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Phineas Gage was a 25 years old construction foreman who lived in Vermont in the 1860s. While working on a railroad bed, he packed powdered explosives into a hole in the ground, using tamping iron. The powder heated and blew in his face. The tamping iron rebounded and pierced the top of his skull, ravaging the frontal lobes.

In 1868, Harlow, his doctor, reported the changes to his personality following the accident:

He became "fitful, irreverent, indulging at times in the grossest profanity (which was not previously his customs), manifesting but little deference to his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate yet capricious and vacillating, devising many plans for future operation which are no sooner arranged than they are abandoned in turn for others appearing more feasible ... His mind was radically changed, so that his friends and acquaintances said he was no longer Gage."

In other words, his brain injury turned him into a psychopathic narcissist.

Similarly startling transformation have been recorded among soldiers with penetrating head injuries suffered in World War I. Orbitomedial wounds made people "pseudopsychopathic": grandiose, euphoric, disinhibited, and puerile. When the dorsolateral convexities were damaged, those affected became lethargic and apathetic ("pseudodepressed"). As Geschwind noted, many had both syndromes.

The DSM is clear: the brain-injured may acquire traits and behaviors typical of certain personality disorders but head trauma never results in a full-fledged personality disorder.

"General diagnostic criteria for a personality disorder:
F. The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma)." (DSM-IV-TR, p.689)

From my book "Malignant Self-love - Narcissism Revisited":

"It is conceivable, though, that a third, unrelated problem causes chemical imbalances in the brain, metabolic diseases such as diabetes, pathological narcissism, and other mental health syndromes. There may be a common cause, a hidden common denominator (perhaps a group of genes).

Certain medical conditions can activate the narcissistic defense mechanism. Chronic ailments are likely to lead to the emergence of narcissistic traits or a narcissistic personality style. Traumas (such as brain injuries) have been known to induce states of mind akin to full-blown personality disorders. Such "narcissism", though, is reversible and tends to be ameliorated or disappear altogether when the underlying medical problem does. Other disorders, like the Bipolar Disorder (mania-depression) are characterised by mood swings that are not brought about by external events (endogenous, not exogenous). But the narcissist's mood swings are strictly the results of external events (as he perceives and interprets them, of course).

But phenomena, which are often associated with NPD (Narcissistic Personality Disorder), such as depression or OCD (obsessive-compulsive disorder), are treated with medication. Rumour has it that SSRI's (such as Fluoxetine, known as Prozac) might have adverse effects if the primary disorder is NPD. They sometimes lead to the Serotonin syndrome, which includes agitation and exacerbates the rage attacks typical of a narcissist. The use of SSRI's is associated at times with delirium and the emergence of a manic phase and even with psychotic microepisodes.

This is not the case with the heterocyclics, MAO and mood stabilisers, such as lithium. Blockers and inhibitors are regularly applied without discernible adverse side effects (as far as NPD is concerned).

Not enough is known about the biochemistry of NPD. There seems to be some vague link to Serotonin but no one knows for sure. There isn't a reliable non-intrusive method to measure brain and central nervous system Serotonin levels anyhow, so it is mostly guesswork at this stage."

Read more about Narcissism and the Bipolar Disorder - click HERE!

Read more about Narcissism and Asperger's Disorder - click HERE!

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Psychosexual Stages of Personal Development

First published here: "Personality Disorders (Suite101)"

By: Dr. Sam Vaknin

The Viennese neurologist, Sigmund Freud, was among the first to offer a model of psychological development in early childhood (within the framework of psychoanalysis). He closely linked the sex drive (libido) to the formation of personality and described five psychosexual stages, four of which are centered around various erogenous zones in the body.

The pursuit of pleasure ("the pleasure principle") and the avoidance of pain drive the infant to explore his or her self and the world at large. Pleasure is inextricably linked to sexual gratification. In the oral phase (from birth to 24 months), the baby focuses on the tongue, lips, and mouth and derives gratification from breast feeding, thumb sucking, biting, swallowing, and other oral exploratory activities.

This is naturally followed by the anal stage (24 to 36 months). The baby immensely enjoys defecation and related bowel movements. But it is also the first time in his or her life that the toddler is subjected to the censure and displeasure of caretakers. Hitherto unconditionally adoring adults now demand that the infant delay gratification, relieve himself only in the bathroom, and not play with his feces. This experience - of hitherto unprecedented adult approbation - can be traumatic.

The phallic stage (age 3 to 6 years) involves the discovery of the penis and clitoris as foci of pleasurable experience. This tantalizing novelty is coupled with sexual desire directed at the parent of the opposite sex (boys are attracted to their mothers and girls, to their fathers). The child overtly and covertly competes with the same-sex parent for the desired parent's attention: boys joust with their fathers and girls with their mothers. These are the famous Oedipal and Electra complexes.

If the parent is insufficiently mature or narcissistic and encourages the attentions of the child in acts of covert (emotional) and overt (physical) incest, it could lead to the development of certain mental health disorders, among them the Histrionic, Narcissistic, and Borderline personality disorders. Doting, over-indulgence, and smothering are, therefore, forms of child abuse. Sexual innuendo, treating the child as an adult or substitute partner, or regarding one's offspring as an extension of one's self also constitute abusive conduct.

The phallic stage is followed by 6 to 7 years of latent sexuality that is rekindled in puberty. Adolescence is a period of personal development labeled by Freud the genital phase. In the previous rungs of psychosexual evolution, the child's own body was the source of sexual pleasure. Hitherto, the adolescent and young adult seeks sexual gratification from and invests sexual energy in others. This object-relatedness is what we call mature love.

Also read these:

The Pathology of Love - click HERE!

In Defense of Psychoanalysis - click HERE!

On Incest - click HERE!

Many additional Frequently Asked Questions (FAQs) about Personality Disorders - click HERE!

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Gender Bias

In Diagnosing Personality Disorders

First published here: "Personality Disorders (Suite101)"

By: Dr. Sam Vaknin

Ever since Freud, more women than men sought therapy. Consequently, terms like "hysteria' are intimately connected to female physiology and alleged female psychology. The DSM (Diagnostic and Statistical Manual, the bible of the psychiatric profession) expressly professes gender bias: personality disorders such as Borderline and Histrionic are supposed to be more common among women. but the DSM is rather even-handed: other personality disorders (e.g., the Narcissistic and Antisocial as well as the Schizotypal, Obsessive-Compulsive, Schizoid, and Paranoid) are more prevalent among men.

Why this gender disparity? There are a few possible answers:

Maybe personality disorders are not objective clinical entities, but culture-bound syndromes. In other words, perhaps they reflect biases and value judgments. Some patriarchal societies are also narcissistic. They emphasize qualities such as individualism and ambition, often identified with virility. Hence the preponderance of pathological narcissism among men. Women, on the other hand, are widely believed to be emotionally labile and clinging. This is why most Borderlines and Dependents are females.

Upbringing and environment, the process of socialization and cultural mores all play an important role in the pathogenesis of personality disorders. These views are not fringe: serious scholars (e.g., Kaplan and Pantony, 1991) claim that the mental health profession is inherently sexist.

Then again, genetics may be is at work. Men and women do differ genetically. This may account for the variability of the occurrence of specific personality disorders in men and women.

Some of the diagnostic criteria are ambiguous or even considered "normal" by the majority of the population. Histrionics "consistently use physical appearance to draw attention to self." Well, who doesn't in Western society? Why when a woman clings to a man it is labeled "codependence", but when a man relies on a woman to maintain his home, take care of his children, choose his attire, and prop his ego it is "companionship" (Walker, 1994)?

The less structured the interview and the more fuzzy the diagnostic criteria, the more the diagnostician relies on stereotypes (Widiger, 1998).

Quotes from the Literature

"Specifically, past research suggests that exploitive tendencies and open displays of feelings of entitlement will be less integral to narcissism for females than for males. For females such displays may carry a greater possibility of negative social sanctions because they would violate stereotypical gender-role expectancies for women, who are expected to engage in such positive social behavior as being tender, compassionate, warm, sympathetic, sensitive, and understanding.

In females, Exploitiveness/Entitlement is less well-integrated with the other components of narcissism as measured by the Narcissistic Personality Inventory (NPI) - Leadership/Authority, Self-absorption/Self-admiration, and Superiority/Arrogance- than in males - though 'male and female narcissists in general showed striking similarities in the manner in which most of the facets of narcissism were integrated with each other'."

Gender differences in the structure of narcissism: a multi-sample analysis of the narcissistic personality inventory - Brian T. Tschanz, Carolyn C. Morf, Charles W. Turner - Sex Roles: A Journal of Research - Issue: May, 1998

"Women leaders are evaluated negatively if they exercise their authority and are perceived as autocratic."

Eagly, A. H., Makhijani, M. G., & Klonsky, B. G. (1992). Gender and the evaluation of leaders: A meta-analysis. Psychological Bulletin, 111, 3-22, and ...

Butler, D., & Gels, F. L. (1990). Nonverbal affect responses to male and female leaders: Implications for leadership evaluations. Journal of Personality and Social Psychology, 58, 48-59.

"Competent women must also appear to be sociable and likable in order to influence men - men must only appear to be competent to achieve the same results with both genders."

Carli, L. L., Lafleur, S. J., & Loeber, C. C. (1995). Nonverbal behavior, gender, and influence. Journal of Personality and Social Psychology, 68, 1030-1041.

Gender and the Narcissist - click HERE!

Homosexual and Transsexual Narcissists - click HERE!

Sex and Gender - click HERE!

Many additional Frequently Asked Questions (FAQs) about Personality Disorders - click HERE!

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Genetics and Personality Disorders

First published here: "Personality Disorders (Suite101)"

By: Dr. Sam Vaknin

Are personality disorders the outcomes of inherited traits? Are they brought on by abusive and traumatizing upbringing? Or, maybe they are the sad results of the confluence of both?

To identify the role of heredity, researchers have resorted to a few tactics: they studied the occurrence of similar psychopathologies in identical twins separated at birth, in twins and siblings who grew up in the same environment, and in relatives of patients (usually across a few generations of an extended family).

Tellingly, twins - both those raised apart and together - show the same correlation of personality traits, 0.5 (Bouchard, Lykken, McGue, Segal, and Tellegan, 1990). Even attitudes, values, and interests have been shown to be highly affected by genetic factors (Waller, Kojetin, Bouchard, Lykken, et al., 1990).

A review of the literature demonstrates that the genetic component in certain personality disorders (mainly the Antisocial and Schizotypal) is strong (Thapar and McGuffin, 1993). Nigg and Goldsmith found a connection in 1993 between the Schizoid and Paranoid personality disorders and schizophrenia.

The three authors of the Dimensional Assessment of Personality Pathology (Livesley, Jackson, and Schroeder) joined forces with Jang in 1993 to study whether 18 of the personality dimensions were heritable. They found that 40 to 60% of the recurrence of certain personality traits across generations can be explained by heredity: anxiousness, callousness, cognitive distortion, compulsivity, identity problems, oppositionality, rejection, restricted expression, social avoidance, stimulus seeking, and suspiciousness. Each and every one of these qualities is associated with a personality disorder. In a roundabout way, therefore, this study supports the hypothesis that personality disorders are hereditary.

This would go a long way towards explaining why in the same family, with the same set of parents and an identical emotional environment, some siblings grow to have personality disorders, while others are perfectly "normal". Surely, this indicates a genetic predisposition of some people to developing personality disorders.

Still, this oft-touted distinction between nature and nurture may be merely a question of semantics.

As I wrote in my book, "Malignant Self Love - Narcissism Revisited":

"When we are born, we are not much more than the sum of our genes and their manifestations. Our brain - a physical object - is the residence of mental health and its disorders. Mental illness cannot be explained without resorting to the body and, especially, to the brain. And our brain cannot be contemplated without considering our genes. Thus, any explanation of our mental life that leaves out our hereditary makeup and our neurophysiology is lacking. Such lacking theories are nothing but literary narratives. Psychoanalysis, for instance, is often accused of being divorced from corporeal reality.

Our genetic baggage makes us resemble a personal computer. We are an all-purpose, universal, machine. Subject to the right programming (conditioning, socialization, education, upbringing) - we can turn out to be anything and everything. A computer can imitate any other kind of discrete machine, given the right software. It can play music, screen movies, calculate, print, paint. Compare this to a television set - it is constructed and expected to do one, and only one, thing. It has a single purpose and a unitary function. We, humans, are more like computers than like television sets.

True, single genes rarely account for any behavior or trait. An array of coordinated genes is required to explain even the minutest human phenomenon. "Discoveries" of a "gambling gene" here and an "aggression gene" there are derided by the more serious and less publicity-prone scholars. Yet, it would seem that even complex behaviors such as risk taking, reckless driving, and compulsive shopping have genetic underpinnings."

Read More

Liveslye, W.J., Jank, K.L., Jackson, B.N., Vernon, P.A.. 1993. Genetic and environmental contributions to dimensions of personality disorders. Am. J. Psychiatry. 150(O12):1826-31.

On Dis-ease - click HERE!

The Interrupted Self - click HERE!

The Genetic Roots of Narcissism - Click HERE!

Many additional Frequently Asked Questions (FAQs) about Personality Disorders - click HERE!

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Defense Mechanisms

First published here: "Personality Disorders (Suite101)"

By: Dr. Sam Vaknin

According to Freud and his followers, our psyche is a battlefield between instinctual urges and drives (the id), the constraints imposed by reality on the gratification of these impulses (the ego), and the norms of society (the superego). This constant infighting generates what Freud called "neurotic anxiety" (fear of losing control) and "moral anxiety" (guilt and shame).

But these are not the only types of anxiety. "Reality anxiety" is the fear of genuine threats and it combines with the other two to yield a morbid and surrealistic inner landscape.

These multiple, recurrent, "mini-panics" are potentially intolerable, overwhelming, and destructive. Hence the need to defend against them. There are dozens of defense mechanisms. The most common among them:

Acting Out

When an inner conflict (most often, frustration) translates into aggression. It involves acting with little or no insight or reflection and in order to attract attention and disrupt other people's cosy lives.

Denial

Perhaps the most primitive and best known defense mechanism. People simply ignore unpleasant facts, they filter out data and content that contravene their self-image, prejudices, and preconceived notions of others and of the world.

Devaluation

Attributing negative or inferior traits or qualifiers to self or others. This is done in order to punish the person devalued and to mitigate his or her impact on and importance to the devaluer. When the self is devalued, it is a self-defeating and self-destructive act.

Displacement

When we cannot confront the real sources of our frustration, pain, and envy, we tend to pick a fight with someone weaker or irrelevant and, thus, less menacing. Children often do it because they perceive conflicts with parents and caregivers as life-threatening. Instead, they go out and torment the cat or bully someone at school or lash out at their siblings.

Dissociation

Our mental existence is continuous. We maintain a seamless flow of memories, consciousness, perception, and representation of both inner and external worlds. When we face horrors and unbearable truths, we sometimes "disengage". We lose track of space, time, and the continuum of our identity. We become "someone else" with minimal awareness of our surroundings, of incoming information, and of circumstances. In extreme cases, some people develop a permanently rent personality and this is known as "Dissociative Identity Disorder (DID)".

Fantasy

Everyone fantasizes now and then. It helps to fend off the dreariness and drabness of everyday life and to plan for an uncertain future. But when fantasy becomes a central feature of grappling with conflict, it is pathological. Seeking gratification - the satisfaction of drives or desires - mainly by fantasizing is an unhealthy defense. Narcissists, for instance, often indulge in grandiose fantasies which are incommensurate with their accomplishments and abilities. Such fantasy life retards personal growth and development because it substitutes for true coping.

Idealization

Another defense mechanism in the arsenal of the narcissist (and, to lesser degree, the Borderline and Histrionic) is the attribution of positive, glowing, and superior traits to self and (more commonly) to others. Again, what differentiates the healthy from the pathological is the reality test. Imputing positive characteristics to self or others is good, but only if the attributed qualities are real and grounded in a firm grasp of what's true and what's not.

Isolation of Affect

Cognition (thoughts, concepts, ideas) is never divorced from emotion. Conflict can be avoided by separating the cognitive content (for instance, a disturbing or depressing idea) from its emotional correlate. The subject is fully aware of the facts or of the intellectual dimensions of a problematic situation but feels numb. Casting away threatening and discomfiting feelings is a potent way of coping with conflict in the short-term. It is only when it become habitual that it rendered self-defeating.

Omnipotence

When one has a pervading sense and image of oneself as incredibly powerful, superior, irresistible, intelligent, or influential. This is not an adopted affectation but an ingrained, ineradicable inner conviction which borders on magical thinking. It is intended to fend off expected hurt in having to acknowledge one's shortcomings, inadequacies, or limitations.

Projection

We all have an image of how we "should be". Freud called it the "Ego Ideal". But sometimes we experience emotions and drives or have personal qualities which don't sit well with this idealized construct. Projection is when we attribute to others these unacceptable, discomfiting, and ill-fitting feelings and traits that we possess. This way we disown these discordant features and secure the right to criticize and chastise others for having or displaying them. When entire collectives (nations, groups, organizations, firms) project, Freud calls it the Narcissism of Small Differences.

Projective Identification

Projection is unconscious. People are rarely aware that they are projecting onto others their own ego-dystonic and unpleasant characteristics and feelings. But, sometimes, the projected content is retained in the subject's awareness. This creates a conflict. On the one hand, the patient cannot admit that the emotions, traits, reactions, and behaviors that he so condemns in others are really his. On the other hand, he can't help but being self-aware. He fails to erase from his consciousness the painful realization that he is merely projecting.

So, instead of denying it, the subject explains unpleasant emotions and unacceptable conduct as reactions to the recipient's behavior. "She made me do it!" is the battle cry of projective identification.

We all have expectations regarding the world and its denizens. Some people expect to be loved and appreciated - others to be feared and abused. The latter behave obnoxiously and thus force their nearest and dearest to hate, fear, and "abuse" them. Thus vindicated, their expectations fulfilled, they calm down. The world is rendered once more familiar by making other people behave the way they expect them to. "I knew you would cheat on me! It was clear I couldn't trust you!".

Rationalization or Intellectualization

To cast one's behavior after the fact in a favorable light. To justify and explain one's conduct or, more often, misconduct by resorting to ":rational, logical, socially-acceptable" explications and excuses. Rationalization is also used to re-establish ego-syntony (inner peace and self-acceptance).

Though not strictly a defense mechanism, cognitive dissonance may be considered a variant of rationalization. It involves the devaluation of things and people very much desired but frustratingly out of one's reach and control. In a famous fable, a fox, unable to snag the luscious grapes he covets, says: "these grapes are probably sour anyhow!". This is an example of cognitive dissonance in action.

Reaction Formation

Adopting a position and mode of conduct that defy personally unacceptable thoughts or impulses by expressing diametrically opposed sentiments and convictions. Example: a latent (closet) homosexual finds his sexual preference deplorable and acutely shameful (ego-dystonic). He resorts to homophobia. He public berates, taunts, and baits homosexuals. Additionally, he may flaunt his heterosexuality by emphasizing his sexual prowess, or by prowling singles bars for easy pick-ups and conquests. This way he contains and avoids his unwelcome homosexuality.

Repression

The removal from consciousness of forbidden thoughts and wishes. The removed content does not vanish and it remains as potent as ever, fermenting in one's unconscious. It is liable to create inner conflicts and anxiety and provoke other defense mechanisms to cope with these.

Splitting

This is a "primitive" defense mechanism. In other words, it begins to operate in very early infancy. It involves the inability to integrate contradictory qualities of the same object into a coherent picture. Mother has good qualities and bad, sometimes she is attentive and caring and sometimes distracted and cold. The baby is unable to grasp the complexities of her personality. Instead, the infant invents two constructs (entities), "Bad Mother" and "Good Mother". It relegates everything likable about mother to the "Good Mother" and contrasts it with "Bad Mother", the repository of everything it dislikes about her.

This means that whenever mother acts nicely, the baby relates to the idealized "Good Mother" and whenever mother fails the test, the baby devalues her by interacting, in its mind, with "Bad Mother". These cycles of idealization followed by devaluation are common in some personality disorders, notably the Narcissistic and Borderline.

Splitting can also apply to one's self. Patients with personality disorders often idealize themselves fantastically and grandiosely, only to harshly devalue, hate, and even harm themselves when they fail or are otherwise frustrated.

Read more about idealization followed by devaluation - click on the links:

http://www.narcissistic-abuse.com/faq43.html

http://www.narcissistic-abuse.com/faq44.html

http://www.narcissistic-abuse.com/devaluediscard.html

Sublimation

The conversion and channelling of unacceptable emotions into socially-condoned behavior. Freud described how sexual desires and urges are transformed into creative pursuits or politics.

Undoing

Trying to rid oneself of gnawing feelings of guilt by compensating the injured party either symbolically or actually.

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Topics in Developmental Psychology

The Narcissistic Parent

By: Dr. Sam Vaknin

Question:

Is there a "typical" relationship between the narcissist and his family?

Answer:

We are all members of a few families in our lifetime: the one that we are born to and the one(s) that we create. We all transfer hurts, attitudes, fears, hopes and desires – a whole emotional baggage – from the former to the latter. The narcissist is no exception.

The narcissist has a dichotomous view of humanity: humans are either Sources of Narcissistic Supply (and, then, idealised and over-valued) or do not fulfil this function (and, therefore, are valueless, devalued). The narcissist gets all the love that he needs from himself. From the outside he needs approval, affirmation, admiration, adoration, attention – in other words, externalised Ego boundary functions.

He does not require – nor does he seek – his parents' or his siblings' love, or to be loved by his children. He casts them as the audience in the theatre of his inflated grandiosity. He wishes to impress them, shock them, threaten them, infuse them with awe, inspire them, attract their attention, subjugate them, or manipulate them.

He emulates and simulates an entire range of emotions and employs every means to achieve these effects. He lies (narcissists are pathological liars – their very self is a false one). He acts the pitiful, or, its opposite, the resilient and reliable. He stuns and shines with outstanding intellectual, or physical capacities and achievements, or behaviour patterns appreciated by the members of the family. When confronted with (younger) siblings or with his own children, the narcissist is likely to go through three phases:

At first, he perceives his offspring or siblings as a threat to his Narcissistic Supply, such as the attention of his spouse, or mother, as the case may be. They intrude on his turf and invade the Pathological Narcissistic Space. The narcissist does his best to belittle them, hurt (even physically) and humiliate them and then, when these reactions prove ineffective or counter productive, he retreats into an imaginary world of omnipotence. A period of emotional absence and detachment ensues.

His aggression having failed to elicit Narcissistic Supply, the narcissist proceeds to indulge himself in daydreaming, delusions of grandeur, planning of future coups, nostalgia and hurt (the Lost Paradise Syndrome). The narcissist reacts this way to the birth of his children or to the introduction of new foci of attention to the family cell (even to a new pet!).

Whoever the narcissist perceives to be in competition for scarce Narcissistic Supply is relegated to the role of the enemy. Where the uninhibited expression of the aggression and hostility aroused by this predicament is illegitimate or impossible – the narcissist prefers to stay away. Rather than attack his offspring or siblings, he sometimes immediately disconnects, detaches himself emotionally, becomes cold and uninterested, or directs transformed anger at his mate or at his parents (the more "legitimate" targets).

Other narcissists see the opportunity in the "mishap". They seek to manipulate their parents (or their mate) by "taking over" the newcomer. Such narcissists monopolise their siblings or their newborn children. This way, indirectly, they benefit from the attention directed at the infants. The sibling or offspring become vicarious sources of Narcissistic Supply and proxies for the narcissist.

An example: by being closely identified with his offspring, a narcissistic father secures the grateful admiration of the mother ("What an outstanding father/brother he is"). He also assumes part of or all the credit for baby's/sibling's achievements. This is a process of annexation and assimilation of the other, a strategy that the narcissist makes use of in most of his relationships.

As siblings or progeny grow older, the narcissist begins to see their potential to be edifying, reliable and satisfactory Sources of Narcissistic Supply. His attitude, then, is completely transformed. The former threats have now become promising potentials. He cultivates those whom he trusts to be the most rewarding. He encourages them to idolise him, to adore him, to be awed by him, to admire his deeds and capabilities, to learn to blindly trust and obey him, in short to surrender to his charisma and to become submerged in his follies-de-grandeur.

It is at this stage that the risk of child abuse - up to and including outright incest - is heightened. The narcissist is auto-erotic. He is the preferred object of his own sexual attraction. His siblings and his children share his genetic material. Molesting or having intercourse with them is as close as the narcissist gets to having sex with himself.

Moreover, the narcissist perceives sex in terms of annexation. The partner is "assimilated" and becomes an extension of the narcissist, a fully controlled and manipulated object. Sex, to the narcissist, is the ultimate act of depersonalization and objectification of the other. He actually masturbates with other people's bodies.

Minors pose little danger of criticizing the narcissist or confronting him. They are perfect, malleable and abundant sources of Narcissistic Supply. The narcissist derives gratification from having coital relations with adulating, physically and mentally inferior, inexperienced and dependent "bodies".

These roles – allocated to them explicitly and demandingly or implicitly and perniciously by the narcissist – are best fulfilled by ones whose mind is not yet fully formed and independent. The older the siblings or offspring, the more they become critical, even judgemental, of the narcissist. They are better able to put into context and perspective his actions, to question his motives, to anticipate his moves.

As they mature, they often refuse to continue to play the mindless pawns in his chess game. They hold grudges against him for what he has done to them in the past, when they were less capable of resistance. They can gauge his true stature, talents and achievements – which, usually, lag far behind the claims that he makes.

This brings the narcissist a full cycle back to the first phase. Again, he perceives his siblings or sons/daughters as threats. He quickly becomes disillusioned and devaluing. He loses all interest, becomes emotionally remote, absent and cold, rejects any effort to communicate with him, citing life pressures and the preciousness and scarceness of his time.

He feels burdened, cornered, besieged, suffocated, and claustrophobic. He wants to get away, to abandon his commitments to people who have become totally useless (or even damaging) to him. He does not understand why he has to support them, or to suffer their company and he believes himself to have been deliberately and ruthlessly trapped.

He rebels either passively-aggressively (by refusing to act or by intentionally sabotaging the relationships) or actively (by being overly critical, aggressive, unpleasant, verbally and psychologically abusive and so on). Slowly – to justify his acts to himself – he gets immersed in conspiracy theories with clear paranoid hues.

To his mind, the members of the family conspire against him, seek to belittle or humiliate or subordinate him, do not understand him, or stymie his growth. The narcissist usually finally gets what he wants and the family that he has created disintegrates to his great sorrow (due to the loss of the Narcissistic Space) – but also to his great relief and surprise (how could they have let go someone as unique as he?).

This is the cycle: the narcissist feels threatened by arrival of new family members – he tries to assimilate or annex of siblings or offspring – he obtains Narcissistic Supply from them – he overvalues and idealizes these newfound sources – as sources grow older and independent, they adopt anti narcissistic behaviours – the narcissist devalues them – the narcissist feels stifled and trapped – the narcissist becomes paranoid – the narcissist rebels and the family disintegrates.

This cycle characterises not only the family life of the narcissist. It is to be found in other realms of his life (his career, for instance). At work, the narcissist, initially, feels threatened (no one knows him, he is a nobody). Then, he develops a circle of admirers, cronies and friends which he "nurtures and cultivates" in order to obtain Narcissistic Supply from them. He overvalues them (to him, they are the brightest, the most loyal, with the biggest chances to climb the corporate ladder and other superlatives).

But following some anti-narcissistic behaviours on their part (a critical remark, a disagreement, a refusal, however polite) – the narcissist devalues all these previously idealized individuals. Now that they have dared oppose him - they are judged by him to be stupid, cowardly, lacking in ambition, skills and talents, common (the worst expletive in the narcissist's vocabulary), with an unspectacular career ahead of them.

The narcissist feels that he is misallocating his scarce and invaluable resources (for instance, his time). He feels besieged and suffocated. He rebels and erupts in a serious of self-defeating and self-destructive behaviours, which lead to the disintegration of his life.

Doomed to build and ruin, attach and detach, appreciate and depreciate, the narcissist is predictable in his "death wish". What sets him apart from other suicidal types is that his wish is granted to him in small, tormenting doses throughout his anguished life.

Appendix - Custody and Visitation

A parent diagnosed with full-fledged Narcissistic Personality Disorder (NPD) should be denied custody and be granted only restricted rights of visitation under supervision.

Narcissists accord the same treatment to children and adults. They regard both as sources of narcissistic supply, mere instruments of gratification - idealize them at first and then devalue them in favour of alternative, safer and more subservient, sources. Such treatment is traumatic and can have long-lasting emotional effects.

The narcissist's inability to acknowledge and abide by the personal boundaries set by others puts the child at heightened risk of abuse - verbal, emotional, physical, and, often, sexual. His possessiveness and panoply of indiscriminate negative emotions - transformations of aggression, such as rage and envy - hinder his ability to act as a "good enough" parent. His propensities for reckless behaviour, substance abuse, and sexual deviance endanger the child's welfare, or even his or her life.

Also read

Narcissistic Parents

Beware the Children

Leveraging the Children

Tell Your Children the Truth

The Roots of Pedophilia

The Incest Taboo

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Parenthood - The Irrational Vocation

The Genetic Underpinnings of Narcissism

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The Narcissist's Mother

By: Dr. Sam Vaknin

A. The Loved Enemies - An Introduction

An oft-overlooked fact is that the child is not sure that it exists. It avidly absorbs cues from its human environment. "Am I present?", "Am I separate?", "Am I being noticed?" – these are the questions that compete in his mind with his need to merge, to become a part of his caregivers.

Granted, the infant (ages 0 to 2) does not verbally formulate these "thoughts" (which are part cognitive, part instinctual). This nagging uncertainty is more akin to a discomfort, like being thirsty or wet. The infant is torn between its need to differentiate and distinguish its self and its no less urgent urge to assimilate and integrate by being assimilated and integrated.

"Just as we know, from the point of view of the physiologist, that a child needs to be given certain foods, that he needs to be protected against extreme temperatures, and that the atmosphere he breathes has to contain sufficient oxygen, if his body is to become strong and resilient, so do we also know, from the point of view of the depth-psychologist, that he requires an empathic environment, specifically, an environment that responds (a) to his need to have his presence confirmed by the glow of parental pleasure and (b) to his need to merge into the reassuring calmness of the powerful adult, if he is to acquire a firm and resilient self."
(J. D. Levine and Rona H. Weiss. The Dynamics and Treatment of Alcoholism. Jason Aronson, 1994)

The child's nascent self must first overcome its feelings of diffusiveness, of being an extension of its caregivers (to include parents, in this text), or a part of them. Kohut says that parents perform the functions of the self for their child. More likely, a battle is joined from the child's first breath: a battle to gain autonomy, to usurp the power of the parents, to become a distinct entity.

The child refuses to let the parents continue to serve as its self. It rebels and seeks to depose them and take over their functions. The better the parents are at being self-objects (in lieu of the child's self) – the stronger the child's self becomes, the more vigorously it fights for its independence.

The parents, in this sense, are like a benign, benevolent and enlightened colonial power, which performs the tasks of governance on behalf of the uneducated and uninitiated natives. The more lenient the colonial regime – the more likely it is to be supplanted by an indigenous, successful, government.

"The crucial question then is whether the parents are able to reflect with approval at least some of the child's proudly exhibited attributes and functions, whether they are able to respond with genuine enjoyment to his budding skills, whether they are able to remain in touch with him throughout his trials and errors. And, furthermore, we must determine whether they are able to provide the child with a reliable embodiment of calmness and strength into which he can merge and with a focus for his need to find a target for his admiration. Or, stated in the obverse, it will be of crucial importance to ascertain the fact that a child could find neither confirmation of his own worth-whileness nor a target for a merger with the idealised strength of the parent and that he, therefore, remained deprived of the opportunity for the gradual transformation of these external sources of narcissistic sustenance into endopsychic resources, that is, specifically into sustaining self-esteem and into a sustaining relationship to internal ideals." [Ibid.]

B. The Narcissistic Personality

"When the habitual narcissistic gratifications that come from being adored, given special treatment, and admiring the self are threatened, the results may be depression, hypochondriasis, anxiety, shame, self-destructiveness, or rage directed toward any other person who can be blamed for the troubled situation. The child can learn to avoid these painful emotional states by acquiring a narcissistic mode of information processing. Such learning may be by trial-and-error methods, or it may be internalised by identification with parental modes of dealing with stressful information."

(Jon Mardi Horowitz. Stress Response Syndromes: PTSD, Grief and Adjustment Disorders. Third edition. New York, NY University Press, 1998)

Narcissism is fundamentally an evolved version of the psychological defence mechanism known as splitting. The narcissist does not regard people, situations, entities (political parties, countries, races, his workplace) as a compound of good and bad elements. He is an "all or nothing" primitive "machine" (a common metaphor among narcissists).

He either idealises his objects or devalues them. At any given time, the objects are either all good or all bad. The bad attributes are always projected, displaced, or otherwise externalised. The good ones are internalised in order to support the inflated ("grandiose") self-concepts of the narcissist and his grandiose fantasies and to avoid the pain of deflation and disillusionment.

The narcissist's earnestness and his (apparent) sincerity make people wonder whether he is simply detached from reality, unable to appraise it properly or willingly and knowingly distorts reality and reinterprets it, subjecting it to his self-imposed censorship. The truth is somewhere in between: the narcissist is dimly aware of the implausibility of his own constructions. He has not lost touch with reality. He is just less scrupulous in remoulding it and in ignoring its uncomfortable angles.

"The disguises are accomplished by shifting meanings and using exaggeration and minimisation of bits of reality as a nidus for fantasy elaboration. The narcissistic personality is especially vulnerable to regression to damaged or defective self-concepts on the occasions of loss of those who have functioned as self-objects. When the individual is faced with such stress events as criticism, withdrawal of praise, or humiliation, the information involved may be denied, disavowed, negated, or shifted in meaning to prevent a reactive state of rage, depression, or shame." [Ibid.]

The second psychological defence mechanism which characterizes the narcissist is the active pursuit of Narcissistic Supply. The narcissist seeks to secure a reliable and continuous supply of admiration, adulation, affirmation and attention. As opposed to common opinion (which infiltrated literature), the narcissist is content to have any kind of attention - good or bad. If fame cannot be had – notoriety would do. The narcissist is obsessed with his Narcissistic Supply, he is addicted to it. His behaviour in its pursuit is impulsive and compulsive.

"The hazard is not simply guilt because ideals have not been met. Rather, any loss of a good and coherent self-feeling is associated with intensely experienced emotions such as shame and depression, plus an anguished sense of helplessness and disorientation. To prevent this state, the narcissistic personality slides the meanings of events in order to place the self in a better light. What is good is labelled as being of the self (internalised) Those qualities that are undesirable are excluded from the self by denial of their existence, disavowal of related attitudes, externalisation, and negation of recent self-expressions. Persons who function as accessories to the self may also be idealised by exaggeration of their attributes. Those who counter the self are depreciated; ambiguous attributions of blame and a tendency to self-righteous rage states are a conspicuous aspect of this pattern.

Such fluid shifts in meanings permit the narcissistic personality to maintain apparent logical consistency while minimising evil or weakness and exaggerating innocence or control. As part of these manoeuvres, the narcissistic personality may assume attitudes of contemptuous superiority toward others, emotional coldness, or even desperately charming approaches to idealised figures." [Ibid.]

Freud versus Jung

Freud was the first to present a coherent theory of narcissism. He described transitions from subject-directed libido to object-directed libido through the intermediation and agency of the parents. To be healthy and functional, these transitions must be smooth and unperturbed. Neuroses are the outcomes of bumpy or incomplete transitions.

Freud conceived of each stage as the default (or fallback) of the next one. Thus, if a child reaches out to his objects of desire and fails to attract their love and attention, it regresses to the previous phase, to the narcissistic phase.

The first occurrence of narcissism is adaptative. It "trains" the child to love an object, albeit this object is merely his self. It secures gratification through the availability, predictability and permanence of the loved object (oneself). But regressing to "secondary narcissism" is maladaptive. It is an indication of failure to direct the libido at the "right" targets (at objects, such as the parents).

If this pattern of regression persists and prevails, it leads to a narcissistic neurosis. The narcissist stimulates his self habitually in order to derive pleasure. He prefers this mode of deriving gratification to others. He is "lazy" because he takes the "easy" route of resorting to his self and reinvesting his libidinal resources "in-house" rather than making an effort (and risking failure) to seek out libidinal objects other than his self. The narcissist prefers fantasyland to reality, grandiose self-conception to realistic appraisal, masturbation and fantasies to mature adult sex and daydreaming to real life achievements.

Jung suggested a mental picture of the psyche as a giant warehouse of archetypes (the conscious representations of adaptative behaviours). Fantasies to him are just a way of accessing these archetypes and releasing them. Almost by definition, Jungian psychology does not allow for regression.

Any reversion to earlier phases of mental life, to earlier coping strategies, or to earlier choices is interpreted by Jungians as simply the psyche's way of using yet another, hitherto untapped, adaptation strategy. Regressions are compensatory processes intended to enhance adaptation and not methods of obtaining or securing a steady flow of gratification.

It would seem, though, that there is only a semantic difference between Freud and his disciple turned-heretic. When libido investment in objects (esp. the Primary Object) fails to produce gratification, the result is maladaptation. This is dangerous and the default option - secondary narcissism - is activated.

This default enhances adaptation (is adaptative) and is functional. It triggers adaptative behaviours. As a by-product, it secures gratification. We are gratified when we exert reasonable control over our environment, i.e., when our behaviours are adaptative. Thus, the compensatory process has two results: enhanced adaptation and inevitable gratification.

Perhaps the more serious disagreement between Freud and Jung is with regards to introversion.

Freud regards introversion as an instrument in the service of a pathology (introversion is indispensable to narcissism, as opposed to extroversion which is a necessary condition for libidinal object-orientation).

As opposed to Freud, Jung regards introversion as a useful tool in the service of the psychic quest for adaptation strategies (narcissism being one of them). The Jungian adaptation repertoire does not discriminate against narcissism. To Jung it is as legitimate a choice as any.

But even Jung acknowledged that the very need to look for new adaptation strategies means that adaptation has failed. In other words, the search itself is indicative of a pathological state of affairs. It does seem that introversion per se is not pathological (because no psychological mechanism is pathological per se). Only the use made of it can be pathological. One tends to agree with Freud, though, that when introversion becomes a permanent feature of the psychic landscape of a person – it facilitates pathological narcissism.

Jung distinguished introverts (who habitually concentrate on their selves rather than on outside objects) from extroverts (the converse preference). According to him, not only is introversion a totally normal and natural function, it remains normal and natural even if it predominates one's mental life.

But surely the habitual and predominant focussing of attention upon one's self, to the exclusion of others, is the very definition of pathological narcissism. What differentiates the pathological from the normal and even the welcome is, of course, a matter of degree.

Pathological narcissism is exclusive and all-pervasive. Other forms of narcissism are not. So, although there is no healthy state of habitual, predominant introversion, it remains a question of form and degree of introversion. Often a healthy, adaptative mechanism goes awry. When it does, as Jung himself recognised, neuroses form.

Last but not least, Freud regards narcissism as a point while Jung regards it as a continuum (from health to sickness). Modern views of narcissism tend to adopt Jung's view in this respect.

Kohut's Approach

In a way, Kohut took Jung a step further. He said that pathological narcissism is not the result of excessive narcissism, libido or aggression. It is the result of defective, deformed or incomplete narcissistic (self) structures. Kohut postulated the existence of core constructs which he named the "grandiose exhibitionistic self" and the "idealised parent imago" [see below].

Children entertain notions of greatness (primitive or naive grandiosity) mingled with magical thinking, feelings of omnipotence and omniscience and a belief in their immunity to the consequences of their actions. These elements and the child's feelings regarding its parents (whom it tars with the same brush of omnipotence and grandiosity) coagulate and form these constructs.

The child's feelings towards its parents are his or her reactions to their responses (affirmation, buffering, modulation or disapproval, punishment, even abuse). These responses help maintain the self-structures. Without appropriate parental responses, infantile grandiosity, for instance, cannot be transformed into healthy adult ambitions and ideals.

To Kohut, grandiosity and idealisation are positive childhood development mechanisms. Even their reappearance in transference should not be considered a pathological narcissistic regression.

"You see, the actual issue is really a simple one … a simple change in classical [Freudian] theory, which states that autoeroticism develops into narcissism and that narcissism develops into object love … there is a contrast and opposition between narcissism and object love. The (forward) movement toward maturation was toward object love. The movement from object love toward narcissism is a (backward) regressive movement toward a fixation point. To my mind (this) viewpoint is a theory built into a non-scientific value judgement … that has nothing to do with developmental psychology."

(H. Kohut. The Chicago Institute Lectures 1972-1976. Marian and Paul Tolpin (Eds.). Analytic Press, 1998)

Kohut's contention is nothing less than revolutionary. He says that narcissism (subject-love) and object-love coexist and interact throughout life. True, they wear different guises with age and maturation – but they always cohabitate.

Kohut:

"It is not that the self-experiences are given up and replaced by … a more mature or developmentally more advanced experience of objects." [Ibid.]

This dichotomy inevitably leads to a dichotomy of disorders. Kohut agreed with Freud that neuroses are conglomerates of defence mechanisms, formations, symptoms, and unconscious conflicts. He even did not object to identifying unresolved Oedipal conflicts (ungratified unconscious wishes and their objects) as the root of neuroses. But he identified a whole new class of disorders: the self-disorders. These are the result of the perturbed development of narcissism.

It was not a cosmetic or superficial distinction. Self-disorders are the outcomes of childhood traumas very much different to Freud's Oedipal, castration and other conflicts and fears. These are the traumas of the child either not being "seen" (that is not being affirmed by objects, especially the Primary Objects, the parents) – or being regarded merely as an object for gratification or abuse.

Such children grow up to become adults who are not sure that they exist (lack a sense of self-continuity) or that they are worth anything (labile sense of self-worth and fluctuating or bipolar self-esteem). They suffer from depressions, as neurotics do. But the source of these depressions is existential (a gnawing sensation of emptiness) as opposed to the "guilty conscience" depressions of neurotics.

Such depressions: "…are interrupted by rages because things are not going their way, because responses are not forthcoming in the way they expected and needed. Some of them may even search for conflict to relieve the pain and intense suffering of the poorly established self, the pain of the discontinuous, fragmenting, undercathected self of the child not seen or responded to as a unit of its own, not recognised as an independent self who wants to feel like somebody, who wants to go its own way [see Lecture 22]. They are individuals whose disorders can be understood and treated only by taking into consideration the formative experiences in childhood of the total body-mind-self and its self-object environment – for instance, the experiences of joy of the total self feeling confirmed, which leads to pride, self-esteem, zest, and initiative; or the experiences of shame, loss of vitality, deadness, and depression of the self who does not have the feeling of being included, welcomed, and enjoyed."

(Paul and Marian Tolpin (Eds.). The Preface to the "Chicago Institute Lectures 1972-1976 of H. Kohut", 1996)

One note: "constructs" or "structures" are permanent psychological patterns. But this is not to say that they do not change, for they are capable of slow change. Kohut and his self-psychology disciples believed that the only viable constructs are comprised of self self-object experiences and that these structures are lifelong ones.

Melanie Klein believed more in archaic drives, splitting defences and archaic internal objects and part objects. Winnicott [and Balint and other, mainly British researchers] as well as other ego-psychologists thought that only infantile drive wishes and hallucinated oneness with archaic objects qualify as structures.

Karen Horney's Contributions

Horney is one of the precursors of the "object relations" school of psychodynamics. She observed that one's personality was shaped mostly by one's environment, society, or culture. She believed that one's relationships and interactions with others in one's childhood determine both the shape and functioning of one's personality.

She expanded the psychoanalytic repertoire. She added needs to drives. Where Freud believed in the exclusivity of the sex drive as an agent of transformation (to which he later added other drives) – Horney believed that people (children) needed to feel secure, to be loved, protected, emotionally nourished and so on.

She believed that the satisfaction of these needs or their frustration early in childhood are as important a determinant as any drive. Society came in through the parental door. Biology converged with social injunctions to yield human values such as the nurturance of children.

Horney's great contribution was the concept of anxiety. Freudian anxiety is a rather primitive mechanism, a reaction to imaginary threats arising from early childhood sexual conflicts. Horney argued convincingly that anxiety is a primary reaction to the child's dependence on adults for his survival.

Children are uncertain (of love, protection, nourishment, nurturance) – so they become anxious. They develop psychological defences to compensate for the intolerable and gradual realisation that adults are merely human and are, at times, capricious, arbitrary, unpredictable, unreliable. These defences provide both gratification and a sense of security. The problem of dangerous dependence still exists, but it is "one stage removed". When the defences are attacked or perceived to be attacked (such as in therapy) – anxiety is reawakened.

Karen B. Wallant in "Creating Capacity for Attachment: Treating Addictions and the Alienated Self" [Jason Aronson, 1999] wrote:

"The capacity to be alone develops out of the baby's ability to hold onto the internalisation of his mother, even during her absences. It is not just an image of mother that he retains but also her loving devotion to him. Thus, when alone, he can feel confident and secure as he continues to infuse himself with her love. The addict has had so few loving attachments in his life that when alone he is returned to his detached, alienated self. This feeling-state can be compared to a young child's fear of monsters without a powerful other to help him, the monsters continue to live somewhere within the child or his environment. It is not uncommon for patients to be found on either side of an attachment pendulum. It is invariably easier to handle patients for whom the transference erupts in the idealising attachment phase than those who view the therapist as a powerful and distrusted intruder."

So, the child learns to sacrifice a part of his autonomy and of his identity in order to feel secure.

Horney identified three neurotic strategies: submission, aggression and detachment. The choice of strategy determines the type of neurotic personality. The submissive (or compliant) type is a fake. He hides aggression beneath a facade of friendliness. The aggressive type is fake as well: at heart he is submissive. The detached neurotic withdraws from people. This cannot be considered an adaptative strategy.

Horney's is an optimistic outlook. Because biology is only one of the forces shaping our adulthood – culture and society being the predominant ones – she believes in reversibility and in the power of insight to heal. She believes that when an adult understands his problem (his anxiety), he also acquires the ability to eliminate it altogether.

Yet, clinical experience shows that childhood trauma and abuse are difficult to completely erase. Modern brain research tends to support this sad view and, yet, offer some hope. The brain seems to be more plastic than previously imagined - but no one knows when this "window of plasticity" shuts. What has been established is that the brain is physically impressed with abuse and trauma.

It is conceivable that the brain's plasticity continues well into adulthood and that later "reprogramming" (by loving, caring, compassionate and empathic experiences) can remould the brain permanently. Clearly, the patient has to accept his disorder as a given and work around it rather than confront it directly.

After all, our disorders are adaptative and help us to function. Their removal may not always be wise or necessary to attain a full and satisfactory life. We should not all conform to the same mould and experience life the same. Idiosyncrasies are a good thing, both on the individual level and on the level of the species.

C. The Issue of Separation and Individuation

It is by no means universally accepted that children go through a phase of separation from their parents and through consequent individuation. Most psychodynamic theories [especially Klein, Mahler] are virtually constructed upon this foundation. The child is considered to be merged with his parents until it differentiates itself (through object-relations).

But researchers like Daniel N. Stern dispute this hypothesis. Based on many studies, it appears that, as always, what seems intuitively right is not necessarily right.

In "The Interpersonal World of the Infant: A View from Psychoanalysis and Developmental Psychology" [New York, Basic Books – 1985], Stern seems to, inadvertently, support Kohut by concluding that children possess selves and are separate from their caregivers from the very start.

In effect, he says that the picture of the child, as proffered by psychodynamic theories, is biased by the way adults see children and childhood in retrospect. Adult disorders (for instance, the pathological need to merge) are attributed to children and to childhood.

This view is in stark contrast to the belief that children accept any kind of parents (even abusive) because they depend on them for their survival and self-definition. Attachment to and dependence on significant others is the result of the non-separateness of the child, go the classical psychodynamic/object-relations theories.

The self is a construct (in a social context, some add), an assimilation of the oft-imitated and idealised parents plus the internalisation of the way others perceive the child in social interactions. The self is, therefore, an internalised reflection, an imitation, a series of internalised idealisations. This sounds close to pathological narcissism. Perhaps it is really a matter of quantity rather than quality.

D. Childhood Traumas and the Development of the Narcissistic Personality

Traumas are inevitable. They are an integral and important part of life. But in early childhood, especially in infancy (ages 0 to 4 years), they acquire an ominous aura and an evil interpretation. No matter how innocuous the event and the surrounding circumstances, the child's vivid imagination is likely to embed it in the framework of a highly idiosyncratic horror story.

Parents sometimes have to be abxsent due to medical or economic conditions. They may be too preoccupied to stay attuned at all times to the child's emotional needs. The family unit itself may be disintegrating with looming divorce or separation. The values of the parent may stand in radical contrast to those of society.

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