What we’ve said about Narcissistic personality disorder

“people think of narcissism as it's just this one thing. Like there's a monolithic, I forget who I heard talk about this, but there's like a monolithic, the narcissist”

“What are the ordinary aspects here? Well, grandiosity, pride, ambition, and a willingness to do what it takes to be the best, right? These are not necessarily pathological and these are not necessarily the result of pathological narcissism and psychopathy”

“underneath what we see, the grandiosity, the arrogance, the need for admiration, there's a deeper psychological injury, what we call the narcissistic injury. And at its core, that injury is the experience that who you really are is somehow unacceptable”

“The grandiosity and the worthlessness are two sides of the same coin. So the appearance of excessive love, of excessive grandiosity in a psychodynamic formulation is better understood as just like a profound suppression, push down, inability to accept who the person truly is”

“early in life, the environment, typically the parents, need you to be substantially different from who you actually are. Maybe the parents need you to be successful. They need you to not show any weakness”

“Then comes self-psychology led by Kohut. He reframed patients who he felt were empty or lack cohesion, and he mapped how the self develops and what happens when that development stalls, which kind of reshaped how we think about and treat narcissistic pathology”

“for a clinical level, Of narcissistic personality, I would generally want to see that there is such rigid preservation and defense of an identity that has been chosen by the subject, that it defeats their own long-term goals and functioning”

“That they feel depressed and empty when they're not validated or admired. And that they have such a poor understanding of other people's motivations and desires that they only attune themselves to the ones that matter to their identity or their well-being”

“You might see also problems in work. Functioning, basically. They won't be able to do well in work and studies, or they'll do really, really well until they collapse, right? Because of this strong tendency to do all or nothing stuff, to totally idealize or devalue certain aspects of themselves or others”

“The truly narcissistic person will simply adapt their worldview of the other person in a quasi-psychotic fashion to fit what their worldview is”

“Someone can have pathology and not perfectly fit a label. And then you kind of need to go more into formulation and particular traits”

“whether we should define disorders as traits only, severe traits, or whether it's a matter of interpersonal functioning. I think a hybrid approach is best, but I tend to try to split the difference”

“Narcissism is on a dimension, OCPD, obsessionality is on a dimension, but borderline and antisocial syndromes retain those”

“I'm very fond of Gerald Adler's conceptualization of a borderline narcissistic continuum in which narcissistic personality disorder is the less severe condition and borderline personality disorder is the more severe condition. And Adler thought that as borderline patients get better in treatment, they actually look more narcissistic”

“I wonder if that's a matter of more overt, overtly borderline seeming patients may be undiagnosed narcissists who have been rendered unstable by their life circumstances. And if you stabilize them, they tend to start to present the narcissistic pathology versus the more quiet borderline types where the deficit's more in the identity and self-direction”

“Psychopathy is not a totally separate thing. Psychopathy often has this structure and then often what we call like super ego deficits. So there's absolutely no guilt. There's often on top of this a desire to kind of get over on other people, to manipulate, to use other people”

“In the hysterical person, it's a defense against fear. In the obsessive compulsive person, it's a defense against the feeling of badness. And in the more narcissistic person, perfectionism would be a defense against shame”

“For instance, hyperthymia and narcissistic personality, cyclothymia and borderline personality. And the misdiagnosis can go both ways”

“some people think once they get a whiff of personality, a whiff of borderline personality disorder, or a whiff of narcissism, then all the other stuff is explained away and the person can be discharged, which is... ridiculous”

“I think a lot of people reach for the vulnerable narcissism without adequate evidence, that they assume that that's the subtype just because you have somebody who is A, male, and B, male”

“Her image of herself is such that even normal human lying is something that she is completely outside of her awareness”