Identifying, understanding and relating Identifying, understanding and relating to them to them NARCISSISTIC PERSONALITIES NARCISSISTIC PERSONALITIES Claudia Diez, PhD, ABPP Claudia Diez, PhD, ABPP Board Certified Specialist in Clinical Psychology Board Certified Specialist in Clinical Psychology Supervising Psychologist Supervising Psychologist St. Luke’s-Roosevelt Hospital Center St. Luke’s-Roosevelt Hospital Center Assistant Clinical Professor, Columbia University Assistant Clinical Professor, Columbia University [email protected]http://www.drclaudiadiez.com http://www.slrpsych.org
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Identifying, understanding and relating to them NARCISSISTIC PERSONALITIES Claudia Diez, PhD, ABPP Board Certified Specialist in Clinical Psychology Supervising.
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Identifying, understanding and relating to themIdentifying, understanding and relating to them
DSM-IV TR Diagnostic Criteria Pervasive pattern of grandiosity, need for admiration, lack of
empathy; beginning in adulthood, indicated by five (+) of the following:
grandiose sense of self-importance
fantasies of unlimited success, power, beauty, etc.
believes he/she is "special"
requires excessive admiration
has a sense of entitlement
is interpersonally exploitative
lacks empathy
is often envious, or believes that others are envious of him
shows arrogant behaviors or attitudes
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Hack it, or Pack it! Hack it, or Pack it! The Great Santini, “failed score”11
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Narcissism as a Clinical DisorderNarcissism as a Clinical Disorder
Not all narcissists are created equal
Shedler’s Typology (1)
Grandiose/malignant
Fragile
High Functioning/Exhibitionistic
Other distinctive features Emptiness, sense of “being false, fraudulent”
(1) Shedler et al, 2008. Refining the Construct of Narcissistic Personality Disorder: Diagnostic Criteria and Subtypes; (Am J Psychiatry 2008; 165:1473–1481)1212
Faces of Pathological NarcissismFaces of Pathological Narcissism
Abusive Partners Rapists
Celebrities Cult Leaders
Con Artists Stalkers
White Collar Criminals Gang Members
Moderate Narcissism
Overbearing/obnoxious /cruel parents, demanding or callous partners, inconsiderate coworkers, etc….
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Empathy, Shame, EnvyEmpathy, Shame, Envy
Empathy inner capacity of sharing and comprehending the
psychological state of another person
Shame painful social emotion caused by the experience of feeling
inferior or losing value in the estimation of others
Envy painful social emotion caused by the thought of another
person having something that one does not have oneself
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Origins of NarcissismOrigins of Narcissism
No known link to genetics
Biological (neurophysiological paths) imprints in early childhood (1)
Origins ascribed to early attachment and parenting, resulting in specific pattern of affect regulation
(1) Schore, Allan (2009). Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development 1515
Normal Human DevelopmentNormal Human Development
Under normal circumstances, caregiver help child to handle intense or stressful affect
Development of empathy
Tolerance of shame
“Monkey see, monkey do” (mirror neurons; mimicry)
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Parental Attunement
Origins of Pathological NarcissismOrigins of Pathological Narcissism
Unattuned Parents cannot model affect regulation Resulting in diminished capacity for empathy
Child is in some way “Special” to the parent
“Narcissistic children often occupy a pivotal point in the family structure, such as being ….the one that is supposed to fulfill family aspirations….”
Child raised in overtly well-organized home, but with parent(s) present a degree of callousness and subtle aggression
Child may have an inherent quality that arouses admiration or envy such as beauty, special talent, etc. ( I.e: Pageant Queen/Mother)
Kernberg, 1984. Severe personality disorders. New Haven: Yale University Press1717
Paths to Pathological NarcissismPaths to Pathological Narcissism
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Narcissistic CognitionsNarcissistic Cognitions
Entitlement/Grandiosity
Emotional Deprivation
Defectiveness/Shame
Subjugation /Control
Approval Seeking
Insufficient Self-Control
Mistrust/Abuse
Unrelenting Standards
Underlying Assumptions (Schemas)
Young, (1998). Schema-focused therapy for narcissistic patients. In E. Ronningstam (Ed.), Disorders of narcissism: Diagnostic, clinical and empirical implications1919
Extreme (Malignant) NarcissismExtreme (Malignant) NarcissismCharles Manson
Manson's mother was a promiscuous heavy drinker who spent years in prison for robbery. Manson was placed at reform schools and relatives while she was away.
Manson did not know his biological father; his step-father was an alcoholic, abusive offender
His mother’s physical embrace of him when she returned from prison was, he reported, his sole happy childhood memory
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Children at RiskChildren at Risk
Children of Narcissistic Parents
Abused Children
Overindulged, Overpraised, Wealthy Children
Adopted Children (chosen, yet abandoned)
Kernberg, P. (1998). In E. F. Ronningstam (Ed.), Disorders of narcissism. Diagnostic, clinical, and empirical implications. Developmental aspects of normal and pathological narcissism
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Course and PrognosisCourse and Prognosis
Room for improvement in certain cases As a result of significant losses/personal costs, or
As a result of corrective emotional experiences (i.e., relationship, achievement)
In severe cases, symptoms may worsen over time, (i.e., mid life crisis, aging parents)
Narcissists do not typically seek help (as they do not find fault in themselves)
Difficult to treat; may seek help because “mandated” by others
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Is there a Narcissist in my life?Is there a Narcissist in my life?
Does the person act as if life revolves around him/her?
Do I have to compliment him/her to get his attention or approval?
Does he constantly steer the conversation back to himself?
Does she downplay my feelings or interests?
If I disagree, does he become cold, withholding or angry?
Do I feel belittled, manipulated, or feel I can’t please him/her?
Adapted from Judith Orloff’s “Emotional Freedom” (Three Rivers Press, 2011)
If you answered “yes” to three or more questions, it is likely that this person’s narcissism is affecting your life
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How to Relate to a NarcissistHow to Relate to a Narcissist
DO-NOTS Do not retaliate
Do not shame, belittle, “pay back”
Do not expect fairness or reciprocity
Do not isolate from friends, other family
Do not surrender to the narcissist’s attempts to control/disparage
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How to Relate to a NarcissistHow to Relate to a Narcissist
DO(s)Know yourself Identify your motives to stay in the relationship: desire to please? gain
his/her regard? feel protected? bask in their power? Etc. Identify your “hot buttons” and your problematic responses
Know your own worth, independently of his/her valuation
Cultivate reciprocal, satisfying relationships
Be empathic, respectful, fair
Be mindful of his/her sensitivity to shame/humilliation
Practice self-control and patience
Use non-confrontational limit-setting
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How to Relate to a NarcissistHow to Relate to a Narcissist
DO(s)Set boundaries Re-engineer the terms of the interactions
How to Relate to a NarcissistHow to Relate to a Narcissist
DO(s)
Consider the costs (risk/benefit analysis) of staying in the relationship
Assess damages/severity of behaviors
If risk/damage is high, consider an exit plan
Avoid/Minimize contact
Seek external help
Build a support network
Be mindful of characteristic feelings of shame/guilt
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Recommended ReadingsRecommended Readings
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More suggested readingsMore suggested readings
Neurobiology of Empathy ; Attachment Theory Mirror neurons and the brain in the vat. By V.S. Ramachandran, 1/10/2006
The mind’s mirror. (on mirror neurons and its relation to empathy) By L. Winerman, Monitor Staff, 10/2005, Vol 36, No. 9. American Psychological Association
Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation and Infant Mental Health. A. N. Schore, in Infant Mental Health Journal 22, 1-2 (2001): 7-66
Narcissism in organizations and leadership
Leadership. By Hogan and Fico, 2009. Chapter to appear in W. K. Campbell & J. Miller (Eds.) The handbook of narcissism and narcissistic personality disorder. New York: Wiley, in press.
Cultural Aspects
What the Experts Are Saying Now . By K. Hymowitz, 8/25/2009,. A Review of the “self-esteem movement” as per new book, “Nurture Shock” by Po Bronson & Ashley Merryman
Best Weapons against Honor Killers: Shame. By Kwame A. Appiah. 9/25/2010. On the customs of honor codes (dueling, honor killings) and public dishonor. Listen to him also in “Talk of the Nation”, NPR
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