narcissist's dream. Abundant Narcissistic Supply - rivers of awe, the aura of glamour, incessant attention, open adulation, country-wide fame.

I refused to grow up. In my mind, my tender age was an integral part of the precocious miracle that I became. One looks much less phenomenal and one's exploits and achievements are much less awe-inspiring at the age of 40, I thought. Better stay young forever and thus secure my Narcissistic Supply. Plus, my life is my parents' punishment. Childless and a sad failure, I keep hoping against hope and counterfactually that they care enough to hurt.

So, I wouldn't grow up. I never took out a driver's licence.

I do not have children. I rarely have sex. I never settle down in one place. I reject intimacy. In short: I refrain from adulthood and adult chores. I have no adult skills. I assume no adult responsibilities. I expect indulgence from others. I am petulant and haughtily spoiled. I am capricious, infantile and emotionally labile and immature. In short: I am a 40 years old brat.

When I talk to my girlfriend, I do so in a baby's voice, making baby faces and baby gestures. It is a pathetic and repulsive sight, very much like a beached whale trying to imitate a seaborne trout. I want to be her child, you see, I want to regain my lost childhood. I want to be admired as I was when I was one year old and recited poems in three languages to stunned visiting high school teachers. I want to be four again, when I first read a daily paper to the silent astonishment of the neighbours.

I am not preoccupied with my age, nor am I obsessed with my dwindling, fat flapping body. I am no hypochondriac. But There is a streak of sadness in me, like an undercurrent and a defiance of Time itself. Like Dorian Gray, I want to remain as I was when I became the centre of attention, the focus of adoration, the heart of a twister of media attention. I know I can't. And I know that I have failed not only at arresting Chronos - but on a more mundane, degrading level. I failed as an adult.

Q: As a narcissist, did you go to school? If so, what kind? What did you think of the facilities? The other students? The teachers? And what was your overall experience of the school years?

A: I attended both primary and high school in my hometown in Israel - a community of immigrants hardened by economic duress and constant insecurity. The facilities - sponsored by wealthy American Jews out to immortalize themselves - were more than adequate. I especially loved the library, an oasis of serene knowledge in a sea of boorishness and irrationality. I was a bespectacled, flabby, smelly and inert student but considered myself, haughtily and unjustly, intellectually superior to both my fellow pupils and our youngish and inexperienced teachers. Overall, I felt, school was a drudgery I had to endure before my meteoric rise to unbridled fame commences.

Q: Was any of the subject matter they taught of any interest to you, if so, what and why? What was your most favourite and least favourite subject and why?

A: My most favourite subject was history because I was allowed to teach it and thus to indulge in theatrics and power plays. I detested math because my inaptitude in it deflated my grandiosity and my claim to be a Renaissance Man.

Q: How were you treated by the other students? By the teachers?

A: Largely with pity and disdain, I guess. Though a few - both students and teachers - succumbed to my dubious charms and admired my accomplishments, whether real and imaginary. These acolytes were at the mercy of my capricious and overweening conduct. They formed my fan club, a source of adulation, affirmation and obsequious applause.

Earlier on I was allowed to skip one year and go directly from fourth to sixth grade. For a short while, I became the toast of the town. I then leveraged this fortuitous celebrity by brazenly lying about the extent of my academic achievements. I learned a few crucial lessons: you are what you say you are, people crave to be manipulated, victims prefer fantasies to reality and it is obscenely easy to gain fame.

Q: Did you have a pet during your school years, if so, what happened to it?

A: I never had a pet, though I came close by sharing a turtle with my siblings and a snail with my ex-wife.

Q: Did you happen to make any friends from the student body? If so, do you still keep in contact with them?

A: My life is rigidly compartmentalized. "Friends" belong to time periods, forever locked in mental boxes. The minute I move from one period to the next, relocate, or find a new interest - I lose my "friendships" and "relationships" as that much ballast. I never look back and I actively refuse contact with figures from my former lives.

I did have "buddies" in both primary and high school - mainly collaborators in nasty deeds conceived largely by me and, at the time, deemed hilarious by all of us. But these were shallow and ephemeral liaisons. My prankish creativity did not buy me he other students' love or affiliation. They regarded me as a freak whose very freakishness allowed him to innovate.

Additionally, I attached myself to a series of mentally disordered or challenged students and deliberately played meticulously executed mind games on them intended to gain unmitigated control over their mental functions. One of the victims ended up in an asylum. This propensity did not survive primary school, I am glad to say.

Q: Did you have favourite teachers, if so why were they your favourites?

A: I had two favourite teachers - one in primary school and one in high school. The first was chosen due to a confluence of circumstances. She taught me English in my aforementioned brief days of glory and was, therefore, associated in my mind with the "good old times". I had a crush on her - the urbanite, sexually liberated, glamorous, well-read woman that she was. She was the first person I dared disclose my overwhelming emotional distress to.

The other favourite instructor, in high school, was her antithesis. Fat, a-feminine, brooding, moody - but she worshipped the ground I walked on. I needed this kind of unconditional acceptance. I was going through a rough patch. My grades deteriorated. My budding sexuality was thwarted by my perverted self-image. She gave me hope and restored in me a modicum of self-confidence by surrendering her classes. I taught as she sat at the back of the class, glowing.

Q: Were you involved in any extracurricular activities such as clubs, sports, or theatre?

A: I lectured a lot and made numerous appearances in school plays. I was the town crier and the master of ceremonies of the local municipality. I published poetry and, by the age of 16, had my own column in a regional rag. I worked in the local library and also tutored immigrants, mainly from Russia and Soviet Georgia. I was a very active lad. I even invented an extremely detailed and micromanaged daily schedule to better myself through a self-imposed syllabus of reading and theatre-going.

Q: Did you attend parties or dances during the school years?

A: Not even once.

Q: Did you learn how to play any musical instruments, sing or dance? Is art something you enjoy? If so, why?

A: The only form of art I really enjoy - to the point of addiction - is cinema. I do pretend, of course, to be interested in higher-brow pursuits: painting, sculpture and music. But at heart I am not, it is merely perfunctory. I played the flute when I was young because my mother wanted to. I stopped the minute she lost interest.

Q: What activities did you do for fun?

A: Reading and - far more rarely - watching movies.

Q: Did you seek out or were approached by suitors?

A: In hindsight I now understand that some girls found me attractive - though why, it eludes me. But I was unable - and, at times, resentfully unwilling - to decipher their increasingly desperate signals. I, myself, never courted. I haven't had sex until the age of 25and have first fully masturbated - with ejaculation - only when I was 19. I was - and am still - very retarded sexually, on the verge of being a-sexual.

Q: What role did your parents play in your life during the school years?

A: I perceived my mother as both an evil entity, out to harm me, hating and contemptuous - and the driving force in my life. For a stretch of time, everything I did was geared to impress her and disprove her lowly opinion of me. When it was clear that I do not stand a fighting chance against her searing disappointment and disdain, I gave up completely. I did not proceed to university and have been peripatetic ever since with little to show for my efforts.

My father was tyrannical but also more lovable because he was mostly absent, toiling hard to extract us from the slums. When present, he was so manifestly sad and frustrated, so down-trodden and ineffectually rebellious that my insurrection against his arbitrariness was inevitably interspersed with moments of great pity.

Q: Did you have any siblings? If so, what role did they play in your life then?

A: I am the first born and my siblings are far younger than me. I, thus, emulated my father's despotism in my relationships with them. In later years, as I became economically independent, I endeavored to secure their affection with numerous gifts. In all, I was a fun brother, always full of stories and wild poems - but, more typically, remote, uninterested and ensconced in an imaginary escapist Universe of my own making. My prolonged and recurrent emotional - and, later, physical - absences have deeply injured my siblings who, throughout their childhoods, were my most ardent, persistent and blind admirers.

Q: Did you notice any racism or prejudice amongst the students?

A: I belong to a minority - the Moroccan Jews - much derided in Israel for its alleged backwardness, ignorance, proneness to superstition, paranoia and hot temper. Inevitably, I was judged more by the stereotype than by any biographical fact. This greatly affected my anyhow volatile sense of self-worth, self-esteem and self-confidence. For a short time I was even active in divisive ethnic politics in Israel.

Q: How did you tend to dress while attending school?

A: We wore obligatory school uniforms so personal choice was never an issue. Off-school, though, I fitted my unwieldy body into whatever clothes my parents bought me. To this very day, I dress shabbily and inappropriately - when at home, virtually in tattered rags.

Q. After you were diagnosed, were you able to change your mindframe and attitude at all, or get help for your condition?

A. Narcissism defines the narcissist's waking moments and his nocturnal dreams. It is all-pervasive. Everything the narcissist does is motivated by it. Everything he avoids is its result. Every utterance, decision, his very body language - are all manifestations of narcissism. It is rather like being abducted by an alien and ruthlessly indoctrinated ever since. The alien is the narcissist's False Self - a defence mechanism constructed in order to shield his True Self from hurt and inevitable abandonment.

Cognitive understanding of the disorder does not constitute a transforming INSIGHT. In other words, it has no emotional correlate. The narcissist does not INTERNALIZE what he understands and learns about his disorder. This new gained knowledge does not become a motivating part of the narcissist. It remains an inert and indifferent piece of knowledge, with minor influence on the narcissist's psyche.

Sometimes, when the narcissist first learns about the Narcissistic Personality Disorder (NPD), he really believes he could change (usually, following a period of violent rejection of the "charges" against him). He fervently wants to. This is especially true when his whole world is in shambles. Time in prison, a divorce, a bankruptcy, a death of a major source of narcissistic supply - are all transforming life crises. The narcissist admits to a problem only when abandoned, destitute, and devastated. He feels that he doesn't want any more of this. He wants to change. And there often are signs that he IS changing. And then it fades. He reverts to old form. The "progress" he had made evaporates virtually overnight. Many narcissists report the same process of progression followed by recidivist remission and many therapists refuse to treat narcissists because of the Sisyphean frustration involved.

Q. I have heard that there are different types of narcissists, ranging from slightly narcissistic to borderline to psychopath...Do you agree with categorizing narcissism into different types, and where do you see yourself (how extreme is your condition)?

A. All of us have narcissistic TRAITS. Some of us even develop a narcissistic PERSONALITY, or a narcissistic STYLE. Moreover, narcissism is a SPECTRUM of behaviors - from the healthy to the utterly pathological (a condition known as the Narcissistic Personality Disorder, or NPD).

I am a malignant, incurable, narcissist in the last pre-psychotic phases of my disorder.

Q. If you could define narcissism in your own words, how would you describe this personality disorder?

A. Pathological narcissism is a life-long pattern of traits and behaviours which signify infatuation and obsession with one's self to the exclusion of all others and the egotistic and ruthless pursuit of one's gratification, dominance and ambition.

As distinct from healthy narcissism which we all possess, pathological narcissism is maladaptive, rigid, persisting, and causes significant distress, and functional impairment.

Pathological narcissism was first described in detail by Freud in his essay "On Narcissism" (1915). Other major contributors to the study of narcissism are: Melanie Klein, Karen Horney, Franz Kohut, Otto Kernberg, Theodore Millon, Elsa Roningstam, Gunderson, and Robert Hare.

What is Narcissistic Personality Disorder (NPD)?

The Narcissistic Personality Disorder (NPD) (formerly known as megalomania or, colloquially, as egotism) is a form of pathological narcissism. It is a Cluster B (dramatic, emotional, or erratic) personality disorder. Other Cluster B personality disorders are the Borderline Personality Disorder (BPD), the Antisocial Personality Disorder (APD), and the Histrionic Personality Disorder (HPD). The Narcissistic Personality Disorder (NPD) first appeared as a mental health diagnosis in the DSM III-TR (Diagnostic and Statistical Manual) in 1980.

Diagnostic Criteria

The ICD-10, the International Classification of Diseases, published by the World Health Organisation in Geneva [1992] regards the Narcissistic Personality Disorder (NPD) as "a personality disorder that fits none of the specific rubrics". It relegates it to the category "Other Specific Personality Disorders" together with the eccentric, "haltlose", immature, passive-aggressive, and psychoneurotic personality disorders and types.

The American Psychiatric Association, based in Washington D.C., USA, publishes the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM-IV-TR) [2000] where it provides the diagnostic criteria for the Narcissistic Personality Disorder (301.81, p. 717).

The DSM-IV-TR defines Narcissistic Personality Disorder (NPD) as "an all-pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts", such as family life and work.

The DSM specifies nine diagnostic criteria. Five (or more) of these criteria must be met for a diagnosis of Narcissistic Personality Disorder (NPD) to be rendered.

[In the text below, I have proposed modifications to the language of these criteria to incorporate current knowledge about this disorder. My modifications appear in bold italics.]

[My amendments do not constitute a part of the text of the DSM-IV-TR, nor is the American Psychiatric Association (APA) associated with them in any way.]

[Click here to download a bibliography of the studies and research regarding the Narcissistic Personality Disorder (NPD) on which I based my proposed revisions.]

Proposed Amended Criteria for the Narcissistic Personality Disorder

Feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to the point of lying, demands to be recognised as superior without commensurate achievements);

Is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion;

Firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions);

Requires excessive admiration, adulation, attention and affirmation – or, failing that, wishes to be feared and to be notorious (Narcissistic Supply);

Feels entitled. Demands automatic and full compliance with his or her unreasonable expectations for special and favourable priority treatment;

Is "interpersonally exploitative", i.e., uses others to achieve his or her own ends;

Devoid of empathy. Is unable or unwilling to identify with, acknowledge, or accept the feelings, needs, preferences, priorities, and choices of others;

Constantly envious of others and seeks to hurt or destroy the objects of his or her frustration. Suffers from persecutory (paranoid) delusions as he or she believes that they feel the same about him or her and are likely to act similarly;

Behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient, invincible, immune, "above the law", and omnipresent (magical thinking). Rages when frustrated, contradicted, or confronted by people he or she considers inferior to him or her and unworthy.

Prevalence and Age and Gender Features

According to the DSM IV-TR, between 2% and 16% of the population in clinical settings (between 0.5-1% of the general population) are diagnosed with Narcissistic Personality Disorder (NPD).

Most narcissists (50-75%, according to the DSM-IV-TR) are men. Narcissistic traits are common among adolescents, but few go on to develop the full-fledge disorder.

"The lifetime prevalence rate of NPD is approximately 0.5-1 percent; however, the estimated prevalence in clinical settings is approximately 2-16 percent. Almost 75 percent of individuals diagnosed with NPD are male (APA, DSM IV-TR 2000)."

From the Abstract of Psychotherapeutic Assessment and Treatment of Narcissistic Personality Disorder By Robert C. Schwartz,Ph.D., DAPA and Shannon D. Smith, Ph.D., DAPA (American Psychotherapy Association, Article #3004 Annals July/August 2002)

Narcissistic Personality Disorder (NPD) is exacerbated by the onset of aging and the physical, mental, and occupational restrictions it imposes.

In certain situations, such as under constant public scrutiny and exposure, a transient and reactive form of the Narcissistic Personality Disorder (NPD) has been observed by Robert Milman and labelled "Acquired Situational Narcissism".

There is only scant research regarding the Narcissistic Personality Disorder (NPD), but studies have not demonstrated any ethnic, social, cultural, economic, genetic, or professional predilection to it.

Comorbidity and Differential Diagnoses

Narcissistic Personality Disorder (NPD) is often diagnosed with other mental health disorders ("co-morbidity"), such as mood disorders, eating disorders, and substance-related disorders. Patients with Narcissistic Personality Disorder (NPD) are frequently abusive and prone to impulsive and reckless behaviours ("dual diagnosis").

Narcissistic Personality Disorder (NPD) is commonly diagnosed with other personality disorders, such as the Histrionic, Borderline, Paranoid, and Antisocial Personality Disorders.

The personal style of those suffering from the Narcissistic Personality Disorder (NPD) should be distinguished from the personal styles of patients with other Cluster B Personality Disorders. The narcissist is grandiose, the histrionic coquettish, the antisocial (psychopath) callous, and the borderline needy.

As opposed to patients with the Borderline Personality Disorder, the self-image of the narcissist is stable, he or she are less impulsive and less self-defeating or self-destructive and less concerned with abandonment issues (not as clinging).

Contrary to the histrionic patient, the narcissist is achievements-orientated and proud of his or her possessions and accomplishments. Narcissists also rarely display their emotions as histrionics do and they hold the sensitivities and needs of others in contempt.

According to the DSM-IV-TR, both narcissists and psychopaths are "tough-minded, glib, superficial, exploitative, and unempathic". But narcissists are less impulsive, less aggressive, and less deceitful. Psychopaths rarely seek narcissistic supply. As opposed to psychopaths, few narcissists are criminals.

(continued below)

This article appears in my book, "Malignant Self-love: Narcissism Revisited"

Click HERE to buy the print edition from Amazon (click HERE to buy a copy dedicated by the author)

Click HERE to buy the print edition from Barnes and Noble

Click HERE to buy the print edition from the publisher and receive a BONUS PACK

Click HERE to buy electronic books (e-books) and video lectures (DVDs) about narcissists, psychopaths, and abuse in relationships

Click HERE to buy the ENTIRE SERIES of sixteen electronic books (e-books) about narcissists, psychopaths, and abuse in relationships

Click HERE for SPECIAL OFFER 1 and HERE for SPECIAL OFFER 2

Follow me on Twitter, Facebook (my personal page or the book’s), YouTube

Patients suffering from the range of obsessive-compulsive disorders are committed to perfection and believe that only they are capable of attaining it. But, as opposed to narcissists, they are self-critical and far more aware of their own deficiencies, flaws, and shortcomings.

Clinical Features of the Narcissistic Personality Disorder

The onset of pathological narcissism is in infancy, childhood and early adolescence. It is commonly attributed to childhood abuse and trauma inflicted by parents, authority figures, or even peers. Pathological narcissism is a defense mechanism intended to deflect hurt and trauma from the victim's "True Self" into a "False Self" which is omnipotent, invulnerable, and omniscient. The narcissist uses the False Self to regulate his or her labile sense of self-worth by extracting from his environment narcissistic supply (any form of attention, both positive and negative).

There is a whole range of narcissistic reactions, styles, and personalities – from the mild, reactive and transient to the permanent personality disorder.

Patients with Narcissistic Personality Disorder (NPD) feel injured, humiliated and empty when criticized. They often react with disdain (devaluation), rage, and defiance to any slight, real or imagined. To avoid such situations, some patients with Narcissistic Personality Disorder (NPD) socially withdraw and feign false modesty and humility to mask their underlying grandiosity. Dysthymic and depressive disorders are common reactions to isolation and feelings of shame and inadequacy.

The interpersonal relationships of patients with Narcissistic Personality Disorder (NPD) are typically impaired due to their lack of empathy, disregard for others, exploitativeness, sense of entitlement, and constant need for attention (narcissistic supply).

Though often ambitious and capable, inability to tolerate setbacks, disagreement, and criticism make it difficult for patients with Narcissistic Personality Disorder (NPD) to work in a team or to maintain long-term professional achievements. The narcissist's fantastic grandiosity, frequently coupled with a hypomanic mood, is typically incommensurate with his or her real accomplishments (the "grandiosity gap").

Patients with Narcissistic Personality Disorder (NPD) are either "cerebral" (derive their Narcissistic Supply from their intelligence or academic achievements) or "somatic" (derive their Narcissistic Supply from their physique, exercise, physical or sexual prowess and romantic or physical "conquests").

Patients with Narcissistic Personality Disorder (NPD) are either "classic" (meet five of the nine diagnostic criteria included in the DSM), or they are "compensatory" (their narcissism compensates for deep-set feelings of inferiority and lack of self-worth).

Some narcissists are covert, or inverted narcissists

. As codependents, they derive their narcissistic supply from their relationships with classic narcissists.

Q. On a larger scale, how do you think narcissism effects our society, and do you believe modern-day society has a narcissistic mentality overall?

A. In their book "Personality Disorders in Modern Life", Theodore Millon and Roger Davis state, as a matter of fact, that pathological narcissism was the preserve of "the royal and the wealthy" and that it "seems to have gained prominence only in the late twentieth century". Narcissism, according to them, may be associated with "higher levels of Maslow's hierarchy of needs ... Individuals in less advantaged nations .. are too busy trying (to survive) ... to be arrogant and grandiose".

They - like Lasch before them - attribute pathological narcissism to "a society that stresses individualism and self-gratification at the expense of community, namely the United States." They assert that the disorder is more prevalent among certain professions with "star power" or respect. "In an individualistic culture, the narcissist is 'God's gift to the world'. In a collectivist society, the narcissist is 'God's gift to the collective'".

Millon quotes Warren and Caponi's "The Role of Culture in the Development of Narcissistic Personality Disorders in America, Japan and Denmark":

"Individualistic narcissistic structures of self-regard (in individualistic societies) ... are rather self-contained and independent ... (In collectivist cultures) narcissistic configurations of the we-self ... denote self-esteem derived from strong identification with the reputation and honor of the family, groups, and others in hierarchical relationships."

Having lived in the last 20 years 12 countries in 4 continents - from the impoverished to the affluent, with individualistic and collectivist societies - I know that Millon and Davis are wrong. Theirs is, indeed, the quintessential American point of view which lacks an intimate knowledge of other parts of the world. Millon even wrongly claims that the DSM's international equivalent, the ICD, does not include the narcissistic personality disorder (it does).

Pathological narcissism is a ubiquitous phenomenon because every human being - regardless of the nature of his society and culture - develops healthy narcissism early in life. Healthy narcissism is rendered pathological by abuse - and abuse, alas, is a universal human behavior. By "abuse" we mean any refusal to acknowledge the emerging boundaries of the individual - smothering, doting, and excessive expectations - are as abusive as beating and incest.

There are malignant narcissists among subsistence farmers in Africa, nomads in the Sinai desert, day laborers in east Europe, and intellectuals and socialites in Manhattan. Malignant narcissism is all-pervasive and independent of culture and society.

It is true, though, that the WAY pathological narcissism manifests and is experienced is dependent on the particulars of societies and cultures. In some cultures, it is encouraged, in others suppressed. In some societies it is channeled against minorities - in others it is tainted with paranoia. In collectivist societies, it may be projected onto the collective, in individualistic societies, it is an individual's trait.

Yet, can families, organizations, ethnic groups, churches, and even whole nations be safely described as "narcissistic" or "pathologically self-absorbed"? Wouldn't such generalizations be a trifle racist and more than a trifle wrong? The answer is: it depends.

Human collectives - states, firms, households, institutions, political parties, cliques, bands - acquire a life and a character all their own. The longer the association or affiliation of the members, the more cohesive and conformist the inner dynamics of the group, the more persecutory or numerous its enemies, the more intensive the physical and emotional experiences of the individuals it is comprised of, the stronger the bonds of locale, language, and history - the more rigorous might an assertion of a common pathology be.

Such an all-pervasive and extensive pathology manifests itself in the behavior of each and every member. It is a defining - though often implicit or underlying - mental structure. It has explanatory and predictive powers. It is recurrent and invariable - a pattern of conduct melded with distorted cognition and stunted emotions. And it is often vehemently denied.

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