Wednesday, December 15, 2010

Today's Observation

There was very little interaction between Edna and Julie today.  Julie was extremely busy when Edna came into the office.  Julie stopped what she was doing for only a few minutes when some paperwork was apparently missing from the safe then continued with her project.  When Edna began complaining Julie simply ignored her and Edna left the office.

Excerpts from Sam Vaknin - "Malignant Self-Love: Narcissism Revisited"

"Narcissists and psychopaths lack empathy. This deficiency renders them emotionally and cognitively crippled. They exploit, manipulate, and abuse other people because they are unable to relate to them otherwise.

The somatic narcissist flaunts his sexual conquests, parades his possessions, exhibits his muscles, brags about his physical aesthetics or sexual prowess or exploits, is often a health freak and a hypochondriac. The cerebral narcissist is a know-it-all, haughty and intelligent "computer". He uses his awesome intellect, or knowledge (real or pretended) to secure adoration, adulation and admiration. To him, his body and its maintenance are a burden and a distraction.

Narcissists cheat on their spouses, commit adultery and have extramarital affairs and liaisons for a variety of reasons which reflect disparate psychodynamic processes.

Narcissists are clustered and over-represented in certain professions: teaching, the clergy, show business, corporate management, the medical professions, the military, law enforcement agencies, politics, and sports. It is safe to predict that narcissists would be over-represented in these occupations.

The False Self is a decoy, it "attracts the fire". It is a proxy for the True Self. It is tough as nails and can absorb any amount of pain, hurt and negative emotions. By inventing it, the child develops immunity to the indifference, manipulation, sadism, smothering, or exploitation -- in short: to the abuse -- inflicted on him by his parents (or by other Primary Objects in his life). It is a cloak, a Harry Potter-like contraption, protecting the narcissist and rendering him invisible and omnipotent at the same time.

God is everything the narcissist ever wants to be: omnipotent, omniscient, omnipresent, admired, much discussed, and awe inspiring. God is the narcissist's wet dream, his ultimate grandiose fantasy. But God comes handy in other ways as well.

The narcissist is able to tell right from wrong and to distinguish between good and evil. In the pursuit of his interests and causes, he sometimes chooses to act wickedly. Lacking empathy, the narcissist is rarely remorseful. Because he feels entitled, exploiting others is second nature. The narcissist abuses others absent-mindedly, off-handedly, as a matter of fact.

Is pathological narcissism the outcome of inherited traits - or the sad result of abusive and traumatizing upbringing? Or, maybe it is the confluence of both? It is a common occurrence, after all, that, in the same family, with the same set of parents and an identical emotional environment - some siblings grow to be malignant narcissists, while others are perfectly "normal". Surely, this indicates a predisposition of some people to developing narcissism, a part of one's genetic heritage.

Narcissistic bosses and employers forever shift the blame, pass the buck, and engage in cognitive dissonance. They "pathologize" the other, foster feelings of guilt and shame in her, demean, debase and humiliate in order to preserve their sense of superiority.

As opposed to most narcissists, psychopaths are either unable or unwilling to control their impulses or to delay gratification. They use their rage to control people and manipulate them into submission. Psychopaths, like narcissists, lack empathy but many of them are also sadistic: they take pleasure in inflicting pain on their victims or in deceiving them. They even find it funny!

Many abusers have a specific body language. It comprises an unequivocal series of subtle -- but discernible -- warning signs. Pay attention to the way your date comports himself -- and save yourself a lot of trouble!

Is there anything you can do to avoid abusers and narcissists to start with? Are there any warning signs, any identifying marks, rules of thumb to shield you from the harrowing and traumatic experience of an abusive relationship? Imagine a first or second date. You can already tell if he is a would-be abuser.

Abuse in relationships has many guises: gaslighting (ambient), overt, covert, by proxy, Emotional, Verbal, and Psychological Abuse, Domestic and Family Violence and Spousal Abuse.

To "qualify" as an inverted narcissist, you must CRAVE to be in a relationship with a narcissist, regardless of any abuse inflicted on you by him/her. You must ACTIVELY seek relationships with narcissists and ONLY with narcissists, no matter what your (bitter and traumatic) past experience has been. You must feel EMPTY and UNHAPPY in relationships with ANY OTHER kind of person. Only then, and if you satisfy the other diagnostic criteria of a Dependent Personality Disorder, can you be safely labelled an "inverted narcissist".

The Primary Narcissistic Supply is attention, in both its public forms (fame, notoriety, infamy, celebrity) and its private, interpersonal, forms (adoration, adulation, applause, fear, repulsion). It is important to understand that attention of any kind -- positive or negative -- constitutes Primary Narcissistic Supply. Infamy is as sought after as fame, being notorious is as good as being renowned.

Asperger's Disorder is often misdiagnosed as Narcissistic Personality Disorder (NPD). In both cases, the patient is self-centered and engrossed in a narrow range of interests and activities. Social and occupational interactions are severely hampered and conversational skills (the give and take of verbal intercourse) are primitive. The Asperger's patient body language - eye to eye gaze, body posture, facial expressions - is constricted and artificial, akin to the narcissist's. Nonverbal cues are virtually absent and their interpretation in others lacking.

The manic phase of Bipolar I Disorder is often misdiagnosed as Narcissistic Personality Disorder (NPD). Bipolar patients in the manic phase exhibit many of the signs and symptoms of pathological narcissism - hyperactivity, self-centeredness, lack of empathy, and control freakery. During this recurring chapter of the disease, the patient is euphoric, has grandiose fantasies, spins unrealistic schemes, and has frequent rage attacks (is irritable) if her or his wishes and plans are (inevitably) frustrated.

Ambient abuse is the stealth, subtle, underground currents of maltreatment that sometimes go unnoticed even by the victims themselves, until it is too late. Ambient abuse penetrates and permeates everything -- but is difficult to pinpoint and identify. It is ambiguous, atmospheric, diffuse. Hence its insidious and pernicious effects. It is by far the most dangerous kind of abuse there is. It is the outcome of fear -- fear of violence, fear of the unknown, fear of the unpredictable, the capricious, and the arbitrary. It is perpetrated by dropping subtle hints, by disorienting, by constant -- and unnecessary -- lying, by persistent doubting and demeaning, and by inspiring an air of unmitigated gloom and doom ("gaslighting").

Contrary to popular misconceptions, Post-Traumatic Stress Disorder (PTSD) and Acute Stress Disorder (or Reaction) are not typical responses to prolonged abuse. They are the outcomes of sudden exposure to severe or extreme stressors (stressful events). Yet, some victims whose life or body have been directly and unequivocally threatened by an abuser react by developing these syndromes. PTSD is, therefore, typically associated with the aftermath of physical and sexual abuse in both children and adults.

The erotomaniac stalker believes that he is in love with you. To show his keen interest, he keeps calling you, dropping by, writing e-mails, doing unsolicited errands "on your behalf", talking to your friends, co-workers, and family, and, in general, making himself available at all times. The erotomaniac feels free to make for you legal, financial, and emotional decisions and to commit you without your express consent or even knowledge.

The narcissist is the guru at the centre of a cult. Like other gurus, he demands complete obedience from his flock: his spouse, his offspring, other family members, friends, and colleagues. He feels entitled to adulation and special treatment by his followers. He punishes the wayward and the straying lambs. He enforces discipline, adherence to his teachings, and common goals. The less accomplished he is in reality -- the more stringent his mastery and the more pervasive the brainwashing.

The narcissist is a partial adult. He seeks to avoid adulthood. Infantilisation -- the discrepancy between one's advanced chronological age and one's retarded behaviour, cognition, and emotional development -- is the narcissist's preferred art form. Some narcissists even use a childish tone of voice occasionally and adopt a toddler's body language.

The unpalatable truth is that falling in love is, in some ways, indistinguishable from a severe pathology. Behavior changes are reminiscent of psychosis and, biochemically speaking, passionate love closely imitates substance abuse. Appearing in the BBC series Body Hits on December 4, 2002 Dr. John Marsden, the head of the British National Addiction Center, said that love is addictive, akin to cocaine and speed. Sex is a "booby trap", intended to bind the partners long enough to bond.

The narcissistic or psychopathic leader is the culmination and reification of his period, culture, and civilization. He is likely to rise to prominence in narcissistic societies. The leader's mental health pathologies resonate with the anomies of his society and culture ("psychopathological resonance".) The leader and the led form a self-enhancing and self-reinforcing feedback loop, a dyad of mirrored adoration and reflected love. By elevating and idealizing their "fuehrer", the mob actually elevates and idealizes itself; in his ascendance they find hope, in his manifest illness -- curative solace and a legitimation of their own collective insanity.

Pathological narcissism is an addiction to Narcissistic Supply, the narcissist's drug of choice. It is, therefore, not surprising that other addictive and reckless behaviours -- workaholism, alcoholism, drug abuse, pathological gambling, compulsory shopping, or reckless driving -- piggyback on this primary dependence.

To the narcissist, the Internet is an alluring and irresistible combination of playground and hunting grounds, the gathering place of numerous potential Sources of Narcissistic Supply, a world where false identities are the norm and mind games the bon ton. And it is beyond the reach of the law, the pale of social norms, the strictures of civilized conduct. The somatic finds cyber-sex and cyber-relationships aplenty. The cerebral claims false accomplishments, fake skills, erudition and talents. Both, if minimally communicative, end up at the instantly gratifying epicenter of a cult of fans, followers, stalkers, erotomaniacs, denigrators, and plain nuts. The constant attention and attendant quasi-celebrity feed and sustain their grandiose fantasies and inflated self-image.

The sexuality of the serial, psychopathic, killer is self-directed. His victims are props, extensions, aides, objects, and symbols. He interacts with them ritually and, either before or after the act, transforms his diseased inner dialog into a self-consistent extraneous catechism. The narcissist is equally auto-erotic. In the sexual act, he merely masturbates with other - living - people's bodies.

Raging narcissists usually perceive their reaction to have been triggered by an intentional provocation with a hostile purpose. Their targets, on the other hand, invariably regard raging narcissists as incoherent, unjust, and arbitrary.

Repeated abuse has long lasting pernicious and traumatic effects such as panic attacks, hypervigilance, sleep disturbances, flashbacks (intrusive memories), suicidal ideation, and psychosomatic symptoms. The victims experience shame, depression, anxiety, embarrassment, guilt, humiliation, abandonment, and an enhanced sense of vulnerability.

Perhaps the most immediately evident trait of patients with Narcissistic Personality Disorder (NPD) is their vulnerability to criticism and disagreement. Subject to negative input, real or imagined, even to a mild rebuke, a constructive suggestion, or an offer to help, they feel injured, humiliated and empty and they react with disdain (devaluation), rage, and defiance.

According to the DSM IV-TR, Narcissistic Personality Disorder (NPD) is diagnosed in between 2% and 16% of the population in clinical settings (between 0.5-1% of the general population). The DSM-IV-TR proceeds to tell us that most narcissists (50-75% of all patients) are men. Narcissistic Personality Disorder (NPD) is often diagnosed with other mental health disorders ("co-morbidity"), such as mood disorders, eating disorders, and substance-related disorders. Patients with Narcissistic Personality Disorder (NPD) are frequently abusive and prone to impulsive and reckless behaviours ("dual diagnosis").

The Diagnostic and Statistical Manual (DSM-IV-TR, 2000) defines Narcissistic Personality Disorder (NPD) as "an all-pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts", such as family life and work.

Pathological charmers react with rage and aggression when their intended targets prove to be impervious and resistant to their lure. This kind of narcissistic injury -- being spurned and rebuffed -- makes them feel threatened, rejected, and denuded.

The narcissist is besieged and tormented by a sadistic Superego which sits in constant judgement. It is an amalgamation of negative evaluations, criticisms, angry or disappointed voices, and disparagement meted out in the narcissist's formative years and adolescence by parents, peers, role models, and authority figures.

Narcissists can't empathise or love and, therefore, have no friends. The narcissist is one track minded. He is interested in securing Narcissistic Supply from Narcissistic Supply Sources. He is not interested in people as such. He is incapable of empathising, is a solipsist, and recognises only himself as human. To the narcissist, all others are three dimensional cartoons, tools and instruments in the tedious and Sisyphean task of generating and consuming Narcissistic Supply.

Many scholars consider pathological narcissism to be a form of depressive illness. This is the position of the authoritative magazine "Psychology Today". The life of the typical narcissist is, indeed, punctuated with recurrent bouts of dysphoria (ubiquitous sadness and hopelessness), anhedonia (loss of the ability to feel pleasure), and clinical forms of depression (cyclothymic, dysthymic, or other).

The narcissist needs his parents alive mostly in order to get back at them, to accuse and punish them for what they have done to him. This attempt at reciprocity ("settling the scores") represents to him justice and order, it introduces sense and logic into an otherwise totally chaotic mental landscape. It is a triumph of right over wrong, weak over strong, law and order over chaos and capriciousness. The demise of his parents is perceived by him to be a cosmic joke at his expense. He feels "stuck" for the rest of his life with the consequences of events and behaviour not of his own doing or fault. The villains evade responsibility by leaving the stage, ignoring the script and the director's (the narcissist's) orders.

The Narcissist says: Children, to me, are both mirrors and competitors. They reflect authentically my constant need for adulation and attention. Their grandiose fantasies of omnipotence and omniscience are crass caricatures of my internal world. The way they abuse others and mistreat them hits close to home. Their innocuous charm, their endless curiosity, their fount of energy, their sulking, nagging, boasting, bragging, lying, and manipulating are mutations of my own behaviour. I recognize my thwarted self in them. When they make their entrance, all attention is diverted. Their fantasies endear them to their listeners. Their vainglorious swagger often causes smiles. Their trite stupidities are invariably treated as pearls of wisdom. Their nagging is yielded to, their threats provoke to action, their needs accommodated urgently. I stand aside, an abandoned centre of attention, the dormant eye of an intellectual storm, all but ignored and neglected. I watch the child with envy, with rage, with wrath. I hate its effortless ability to defeat me.

The abuser often recruits his children to do his bidding. He uses them to tempt, convince, communicate, threaten, and otherwise manipulate his target, the children's other parent or a devoted relative (e.g., grandparents). He controls his - often gullible and unsuspecting - offspring exactly as he plans to control his ultimate prey. He employs the same mechanisms and devices. And he dumps his props unceremoniously when the job is done - which causes tremendous (and, typically, irreversible) emotional hurt.

Children have a right to know the overall state of affairs between their parents. They have a right not to be cheated and deluded into thinking that "everything is basically OK" -- or that the separation is reversible. Both parents are under a moral obligation to tell their offspring the truth: the relationship is over for good. A responsible parent should teach the child how to resist inappropriate and hurtful actions. The child should be brought up to insist on being respected by the other parent, on having him or her observe the child's boundaries and accept the child's needs and emotions, choices, and preferences. The child should learn to say "no" and to walk away from potentially compromising situations with the abusive parent. The child should be brought up not to feel guilty for protecting himself or herself and for demanding his or her rights.

It has become fashionable to castigate Twitter - the microblogging service - as an expression of rampant narcissism. Yet, narcissists are verbose and they do not take kindly to limitations imposed on them by third parties. They feel entitled to special treatment and are rebellious. They are enamored with their own voice. Thus, rather than gratify the average narcissist and provide him or her with narcissistic supply (attention, adulation, affirmation), Twitter is actually liable to cause narcissistic injury.

Anxiety Disorders -- and especially Generalised Anxiety Disorder (GAD) -- are often misdiagnosed as Narcissistic Personality Disorder (NPD).

Anxiety is uncontrollable and excessive apprehension. Anxiety disorders usually come replete with obsessive thoughts, compulsive and ritualistic acts, restlessness, fatigue, irritability, difficulty concentrating, and somatic manifestations (such as an increased heart rate, sweating, or, in Panic Attacks, chest pains).

Pathological narcissism can be induced in adulthood by celebrity, wealth, and fame. The "victims" - billionaire tycoons, movie stars, renowned authors, politicians, and other authority figures - develop grandiose fantasies, lose their erstwhile ability to empathize, react with rage to slights, both real and imagined and, in general, act like textbook narcissists.

Three traits conspire to render the narcissist a failure and a loser: his sense of entitlement, his haughtiness and innate conviction of his own superiority, and his aversion to routine. The narcissist's sense of entitlement encourages his indolence. He firmly believes that he should be spoon-fed and that accomplishments and honors should be handed to him on a silver platter, without any commensurate effort on his part. His mere existence justifies such exceptional treatment. Many narcissists are under-qualified and lack skills because they can't be bothered with the minutia of obtaining an academic degree, professional training, or exams. The narcissist's arrogance and belief that he is superior to others, whom he typically holds in contempt - in other words: the narcissist's grandiose fantasies - hamper his ability to function in society. The cumulative outcomes of this social dysfunction gradually transform him into a recluse and an outcast. He is shunned by colleagues, employers, neighbors, erstwhile friends, and, finally, even by long-suffering family members who tire of his tirades and rants.

Victims of abuse are saddled with emotional baggage which often provokes even in the most experienced therapists reactions of helplessness, rage, fear and guilt. Countertransference is common: therapists of both genders identify with the victim and resent her for making them feel impotent and inadequate (for instance, in their role as "social protectors"). Reportedly, to fend off anxiety and a sense of vulnerability ("it could have been me, sitting there!"), female therapists involuntarily blame the "spineless" victim and her poor judgement for causing the abuse. Some female therapists concentrate on the victim's childhood (rather than her harrowing present) or accuse her of overreacting.

Why do good people - church-goers, pillars of the community, the salt of the earth - ignore abuse and neglect, even when it is on their doorstep and in their proverbial backyard (for instance, in families, hospitals, orphanages, shelters, prisons, and the like)?

The Grandiosity Gap (between a fantastically grandiose - and unlimited - self-image and actual - limited - accomplishments and achievements) is grating. Its recurrence threatens the precariously balanced house of cards that is the narcissistic personality. The narcissist finds, to his chagrin, that people out there are much less admiring, accommodating and accepting than his parents. As he grows old, the narcissist often become the target of constant derision and mockery, a sorry sight indeed. His claims for superiority appear less plausible and substantial the more and the longer he makes them. The narcissist then resorts to self-delusion. Unable to completely ignore contrarian opinion and data - he transmutes them. Unable to face the dismal failure that he is, the narcissist partially withdraws from reality. To soothe and salve the pain of disillusionment, he administers to his aching soul a mixture of lies, distortions, half-truths and outlandish interpretations of events around him.

The narcissist ages without mercy and without grace. His withered body and his overwrought mind betray him all at once. He stares with incredulity and rage at cruel mirrors. He refuses to accept his growing fallibility. He rebels against his decrepitude and mediocrity. Accustomed to being awe-inspiring and the recipient of adulation - the narcissist cannot countenance his social isolation and the pathetic figure that he cuts.

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.

The outcomes of various tests must fit in with each other. Put together, they must provide a consistent and coherent picture. If one test yields readings that are constantly at odds with the conclusions of other questionnaires or interviews, it may not be valid. In other words, it may not be measuring what it claims to be measuring. Thus, a test quantifying one's grandiosity must conform to the scores of tests which measure reluctance to admit failings or propensity to present a socially desirable and inflated facade ("False Self"). If a grandiosity test is positively related to irrelevant, conceptually independent traits, such as intelligence or depression, it does not render it valid. Most tests are either objective or projective.

The PCL-R is based on a structured interview and collateral data gathered from family, friends, and colleagues and from documents. The questions comprising the structured interview are so transparent and self-evident that it is easy to lie one's way through the test and completely skew its results. Moreover, scoring by the diagnostician is highly subjective (which is why the DSM and the ICD stick to observable behaviours in its criteria for Antisocial or Dissocial Personality Disorder). The hope is that information gathered outside the scope of the structured interview will serve to rectify such potential abuse, diagnostic bias, and manipulation by both testee and tester. The PCL-R, in other words, relies on the truthfulness of responses provided by notorious liars (psychopaths) and on the biased memories of multiple witnesses, all of them close to the psychopath and with an axe to grind.

Some narcissists are ostentatiously generous -- they donate to charity, lavish gifts on their closest, abundantly provide for their nearest and dearest, and, in general, are open-handed and unstintingly benevolent. How can this be reconciled with the pronounced lack of empathy and with the pernicious self-preoccupation that is so typical of narcissists? The act of giving enhances the narcissist's sense of omnipotence, his fantastic grandiosity, and the contempt he holds for others. It is easy to feel superior to the supplicating recipients of one's largesse. Narcissistic altruism is about exerting control and maintaining it by fostering dependence in the beneficiaries.

So, you go back to your "relationship" and hope for a better ending. You walk on eggshells. You become the epitome of submissiveness, a perfect Source of Narcissistic Supply, the ideal mate or spouse or partner or colleague. You keep your fingers crossed. But how does the narcissist react to the resurrection of the bond?

Some people adopt the role of a professional victim. In doing so, they become self-centred, devoid of empathy, abusive, and exploitative. In other words, they become narcissists. The role of "professional victims" - people whose existence and very identity rests solely and entirely on their victimhood - is well researched in victimology. It doesn't make for a nice reading. These victim "pros" are often more cruel, vengeful, vitriolic, lacking in compassion and violent than their abusers. They make a career of it. They identify with this role to the exclusion of all else. It is a danger to be avoided. And this is precisely what I call "Narcissistic Contagion" or "Narcissism by Proxy".

Two narcissists of the same type (somatic, cerebral, classic, compensatory, inverted, etc.) cannot maintain a stable, long-term full-fledged, and functional relationship. But if the narcissists involved are of different types, if one of them is cerebral and the other one somatic, a long-term partnership based on the mutual provision of Narcissistic Supply can definitely survive.

Narcissistic Supply is exciting. When it is available, the narcissist feels elated, omnipotent, omniscient, handsome, sexy, adventurous, invincible, and irresistible. When it is missing, the narcissist first enters a manic phase of trying to replenish his supply and, if he fails, the narcissist shrivels, withdraws and is reduced to a zombie-like state of numbness. Some people -- and all narcissists -- are addicted to excitement, to the adrenaline rush, to the danger inevitably and invariably involved. They are the adrenaline junkies. All narcissists are adrenaline junkies -- but not all adrenaline junkies are narcissists.

The irony is that narcissists, who consider themselves worldly, discerning, knowledgeable, shrewd, erudite, and astute - are actually more gullible than the average person. This is because they are fake. Their self is false, their life a confabulation, their reality test gone. They live in a fantasy land all their own in which they are the center of the universe, admired, feared, held in awe, and respected for their omnipotence and omniscience. Narcissists are prone to magical thinking. They hold themselves immune to the consequences of their actions (or inaction) and, therefore, beyond punishment and the laws of Man. Narcissists are easily persuaded to assume unreasonable risks and expect miracles to happen. They often find themselves on the receiving end of investment scams, for instance.

Most spree shooters are loners. They are either schizoid (with deficient interpersonal skills) or paranoid and even paranoid-schizophrenic (psychotic, delusional). Their dysfunction is all-pervasive: their family life, career, romantic relationships, professional and material accomplishments are all adversely affected by their mental mayhem. They feel excluded and shunned and are profoundly ashamed of and frustrated with their inadequacies and with their sadistic, self-destructive, suicidal, and self-defeating "inner judge" (inner, introjected "voices" or narrative). This frustration builds up and results in pent-up aggression which ultimately manifests as furious, uncontrollable rage. The typical spree shooter is in love with all things violent: guns, the military, police work, virulent racism, and crime.

Adolescents who are consistently mocked and bullied by peers, role models, and socialization agents (such as teachers, coaches, and parents) are prone to find succor in grandiose fantasies of omnipotence and omniscience. To sustain these personal myths, they may resort to violence and counter-bullying. The same applies to youths who feel deprived, underestimated, discriminated against, or at a dead end. They are likely to evoke narcissistic defenses to fend off the constant hurt and to achieve self-sufficient and self-contained emotional gratification.

The way the narcissist experiences his life is akin to watching a movie, the illusion is not complete, neither is it precise. This detachment continues for as long as the narcissist's ego-dystonic behaviour persists, for as long as the crisis goes on, for as long as the narcissist cannot face who he is, what he is doing and the consequences of his actions. Since this is the case most of the time, the narcissist gets used to seeing himself in the role of the protagonist (usually the hero) of a motion picture or of a novel. It also sits well with his grandiosity and fantasies. Sometimes, he talks about himself in the third person singular. Sometimes he calls his "other", narcissistic, self by a different name.

He looks completely puzzled and disdainful when I ask him why he did what he did. "For the money, of course" - he blurts out impatiently and then recomposes himself: "Had this panned out, these guys would have had a great retirement, far better than their meager and laughable pensions could provide." Can he describe his typical "customer"? Of course he can - he is nothing if not thorough. He provides me with a litany of detailed demographics. No, I say - I am interested to know about their wishes, hopes, needs, fears, backgrounds, families, emotions. He is stumped for a moment: "Why would I want to know these data? It's not like I was their bloody grandson, or something!"

He is married but sexually inactive. Sex bores him and he regards it as a "low-level" activity practiced by "empty-headed" folk. He has better uses for his limited time. He is aware of his own mortality and conscious of his intellectual legacy. Hence his sense of entitlement. He never goes through established channels. Instead, he uses his connections to secure anything from medical care to car repair. He expects to be treated by the best but is reluctant to buy their services, holding himself to be their equal in his own field of activity. He gives little or no thought to the needs, wishes, fears, hopes, priorities, and choices of his nearest and dearest. He is startled and hurt when they become assertive and exercise their personal autonomy (for instance, by setting boundaries).

There are two differences between healthy self-love and pathological narcissism: (a) in the ability to tell reality from fantasy, and (b) in the ability to empathise and, indeed, to fully and maturely love others. As we said, the narcissist does not love himself. It is because he has very little True Self to love. Instead, a monstrous, malignant construct -- the False Self -- encroaches upon his True Self and devours it. The narcissist loves an image which he projects onto others who reflect it to the narcissist (the False Self). This process reassures the narcissist of both the objective existence of his False Self and of the boundaries of his Ego. It blurs all distinctions between reality and fantasy.

The narcissist often has rage attacks and grandiose fantasies. Most narcissists are also mildly obsessive-compulsive. Yet, all narcissists should be held accountable to the vast and overwhelming majority of their actions.  At all times, even during the worst explosive episode, the narcissist can tell right from wrong and reign in their impulses. The narcissist's impulse control is unimpaired, though he may pretend otherwise in order to terrorize, manipulate and coerce his human environment into compliance.

Normally, one's energy is expended on the proper functioning of one's personality. The personality disordered devote any shred of vitality to the projection and maintenance of a False Self, whose sole purpose is to elicit attention, admiration, approval, acknowledgement, fear, or adulation from others. The Narcissistic Supply thus obtained helps these unfortunates to calibrate a wildly fluctuating self-esteem and, thus, fulfils critical ego functions.

Syphilis is a venereal (sexually transmitted) disease. It has a few stages and involves unpleasant phenomena such as lesions and skin eruptions. Syphilis can go dormant (latent) for years or even decades before it affects the brain in a condition known as general paresis. Brain tissue is gradually destroyed by the tiny organisms that cause syphilis, the spirochetes. This progressive devastation causes mania, dementia, megalomania (delusions of grandeur), and paranoia. Even when its existence is suspected, syphilis is difficult to diagnose. Most mental health clinicians are unlikely to try to rule it out. Syphilis in its tertiary (brain consuming) phase produces symptoms that are easily misdiagnosed as Bipolar Disorder combined with the Narcissistic and the Paranoid Personality Disorders.

The codependent molds himself/herself and bends over backward to cater to the needs of his nearest and dearest and satisfy their every whim, wish, expectation, and demand. Nothing is too unpleasant or unacceptable if it serves to secure the uninterrupted presence of the codependent's family and friends and the emotional sustenance s/he can extract (or extort) from them.

The codependent does not feel fully alive when alone. S/he feels helpless, threatened, ill-at-ease, and child-like. This acute discomfort drives the codependent to hop from one relationship to another. The sources of nurturance are interchangeable. To the codependent, being with someone, with anyone, no matter whom - is always preferable to solitude.

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 - from emotional incest and 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.

To all appearances, the compulsive giver is an altruistic, empathic, and caring person. Actually, he or she is a people-pleaser and a codependent. The compulsive giver is trapped in a narrative of his own confabulation: how his nearest and dearest need him because they are poor, young, inexperienced, lacking in intelligence or good looks, and are otherwise inferior to him. Compulsive giving, therefore, involves pathological narcissism. In reality, it is the compulsive giver who coerces, cajoles, and tempts people around him to avail themselves of his services or money. He forces himself on the recipients of his ostentatious largesse and the beneficiaries of his generosity or magnanimity. He is unable to deny anyone their wishes or a requests, even when these are not explicit or expressed and are mere figments of his own neediness and grandiose imagination.

Early on in life, the narcissist learns to disguise his socially-unacceptable indifference as benevolence, equanimity, cool-headedness, composure, or superiority. "It is not that I don't care about others" -- he shrugs off his critics -- "I am simply more level-headed, more resilient, more composed under pressure... They mistake my equanimity for apathy." The narcissist tries to convince people that he is compassionate. His profound lack of interest in his spouse's life, vocation, interests, hobbies, and whereabouts he cloaks as benevolent altruism. "I give her all the freedom she can wish for!" -- he protests -- "I don't spy on her, follow her, or nag her with endless questions. I don't bother her. I let her lead her life the way she sees fit and don't interfere in her affairs!" He makes a virtue out of his emotional truancy. All very commendable but when taken to extremes such benign neglect turns malignant and signifies the voidance of true love and attachment. The narcissist's emotional (and, often, physical) absence from all his relationships is a form of aggression and a defence against his own thoroughly repressed feelings.

As Horney pointed out, the child-prodigy is dehumanised and instrumentalised. His parents love him not for what he really is -- but for what they wish and imagine him to be: the fulfilment of their dreams and frustrated wishes. The child becomes the vessel of his parents' discontented lives, a tool, the magic brush with which they can transform their failures into successes, their humiliation into victory, their frustrations into happiness. The child is taught to ignore reality and to occupy the parental fantastic space. Such an unfortunate child feels omnipotent and omniscient, perfect and brilliant, worthy of adoration and entitled to special treatment. The faculties that are honed by constantly brushing against bruising reality -- empathy, compassion, a realistic assessment of one's abilities and limitations, realistic expectations of oneself and of others, personal boundaries, team work, social skills, perseverance and goal-orientation, not to mention the ability to postpone gratification and to work hard to achieve it -- are all lacking or missing altogether. The child turned adult sees no reason to invest in his skills and education, convinced that his inherent genius should suffice. He feels entitled for merely being, rather than for actually doing (rather as the nobility in days gone by felt entitled not by virtue of its merit but as the inevitable, foreordained outcome of its birth right). In other words, he is not meritocratic -- but aristocratic. In short: a narcissist is born.

When Narcissistic Supply is deficient, the narcissist de-compensates and acts out in a variety of ways. Narcissists often experience psychotic micro-episodes during therapy and when they suffer narcissistic injuries in a life crisis. But can the narcissist "go over the edge"? Do narcissists ever become psychotic?

The "modesty" displayed by narcissists is false. It is mostly and merely verbal. It is couched in flourishing phrases, emphasised to absurdity, repeated unnecessarily -- usually to the point of causing gross inconvenience to the listener. The real aim of such behaviour and its subtext are exactly the opposite of common modesty. It is intended to either aggrandise the narcissist or to protect his grandiosity from scrutiny and possible erosion. Such modest outbursts precede inflated, grandiosity-laden statements made by the narcissist and pertaining to fields of human knowledge and activity in which he is sorely lacking. The person to whom the falsely modest statement is addressed is expected to vehemently deny the narcissist's claims: "But, really, you are more of an expert than you say!", or "Why did you tell me that you are unable to do (this or that)? Truly, you are very gifted!" "Don't put yourself down so much - you are a generous man!" The narcissist then shrugs, smirks, blushes and moves uncomfortably from side to side. This was not his intention, he assures his interlocutor. He did not mean to fish for compliments (exactly what he did mean to do). He really does not deserve the praise. But the aim has, thus, been achieved: the Narcissistic Supply has been doled out and avidly consumed. Despite the narcissist's protestations, he feels much better now.

In the manifestation of their narcissism, female and male narcissists, inevitably, do tend to differ. They emphasise different things. They transform different elements of their personalities and of their lives into the cornerstones of their disorder. Women concentrate on their body (many also suffer from eating disorders: Anorexia Nervosa and Bulimia Nervosa). They flaunt and exploit their physical charms, their sexuality, their socially and culturally determined "femininity". They secure their Narcissistic Supply through their more traditional gender role: the home, children, suitable careers, their husbands ("the wife of..."), their feminine traits, their role in society, etc.

The narcissist is as much an artist of pain as any sadist. The difference between them lies in their motivation. The narcissist tortures and abuses as means to punish and to reassert superiority, omnipotence, and grandiosity. The sadist does it for pure (usually, sexually-tinged) pleasure. But both are adept at finding the chinks in people's armours. Both are ruthless and venomous in the pursuit of their prey. Both are unable to empathise with their victims, self-centred, and rigid. The narcissist abuses his victim verbally, mentally, or physically (often, in all three ways). He infiltrates her defences, shatters her self-confidence, confuses and confounds her, demeans and debases her. He invades her territory, abuses her confidence, exhausts her resources, hurts her loved ones, threatens her stability and security, enmeshes her in his paranoid state of mind, frightens her out of her wits, withholds love and sex from her, prevents satisfaction and causes frustration, humiliates and insults her privately and in public, points out her shortcomings, criticises her profusely and in a "scientific and objective" manner -- and this is a partial list.

The narcissist rarely admits to a weakness, ignorance, or deficiency. He filters out information to the contrary - a cognitive impairment with serious consequences. Narcissists are likely to unflinchingly make inflated and inane claims about their sexual prowess, wealth, connections, history, or achievements. All this is mighty embarrassing to the narcissist's nearest, dearest, colleagues, friends, neighbours, even on-lookers. The narcissist's tales are so patently absurd that he often catches people off-guard. Unbeknownst to him, the narcissist is derided and mockingly imitated. He fast makes a nuisance and an imposition of himself in every company.

Nothing is more hated by the narcissist than the sentence "I Love You". It evokes in him almost primordial reactions. It provokes him to uncontrollable rage. Why is that?

The narcissist hates women virulently and vehemently. A misogynist, he identifies being loved with being possessed, encroached upon, shackled, transformed, reduced, exploited, weakened, engulfed, digested and excreted. To him love is a dangerous pursuit.

Being loved means being known intimately. The narcissist likes to think that he is so unique and deep that he can never be fathomed. The narcissist believes that he is above mere human understanding and empathy, that he is one of a kind (sui generis). To say to him "I love you", means to negate this feeling, to try to drag him to the lowest common denominator, to threaten his sense of uniqueness. After all, everyone is capable of loving and everyone, even the basest human beings, fall in love. To the narcissist loving is an animalistic and pathological behaviour -- exactly like sex.

The narcissist knows that he is a con artist, a fraud, an elaborate hoax, a script, hollow and really non-existent. The person who claims to love him is either lying (what is there to love in a narcissist?) -- or a self-deceiving, clinging, and immature codependent. The narcissist cannot tolerate the thought that he has chosen a liar or an idiot for a mate. Indirectly, her declaration of love is a devastating critique of the narcissist's own powers of judgement.

Narcissists are aided, abetted and facilitated by four types of people and institutions: the adulators, the blissfully ignorant, the self-deceiving and those deceived by the narcissist.
Some narcissists have a great sense of humor. In this, they are no different than healthier specimen of the human species. The narcissist, though, rarely engages in self-directed, self-deprecating humour. If he does, he expects to be contradicted, rebuked and rebuffed by his listeners ("Come on, you are actually quite handsome!"), or to be commended or admired for his courage or for his wit and intellectual acerbity ("I envy your ability to laugh at yourself!"). As everything else in a narcissist's life, his sense of humour is deployed in the interminable pursuit of Narcissistic Supply.

The Grandiosity Gap is the difference between self-image - the way the narcissist perceives himself - and contravening cues from reality. The greater the conflict between grandiosity and reality, the bigger the gap and the greater the narcissist's feelings of shame and guilt.

There are two varieties of shame:

Narcissistic Shame -- which is the narcissist's experience of the Grandiosity Gap (and its affective correlate). Subjectively it is experienced as a pervasive feeling of worthlessness (the dysfunctional regulation of self-worth is the crux of pathological narcissism), "invisibleness" and ridiculousness. The patient feels pathetic and foolish, deserving of mockery and humiliation.

Narcissists adopt all kinds of defences to counter narcissistic shame. They develop addictive, reckless, or impulsive behaviours. They deny, withdraw, rage, or engage in the compulsive pursuit of some kind of (unattainable, of course) perfection. They display haughtiness and exhibitionism and so on. All these defences are primitive and involve splitting, projection, projective identification, and intellectualization.

It is healthy to daydream and fantasise. It is the antechamber of life and often anticipates its circumstances. It is a process of preparing for eventualities. But healthy daydreaming is different from grandiosity. The narcissist's grandiosity has four components.

Research failed to find any substantive difference between the psychological make-up of a narcissist who happens to have homosexual preferences -- and a heterosexual narcissist. There is, however, one element, which might be unique to homosexuals: the fact that their self-definition hinges on their sexual identity. I know of no heterosexual who would use his sexual preferences to define himself almost fully. Homosexuality has been inflated to the level of a sub-culture, a separate psychology, or a myth. This is typical of persecuted minorities. However, it does have an influence on the individual. Preoccupation with body and sex makes most homosexual narcissists SOMATIC narcissists. Moreover, the homosexual makes love to a person of the SAME sex -- in a way, to his REFLECTION. In this respect, homosexual relations are highly narcissistic and autoerotic affairs.

The narcissist is emotionally attached to only one thing: his disorder. The narcissist loves his disorder, desires it passionately, cultivates it tenderly, is proud of its "achievements" (and in my case, makes a living off it). His emotions are misdirected. Where normal people love others and empathize with them, the narcissist loves his False Self and identifies with it to the exclusion of all else - his True Self included.

The narcissist is an actor in a monodrama, yet he is forced to remain behind the scenes. The scenes take centre stage, instead.

The narcissist's True Self is introverted and dysfunctional. In healthy people, Ego functions are generated from the inside, from the Ego. In narcissists, the Ego is dormant, comatose. The narcissist needs the input of the outside world to perform the most basic Ego functions (e.g., "recognition" of the world, setting boundaries, differentiation, self-esteem and regulation of a sense of self-worth). Only the False Self gets in touch with the world. The True Self is isolated, repressed, unconscious, a shadow of its former self.

Forcing the narcissist's False Self to acknowledge and interact with his True Self is not only difficult but may also be counterproductive and dangerously destabilising. The narcissist's disorder is adaptive and functional, though rigid. The alternative to this (mal)adaptation would have been self-destructive (suicidal). This bottled up, self-directed venom is bound to resurface if the narcissist's various personality structures are coerced into making contact.

The narcissist parades his objects, flaunts them, consumes them conspicuously, praises them vocally, draws attention to them compulsively, brags about them incessantly. When they fail to elicit Narcissistic Supply - admiration, adulation, marvel - the narcissist feels wounded, humiliated, deprived, discriminated against, the victim of a conspiracy, unloved.

Objects often make the accumulator-narcissist. They are an inseparable part of his pathology. This type of narcissist is possessive. He obsesses about his belongings and collects them compulsively. He "brands" them as his own. He infuses them with his spirit and his personality. He attributes to them his traits. He projects to them his thwarted emotions, his fears, his hopes. They are an integral part of him, inseparable, providing emotional succor.

Donovan, 16 years old, is incapable of loving and, therefore, has never loved you, his mother (or, for that matter, anyone else, himself included) in his entire life. His natural capacity to love and to return love was all but eliminated by his horrid childhood. We practice loving first and foremost through our parents. If they fail us, if they turn out to be unpredictable, capricious, violent, unjust -- this capacity is stunted forever. This is what happened to Donovan: the ideal figures of his childhood proved to be much less than ideal. Abuse is a very poor ground to breed healthy emotions in.

Granted, Donovan -- being the brilliant and manipulative person that he is -- knows how to perfectly simulate and emulate LOVE. He acts lovingly -- but this is a mere act and it should not be confused with the real thing. Donovan shows love in order to achieve goals: money, a warm house, food on the table, adoration (Narcissistic Supply). Once these are available from other sources -- the former ones are abandoned callously, cold-heartedly, cruelly and abruptly.

"Holiday blues are a common occurrence even among the mentally sound. In me they provoke a particularly virulent strain of pathological envy. I am jealous at others for having a family, or for being able to celebrate lavishly, or for being in the right, festive mood. My cognitive dissonances crumble. I keep telling myself: "Look at those inferior imitations of humans, slaves of their animated corpses, wasting their time, pretending to be happy". Yet, deep inside, I know that I am the defective one. I realize that my inability to rejoice is a protracted and unusual punishment meted out to me by my very self. I am sad and enraged. I want to spoil it for those who can. I want them to share my misery, to reduce them to my level of emotional abstinence and absence. I hate humans because I am unable to be one."

Assuming that you want to stay with your abuser and to maintain the "relationship", maltreatment can, to some extent, be ameliorated or even avoided.

Contrary to its name, the conflictive posture is actually about avoiding conflict by minimizing contact and insisting on boundaries. It is about refusal to accept abusive behavior by demanding reasonably predictable and rational actions and reactions. It is about respect for you and for your predilections, preferences, emotions, needs, and priorities.

A healthy relationship requires justice and proportionality. Reject or ignore unjust and capricious behavior. Conflicts are inevitable even in the most loving and mature bonds -- but the rules of engagement are different in an abusive liaison. There, you must react in kind and let him taste some of his own medicine.

There are a few techniques which work wonders with abusers. Some psychologists recommend to treat repeat offenders as one would toddlers. The abuser is, indeed, an immature brat -- though a dangerous one, endowed as he is with the privileges and capabilities of an adult. Sometimes ignoring his temper tantrums until it is over is a wise policy. But not very often -- and, definitely not as a rule.

For her traumatic wounds to heal, the victim of abuse requires closure - one final interaction with her tormentor in which he, hopefully, acknowledges his misbehaviour and even tenders an apology. Fat chance. Few abusers - especially if they are narcissistic - are amenable to such weakling pleasantries. More often, the abused are left to wallow in a poisonous stew of misery, self-pity, and self-recrimination. Depending on the severity, duration, and nature of the abuse, there are three forms of effective closure.

The most dangerous class of abusers is the paranoid-delusional. If your ex is one of these, he is likely to:

Believe that you still love him (erotomania). Interpret everything you do or say -- even to third parties -- as "hidden messages" addressed to him and professing your undying devotion (ideas of reference).

Confuse the physical with the emotional (regard sex as "proof" of love and be prone to rape you).

Blame the failure of the relationship on you or on others -- social workers, your friends, your family, your children.

Seek to "remove" the obstacles to a "happy" and long relationship -- sometimes by resorting to violence (kidnapping or murdering the sources of frustration).

Be very envious of your newfound autonomy and try to sabotage it by reasserting his control over you (for instance, break and enter into your house, leave intrusive messages on your answering machine, follow you around and monitor your home from a stationary car).

Harm you (and sometimes himself) in a fit of indignation (and to punish you) if he feels that no renewed relationship is possible.

Develop persecutory delusions. Perceive slights and insults where none are intended. Become convinced that he is the centre of a conspiracy to deny him (and you) happiness, to humiliate him, punish him, delude him, impoverish him, confine him physically or intellectually, censor him, impose on his time, force him to action (or to inaction), frighten him, coerce him, surround and besiege him, change his mind, part with his values, victimise or even murder him, and so on.

Narcissistic immunity is the narcissist's (erroneous) feeling that he is immune to the consequences of his actions. That he will never be effected by the outcomes of his own decisions, opinions, beliefs, deeds and misdeeds, acts, inaction, or by being a member of certain groups. That he is above reproach and punishment (though not above being feared and notorious). That, magically, he is protected and will miraculously be saved at the last moment. What are the sources of this fantastic mis-appraisal of situations and chains of events?

You should distinguish the factual pillar from the psychological pillar of any cross-examination of a narcissist or deposition made by him. It is essential to be equipped with absolutely unequivocal, first rate, thoroughly authenticated and vouched for information. The reason is that narcissists are superhuman in their capacity to distort reality by offering highly "plausible" alternative scenarios, which fit most of the facts. On or off the stand, it is very easy to "break" a narcissist -- even a well-trained and well-prepared one.

Psychopaths are irresponsible and unreliable. They do not honor contracts, undertakings, and obligations. They are unstable and unpredictable and rarely hold a job for long, repay their debts, or maintain long-term intimate relationships. Psychopaths are vindictive and hold grudges. They never regret or forget a thing. They are driven, and dangerous. Always in conflict with authority and frequently on the run, psychopaths possess a limited time horizon and seldom make medium or long term plans. They are impulsive and reckless, aggressive, violent, irritable, and, sometimes, the captives of magical thinking, believing themselves to be immune to the consequences of their own actions.

Thus, psychopaths often end up in jail, having repeatedly flouted social norms and codified laws. Partly to avoid this fate and evade the law and partly to extract material benefits from unsuspecting victims, psychopaths habitually lie, steal others' identities, deceive, use aliases, and con for "personal profit or pleasure" as the Diagnostic and Statistical Manual puts it.

Unlike narcissists, though, histrionics are genuinely enthusiastic, open, emotional, warm, and empathic, up to the point of being maudlin and sentimental. They also strive to "fit in", mingle, blend, and "become a part of" groups, collectives, and social institutions.

Histrionics sexualize everyone and every situation. They constantly act flirtatious, provocative, and seductive, even when such behavior is not warranted by circumstances or, worse still, is proscribed and highly inappropriate (for instance in professional and occupational settings).

Like both narcissists and psychopaths, borderlines are impulsive and reckless. Like histrionics, their sexual conduct is promiscuous, driven, and unsafe. Many borderlines binge eat, gamble, drive, and shop carelessly, and are substance abusers. Lack of impulse control is joined with self-destructive and self-defeating behaviors, such as suicidal ideation, suicide attempts, gestures, or threats, and self-mutilation or self-injury.

The main dynamic in the Borderline Personality Disorder is abandonment anxiety. Like codependents, borderlines attempt to preempt or prevent abandonment (both real and imagined) by their nearest and dearest. They cling frantically and counterproductively to their partners, mates, spouses, friends, children, or even neighbors. This fierce attachment is coupled with idealization and then swift and merciless devaluation of the borderline's target.

Passive-aggressiveness wears a multitudes of guises: procrastination, malingering, perfectionism, forgetfulness, neglect, truancy, intentional inefficiency, stubbornness, and outright sabotage. This repeated and advertent misconduct has far reaching effects. Consider the Negativist in the workplace: he or she invests time and efforts in obstructing their own chores and in undermining relationships. But, these self-destructive and self-defeating behaviors wreak havoc throughout the workshop or the office.

People diagnosed with the Negativistic (Passive-Aggressive) Personality Disorder resemble narcissists in some important respects. Despite the obstructive role they play, passive-aggressives feel unappreciated, underpaid, cheated, and misunderstood. They chronically complain, whine, carp, and criticize. They blame their failures and defeats on others, posing as martyrs and victims of a corrupt, inefficient, and heartless system (in other words, they have alloplastic defenses and an external locus of control).

Passive-aggressives sulk and give the "silent treatment" in reaction to real or imagined slights. They suffer from ideas of reference (believe that they are the butt of derision, contempt, and condemnation) and are mildly paranoid (the world is out to get them, which explains their personal misfortune). In the words of the DSM: "They may be sullen, irritable, impatient, argumentative, cynical, skeptical and contrary." They are also hostile, explosive, lack impulse control, and, sometimes, reckless.

There is a strong compulsive strand in the narcissist's behaviour. He is driven to exorcise internal demons by means of ritualistic acts. The narcissist's very pursuit of Narcissistic Supply is compulsive. The narcissist seeks to recreate and reenact old traumas, ancient, unresolved conflicts with figures of (primary) importance in his life.

The narcissist develops a private religion with the False Self at its centre. It is replete with rites, mantras, scriptures, and spiritual and physical exercises. The child worships this new deity. He succumbs to what he perceives to be its wishes and its needs. He makes sacrifices of Narcissistic Supply to it. He is awed by it because it possesses many of the traits of the hallowed tormentors, the parents.

The child reduces his True Self, minimises it. He is looking to appease the new Divinity -- not to incur its wrath. He does so by adhering to strict schedules, ceremonies, by reciting texts, by self-imposition of self-discipline. Hitherto, the child is transformed into the servant of his False Self. Daily, he caters to its needs and offers to it Narcissistic Supply. And he is rewarded for his efforts: he feels elated when in compliance with the creed, he emulates the characteristics of this entity.

The narcissist's positive emotions come bundled with very negative ones. This is the outcome of frustration and the consequent transformations of aggression. This frustration is connected to the Primary Objects of the narcissist's childhood (parents and caregivers).

The narcissist can appreciate beauty but in a cerebral, cold and "mathematical" way. Many have no mature, adult sex drive to speak of. Their emotional landscape is dim and grey, as though through a glass darkly.

Many narcissists can intelligently discuss those emotions never experienced by them -- like empathy, or love -- because they make it a point to read a lot and to communicate with people who claim to be experiencing them. Thus, they gradually construct working hypotheses as to what people feel. As far as the narcissist is concerned, it is pointless to try to really understand emotions -- but at least these models he does form allow him to better predict people's behaviours and adjust to them.

Narcissists are not envious of others for having emotions. They disdain feelings and sentimental people because they find them to be weak and vulnerable and they deride human frailties and vulnerabilities. Such derision makes the narcissist feel superior and is probably the ossified remains of a defence mechanism gone awry.

Isn't your definition of malignant narcissism too wide? Having read it, I think that it fits my neighbours, friends, and family to a "t". Everyone seems to be a narcissist to me now!

This is an understandable reaction. All of us have narcissistic TRAITS. Some of us even develop a narcissistic PERSONALITY, or a narcissistic STYLE. Moreover, narcissism is a SPECTRUM of behaviors - from the healthy to the utterly pathological (a condition known as the Narcissistic Personality Disorder, or NPD).

Narcissism defines the narcissist's waking moments and his nocturnal dreams. It is all-pervasive. Everything the narcissist does is motivated by it. Everything he avoids is its result. Every utterance, decision, his very body language - are all manifestations of narcissism. It is rather like being abducted by an alien and ruthlessly indoctrinated ever since. The alien is the narcissist's False Self - a defence mechanism constructed in order to shield his True Self from hurt and inevitable abandonment.

Cognitive understanding of the disorder does not constitute a transforming INSIGHT. In other words, it has no emotional correlate. The narcissist does not INTERNALIZE what he understands and learns about his disorder. This new gained knowledge does not become a motivating part of the narcissist. It remains an inert and indifferent piece of knowledge, with minor influence on the narcissist's psyche.

Sometimes, when the narcissist first learns about the Narcissistic Personality Disorder (NPD), he really believes he could change (usually, following a period of violent rejection of the "charges" against him). He fervently wants to. This is especially true when his whole world is in shambles. Time in prison, a divorce, a bankruptcy, a death of a major source of narcissistic supply - are all transforming life crises. The narcissist admits to a problem only when abandoned, destitute, and devastated. He feels that he doesn't want any more of this. He wants to change. And there often are signs that he IS changing. And then it fades. He reverts to old form. The "progress" he had made evaporates virtually overnight. Many narcissists report the same process of progression followed by recidivist remission and many therapists refuse to treat narcissists because of the Sisyphean frustration involved.

Your first "fallback" option is your family. They are, in many cases (though by no means always) your natural allies. They can provide you with shelter, money, emotional support, and advice. Don't hesitate to call on them in times of need.

Your friends and, to a lesser extent, your colleagues and neighbours will usually lend you a sympathetic ear and will provide you with useful tips. Merely talking to them can not only ease the burden -- but protect you from future abuse. Stalkers and paranoids thrive on secrecy and abhor public exposure.

Regrettably, resorting to the legal system -- your next logical step -- is bound to be a disappointing, disempowering, and invalidating experience. I wrote about it extensively in the essay "Pathologizing the Victim".

When you move into a shelter, you must know in advance what your final destination is. Imagine and plan your life after the shelter. Do you intend to relocate? If so, would you need financial assistance? What about the children's education and friends? Can you find a job? Have everything sorted out. Only then, pack your things and leave your abuser. So, before you opt for moving with your children into a sheltered home or apartment, go through this check list.

Do not leave unprepared. Study and execute every detail of your getaway. This is especially important if your partner is violent. Be sure to make a Safety Plan -- how to get out of the house unnoticed and the indispensable minimum items that you should carry with you, even on a short notice.

Involve the courts whenever possible.

In many countries, the first step is to obtain a restraining order from a civil court as part of your divorce or custody proceedings or as a stand-alone measure.

In some countries, the police applies to the court for an emergency protection order on your behalf. The difference between a protection order and a restraining order is that the former is obtained following an incident of domestic violence involving injury or damage to property, it is available immediately, granted at the police's request, and issued even outside court hours.

Many restraining orders are granted ex parte, without the knowledge or presence of your abusive partner, based solely on a signed and sworn affidavit submitted by you. A typical emergency restraining order forbids the offender from visiting certain locations such as the children's schools, your workplace, or your home. It is later reviewed. At the review you should produce evidence of the abuse and witnesses. If the emergency or temporary order upheld it is fixed for a period of time at the judge's discretion.

Always carry the restraining order with you and leave copies at your place of employment and at your children's day-care and schools. You will have to show it to the police if you want to get your abuser arrested when he violates its terms. Breach of the restraining order is a criminal offence.

In most countries, the police must respond to your complaint. They cannot just file it away or suppress it. They must talk to you and to your partner separately and obtain written and signed statements from both parties. The police officer on the scene must inform you of your legal options. The officer in charge must also furnish you with a list of domestic violence shelters and other forms of help available in your community.

The narcissist lacks empathy. He is, therefore, unable to meaningfully relate to other people and to truly appreciate what it is to be human. Instead, he withdraws inside, into a universe populated by avatars -- simple or complex representations of parents, peers, role models, authority figures, and other members of his social milieu. There, in this twilight zone of simulacra, he develops "relationships" and maintains an on-going internal dialog with them.

The narcissist attributes his failures and mistakes to circumstances and external causes. This propensity to blame the world for one's mishaps and misfortunes is called "alloplastic defence". At the same time, the narcissist regards his successes and achievements (some of which are imaginary) as proofs of his omnipotence and omniscience. This is known in attribution theory as "defensive attribution".

Conversely, the narcissist traces other people's errors and defeats to their inherent inferiority, stupidity, and weakness. Their successes he dismisses as "being in the right place at the right time" -- i.e., the outcome of luck and circumstance.

According to the Washington State Domestic Violence Fatality Review Project, and Neil Websdale, Understanding Domestic Homicide, Northeastern University Press, 1999 -- women in the process of separation or divorce were the targets of half of all intimate partner violent crimes. In Florida the figure is even higher (60%).

Hospital staff are ill-equipped and ill-trained to deal with this pandemic. Only 4% of hospital emergency room admissions of women in the United States were put down to domestic violence. The true figure, according to the FBI, is more like 50%.

Michael R. Rand in "Violence-related Injuries Treated in Hospital Emergency Departments", published by the U.S. Department of Justice, Bureau of Justice Statistics, August 1997 pegs the real number at 37%. Spouses and ex-husbands were responsible for one in three murdered women in the USA.

Two million spouses (mostly women) are threatened with a deadly weapon annually, according to the US Department of Justice. One half of all American homes are affected by domestic violence at least once a year.

And the violence spills over.

One type of narcissist "loves" others as one would attach to objects. He "loves" his spouse, for instance, simply because she exists and is available to provide him with Narcissistic Supply. He "loves" his children because they are part of his self-image as a successful husband and father. He "loves" his "friends" because -- and only as long as -- he can exploit them.

Such a narcissist reacts with alarm and rage to any sign of independence and autonomy in his "charges". He tries to "freeze" everyone around him in their "allocated" positions and "assigned roles". His world is rigid and immovable, predictable and static, fully under his control. He punishes for "transgressions" against this ordained order. He thus stifles life as a dynamic process of compromising and growing -- rendering it instead a mere theatre, a tableau vivant.

The other type of narcissist abhors monotony and constancy, equating them, in his mind, with death. He seeks upheaval, drama, and change -- but only when they conform to his plans, designs, and views of the world and of himself. Thus, he does not encourage growth in his nearest and dearest. By monopolizing their lives, he, like the other kind of narcissist, also reduces them to mere objects, props in the exciting drama of his life.

The coherence of the narcissist's dysfunctional and precariously-balanced personality depends on the plausibility of his stories and on their acceptance by his Sources of Narcissistic Supply. The narcissist invests an inordinate time in substantiating his tales, collecting "evidence", defending his version of events, and in re-interpreting reality to fit his scenario. As a result, most narcissists are self-delusional, obstinate, opinionated, and argumentative.

The narcissist's lies are not goal-orientated. This is what makes his constant dishonesty both disconcerting and incomprehensible. The narcissist lies at the drop of a hat, needlessly, and almost ceaselessly. He lies in order to avoid the Grandiosity Gap - when the abyss between fact and (narcissistic) fiction becomes too gaping to ignore.

The narcissist lies in order to preserve appearances, uphold fantasies, support the tall (and impossible) tales of his False Self and extract Narcissistic Supply from unsuspecting sources, who are not yet on to him. To the narcissist, confabulation is not merely a way of life - but life itself.

This is the first and, by far, the most critical step on the way to coping with the disorder: will the narcissist admit, be forced, or convinced to concede that he is absolutely and unconditionally wrong, that something is very amiss in his life, that he is in need of urgent, professional, help and that, in the absence of such help, things will only get worse? Having crossed this Rubicon, the narcissist is more open and amenable to constructive suggestions and assistance.

The second important leap forward is when the narcissist begins to confront a more REALISTIC version of himself. A good friend, a spouse, a therapist, a parent, or a combination of these people can decide not to collaborate with the narcissist's confabulations anymore, to stop fearing the narcissist and not to acquiesce in his folly any longer.

When they confront the narcissist with the truth about himself, they help demolish the grandiose phantom that "runs" the narcissist. They no longer succumb to his whims or accord him a special treatment. They reprimand him when needed. They disagree with him and show him why and where he is mistaken. In short: they deprive him of many of his sources of Narcissistic Supply. They refuse to take part in the elaborate game that is the narcissist. They rebel.

The only thing you can do to prevent your son from emulating his father - is to present to him another role model of a NON-narcissist - YOU. Hopefully, when he grows up, he will prefer your model to his father's. But there is only that much you can do. You cannot control the developmental path of your son. Exerting unlimited control over your son is what narcissism is all about - and is exactly what you should avoid at all costs, however worried you might be.

Narcissism does tend to breed Narcissism - but not inevitably. Not all the off-spring of a narcissist inexorably become narcissists.

The narcissist always feels "bad". He experiences all manner of depressive episodes and lesser dysphoric moods. He goes through a full panoply of mood disorders and anxiety disorders. He experiences panic from time to time. It is not pleasant to be a narcissist.

But he has a diminished capacity to empathise so he rarely feels sorry for what he does. He almost never puts himself in the shoes of his "victims". Actually, he doesn't regards them as victims at all! It is very common for the narcissist to feel victimized, deprived and discriminated against. He projects his own moods, cognitions, emotions, and actions onto others.

Sure, he feels distressed because he is intelligent enough to realise that something is wrong with him in a major way. He compares himself to others and the outcome is never favourable. His grandiosity is one of the defence mechanisms that he uses to cover up for this disagreeable state of things.

To get the narcissist to see a therapist is difficult. The therapeutic situation implies a superior-inferior relationship. The therapist is supposed to help him -- and, to the narcissist, this means that he is not as omnipotent as he imagines himself to be. The therapist is supposed to know more (in his field) than the narcissist -- a presumption which seems to undermine the second pillar of narcissism, that of omniscience.

Attending therapy (of whatever nature) implies both imperfection (something is wrong) and need (read: weakness, inferiority). The therapeutic setting (the client visits the therapist, has to be punctual and to pay for the service) -- implies subservience. The process itself is also threatening: it involves transformation, losing one's identity (read: uniqueness), one's long cultivated defences.

The narcissist must shed his False Self and face the world naked, defenceless, and (to his mind) pitiful. He is inadequately equipped to deal with his old hurts, traumas and unresolved conflicts. His True Self is infantile, mentally immature, frozen, incapable of confronting the almighty Superego (the narcissist's inner, chastising, voices). The narcissist knows this -- and recoils. Therapy demands of him to finally place full, unmitigated, trust in another human being.

Moreover, the transaction implicitly offered to him is the most unappealing imaginable. He is to give up decades of emotional investment in an elaborate, adaptive and, mostly, functioning, mental hyper structure. In return, he stands to become "normal" -- an anathema to a narcissist. Being normal, to him, means, being average, not unique, non-existent. Why should the narcissist commit himself to such a move when it doesn't even guarantee him happiness (he sees many unhappy "normal" people around)?

To a narcissist, I would recommend a functional approach, along the following lines:

Know and accept thyself. This is who you are. You have good traits and bad traits and you are a narcissist. These are facts. Narcissism is an adaptive mechanism. It is dysfunctional now, but, once, it saved you from a lot more dysfunction or even non-function. Make a list: what does it mean to be a narcissist in your specific case? What are your typical behaviour patterns? Which types of conduct do you find to be counterproductive, irritating, self-defeating or self-destructive? Which are productive, constructive and should be enhanced despite their pathological origin?

Decide to suppress the first type of behaviours and to promote the second. Construct lists of self-punishments, negative feedback and negative reinforcements. Impose them upon yourself when you have behaved negatively. Make a list of prizes, little indulgences, positive feedbacks and positive reinforcements. Use them to reward yourself when you adopted a behaviour of the second kind.

Keep doing this with the express intent of conditioning yourself. Be objective, predictable and just in the administration of both punishments and awards, positive and negative reinforcements and feedback. Learn to trust your "inner court". Constrain the sadistic, immature and ideal parts of your personality by applying a uniform codex, a set of immutable and invariably applied rules.

Once sufficiently conditioned, monitor yourself incessantly. Narcissism is sneaky and it possesses all your resources because it is you. Your disorder is intelligent because you are. Beware and never lose control. With time this onerous regime will become a second habit and supplant the narcissistic (pathological) superstructure.

You might have noticed that all the above can be amply summed by suggesting to you to become your own parent. This is what parents do and the process is called "education" or "socialisation". Re-parent yourself. Be your own parent. If therapy is helpful or needed, go ahead.

It is healthy to daydream and fantasise. It is the antechamber of life and often anticipates its circumstances. It is a process of preparing for eventualities. But healthy daydreaming is different from grandiosity.

Grandiosity has four components.

Dump him and go about reconstructing your own life. Very few people deserve the kind of investment that is an absolute prerequisite to life with a narcissist. To cope with a narcissist is a full time, energy and emotion-draining job, which reduces people around him to insecure nervous wrecks. Who deserves such a sacrifice?

No one, to my mind, not even the most brilliant, charming, breathtaking, suave narcissist. The glamour and trickery wear thin and underneath them a monster lurks which irreversibly and adversely influences the lives of those around it for the worse.

Narcissists are incorrigibly and notoriously difficult to change. Thus, trying to "modify" them is doomed to failure. You should either accept them as they are or avoid them altogether. If one accepts the narcissist as he is -- one should cater to his needs. His needs are part of what he is. Would you have ignored a physical handicap? Would you not have assisted a quadriplegic? The narcissist is an emotional cripple. He needs constant adulation. He cannot help it. So, if one chooses to accept him -- it is a package deal, all his needs included.

The narcissistic mother is a control freak and does not easily relinquish good and reliable sources of "narcissistic supply" (admiration, adulation, attention of any kind). It is the role of her children to replenish this supply, the children owe it to her. To make sure that the child does not develop boundaries, and does not become independent, or autonomous, the narcissistic parent micromanages the child's life and encourages dependent and infantile behaviors in her offspring.

Such a parent bribes the child (by offering free lodging or financial support or "help" with daily tasks) or emotionally blackmails the child (by constantly demanding help and imposing chores, claiming to be ill or disabled) or even threatens the child (for instance: to disinherit her if she does not comply with the parent's wishes). The narcissistic mother also does her best to scare away anyone who may upset this symbiotic relationship or otherwise threaten the delicate, unspoken contract. She sabotages any budding relationship her child develops with lies, deceit, and scorn.

Therapists, psychologists, social workers, and psychiatrists report similar negative feelings towards such patients. Many of them try to ignore, deny, and repress them. The more mature health professionals realize that denial only exacerbates the undercurrents of tension and resentment, prevents effective patient management, and undermines any therapeutic alliance between healer and the ill.

It is not easy to cater to the needs of patients with personality disorders. By far the worst is the narcissistic (patient with Narcissistic Personality Disorder).

Overweening, smothering, spoiling, overvaluing, and idolizing the child - are all forms of parental abuse.

This is because, as Horney pointed out, the child is dehumanized and instrumentalized. His parents love him not for what he really is - but for what they wish and imagine him to be: the fulfillment of their dreams and frustrated wishes. The child becomes the vessel of his parents' discontented lives, a tool, the magic brush with which they can transform their failures into successes, their humiliation into victory, their frustrations into happiness. The child is taught to ignore reality and to occupy the parental fantastic space. Such an unfortunate child feels omnipotent and omniscient, perfect and brilliant, worthy of adoration and entitled to special treatment. The faculties that are honed by constantly brushing against bruising reality - empathy, compassion, a realistic assessment of one's abilities and limitations, realistic expectations of oneself and of others, personal boundaries, team work, social skills, perseverance and goal-orientation, not to mention the ability to postpone gratification and to work hard to achieve it - are all lacking or missing altogether. The child turned adult sees no reason to invest in his skills and education, convinced that his inherent genius should suffice. He feels entitled for merely being, rather than for actually doing.

Children with Conduct Disorder are in denial. They tend to minimize their problems and blame others for their misbehavior and failures. This shifting of guilt justifies, as far as they are concerned, their invariably and pervasively aggressive, bullying, intimidating, and menacing gestures and tantrums. Adolescents with Conduct Disorder are often embroiled in fights, both verbal and physical. They frequently use weapons, purchased or improvised (e.g., broken glass) and they are cruel. Many underage muggers, extortionists, purse-snatchers, rapists, robbers, shoplifters, burglars, arsonists, vandals, and animal torturers are diagnosed with Conduct Disorder.

Intuitively, a connection between SPD and the Narcissistic Personality Disorder (NPD) seems plausible. After all, narcissists are people who self-sufficiently withdraw from others. They love themselves in lieu of loving others. Lacking empathy, they regard others as mere instruments, objectified "Sources" of Narcissistic Supply.

Schizoids are often described, even by their nearest and dearest, in terms of automata ("robots"). They are uninterested in social relationships or interactions and have a very limited emotional repertoire. It is not that they do not have emotions, but they express them poorly and intermittently. They appear cold and stunted, flat, and "zombie"-like.

Consequently, these people are loners. They confide only in first-degree relatives, but maintain no close bonds or associations, not even with their immediate family. Naturally, they gravitate into solitary activities and find solace and safety in being constantly alone. Their sexual experiences are sporadic and limited and, finally, they cease altogether.

Schizoids are anhedonic - find nothing pleasurable and attractive - but not necessarily dysphoric (sad or depressed). Some schizoid are asexual and resemble the cerebral narcissist. They pretend to be indifferent to praise, criticism, disagreement, and corrective advice (though, deep inside, they are not). They are creatures of habit, frequently succumbing to rigid, predictable, and narrowly restricted routines.

If you are a rebellious child or teenager and you have not been diagnosed with Conduct Disorder, you are still at risk of being labelled and pathologized. The DSM informs us that "The essential feature of Oppositional Defiant Disorder is a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior towards authority figures that persists for at least 6 months."

Unbelievable as this Orwellian, Big Brother text is - it gets worse. If you are under 18 years old and you lose your temper, argue with adults, actively "defy or refuse to comply with the requests or rules of adults", deliberately do things that annoy said adults, blame others for your mistakes or misbehavior - then unquestionably you are a sick little puppy. And who is to make these value judgements? An adult psychologist or psychiatrist or social worker or therapist. And what if you disagree with these authorities? They get annoyed and this is proof positive that you are afflicted with Oppositional Defiant Disorder (ODD). Did anyone mention catch-22?

Self-punishing, guilt-purging behaviors are very reminiscent of compulsive rituals. The narcissist feels guilty. It could be an "ancient", early childhood, guilt, a "sexual" guilt (Freud), or a "social" guilt. In his infancy, the narcissist internalized and introjected the voices of meaningful and authoritative others - parents, role models, peers - that consistently and convincingly judged him to be no good, blameworthy, deserving of punishment or retaliation, or corrupt.

The narcissist's life is thus transformed into an on-going trial. The constancy of this trial, the never adjourning tribunal is the punishment. It is a Kafkaesque "process": meaningless, undecipherable and never-ending. It leads to no verdict, is subject to mysterious and fluid laws and presided over by capricious judges.

Thus the narcissist masochistically frustrates his deepest desires and drives, obstructs his own efforts, alienates his friends and sponsors, provokes figures of authority to punish, demote, or ignore him, actively seeks and solicits disappointment, failure, or mistreatment and relishes them, incites anger or rejection, bypasses or rejects opportunities, or engages in excessive self-sacrifice.

When a patient has a personality disorder and an eating disorder, the therapist would do well to first tackle the eating disorder. Personality disorders are intricate and intractable. They are rarely curable (though certain aspects, like obsessive-compulsive behaviours, or depression can be ameliorated with medication or modified). The treatment of personality disorders requires enormous, persistent and continuous investment of resources of every kind by everyone involved.

From the patient's point of view, the treatment of her personality disorder is not an efficient allocation of scarce mental resources. Neither are personality disorders the real threat. If one's personality disorder is cured but one's eating disorders are left untouched, one might die (though mentally healthy)...

An eating disorder is both a signal of distress ("I wish to die, I feel so bad, somebody help me") and a message: "I think I lost control. I am very afraid of losing control. I will control my food intake and discharge. This way I can control at least ONE aspect of my life."

This is where we can and should begin to help the patient - by letting her regain control of her life. The family or other supporting figures must think what they can do to make the patient feel that she is in control, that she is managing things her own way, that she is contributing, has her own schedules, her own agenda, and that she, her needs, preferences, and choices matter.

At the commencement of the relationship, the Narcissist is a dream-come-true. He is often intelligent, witty, charming, good looking, an achiever, empathetic, in need of love, loving, caring, attentive and much more. He is the perfect bundled answer to the nagging questions of life: finding meaning, companionship, compatibility and happiness. He is, in other words, ideal.

It is difficult to let go of this idealized figure. Relationships with narcissists inevitably and invariably end with the dawn of a double realisation. The first is that one has been (ab)used by the narcissist and the second is that one was regarded by the narcissist as a disposable, dispensable and interchangeable instrument (object).

The assimilation of this new gained knowledge is an excruciating process, often unsuccessfully completed. People get fixated at different stages. They fail to come to terms with their rejection as human beings -- the most total form of rejection there is.

We all react to loss. Loss makes us feel helpless and objectified. When our loved ones die -- we feel that Nature or God or Life treated us as playthings. When we divorce (especially if we did not initiate the break-up), we often feel that we have been exploited and abused in the relationship, that we are being "dumped", that our needs and emotions are ignored. In short, we again feel objectified.

The DSM also fails to distinguish between personality, personality traits, character, temperament, personality styles (Theodore Millon's contribution) and full-fledged personality disorders. It does not accommodate personality disorders induced by circumstances (reactive personality disorders, such as Milman's proposed "Acquired Situational Narcissism"). Nor does it efficaciously cope with personality disorders that are the result of medical conditions (such as brain injuries, metabolic conditions, or protracted poisoning). The DSM had to resort to classifying some personality disorders as NOS "not otherwise specified", a catchall, meaningless, unhelpful, and dangerously vague diagnostic "category".

One of the reasons for this dismal taxonomy is the dearth of research and rigorously documented clinical experience regarding both the disorders and various treatment modalities. Read this week's article to learn about the DSM's other great failing: many of the personality disorders are "culture-bound". They reflect social and contemporary biases, values, and prejudices rather than authentic and invariable psychological constructs and entities.

The narcissist keeps dreaming, hoping, planning, conspiring, scheming and fighting all his life. As far as he is concerned, reality, with its sobering feedback, does not exist. He occupies a world of his own where hope springs eternal. It is a universe of recurrent serendipity, inevitable fortuity, auspiciousness, lucky chances and coincidences, no downs and uplifting ups. It is an unpredictable, titillating, and exciting world. The narcissist may feel bored for long stretches of time but only because he can't wait for the ultimate thrill.

The narcissist experiences a constant midlife crisis. His reality is always way short of his dreams and aspirations. He suffers a constant Grandiosity Gap -- the same Gap that plagues the healthy midlife adult. But the narcissist has one advantage: he is used to being disappointed and disillusioned. He inflicts setbacks and defeats upon himself by devaluing persons and situations that he had previously idealised.

The Narcissistic Personality Disorder (NPD) per se is not treated with medication. The underlying disorder is treated by one of the long-term psychodynamic or cognitive-behavioural therapies. Other Personality Disorders (NPD is usually comorbid - diagnosed with other PDs) are treated separately and according to their own characteristics.

But phenomena, which are often associated with NPD, 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).

Additionally, cognitive-behavioural therapies are often used to treat the attendant OCD and depression.

First and foremost, the narcissist's partner must have a deficient or a distorted grasp of her self and of reality. Otherwise, she (or he) is bound to abandon the narcissist's ship early on. The cognitive distortion is likely to consist of belittling and demeaning herself -- while aggrandising and adoring the narcissist.

The partner is, thus, placing herself in the position of the eternal victim: undeserving, punishable, a scapegoat. Sometimes, it is very important to the partner to appear moral, sacrificial and victimised. At other times, she is not even aware of this predicament. The narcissist is perceived by the partner to be a person in the position to demand these sacrifices from her because he is superior in many ways (intellectually, emotionally, morally, professionally, or financially).

The status of professional victim sits well with the partner's tendency to punish herself, namely: with her masochistic streak. The tormented life with the narcissist is just what she deserves."

(From the book "Malignant Self-love: Narcissism Revisited" by Sam Vaknin)

Tuesday, December 14, 2010

A tip on dealing with a Narcissist

Lower your expectation of an emotional relationship or communion.  The narcissist only responds if you do things their way or feed the inflated sense of self.  Frame situations in terms of how it will serve the narcissist.

If you feel you have been a victim of someone suffering from NPD please seek help in dealing with the feelings family and friends are subjected to by the narcissist.  I have found some extremely informative videos on understanding the narcissist by Sam Vakrin, author of "Malignant Self-Love: Narcissism Revisited".  You can see one of his videos here ( ) or do a search for his name on YouTube.