Abuse, Trauma, and Torture - Their Consequences and Effects (2 page)

We must
carefully distinguish between the narcissistic traits
of 
adolescents
 –
narcissism is an integral part of their healthy personal
development – and the full-fledge disorder. Adolescence is
about self-definition, differentiation, separation from one's
parents, and individuation. These inevitably involve
narcissistic assertiveness which is not to be conflated or confused
with Narcissistic Personality Disorder (NPD).

"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.

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 un-empathic". But narcissists
are less impulsive, less aggressive, and less deceitful.
Psychopaths rarely seek Narcissistic Supply. As opposed to
psychopaths, few narcissists are criminals.

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.

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 defence 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 criticised. 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
co-dependents, they derive their Narcissistic Supply from their
relationships with classic narcissists.

The common
treatment for patients with Narcissistic Personality Disorder (NPD)
is talk therapy (mainly psychodynamic psychotherapy or
cognitive-behavioural treatment modalities). Talk therapy is
used to modify the narcissist's antisocial,
interpersonally exploitative, and dysfunctional
behaviours, often with some success. Medication is prescribed
to control and ameliorate attendant conditions such as
mood
disorders
or
obsessive-compulsive disorders
.

The prognosis for an
adult suffering from the Narcissistic Personality Disorder (NPD) is
poor, though his adaptation to life and to others can improve with
treatment.

[Bibliography:

Goldman, Howard H.,
Review of General Psychiatry, fourth edition, 1995. Prentice-Hall
International, London.

Gelder, Michael, Gath,
Dennis, Mayou, Richard, Cowen, Philip (eds.), Oxford Textbook of
Psychiatry, third edition, 1996, reprinted 2000. Oxford University
Press, Oxford.

Vaknin, Sam, Malignant
Self Love – Narcissism Revisited, seventh revised impression,
1999-2007. Narcissus Publications, Prague and Skopje.]

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I hate routine. When I
find myself doing the same things over and over again, I get
depressed. I oversleep, over-eat, over-drink and, in general,
engage in addictive, impulsive and compulsive behaviours. This is
my way of re-introducing risk and excitement into what I
(emotionally) perceive to be a barren life.

The problem is that even
the most exciting and varied existence becomes routine after a
while. Living in the same country or apartment, meeting the same
people, doing essentially the same things (though with changing
content) – all "qualify" as stultifying rote.

I feel entitled to more.
I feel it is my right – due to my intellectual superiority – to
lead a thrilling, rewarding, kaleidoscopic life. I feel entitled to
force life itself, or, at least, people around me – to yield to my
wishes and needs, supreme among them the need for stimulating
variety.

This rejection of habit
is part of a larger pattern of aggressive entitlement. I feel that
the very existence of a sublime intellect (such as myself) warrants
concessions and allowances. Standing in line is a waste of time
best spent pursuing knowledge, inventing and creating. I should
avail myself of the best medical treatment proffered by the most
prominent medical authorities – lest the asset that is I be lost to
Mankind. I should not be bothered with proofreading my articles (or
even re-reading them) – these lowly jobs best be assigned to the
less gifted. The devil is in paying precious attention to
details.

Entitlement is sometimes
justified in a Picasso or an Einstein. But I am neither. My
achievements are grotesquely incommensurate with my overwhelming
sense of entitlement. I am but a mediocre and forgettable scribbler
who, at the age of 39, is a colossal under-achiever, if
anything.

Of course, the feeling of
supremacy often serves to mask a cancerous complex of inferiority.
Moreover, I infect others with my projected grandiosity and their
feedback constitutes the edifice upon which I construct my
self-esteem. I regulate my sense of self-worth by rigidly insisting
that I am above the madding crowd while deriving my Narcissistic
Supply from this very thus despised source.

But there is a second
angle to this abhorrence of the predictable. As a narcissist, I
employ a host of Emotional Involvement Prevention Mechanisms
(EIPM). Despising routine and avoiding it is one of these
mechanisms. Their function is to prevent me from getting
emotionally involved and, subsequently, hurt. Their application
results in an "approach-avoidance repetition complex". The
narcissist, fearing and loathing intimacy, stability and security –
yet craving them – approaches and then avoids significant others or
important tasks in a rapid succession of apparently inconsistent
and disconnected behaviours.

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Comments on recent research by Roy
Baumeister.

Is pathological narcissism a blessing or a
malediction?

The answer is: it depends. Healthy narcissism
is a mature, balanced love of oneself coupled with a stable sense
of self-worth and self-esteem. Healthy narcissism implies knowledge
of one's boundaries and a proportionate and realistic appraisal of
one's achievements and traits.

Pathological narcissism is wrongly described
as too much healthy narcissism (or too much self-esteem). These are
two absolutely unrelated phenomena which, regrettably, came to bear
the same title. Confusing pathological narcissism with self- esteem
betrays a fundamental ignorance of both.

Pathological narcissism involves an impaired,
dysfunctional, immature (True) Self coupled with a compensatory
fiction (the False Self). The sick narcissist's sense of self-worth
and self-esteem derive entirely from audience feedback. The
narcissist has no self-esteem or self-worth of his own (no such ego
functions). In the absence of observers, the narcissist shrivels to
non-existence and feels dead. Hence the narcissist's preying habits
in his constant pursuit of Narcissistic Supply. Pathological
narcissism is an addictive behavior.

Still, dysfunctions are reactions to abnormal
environments and situations (e.g., abuse, trauma, smothering,
etc.).

Paradoxically, his dysfunction allows the
narcissist to function. It compensates for lacks and deficiencies
by exaggerating tendencies and traits. It is like the tactile sense
of a blind person. In short: pathological narcissism is a result of
over-sensitivity, the repression of overwhelming memories and
experiences, and the suppression of inordinately strong negative
feelings (e.g., hurt, envy, anger, or humiliation).