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Fair warning: this is going to be long!

Narcissism is a word we hear a lot in the media at the moment. It’s a word thrown around that seems to describe any behaviour that seems self indulgent or delusional. The layperson perception of a narcissist would seem to be someone who is self-centred, loud, attention seeking and grandiose.

That in part is true, but true narcissism, or diagnosable Narcissistic Personality Disorder (NPD) is much bigger and incredibly damaging and dangerous. Whilst the prevalence of NPD is low (thought to be around 1%), it seems as though maladaptive narcissistic traits are common. I will look at traits another time…!!

Otto Rank first proposed narcissism as a concept in the late 1800’s followed by Freud’s essay in 1914 called ‘On Narcissism’. In which he describes patients that were unaffected by transference (a phenomena between client and therapist which is informed by subjectivity and need, i.e. putting a therapist in the role of ideal mother if you’ve had a bad experience with your own mother). He put them in the same category as schizophrenic patients, but also said they were the type of people that would be fun to be around and would make great leaders (!).

Freud thought Narcissism was a natural part of development, and believed that primary narcissism existed to sustain and infants survival. If you think about that, it kind of makes sense. An infant is entirely focused on its own needs. They do not care if Mum or Dad need sleep, they need food!

He thought that pathological narcissism arose when someone was confronted with a trauma, and that trauma would fling him or her back into a primary narcissistic state, but obviously, as the person is no longer an infant, it is an unnecessary defence for survival. He called this secondary narcissism.

Freud acknowledged that his essay raised more questions than it answered, and he sadly never really got round to answering them. Luckily two eminent therapists did. Kohut and Kernberg.

Kohut is called a ‘self- theorist’ a kind of evolution of Freud’s school of thinking, but moving away quite from Freud’s psychoanalytical stance; and Kernberg is an conflict theorist, and part of the school of object relations.

Kohut believed that we all have a healthy narcissism. That healthy narcissism gets us up in the morning and get presentable, empowers us to strive for promotion, drives ambition, and essentially generates self-esteem and self-belief.

Kernberg disagrees with this, and believes that narcissism only exists in a pathological form.

For what it’s worth, I’m with Kohut on this point!

Kohut agreed with Freud’s ‘primary narcissism’, but disagreed with secondary narcissism, or more specifically how it came about.

Kohut believed that narcissism develops in an individual as a small child if they are not presented with a nurturing, loving and supportive carer. He says that when a child is not given a strong sense of self through acknowledgment of feelings, experiences and an acceptance of his or her voice, he develops narcissism as a way to regulate their self esteem and identity. He believes that a child who is neglected or abused is more likely to become a narcissist because they are not supported into their individuality.

Overindulgence, spoiling, helicopter parenting can also suppress the development into individuality, and thus those people can also become narcissists too.

He describes these individuals as ‘mirror hungry’. That is to say that they are constantly looking for external validation of themselves to reinforce the created narcissistic identity, and suppress any feelings that question that identity.

Therefore, Kohut’s position is that others only exist as an extension of the narcissist, and serve only to reinforce the grandiosity and glorification of self.

Kernberg envisages narcissism as a defence mechanism against a crippled, fragile and highly sensitive ego. He stands in a similar position to Kohut as to why it develops, and later research has supported these theories. (Just google ‘why does narcissism develop’ for the research).

So from Kohut and Kernberg we are left with two different types of narcissism, grandiose or overt, and vulnerable or covert.

In its introduction to the DSM 3 in 1980, the criteria whilst largely based on Kernberg’s theory was deemed to be one dimensional and only addressing Overt Narcissism. The DSM 4 included a few more criteria allowing for both types following research that evidenced two presentations as thought, but it was still heavily weighted towards overt. In DSM 5 the criteria were further expanded; however, despite plenty of recommendations and input from practitioners, it is still heavily criticised as not giving enough of a picture of narcissism.

It is often claimed that it would be impossibly to diagnose someone with NPD on the basis of the DSM 5 criteria.

My research has led me to believe NPD is a condition that exists as a paint palette with each individual presenting with maladaptive narcissistic traits in a strength or weighting unique to them.

Essentially narcissism is borne out of abuse. It seems to be that it’s more emotional abuse, whether neglect or overindulgence, but essentially a lack of individualisation where a person can accept that they can be flawed and still a good person.

Narcissists will do everything they can to protect the image of self. They will project an image of perfection, and should anyone contradict that they will become incredibly abusive through manipulation, smear campaigning, gaslighting, and triangulation, to name just a few. Narcissistic rage is something Kohut talked about, and is triggered when someone does something to expose the narcissist, or even merely contradict them. A more overt narcissist might create a row there and then, but the more covert might crumple, positioning themselves in victim role and the exposer into persecutor (think about the drama triangle I wrote about).

Narcissists are unlikely ever to be cured, largely because they rarely enter treatment for themselves, because after all, it’s not them, it’s you….

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