Highway to Hell Part 1: ...no this is not about religion. A 3 part blog on NPD

When starting to write this blog I was trying to think of a good song title to go with the topic of narcissistic personality disorder (NPD). I think Highway to Hell is perfect! I think most people who have left any kind of NPD relationship would agree with me on that. NPD, like most other personality disorders, are extremely difficult to understand and navigate through. You may feel like you are in a catch 22 at times, struggling to maintain your love for this person, wanting to stay in the relationship, but seeing more and more abusiveness as time goes on. Some people state they no longer recognized who they were or were on the way to losing their own identity. Not surprising given the fact that an individual in a relationship with someone who has NPD has most likely been bending over backwards to fulfill all the NPD’s needs and desires, as well as to keep the peace. But, that does not describe a healthy relationship. And that is no kind of life for anyone to live.

Before we dive into more about NPD, let’s talk about the term narcissism. In today’s world I would be shocked if anyone said they had never heard of narcissism. The term is used everywhere and is wielded like a sharp sword on anyone who looks slightly as though they are into themselves or proud of their accomplishments even. But, do any of those or other similar factors make someone diagnosable with NPD? Maybe, maybe not.

The word narcissism comes from the myth of narcissus. You can read the entire history of it here. Basically, Narcissus was in love with himself. He would look at his reflection in the water and just admire how he looked. What people often can miss in the myth is the other character… Echo. Echo absolutely loved Narcissus, but was rejected. She was extremely loyal and eventually become nothing more than a whisper. Narcissus stared at his reflection until he died.

What parallels and metaphors do we see in this story? No this is not an English lit lesson, but that schooling would come in handy now (ha, ha). Let’s start with Narcissus staring at himself. Self-admiration. This is something listed in the symptomology for NPD in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM). We will discuss that symptomology shortly. Echo represents what one LMFT calls “the pathologically nice person.” You can learn more about his podcast Waking up to Narcissism here. Echo loves him, is super loyal to him, but is constantly neglected emotionally, physically and mentally, and is rejected. She gives so much of herself to him that who she is in the end is only a fragment of what she could have become. The last metaphor/parallel I would like to draw from this myth is the death of Narcissus. The idea that he constantly just looked at himself parallels what we see in many people with NPD today in terms of selfishness and fantasy.

Often with NPD a fantasy is constructed from many, many lies the NPD individual has to tell people to “keep up appearances” so to speak. When someone lives in their head so often (self-admiration, depression), has a demanding desire for admiration and wants (what we call supply), and tops all that off with near never-ending lies (manipulation is included in this), what we end up with is an individual who is not truly present in reality. Rather he or she lives in the fantasy world the lies created. At that point, can we truly say they are living? Probably not. Relationships no longer exist. Instead of relationships the NPD person attaches to supplies – individuals who will fulfill what the NPD person feels he or she is needing or wanting.

Merriam-Webster Dictionary defines narcissism firstly as egocentrism, among other definitions. Other definitions aside for the purposes of this section, egocentrism seems to be diagnosed unto other individuals easily these days. This “diagnosis” then gets followed up with the idea that the person being “diagnosed” with having a big ego must be a narcissist. Pull the reins back on that please! Us in the mental health profession are begging people to stop diagnosing themselves and others. It’s important for everyone to be aware that just by being a human being we all have a little narcissism in us. For example, do you ever look in the mirror to make sure you “look the part?” Have you ever taken a significant number of selfies? Did you ever make a choice simply because it benefitted you, regardless of the consequences to someone else? Have you ever lied to continue doing something YOU wanted to do? We all have! This does NOT make someone a narcissist and it definitely does not mean that person has NPD. With that being said, let’s look at what the DSM says about NPD.

The DSM is authored by the American Psychiatric Association with the 5th edition being printed in 2013. It outlines various mental health disorders, issues, and illnesses with NPD being part of the section labeled “Personality Disorders.” In this section 10 different personality disorders are outlined, with two more diagnoses involving medical conditions and unspecified personality disorder issues. NPD has a list of 9 symptoms of which 5 must be met and present from early adulthood as well as present in various contexts (e.g. work, school, family, etc.). The DSM section sums up each personality disorder and for NPD states “Narcissistic personality disorder is a pattern of grandiosity, need for admiration, and lack of empathy.” (p. 645) In addition to these general symptoms, there are at least 20 more specific behaviors that NPD persons exhibit as a whole or mostly. The behaviors occur with more frequency and more severity over time as well. Finally, just to complicate the idea of diagnosis, most people with a personality disorder will show symptoms from other personality disorders.

What does all of this information tell us? First, it takes a true mental health professional to accurately diagnose NPD. Second, if someone you know exhibits concerning behaviors related to NPD it would be wise to seek therapy for yourself. Most people with NPD do not come to therapy, and when they do come it does not last long as they do not believe anything is wrong with them and tend to tell the therapist exactly what they believe the therapist wants to hear. Therapy in the context of an NPD relationship exists for those in the relationship with the NPD person as the goal is to help understand, emotionally process, and manage that relationship or even end it if the person feels it is necessary.

In the next part of this blog about NPD, we will talk about what NPD can look like to someone in a relationship with the NPD person, as well as NPD abuse and how it affects the victim(s).

Reference:

American Psychiatric Association: Diagnostic Statistical Manual of Mental Disorder, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.