Narcissism

He that is proud eats up himself: pride is
his own glass, his own trumpet, his own chronicle;
and whatever praises itself but in the deed, devours
the deed in the praise.—Shakespeare, Troilus and Cressida

Personality disorders are a challenge. Psychiatrists have struggled with the diagnosis both in categorizing patients and treating them. The latest iteration of the Diagnostic and Statistical Manual of Mental Disorders or (DSM-5) gives us the most important information about personality disorders in the introductory section. In that description, the DSM-5 says that personality disorders are a disruption in a person’s ability to control impulses, regulate interpersonal relationships and control affect. Everything else we say about personality is secondary to that.

Recent events have brought personality disorders to the conscious attention of us all now which compels me to write about them. We are all keenly aware of the narcissistic personality and I thought a few words about it, and personality in general would be in order.

narcissist wood mannekin over white

It isn’t all bad. We need some degree of narcissism to have a healthy  self image and self esteem. As we grow, we need to have our caregivers reflect a healthy sense of ourselves in order do develop a secure sense of self, and belief that we are going to “make it” in this world. In other words, we need to be taught to love ourselves.  A failure in a developmental milestone can lead to an exaggerated sense of self or self worth. In a sense, the development of a narcissistic personality is a defense against a fractured sense of self, and lack of self esteem or self worth. It is not a conscious act, which is to say, the narcissistic personality doesn’t consciously decide to be this way, but does, instead, develop a narcissistic self to defend against the unwanted sense of worthlessness. If that unconscious reality were to surface, the narcissistic personality would “come unraveled”.

…he has, on the one hand, substituted for real objects imaginary ones from his memory…— Freud, On Narcissism: An Introduction.

What we see in a narcissistic personality is a person who is unable to show empathy. It is impossible to empathize when one is constantly trying to repair a narcissistic injury. The narcissist thinks that it doesn’t take any effort to achieve “great things”. They will often act as though they don’t have to put in the effort to accomplish. They see themselves as being extremely important and will often think that they can only be understood by “experts” in whatever  field they find themselves in. The narcissist has replaced the real world for the fantasy that exists in their own mind. This will at times  call into real question their reality testing, and at times they will look and act as if they are in some “other world”.

The truth is that the narcissist is in intense pain, suffers from intense anxiety and depression, and is in constant fear of being “found out”. They are difficult to treat, and frustrating to have as leaders. The personality disorder doesn’t often improve with time, and only with intense dynamic therapy does the narcissist begin to develop a healthy self and heal.


Stephen Taylor, M. D.

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