Malignant Self Love - Narcissism Revisited

Excerpts from the Archives
of the
Narcissism List

Part 8 cont.

11. Robert Hare

Robert Hare is considered to be a heretic in DSM IV terms. His PCL-R was severely criticized by the compilers of DSM IV (especially after he insisted that they muddled up the definition of AsPD ...)

In this case, I think the DSM may be right. The overlap between AsPD and psychopath is too great to justify a separate clinical category. In any case, Hare is absolutely NOT the orthodoxy. The DSM is clear: AsPD in, psychopaths out.

A distinction exists between NPDs and AsPDs.

The differences between PDs and neuroses have been more sharply defined. In a nutshell, PDs have ALLOPLASTIC defenses (react to stress by attempting to change the external environment or by shifting blame to it) while neurotics have AUTOPLASTIC defenses (react to stress by attempting to change their internal processes). The second important difference is that PDs TEND to be ego-syntonic (perceived by the patient to be acceptable, unobjectionable and part of the self) while neurotics tend to be ego-dystonic (the opposite).

This is exactly why "PD Clusters" were invented in 1987. I believe that there is a continuum BPD-HPD-NPD-AsPD.

Grandiosity in its typical narcissistic form is UNIQUE to narcissists. It cannot be found in ANY OTHER PD. A sense of entitlement is common to ALL Cluster B disorders, though. Narcissists almost never act on their suicidal ideation - BPDs do so incessantly (cutting - Self Injury - or mutilation).

And so it goes. The differential diagnosis is nowhere near where it should be ideally but is sufficient and developing by the day. At this stage, as long as they don't have DSM-V (actually DSM IV-TR was published), diagnosticians are in the habit of diagnosing multiple PDs. It is extremely rare to diagnose a single pure PD. This is called, as you know, "co-morbidity". I have textbooks at home which URGE diagnosticians NEVER to render a single diagnosis.

NPDs can suffer from brief reactive psychoses exactly as BPDs suffer from psychotic microepisodes. Actually, there is a whole sub-field in psychodynamic theories of narcissism which tries to explain the dynamics of reactive psychoses in pathological narcissism.

NPDs are different from BPDs in these areas:

1. Less impulsive behaviors (FAR less)

2. Less self-destructiveness, almost no self-mutilation, practically no suicide attempts

3. Less instability (emotional lability, in interpersonal relationships, and so on)

Psychopaths, or Sociopaths, are the old names for the antisocial PD. They are no longer in use, generally. But, the line between NPD and AsPD is very thin. I, personally, believe that AsPD is simply an exaggerated form of NPD and that having two diagnoses in such cases is superfluous.

12. Accusing the Victims

I would never DREAM to accuse the victim! 

I just meant to distinguish between those victims who don't know better and get burnt - and those who KNOWINGLY, WILLINGLY, sometimes for the fun of it (risk/adventure), sometimes due to vanity (I will be the one to break him or to save him) - go near narcissists.

The first class of victims are real victims. But I refuse to accept victimology. I think it is degrading and scientifically wrong to assume - as a working hypothesis - that victims WANT to be victimized.

13. Multiple Diagnoses and NPD

NPD rarely appears in isolation. It is not in vain that BPD, NPD, HPD and AsPD constitute members of a Cluster (B) of disorders in the DSM. 

Pathological Narcissism is what the DSM says it is simply because the DSM (and the ICD) define our terminology. It would have been very difficult to communicate meaningfully otherwise. We can stretch the definition of narcissism somewhat but we cannot include in it traits which are the absolute opposite of narcissism. A new title would then be called for (Maybe "Inverted Narcissism"?). 

Narcissists do try to merge with an idealized but badly internalized object. They do so by "digesting" the meaningful others in their lives and transforming them into extensions of their selves. They employ various techniques to achieve this. To the "digested" this is the crux of the harrowing experience called "living with a narcissist".

The narcissist has a badly regulated sense of self-worth. However this is not conscious. He goes through cycles of self-devaluation (and experiences them as dysphorias).

Narcissism MUST include a component of active and conscious grandiose self-image. Some narcissists punish themselves by self-defeating and self-destructive behaviors - but if they actively avoid narcissistic supply, they are not narcissists. There is a host of other PDs which incorporate this criterion (social phobia, schizoid PD and many others), though.

The narcissistic dissonance exists on two levels:

Between the UNCONSCIOUS feeling of lack of stable self worth and the grandiose fantasies
AND
Between the grandiose fantasies and reality (the Grandiosity Gap).

If someone thinks that he is not unique - then he can never be defined as a narcissist. The word "narcissist" is taken - a new word must be found. But a sense of worthlessness is typical of many other PDs (AND the feeling that no one could ever understand them).

Narcissists are never empathic. They are attuned to others in order to optimize the extraction of narcissistic supply from them.

Because narcissists are unwilling to change - they are take it or leave it propositions. There is little point in trying to "convert" them through the application of love, compassion, or empathy. 

Those who are attracted to narcissists must suffer from an underlying mental problem (though I do not think that two narcissists are likely to get along well together).

But there is no denying that some people do get attracted to narcissists - even if they are warned IN GREAT DETAIL as to what is a narcissist and what it is to share a life with one.

top | next | table of contents

home | about me | narcissism defined | faq | narcissism list excerpts
the book | book excerpts | articles | email me