Narcissistic Personality Disorder

The DSM-5 lists the criteria for having a diagnosis of Narcissistic Personality Disorder as five or more of the following:

1. Grandiosity with expectations of superior treatment from other people

2. Fixated on fantasies of power, success, intelligence, attractiveness, etc.

3. Self-perception of being unique, superior, and associated with high-status people and institutions

4. Needing continual admiration from others

5. Sense of entitlement to special treatment and to obedience from others

6. Exploitative of others to achieve personal gain

7. Unwilling to empathize with the feelings, wishes, and needs of other people

8. Intensely envious of others, and the belief that others are equally envious of them

9. Pompous and arrogant demeanor

We all have a personality and we all can possess characteristics or traits such as narcissism, but one of the hallmarks of having a personality disorder such as NPD is that it usually persists throughout the lifespan and it is very difficult to effect positive change upon this individual’s internal character structure. This person externalizes all of his problems. Thus, when things go right, it is attributed to that individual’s achievements. When things go wrong, it is someone else’s fault. When people aren’t falling in line as yes men who support and boost up the narcissist’s grandiose sense of self, then slights are experienced as threats, attacks, and injuries.

It comes as no surprise that many individuals with NPD rise to the top of their organizations. The entertainment industry, politics, medicine, academia, law, and corporate America are rife with people with NPD. What is most egregious is when these individuals sexually harass, physically abuse and verbally attack those around them and never face any significant repercussions for their behavior.

It is very rare that a person with NPD will ever seek out therapy to address their problems. Again, they attribute their problems to the shortcomings of others and they need to hold fast to believing a grandiose fantasy of themselves. Therapy would be threatening. If this person ever does go to therapy, it is probably because he has encountered a life tragedy that has brought him into treatment. A threat of divorce, a loss of a job, a serious illness.

What is all too common is to see patients who have been directly and negatively impacted by the behavior of a narcissist. Children who have a parent with NPD. People who have had employers with NPD. People who have been sexually harassed or even raped by a narcissist who is incapable of empathy. Often these patients have been living with the experience of being an object to meet the narcissist’s needs, unable to see themselves as a separate individual with needs of their own. They often describe feeling guilty for disappointing the narcissist. When the child of a narcissistic parent moves away or chooses a career path that is counter to what the parent wants for them, this is wounding to the parent. For some parents with NPD, even simply developing and growing up is perceived as a threat.

It is very sad and disturbing that so many individuals inhabit this Earth with untreated Narcissistic Personality Disorders and continue to inflict harm on others. And it is incredibly infuriating to live in a world where so many narcissists are lauded and given accolades. These people are often rewarded for their narcissistic behaviors. We just lived through four years with a President who is the textbook example of this disorder. Society bolsters up these behaviors and sends the message that this is acceptable, even admirable. And so many, many lives are negatively impacted by it. Our society celebrates those who have the most wealth, the most beauty, and the most talent. We exalt celebrities to a godlike status. Donald Trump, who became famous by building a real estate empire and becoming known as a reality tv personality, then managed to be elected to the highest political office in the world and still continues to garner large numbers of followers even after leaving office. Many celebrities have come under fire for sexually harassing or even raping young men and women, only to face relatively little to no legal consequences. OJ Simpson quite possibly even got away with murder.

I wish I could feel hopeful that things will improve on this front. I do believe that it is important for us to work at not being complicit by colluding with a narcissist’s behavior. Too often people don’t speak up because they are understandably afraid of what will happen if they do. And others blame the victims instead of the abusers. This should collectively concern and upset all of us.

Children of Narcissistic Mothers

I am astonished by the number of patients I have treated who are children of one or two narcissistic parents. Though we often associate narcissism with males, in most of the cases I've witnessed, it is the mother who appears to be the narcissist. The world of entertainment fascinates us with such women. There's a dramatic example in the cult movie Mommie, Dearest. And one review of a Broadway revival of the musical Gypsy described the stage mother Rose who is determined to see her daughters achieve the success she never did as "the mother who is always there when she needs you." While these make for titillating enjoyment and these characters are extreme examples of narcissistic mothers, both based on actual autobiographies, in my practice the children of such mothers are anything but fodder for amusement.

The child of a narcissistic mother is often put into the role of a "self-object function" for the mother. Whereas in a healthy mother/child relationship the mother is tasked with meeting the needs of her child, the scenario is flipped with a narcissistic mother and the child is treated as an extension of her. Everything becomes viewed through the lens of how the child can serve the mother's needs or how the child's behavior wounded the mother.  Thus, if the child makes any move to separate from the mother and form an authentic identity of her own, this is unconsciously perceived as a threat to the mother. Normal developmental milestones such as puberty, adolescence, going to college, turning 21  and becoming an adult, and forging relationships, getting married, and starting one's own family are all potential threats or "narcissistic injuries." Similarly, if the child chooses to forge a unique identity and follow his own path, one that may differ from the mother's ideas of what the child should do, this may be taken as a direct attack on the mother. I've known patients whose mothers reacted negatively when the individual began a normal sexual exploration as a teenager, when the child moved away from home for school or work, when he announced plans for marriage, or when she announced that she was pregnant. These mothers are incredibly needy themselves and they are turning to their children to fill the expansive gulf of neediness they experience because they are unable to rely on themselves to do so and they most likely did not have adequate parenting in their childhood in which their own emotional needs could be met. 

Narcissism in a parent can take different forms. In some instances, the patient has a mother who martyrs herself, acting as a helpless victim and seeing herself as utterly selfless for the sake of her children and others. Yet this is far from unconditional and often the child experiences an enormous amount of guilt-tripping, with the mother making it clear that the child has disappointed her deeply. In some cases, this takes the form of a mother who suffers from a chronic illness, such as fibromyalgia or acute asthma. Far from being a victim, this mother can actually wield a great deal of power and control with her illness, holding her family members hostage and at her mercy. Once again the child's needs are sacrificed for the sake of the mother's "emergency." Other narcissistic parents may abuse alcohol or other substances in an attempt to fill the profound void they feel inside. Such a parent can hardly be relied upon to be responsible and consistently available for one's child. Often the child develops into a "parentified child," reversing roles with her own parents and having to learn to take care of her own needs as best as she can. Being age inappropriate, she cannot adequately function as a parent to herself, and she often is excessively harsh with herself and her siblings and may hold herself up to unreasonable standards. 

Sometimes the father in these scenarios is also a narcissist, pairing with the mother in using his children for his own purposes. More often, I have found the fathers to be emasculated men who cannot provide an adequate buffer to protect the child from the mother's unreasonable demands. They may appear rather passive, relinquishing their own authority as having equal responsibility in parenting their children, instead meekly backing their wives up and going along with their wishes so as to avoid a storm. The children become the true victims here, unable to defend themselves and unable to turn to their father to be the strong buffer they need him to be. 

The stage is set for this perfect storm. Children of narcissistic mothers, more often than not, find themselves in a no-win situation. There is no chance for a healthy development. Either he can squelch parts of himself and contort himself into the son he believes his mother wants him to be, or he can choose to assert his independence at the great risk of forever severing his bond to his mother. There doesn't appear to be a path in which this child can both develop an authentic identity and maintain a close connection to his mother. The fear of becoming an authentic self that is not reliant on the mother for survival may manifest itself as dependency. The child may have learned that she cannot survive without her mother. She remains anchored to her mother for guidance and direction. The mother's own neediness gets projected onto the child, and the child ends up believing that he is the needy one who is unable to be a self-sufficient adult. He may continue to prove how helpless he is by engaging in acting out behaviors such as financial irresponsibility, sexual promiscuity, and substance abuse to confirm his mother's view. In fact, this child is terrified of separating from his mother because to do so risks losing her entirely. 

I suppose it is not surprising that my caseload consists primarily of these children of narcissists, rather than the parents themselves. One of the hallmarks of a personality disorder is how entrenched it is, and a person with a true narcissistic personality disorder externalizes all his problems and does not take responsibility for any of his egregious actions. Remember, the narcissistic mother firmly believes that it is her child who has wronged her and is at fault for whatever problems ensue. Children of narcissistic mothers who find the strength to engage in psychotherapy have the opportunity to become aware of how profoundly their mother's behavior has impacted them and over time can work toward separating from this mother and genuinely forging an authentic identity of one's own. Even initiating the process of therapy is a step toward  greater empowerment and becoming a self-sufficient adult.