Narcissism

general information

The term “narcissism” was introduced by S. Freud in 1914. The disorder is named after the hero of the ancient Greek legend, Narcissus, a handsome young man who was unable to show positive emotions towards other people. According to legend, Narcissus was cursed by a nymph: he fell in love with his own reflection in the water of the lake and died because he could not tear himself away from its contemplation.

Narcissistic personality disorder affects approximately 1% of the world's population. Men aged 20-30 years are more predisposed to it.

Symptoms and signs

Narcissistic Personality Disorder
To be definitively diagnosed as having narcissistic personality disorder rather than as a character trait, a subject must exhibit at least five of the nine characteristic traits.

1. A keenly developed sense of self-importance. Such a person exaggerates his achievements and skills and expects to be recognized as the best in his chosen field, without real achievements and actions;
2. Constant fantasies about one’s own success, strength, brilliance, beauty, the ideal object of love;
3. Belief in one’s own uniqueness, belonging to the society of only the best people: the richest, highest-ranking, famous;
4. Constant need for admiration;
5. The belief that everyone owes him, that is, unreasonably high expectations that they will provide special honors and fulfill his desires;
6. Exploitative behavior in life, using others to realize one’s plans;
7. Complete lack of empathy. Reluctance to acknowledge other people's feelings and inability to identify with their needs;
8. Envy of more successful people or the belief that others are jealous of him or her;
9. Displaying arrogant behavior or individualistic views

Causes

Narcissistic personality disorder develops as a result of the use of inappropriate parenting methods. Psychological disorders can be provoked by both a cold, indifferent attitude towards a child and excessive guardianship. Children at risk include those who:

• grow up in single-parent or foster families;
• were born at a mature age of their parents;
• are the only ones in the family.

The mechanism for the development of clinical narcissism as a result of a lack of love is as follows. The child does not receive proper attention from his parents and constantly experiences a feeling of dissatisfaction, his own inadequacy and fear of the world. As a result, a defensive psychological reaction is triggered - a person begins to convince himself that he is unique and perfect. At the same time, he strives with all his might to win the admiration of others. The narcissist creates a grandiose image of his own “I” in order to convince himself of self-sufficiency and the absence of the need to establish warm relationships with other people.

Excessive attention to a child can also provoke narcissism. Unconditional admiration from parents, constant praise, lack of objective assessment of actions, permissiveness and indulgence in whims lead to the fact that the child develops inflated self-esteem and a disdainful attitude towards others.

In addition, narcissistic disorder may arise due to certain anatomical features. Instrumental studies show that in such people the structure of the area of ​​the brain responsible for empathy (compassion) is disrupted: the cortex is thickened, nerve cells are modified and the amount of gray matter is reduced.

In some cases, narcissism is one of the manifestations of mental illness, for example, schizophrenia.

Symptoms

The main symptoms of narcissistic personality disorder are:

• inflated opinion of oneself;
• feeling of superiority over others;
• inability to empathize.

As a rule, pathological signs begin to appear in adolescence.

Narcissists' inflated self-esteem is based on confidence in their own uniqueness and exceptional talent. A person is absorbed in the pursuit of ideal and perfection in everything: in his career, in appearance, in everyday life, in relationships with other people. At the same time, his value system is very infantile and superficial. He tends to idealize everything that is significant to him and devalue the rest.

The narcissist is convinced that he is better (smarter, prettier, more gifted) than other people. Along with this, he strives to evoke admiration and recognition from others, believing that he deserves their good attitude and submission. He tries to control opinions about himself, lives with the idea that everyone envies him, and categorically does not accept criticism.

A person with narcissistic disorder does not know how to sympathize and empathize. He despises other people, often behaves arrogantly and prudently uses others to achieve his goals. As a rule, the narcissist communicates only with those people whom he considers “chosen”, that is, worthy of himself.

Narcissistic individuals are ambitious and capable of fruitful activities. They achieve success, but are not satisfied due to deep psychological contradictions.

Narcissistic personality disorder

Freud believed that in patients with narcissistic depression, the loading of the object is turned inward to their ego, and not to the personality of the analyst. Usually there is melancholia, and with it there is an object on a narcissistic basis.

If you look at what narcissism is, it is a character trait of exceptional narcissism. In psychiatry and psychology, narcissism is considered a serious personality dysfunction, or its usual formulation is a personality disorder.

People who suffer from narcissistic depression experience reflection, where they are most often aware of their own guilt, shame or envy.

Reflection is when the subject concentrates attention on himself or on the products of his own activity, or enters a phase of rethinking them.

Heinz Kohut (American psychoanalyst who developed an aspect of the Freudian concept of narcissism) - believes that the integrity of the individual as an active source of action, where attraction and defense play only a secondary role, being only products of decay under the pressure of regression, and not the main components of the psychology of conflict.

Also, K. Horney used his approach associated with narcissistic character pathology, where there are differences in situational neuroses, which differ in the duration of therapy and the ease of achieving a therapeutic effect. They manifest themselves something like this: “I must do everything perfectly,” compromise is not possible here, either everything is bad or good. Narcissistic pathology is also associated with introjective depression, where the main reasons are dissatisfaction with oneself.

There are many authors who deny narcissistic depression, believing that anger and vindictive feelings are not signs of depression. Narcissistic patients cannot experience separation or loss, as happens, for example, with atypical depression, but only experience the loss of narcissistic supply to some object.

Some authors, such as D. Svarkich, highlight some specific features of narcissistic depression, meaning a pessimistic mood, during the period of narcissistic “failures”, where the narcissistic personality cannot maintain a sense of grandiosity. Such patients do not experience feelings of worthlessness, sadness, despondency, guilt, but the main one is a feeling of emptiness.

It’s difficult even for a novice narcissist to cheat on his wife: the shame is so strong that it causes erection problems

Diagnostics

Narcissistic personality disorder is identified through patient observation and structured interviewing. According to the US Diagnostic and Statistical Manual of Mental Disorders (DSM), this disorder can be diagnosed if five or more of the following symptoms are observed:

• inflated self-esteem;
• preoccupation with fantasies of success;
• confidence in one’s own exclusivity and endowment with special rights;
• the need for the enthusiastic attitude of others;
• thoughts of universal envy;
• lack of empathy;
• using people for one's own purposes;
• arrogance, arrogant attitude towards others.

As a rule, patients deny the presence of a mental disorder and react painfully to the diagnosis.

Clinical narcissism is differentiated from other personality disorders. The main ones:

1. Hysterical. Common features are an increased need for the attention of others. Differences - the hysterical person needs an audience for his own self-expression, but he knows how to empathize.
2. Borderline. Common features are non-acceptance of criticism, striving for ideal. Differences - borderline individuals are not able to act purposefully for a long time, they have unmotivated outbursts of anger.
3. Antisocial. Common features are a lack of empathy and difficulty in establishing interpersonal contacts. Differences: Sociopaths are prone to addiction and breaking the law.

Treatment

How to treat narcissistic personality disorder? In the vast majority of cases, psychotherapy is used as a means of assistance. Medicines are used extremely rarely.

The main tasks of a psychotherapist:

• correction of the patient's self-esteem;
• developing the ability to empathize.

Since the patient’s relatives or friends most often seek medical help, and the patient himself takes a defensive position and refuses to acknowledge the problem, the doctor is required to establish a trusting relationship with him. To do this, at the first stage it is advisable to show respect for the narcissist and not challenge his exclusivity. Otherwise, he will subconsciously reinforce the grandiosity of his self-esteem.

Next, the therapist should awaken in the narcissistic personality awareness and realism regarding his own worth and his behavior. It is important to teach the patient to express his needs. He must understand: there is nothing shameful in needing other people, as well as in sympathizing with and helping them. As a rule, this requires remembering and overcoming childhood psychological trauma.

Psychotherapeutic treatment of the disorder

There are several treatment methods, there is no point in describing them because none of them will work without a psychotherapist.

Persons with Narcissistic Personality Disorder are focused on the future, the past is irrelevant for them and addressing it is considered inappropriate, since it “distracts from achievements, goals, etc.” Another feature of “not loving” the past is boredom. For people with NPD, the past is always perceived as “treading water”, “water in a mortar”, as something that makes no sense to understand it, since nothing can be corrected.

This peculiarity of perception of the past sometimes greatly complicates the therapy of both narcissism itself and the reasons that a person with NPD may address.

If the treatment of narcissistic personality disorder is psychoanalytic in orientation, then this feature greatly affects the process, since various mistakes were made in the past, the memories of which are extremely unpleasant.

The attitude towards the past is critical and formal, since everything that has already happened, in their opinion, has lost its relevance and will not be repeated.

In addition, persons with NPD have by now “already become much more advanced” (a consequence of Grandiosity). The most convenient way to get to the past is through positive achievements in the narcissist’s life. Memories of them “strokes” Grandiosity, forming the principle of reality (and not conceit).