When you’re with a Narcissistic Personality Disorder (NPD) person, it feels like you don’t exist.
That individual is usually so grandiose and expansive that others around him fade into the background. One day I walked across town with a colleague whom I soon suspected had NPD. He was a tall, handsome doctor in a grey suit. He spent the twenty minutes that it took to get from the Eastside to the Westside of Manhattan telling me all about himself. I tried to get a few words in on another topic, but even though I spoke loudly and insistently, I could tell he didn’t hear me. When we finally parted, I was relieved.
You may be dealing with a NPD, if the person you know or have interacted with displays the following behavior:
1) He or she insists on bragging and exaggerating his or her achievements. An actor patient of mine “knew” that he could be the next Brad Pitt. He constantly fantasized about being discovered, yet he failed to go to auditions or work in any way to improve his skills. When I encouraged him to go and try out for parts, he assured me that for him, it was unnecessary. He would be found by the right people just walking the streets or nightclubbing at the most popular spots. Any reality testing that I tried with him was brushed aside.
2) A person with NPD believes that she is “special” and no one can understand her except other “special” people. Another patient told me that I, her ob-gyn M.D., and her trainer were all “special” and top-notch like herself. When I asked her what “special” meant, she looked at me with scorn and warned that if I didn’t already know what that meant, I could tumble out of my special status. I might fall into the category of ordinary and that was way below her. She did not associate with such people.
3) The individual needs excessive admiration. One woman I treated showed me sweaters and scarves that she knitted. They were exquisitely made and I told her so. One evening I was tired and my tone must not have been as enthusiastic as usual when I praised her work. She was angry after that. When I tried to address the issue, she cried and refused to consider that she had any problem about this. Everyone that she knew had to tell her what wonderful knitting she produced. Most people did admire her work, but she never felt satisfied no matter how much praise she received.
4) The indvidual feels entitled to everything. Whenever I see someone cut into a line at the supermarket, I think NPD. These are the people who never pay their bills even though they have enough money to do so. They are entitled to free treatment in their minds.
5) The person lacks empathy and can’t identify or recognize the needs of others. One patient who was a partner in a big law firm worked his associates, clerks, and secretaries relentlessly without proper pay and little regard for their welfare. One of his paralegals was mugged on his way home to the Bronx after midnight. My patient callously declared that it was the man’s own fault and refused to take any blame for overworking his employee and keeping him late in the office. I tried to explain the worker’s point-of-view to him to no avail.
6) They are usually seen as arrogant and haughty by others and usually disliked.
As in any personality disorder the NPD person is stuck in a certain way of thinking, feeling, and behavior. Those with personality disorders do not think that they have problems, so they are unmotivated to change. They will consult psychiatrists or other therapists when they are struggling with depression, anxiety, or even psychosis.
The cause of NPD is usually based on pathological family interactions when the individual is very young and first forming his mental patterns. Often there are cold, unsympathetic parents who cannot relate to the child’s needs. Otto Kernberg believes that if an infant’s healthy narcissism continues into adulthood then NPD develops. Kernberg and Heinz Kohut have written many books and articles about NPD. They attempted psychotherapy and, in some cases, psychoanalysis with NPD patients. Recently, medical professionals have found genetic evidence that personality disorders may be inherited, especially schizotypal or borderline personality disorders.
One way to treat NPD would be to try to focus the person outside of him/herself. As in the case of my attorney patient who couldn’t understand his employee’s point-of-view, I take the patient through an examination of how another person may feel about something the NPD did or said. This is difficult work, but sometimes the NPD is able to gain some understanding of how humiliated or injured another person might be by the NPD’s statements or behavior. There is a concept of “healthy narcissism,” in which a person takes good care of him/herself but is still able to understand the needs of others. We all should strive for this state.