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Narcissism: The spelling is the easy part. (Final)

We started a three part series on narcissism several days ago. And I’d like to wrap it up, as we discuss the causes of its pathological presentation and treatment options.

Ah, but first – to get caught up, here’s a link to Part 1, which tells the story of Narcissus; and Part 2, that’ll give you a nice description of narcissism.


No great surprise here – whether or not it’s Narcissistic Personality Disorder (NPD), who really knows what causes pathological narcissism. Truly, it’s a matter of conjecture; however, the following is based upon the experience of seasoned emotional/mental health professionals.

Pathological narcissism begins to develop in childhood and early adolescence. Loss of a father figure, or having one that’s emotionally absent may be a factor. These fathers are typically condescending and critical. As a result, the child begins to overcompensate for the resultant poor self-regard by taking-on the very traits that caused the problem in the first place. And future thought processing and behavior are grounded in doing whatever it takes to inflate an already false sense of self-worth.

By the way, in this scenario, mom has been typically passive.

Another factor may be extremes in child rearing. That could mean overindulgence and excessive pampering; and it could also mean abuse and/or neglect.

Finally, there may have been a failure on the part of the parent(s) or caregiver(s) to establish a healthy relationship and attachment with the child. This may result in the child believing his/her personality is somehow defective, which leaves the child feeling insignificant and unattached to others.

That can generate self-absorption, as well as intolerance regarding the needs and views of others. Also developing may be an intense sensitivity to criticism and a haughty presentation of self-importance and superiority.


As with most anything in the emotional/mental health arena, there is no cure for pathological narcissism. Psychotherapy is the treatment of choice; however, participation is the key. And it makes perfect sense that participation could be very difficult to secure. Let’s be realistic, a narcissist very likely believes nothing’s wrong – at least on his/her side of the fence.

The goal of psychotherapy is to help the individual gain insight into his/her thoughts, feelings, and beliefs. In a perfect world, better self-esteem and more realistic expectations of self and others will evolve; which will result in a positive change in behavior. Naturally, any comorbid conditions will be addressed – mood, anxiety, substance issues, etc.

Group work with other pathological narcissists can be very effective. And, given the potential for damage to those who are close (at least physically) to the narcissist, couples and family work are essential.

For Jaime

In closing, I want to address an issue chipur reader, Jaime, brought up after reading Part 2. She asked how I felt about the following….

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the diagnostic handbook for the emotional/mental health disorders. Published by the American Psychiatric Association (APA), the Fifth Edition is due to hit the streets in May 2013.

The current edition of the DSM lists 10 personality disorders (PD), one of which is narcissistic personality disorder. As it stands now, the Fifth Edition will knock that down to five; and NPD is one of the disorders biting the dust. The APA is apparently assigning the traits typically seen in NPD to the new personality disorder grouping, Antisocial/Psychopathic Type.

The APA brain trust state the reasoning behind their decision is based upon excessive PD co-occurrence. In addition, they believe the instability, over time, of a personality diagnosis can’t be accounted for by its definition in the current DSM. So to be able to knock the PD diagnoses down to five, the strategy is to use a “dimensional rating of types.” Simply put, diagnoses will be grounded in traits instead of behavioral criteria.

My thoughts? Well, first and foremost, the DSM no longer recognizing NPD doesn’t in the least equate to it not existing. I can see where the APA is coming from; however, I believe removing the specific diagnosis of NPD is a bad move. And that’s because it makes organizing and planning treatment all the more difficult.

In addition, it could be perceived that pathological narcissism isn’t real, or important, enough to merit its own diagnosis. And that kind of decrease in emphasis could emotionally, mentally, and physically harm a whole lot of innocent people.

And that, chipur readers, will do it for our three-part series on narcissism. I hope you found it informative and helpful. And, as always, your comments are key to our learning. Won’t you?

  • Jaime

    Hi Bill,
    I’m very glad to read your perspective on narcissism. I honestly can’t pinpoint where I think my ex’s narcissism came from. I think it must have been the perfect storm, because I can see it coming from both of his parents in all the ways you describe above.
    As for the term being removed from the DSM, I guess to me it doesn’t much matter. It’s unfortunate I think, BUT, I also don’t think that narcissism is something that is at all understood by the masses. So, the chances of the diagnosis being helpful to me (and to my children) are pretty much nil. My children shouldn’t be with their father half the time, like they are now. Regardless of whether the disorder is listed in the DSM or not probably won’t affect me. My children will remain with their father half the time, and I will just continue my “counter-attack” on narcissism by being the role model of a (at least fairly) healthy parent.
    Thanks for addressing this issue. I think it needs more discussion. Narcissism is tricky. And very, very painful for it’s victims.

    • Great points, all! You know, I guess it really doesn’t matter, within the context you mention, whether NPD has its corner on the diagnostic street map, or not. I mean, you know what, and who, you had – and you’re gone, lessons learned – so what else matters? All of the personality disorders are a mystery, aren’t they? And they have so much in common. Most clinicians avoid them like the plague. However, I’m really into them for whatever reason.

  • Jaime

    They are all mysterious. And there are so many traits in common with other pd’s. And while they may not be “helpful” to me, they are of major interest to me. If I didn’t have two children of an NPD, I probably wouldn’t be so interested. As it is, I SO want to save my children from this disorder. They are already victims, and already suffer. It’s heartbreaking.

    • Isn’t it amazing how interested we become in subject matter that affects us, and those we love, so deeply? I’m sorry you and your children have been so victimized. Yet, it sure sounds like mom has her head on straight – and has a huge heart. Is that cool, or what? I’m so glad you happened by chipur!