Narcissism & Psychiatry
The mental health profession has not identified this phenomenon yet which is separate from domestic violence and complex PTSD (though there may be significant overlap!). Many times people experiencing narcissistic abuse will have their concerns minimized, or even feel gaslighted by therapists and other healthcare providers. The tried recommendations of “communication,” “compromise,” and "forgiveness" do not apply in the world of narcissistic abuse.
narcissism
* not clinical term
* is descriptive term
  • no different than calling someone stubborn, introverted, agreeable, antagonistic…
  • ie.narcissism is described by a lack of empathy, entitlement, grandiosity, arrogance, superficiality, validation seeking …
* is a pattern of behavior that causes more discomfort for people around the narcissist, than for narcissist themselves

prevalence of narcissism -vs- narcissistic personality disorder
* narcissistic personality disorder: 1-4% (some studies 6-8%) ie. not lots of people
  • problem: not much research, because they do not show up to research studies or therapy, because they do not think that they have a problem that causes distress to others
* narcissism: 20-25%. ie. a lot
* 1 in 10 lack empathy/consciousness (DSM-V)
* 3-6% antisocial (do not seek help)
* USA has 326million people.
  • IF 6% narcissist = 20million people.
  • Each of these abuses 5 people in their life (realistically, more) -> so 100 million people victimized
=> narcissism pandemic all over the world:
  • IF 3.3% of 7.5billion = 250 million antisocial disorder
  • IF 6% 7.5billion = 450 million antisocial disorder
  • or lack empathy = 700 million
  • > IF abuse 5 people/life THEN 3.4 bill people abused in world today

narcissism is on a spectrum from
* mild: which is annoying for you
* severe & dangerous: exploitative & coercive, making you feel menaced and unsettled. It does not feel good for you as target

narcissism is deeply misunderstood term
* may have thought that narcissism means self love
  • we now know it’s the opposite. It’s self-loathing.
* may have thought that narcissists are confident
  • we now know that it’s the opposite. They are insecure.


Narcissistic Personality Disorder
Is a diagnosis - achieved by meeting a list of criteria that are written in a books called
* Diagnostic and Statistical Manual for Mental Disorders - 5th edition (DSM-V) published by the American Psychiatric Association
* International Classification of Diseases II (ICD-II)
* Both are books, that medical health professionals will use to generate a diagnosis
The criteria for narcissistic personality disorder:
* Pervasive pattern of grandiosity & validation seeking & envy of other people & the need to be around people who are very important…
* AND 2 other things: either
  • 1)show person experiencing significant “clinical distress”
    • Meaning, that this pattern does not feel good for them
    • (that makes more sense when talk about depression: when person meets diagnostic criteria for depression, they are really uncomfortable. They feel worthless, sad, cannot sleep or eat> It is an uncomfortable place → so they feel distressed)
    • BUT in most cases - narc individuals walk around having all these patterns and they’re not bothered by it. The only time they are bothered - is when in their life does not go their way - but that has nothing to do with their symptoms
  • 2)it is causing social & occupational impairment?:
    • Is it causing problems in their relationship? Is it raising problems in jobs?
    • BUT: narcissistic person says
      • “ya, I don't have any prob. For some reason, my partner seems to have a prob with me,”
      • or “I keep doing well at work, but everybody has a problem with me”
      • → they project out onto others, so are not saying “I have all these problems”
Tricky with DSM: cannot diagnosis a problem IF they are causing problems for someone else
* IF see that narc behavior is clearly causing difficulties for their wives, husband, kids → that doesn't qualify
* It’s got to be for that person
* → dicey space: narcissism is a pattern, that causes more discomfort for people around narcissist, than for narcissist themselves


Covert Narcissism
some observations from professional therapists (I am not one myself)

ORIGINS OF COVERT NARCISSISM
Similar to what observe in other forms of narcissism
  • eg. attachment issues seen in narcissism
  • eg. potentially early traumatic experiences
  • eg. the inconsistency & chaos in their early environment
In covert narcissism:
  • there is often this quest to be noticed by their parents or other significant adults, and then the parents, never actually notice them.
    • These are the parents who are deeply distracted, completely disinterested, maybe even detached,
    • AND may also be parents who are deeply unkind, who will tend to do things like shame and insult their own child
  • ⇒ this can also set up - covert narcissistic patterns - in adulthood
  • The covert narcissist - has a much worse self-concept than we observe in other narc types → and they will often experience other psychological issues in their life, such as depression, anxiety
  • They often did have very difficult negating and invalidating early lives - can really pull the empathy from other people - rightfully so
    • BUT their unwillingness - to push beyond their history get therapy
    • AND they keep treating other people badly
    • ⇒ its a very very complicated mix

AS THERAPISTS
  • Therapists often see, what when covert narcissistic individuals come into therapy, their presenting signs often reflect patterns of depression, anxiety, general sense of dissatisfaction in life, relationship problems, and challenges in workplace.
  • Their negative moods - often lead therapists to believe that they are experiencing a mood disorder or an anxiety disorder
  • → so will often approach them with treatment for depression and anxiety (egs. cognitive behavior therapy | referral for medication)
  • ⇒ NOW see a lift and an adjustment in anxiety and depression
  • ⇒ AND THEN - unfortunately - the other stuff
    • eg. chronic disillusionment with life
    • eg. their chronic sense of victimization
    • eg. the belief, that they are not getting the recognition that they deserve
    • eg. their ongoing irritability
    • eg. their general contempt
    • eg. their almost low-grade paranoia
    • → that DON"T go away
  • as a result, it can sometimes a few months, to determine, that this is in fact more of a covert narcissistic pattern and not just depression and anxiety

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