Personality (Lecture 37)
Transition from Borderline Personality Disorder (BPD)
Heritability of BPD: Borderline Personality Disorder is known to be heritable, similar to normal personality constructs. * Estimates of heritability vary but are generally placed at approximately . * Development of BPD runs in families, which confirms it is familial. While familial aggregation does not inherently confirm a genetic basis, it is consistent with genetic theories of the disorder.
Neurofunctioning: Research is increasingly focusing on brain functioning in individuals with BPD. Efforts are underway to integrate knowledge of normal personality dimensions with neurofunctioning, particularly within the context of the brain's emotional and social processing centers.
Overview of Narcissistic Personality Disorder (NPD)
Definitional Disagreement: There is ongoing debate in clinical science regarding the nature of NPD: * Dimensional View: Narcissism may be an extreme expression of a dimension that exists in all people within the general population. * Disjunctive View: NPD may constitute something different and less continuous, representing a qualitative break or disjunction from normal personality domains.
Initial Presentation and Charm: Individuals with NPD are often perceived as charming or even charismatic. Unlike psychopaths, who are often described as "seductive," the narcissist’s charm can lead others to a positive initial impression without realizing the fragility lurking beneath.
Behavioral Drivers: Narcissistic individuals occupy social spaces to accomplish specific goals: * Attracting attention to themselves. * Seeking praise and acknowledgment. * Centering themselves in every discussion.
Underlying Fragility: While they appear flamboyantly grandiose on the outside, many narcissists feel internally fragile, vulnerable, brittle, or even "damaged."
The Mythological and Historical Origins of Narcissism
The Myth of Narcissus: Common interpretations focus on Narcissus being captivated by his own reflection in a pond. However, the deeper clinical problem illustrated by the myth is not mere vanity but an inability to form attachments.
Inability to Affiliate: Narcissus suffered from an inability to love or affiliate with others. He could only receive or "take" from the world; he could not give love or see himself giving love to another, which is a requirement for intimate relationships. This lack of reciprocity eventually became his downfall.
Defining Self-Absorption: While many people are self-absorbed, they are not necessarily narcissistic. Pathological narcissism is specifically defined by the inability to connect effectively with others.
Theoretical Contributions and Major Clinicians
Sigmund Freud (1914): In his paper On Narcissism, Freud described psychopathology beyond anxiety disorders. He viewed narcissism as a withdrawal of one’s connection from the outside world or a failure to ever form that connection.
Annie Reich: A psychoanalyst who contributed to the understanding of self-inflation. She viewed the inflation of self-worth as a compensatory process to manage fluctuations in self-esteem. She noted that all people experience minor self-esteem fluctuations (e.g., getting a B on a paper versus a C+), but the narcissist’s fluctuations are much more severe.
Otto Kernberg (1960s): Kernberg described a "narcissistic personality structure" as a severe and pathological form of organization. * He viewed it as infused with aggression in adulthood. * He placed NPD on a continuum of severity, specifically at the "borderline level" of personality organization.
Heinz Kohut: Based in Chicago, Kohut specialized in treating narcissistic disorders and moved away from traditional Freudian or object relations therapy to develop "self-psychology."
Alice Miller: Working in Switzerland simultaneously with Kohut, She wrote the famous book The Drama of the Gifted Child. Interestingly, though they did not communicate, Kohut and Miller developed nearly identical models of narcissism.
Psychotherapeutic Approaches and Clinical Dynamics
Self-Psychology and Transferencer: Kohut identified two primary types of dynamics that occur between a narcissistic patient and a therapist: * Idealizing Transference: The patient flatters and praises the therapist, ascribing grandiosity to them to feel special by association. * Example: A patient bragged to friends that his therapist was quoted in the New York Times, using the therapist's status to boost his own self-worth. * Mirroring Relationship: The patient wants the therapist to reflect back how great they are. They may boast about being an amazing musician or teacher, seeking the therapist’s smile and validation.
The Function of Grandiosity: According to Kohut, these behaviors are attempts to shore up a failing sense of self-esteem. By connecting with the therapist in this way, the patient feels more "cohesive," "contiguous," and safe.
Treatment Efficacy: Traditional "treatment as usual" (TAU) was historically ineffective for NPD. The innovations by Kohut, Kernberg, Miller, and Reich were revolutionary because they proved that person-centered therapy could work for this condition, though it is often a long process.
Diagnostic Frameworks: DSM and Kernberg
The DSM Model: * The American Psychiatric Association approach is deliberately atheoretical, meaning it does not subscribe to the specific developmental theories of Freud or Kohut. * Polythetic Criteria: The diagnosis is based on a collection of sampled traits across different domains (e.g., rage, attention to appearance). * Criteria: There are 9 criteria in the DSM; an individual must meet 5 or more for a diagnosis. These symptoms must cause significant distress or impairment in social, occupational, or school functioning.
Kernberg’s Classification: * Kernberg focuses on a broader frame of personality organization rather than a simple checklist. * He views NPD as moderately severe, outwardly directed (in its grandiose form), and infused with aggression. * He noted that his patients tended to be more impaired/sick than those seen by Kohut.
The Alternative Model for Personality Disorders (AMPD)
The Two-Tiered System: The AMPD moves away from categorical "boxes" to a dimensional approach. * Criterion A (General Impairment): Focuses on impairments in Self and Other functioning. * Criterion B (Trait Facets): Describes the specific "flavor" of the disorder.
Criterion A Details: * Identity: Instability in self-view; alternating between excessively elevated or degraded views. Reliance on others to sustain self-esteem. * Example: A 65-year-old man using a 22-year-old girlfriend or an expensive Porsche to "prop up" a failing sense of self. * Example: A person putting all their money into a "monster truck" to feel potent. * Self-Direction: Setting goals primarily to gain approval; a sense of entitlement or birthright to special treatment. * Example: A man in a Mercedes Benz blocking a fire zone and telling others, "Fuck you. I have a Mercedes, and you don't." * Empathy: An inability to recognize or connect with the feelings of others. They are highly attuned to others only to identify threats to their own security or status. * Example: A colleague reacting with hostility to a friend's graduation from Harvard, perceiving the friend's success as a personal slight. * Intimacy: Relationships are transactional and commerce-related, serving primarily to make the narcissist feel better.
Criterion B Trait Facets: * Grandiosity: A facet of Antagonism involving feelings of entitlement and condescension. * Attention Seeking: A facet of Antagonism involving excessive attempts to be the focus of admiration.
Subtypes: Grandiose vs. Vulnerable (Covert) Narcissism
Research by Aaron Pincus and Aiden Wright: Conducted at Penn State University, this research established that narcissism is not always about overt grandiosity.
Grandiose Narcissism: High levels of overt entitlement; when challenged, these individuals react with rage, screaming, and name-calling.
Vulnerable (Covert) Narcissism: * Fragile and quietly sensitive to perceived slights. * May appear shy, withdrawn, or insecure on the surface, but internally believe they are superior. * When challenged, they go into a "tailspin" of depression and anxiety rather than rage. * Schadenfreude: They experience secret joy in the failures of others (e.g., feeling happy when a friend fails the bar exam because it reinforces their own superiority). * Case Example: A data scientist who, after receiving minor criticism about the background color of his PowerPoint slides, felt completely idiots, went home to drink bourbon, and engaged in hours of masturbation as a developmental way to "soothe" a wounded sense of narcissism.
Malignant Narcissism and Categorical "Evil"
Definition: Malignant narcissism is considered the "worst of the worst," blending narcissistic traits with dangerous antisocial behaviors. It was described by Eric Fromm and further specialized by Otto Kernberg and Goldner.
Four Key Features: 1. Grandiosity: A near-divine sense of mission or world leadership. 2. Sadism: Deriving pleasure from inflicting pain or torture on others. 3. Aggression: A high degree of violent or hostile behavior. 4. Paranoia: The belief that there are widespread conspiracies against them.
Historical Examples: * Adolf Hitler: Perpetrated the Holocaust; his sadism was evidenced by his desire to watch films of the SS executing his instructions to go "berserk." * Joseph Stalin: Famously utilized "Tea with Stalin." If a politician was invited to tea, it was terrifying because they would either be treated as a friend or executed immediately after. * Saddam Hussein: An incredibly sadistic leader who enjoyed watching people be beaten to death. His sons were similarly sadistic; one brother beat a man to death on a wedding dance floor while Saddam simply smiled.
The Paranoia-Grandiosity Loop: These leaders often believe they are special but under constant threat. * Example: After a colonel's failed attempt to assassinate Hitler with a briefcase bomb (which hit a wooden table beam instead of Hitler), Hitler had over 1,000 people executed due to his paranoid conviction of a massive conspiracy.
Questions & Discussion
Can a narcissist truly love somebody? This is a subject of major clinical debate. Kernberg argues it is almost impossible for a truly narcissistic person to form a genuine, reciprocal bond. Others are more optimistic, suggesting it depends on the severity of the phenotype. However, relationships are typically described as transactional.
Do narcissists think they are normal? Generally, yes. They often do not see themselves as impaired; rather, they see others as the problem for not recognizing their superiority. They usually only enter therapy when they are "forced" (e.g., by a spouse threatening to leave or an employer threatening disciplinary action).
Is there a "Narcissism Epidemic"? Claims of a modern narcissism epidemic are often based on meager data. Longitudinal studies of 250 individuals through four years of college showed that narcissistic features tended to drop over time as people matured.
Why do they seek attention? Sometimes they surround themselves with high-status people to feel important. * Example: Jeffrey Epstein sought out powerful and intellectual people at Harvard and reportedly wanted a Harvard sweatshirt to signal his association with the institution.
Physical Appearance: Narcissists are often preoccupied with their appearance (e.g., "lookmaxxing" or changing bone structure). * Example: A PI in an elevator demanding guests admire his "coolest effing sneakers" while ignoring the guest's presence entirely.