Features of the manifestation of narcissistic disorder. Negative factors influencing in childhood. How Narcissistic Personality Disorder Occurs. Methods of diagnosis and treatment

Narcissism is a mental disorder that is expressed in a person's inflated self-esteem, complacency and narcissism. Such a pathological love of one's own personality is expressed in close attention to own person, while a person cannot control his ambitions, strives for wealth and external attractiveness, infantilism is manifested in manners and actions.

A bit of history

The term "narcissism" comes from the name of the ancient Greek mythological hero Narcissus. The young man was incredibly handsome: the narcissistic hero rejected the love of the nymph Echo, for which he was punished. ancient greek gods sentenced Narcissus to lifelong admiration of his face through the reflection on the water surface.

According to Sigmund Freud, narcissism is a manifestation of specific intimate behavior. Many children on early stages life show a narcissistic feeling, admire themselves. At the same time, if the personality of the child develops harmoniously and correctly, and the parents participate in the full-fledged upbringing of the child, such narcissism does not bring any harm and disappears on its own as it grows older. In the process of creating the methodology of psychoanalysis, Freud finally introduced the concept of narcissism into psychiatric practice.

Narcissistic personality disorder and its causes

This mental disorder can have various causes. When examining the brains of patients, scientists found a thickening of the cortex and an altered structure of some nerve cells. Deviations affect the part of the brain that is responsible for the feeling of compassion.

According to experts, the feeling of empathy depends on the concentration of gray matter: in narcissists, its amount is significantly less than in healthy people.

Narcissism is a mental illness that occurs for the following reasons:

1. Low self-esteem in childhood. At the same time, such features of behavior can be laid by the parents or the environment of a person, constant reproaches and censures provoke the emergence of protective mechanisms.
2. No parental restrictions childhood, excessive praise and idealization of the child's personality by parents.
3. Permissiveness, in which the child does not understand what he can do and what is forbidden to him.

Please note that certain features of narcissism often appear during puberty, but this does not mean that such a phenomenon will develop into a mental disorder.

Some theorists believe that narcissism is a pathology that is also hereditary. Quite a few important role plays and the presence of a teenager this or that idol. In some cases, this phenomenon is associated with a more serious mental illness(for example, with schizophrenia), in this case the patient completely loses touch with reality, considers himself a messenger of a deity or another idol.

Signs of Narcissism

Below are the symptoms of this disease, on the basis of which the psychiatrist makes a diagnosis.

1. An exaggerated sense of self-importance.
2. Constantly emerging fantasies of overwhelming success and fame, incredible wealth.
3. Conviction in one's own uniqueness, the desire to communicate with people only with a high social position.
4. Demanding admiration and reverence from other people.
5. Arrogant and ambitious (some narcissists make mean and cynical jokes about other people).
6. Lack of empathy and compassion.
7. Negative attitude towards criticism.
8. Inflated self-esteem is just a mask for other people; deep down, such patients are weak personalities with many psychological complexes.
9. Careful disguise of their own shortcomings.
10. Using other people for your own benefit.

All people who suffer from this disease are trying to protect themselves from envious feelings towards others, so they are often not interested in the personal life and professional activities of their friends and acquaintances. A sick person often expresses uncertainty in his opinion: at first he perceives this or that person as an idol or idol, and then expresses contempt for her and considers this or that person unreasonable.

Narcissists are people who are addicted to praise, very often they do not react in any way, do not respond with gratitude when they hear compliments. In most cases, patients show no interest in generally accepted values ​​(moral or aesthetic).

Narcissism in women and men: features and main differences

The psychology of narcissism in men is deep, and the reasons lie in child education. Moreover, this disease is most often found in the representatives of the stronger sex. Male patients are trying with all their might to achieve their own importance in the eyes of society. By all means they achieve career growth and a high financial position. When the desired goal is achieved, the patient's joy from the received lasts only a few minutes, after which their needs increase again, and they begin to want more.

Before reaching middle age growing goals and needs do not disturb the patient, he gradually realizes certain tasks and sees no reason to worry. Later, however, the narcissist begins to realize that he never achieved happiness. Men with this diagnosis are not able to build full-fledged relationships with people, they destroy families, while the children of the narcissist also begin to suffer from negative impact father.

As for female narcissism, it is expressed in the inability to understand your child, the inability to rejoice simple things and consequently dissatisfaction. own life. Patients force their children to study day and night, to get only excellent grades, conflicts often occur against the background of the fact that the child did not live up to the expectations of his mother.

Personal inter-gender relationships also suffer from female narcissism: patients choose exclusively caring and attentive men as partners, but they themselves do not respect them, because they consider them to be weak-willed and incapable of anything. If in a couple both people have signs of narcissism, a relentless struggle of characters begins: these people will compete with each other in absolutely everything, while such a tense relationship is unlikely to last long.

Features of diagnostics

It is possible to determine such a pathology already during a personal conversation with the patient. The format of the conversation in the form of an interview is best suited for these purposes. Based on the results of the survey, points are given, on the basis of which the psychiatrist determines whether the patient has a serious personality disorder or a borderline condition, which is expressed in high self-esteem.

Among the questions are the following:

1. Why do you think you deserve close attention and special treatment of your person?
2. In your opinion, who might deserve your attention, and why exactly?
3. What kind of people are you willing to sacrifice your free time for?
4. Is it important for you to spend time exclusively with influential people with a high social position?

At the same time, it is important to distinguish narcissism from the usual inflated self-esteem, as well as from the symptoms of other diseases (for example, from schizophrenia).

Why is narcissism dangerous? If the correction of the individual's behavior is not started in a timely manner, the mental disorder may progress. As a result, the patient will be unable to maintain social ties and engage in professional activities, gradually moving away from social life, which leads to the development of other mental disorders. In some cases, aggression and psychosis appear, the patient ceases to control his behavior. Treatment in such situations is possible only in a hospital.

Disease testing

In modern psychiatry there are several effective methodologies aimed at identifying narcissism. One of these methods includes a special questionnaire, which includes 163 questions of a different nature. When studying the answers to them, the specialist studies the so-called Likert scale.

The patient must express the degree of his approval or the degree of disagreement with a particular statement. As a result, the psychiatrist calculates the coefficient of narcissism. It is worth noting that this technique also has contraindications: for example, it cannot and is not advisable to use during a period of severe depression or acute psychosis.

How to treat narcissism?

Treatment for this mental disorder ineffective at home. If signs of such a disease appear, it is necessary to contact a psychotherapist who will conduct the necessary diagnostics and prescribe an effective therapy that allows you to normalize self-esteem.

At the same time, doctors are not recommended to show weakness in the presence of the patient, since he can take advantage of the uncertainty of the specialist and exert his influence on the course of therapy, as well as pressure on the medical staff. At the same time, the psychiatrist must treat the patient with respect, so that the patient cannot constantly demonstrate a sense of self-importance.

The treatment of narcissism in men and women includes individual psychotherapeutic techniques. During psychotherapy, the specialist must refrain from excessive criticism of the patient, otherwise his self-esteem will be further violated. You should not show a feeling of pity and sympathy: such a person may simply not understand the compassion of a doctor.

It is worth noting that not all patients are aware of their problem, so the specialist needs to act very carefully and first identify exactly what signs this disease has (it is best to do this using the example of other narcissistic people).

Of no small importance is group psychotherapy, during which the patient develops a healthy and adequate personality (rather than pathological narcissism): regular group conversations with the right bias will allow the patient to get rid of inflated self-esteem, begin to correctly understand other people and consider them full-fledged personalities.

In some cases, therapy also includes medication. The patient may be prescribed psychotropic drugs to eliminate increased excitability and anxiety (if such symptoms are present). If the patient has depressive states associated with deep psychological complexes, a course of antidepressants is prescribed. All these drugs are prescribed only by the attending physician. If the treatment takes place in a hospital, there should be control of medical personnel over the intake of medications. Medicines are prescribed in strictly defined dosages, since they have many side effects.

Only in severe cases, therapy is carried out in stationary conditions. As his well-being improves, the patient can be treated on an outpatient basis, that is, at home with regular visits to a specialist for psychotherapy sessions. The exact duration of such sessions and their number are determined on an individual basis, depending on the specifics of the mental disorder. Often it is not possible to completely get rid of the manifestations of narcissism and inflated self-esteem, however, with the help of complex therapy it is possible to correct the patient's judgments and personal characteristics, help him begin to fully communicate with other people, establish family and friendship ties with a minimum of conflict situations.

Preventive measures

How to act so that the child grows up as a full-fledged personality with adequate self-esteem? The following preventive measures will help prevent the development of narcissism:

1. During puberty, children are especially vulnerable, prone to excessive shyness and psychological complexes. In order for the growing personality to fully develop, it is important to maintain in the child a sense of dignity and independence from the opinions of others.
2. Children often cry, expressing their dissatisfaction with something. Let the child do this, because that is how he will understand that not all needs can be met immediately. It is important to firmly refuse the child if he makes high demands and is capricious (of course, this does not apply to natural needs).
3. It is better to confess your love to your child more often, while not focusing on his beauty. Otherwise, the personality will form unpleasant feeling vanity.
4. Praise a child for really worthy things is normal phenomenon. However, too frequent and exaggerated praise is guaranteed to lead to further narcissism.
5. Don't brag about positive qualities and the actions of a son or daughter in his presence, it is better to do this when he does not hear.
6. You don't have to practice the good and bad parenting technique. Such an imbalance will upset the child's value system, causing him to not distinguish between positive and negative actions.
7. The child must understand that he will have to live in society, while society should not live for him.

Thus, narcissism is a personality disorder that is expressed in excessively inflated ambitions, a tendency to narcissism and a lack of compassion. In most cases, such a disease develops in childhood and adolescence, as a result of which an adult remains infantile and unable to maintain normal social ties. Treatment of such a mental disorder is carried out under the supervision of professional psychotherapists, treatment is provided both in inpatient and outpatient settings.

Narcissistic personality disorder is a personality disorder characterized by high self-esteem, a sense of superiority over others, and an inability to empathize with others.

This anomaly occurs in less than 1% of adults, mainly in men.

Roots this term go to ancient Greek mythology.

Narcissus, an unusually handsome but cruel young man, rejected the love of the nymph Echo and could only fall in love with his own reflection in the stream. He could not stop admiring, could not embrace his own image, because of this he stopped eating and drinking, and died of unrequited love.

Reasons for development

The causes of narcissistic personality disorder lie in childhood. This psychopathy is not congenital. In most cases, this is the result of improper upbringing.

Two extremes can lead to the formation of this personality disorder: both excessive love of parents and complete indifference to the child.

Children brought up in incomplete families, without parents, in families where parents did not pay due attention to the child, constantly feel a lack of love, a feeling of dissatisfaction. As a defense mechanism, over time, such a child begins to inspire himself that he is special, seeks to arouse admiration from others, to reach heights.

Narcissistic personality disorder can also form in children who grew up in an atmosphere of excessive love and admiration. Single and late children, as a rule, bathe in the love of their parents. Every step, every achievement, even the smallest one, is accompanied by encouragement and even praise from the parents. Over time, such children and adolescents begin to consider themselves special, overestimate their own merits, which can also lead to the formation of narcissistic psychopathy.

signs

The main symptoms of narcissistic personality disorder are:

• inflated conceit;
• the desire for unlimited power, wealth, beauty, fantasy on this topic;
• the need for excessive admiration from others;
• confidence in his own exclusivity, such a person believes that he should be friends only with the same as himself, "special";
• inability to sympathize with other people, understand their experiences (lack of empathy);
• using others to achieve their own goals;
• confidence that others envy him;
• demonstrating one's own disdain for others, arrogance.

The narcissistic psychopath does not just strive for success, he wants to achieve universal recognition, praising his own superiority. Having not known parental love and support in childhood, or, conversely, having become accustomed to receiving it in abundance, such a person will urgently need it in adulthood.

It cannot be unequivocally said that psychopathy of the narcissistic type negatively affects a person, there are positive points. Such people are ambitious, prone to fruitful activities, they are hardworking, achieve their goals. But there is one significant disadvantage - in their pursuit of fame, success, they use other people as a means to achieve their goals, neglect them, their feelings, needs.

Relationships with others at work and in family life

When choosing a field of professional activity, such people always prefer the one that promises public recognition and quick fame.

A person with a narcissistic personality disorder can become a great boss, bring a lot of benefits to his enterprise, company, but his subordinates have a very hard time.

The narcissist is not inclined to form strong relationships with other people, does not know what friendship is. He is used to using others for his own purposes, while helping someone, respecting, taking care of someone is not in his rules.

It will be difficult (not to say impossible) for a narcissistic personality to create a harmonious marriage. After all, he is not used to listening to the needs of another person, supporting, empathizing.

He will always demand from his wife (husband) constant admiration, compliments for the slightest reason and without. At the same time, all the events taking place in the life of his spouse will be indifferent to him, moreover, if they go against his plans, he will be angry and will not understand the reasons.

A woman who has connected her life with a narcissist man can count on material wealth, but she cannot see love, care, support, respect.

Narcissistic personality disorder has some similarities with. Both pathologies are manifested by the need for the admiration of others, all the actions of such people are aimed at attracting someone's attention, achieving admiration.

However, the hysteroid is just an actor who needs an audience to express himself, his excessive emotions, so that he has someone to manipulate. At the same time, hysteroids are able to empathize with other people, share their joys and excitements. Narcissists are devoid of empathy, the only thing that interests them in life is wealth and power.

Narcissistic psychopaths are similar to borderline personalities. Both of these personality disorders are distinguished by the desire to act, the ability to reach heights, the rejection of someone else's criticism, outbursts of anger.

Suffering people are not capable of long-term purposeful activity; outbursts of anger can occur in them not only in connection with someone else's criticism, but also without any reason for it. Narcissistic personalities, on the contrary, put success at the head of everything, they work tirelessly and systematically go towards their goal.

Weaknesses, consequences

Fragile self-esteem, the desire for beauty, wealth are the "Achilles heel" of the narcissistic personality. Not reaching the goal, he may become depressed.

No matter how high a person with a narcissistic disorder achieves, deep down he will not feel happy. He will be overwhelmed with envy of others that they have something that he does not have. At the same time, he will painfully need admiration from other people.

Over the years, he will also begin to feel that health and external attractiveness are not eternal, and this can also lead to the development of neurosis.

Neglect of others, inability to listen to others, including leadership, can negatively affect the career of a narcissist. Overestimated and at the same time fragile self-esteem, inability to accept defeat can develop into depression.

Treatment

The most effective treatment for narcissistic personality disorder is psychotherapy. In most cases drug treatment powerless, because the problem lies in the person himself, in his perception and attitude to the world, to other people.

Individuals suffering from this disorder themselves do not go to the doctor. insist on medical care relatives of such a person can be a wife (husband), mother, brother, sister.

The psychotherapist will make every effort to help a person overcome childhood, learn to listen to the feelings and opinions of other people, take them into account. Need to learn how to build constructive relationship with other people, to conduct a productive dialogue.

Another point of application will be a person's self-esteem. Although such people are dismissive of others, they constantly need their admiration, and this must be overcome.

Narcissistic personality disorder is difficult to psychotherapeutic correction, in order to feel visible changes, you will need long time and serious work on yourself.

stress and life difficulties can lead to the development of depression or neurosis, in which case medication may be needed.

The concept of narcissistic personality disorder (NPD), as defined in DSM III and DSM-III-R(Table 11.1) is primarily based on psychoanalytic case literature (Akhtar & Thomson, 1982; Frances, 1985). As with other personality disorders, the assessment of the presence or absence of diagnostic criteria for clinical narcissism is highly subjective and is based on various assumptions (Stangl, Pfohl, Zimmerman, Bowers, & Corenthal, 1985; Widiger & Frances, 1985; APA, 1980, p. 7). Diagnostic reliability for this personality disorder is low (Spitzer, Forman, & Nee, 1979). Improving diagnostic reliability and demonstrating conceptual validity requires a more representative set of independent, observable behaviors, along with defined criteria for the chronic nature of the disorder and association between situations, and possibly a measure of case prototypicality (Widiger & Frances, 1985). Research that aims to isolate complex behaviors associated with particular traits (eg Buss & Craik, 1983; Livesley, 1986) is promising. The cognitive focus of research may also contribute to the specification of observable features of narcissism.

Table 11.1. Diagnostic criteria for narcissistic personality disorder according toDSM-III-R

A pervasive pattern of grandiosity (whether in fantasy or behavior), lack of empathy, and hypersensitivity to the judgments of others, beginning in early adulthood and existing in different contexts, as indicated by at least five of the following signs:

1) reacts to criticism with anger, shame or humiliation (even if these feelings are not expressed);

2) prone to exploitation in interpersonal relationships: uses others to achieve their own goals;

3) has an exaggerated sense of self-importance, for example, exaggerates achievements and talents, expects a “special” attitude towards himself without corresponding achievements;

4) believes that his problems are unique and can only be understood by certain people;

5) preoccupied with fantasies of unlimited success, power, splendor, beauty, or ideal love;

6) feels that he has special rights: unreasonably expects especially good treatment, for example, he believes that he should not wait in line like others;

7) requires constant attention and admiration, for example, constantly asking for compliments;

8) lack of empathy: inability to understand and experience the feelings of others, for example, annoyed and surprised when a seriously ill friend cancels an appointment;

9) preoccupied with feelings of envy.

Note. From The Diagnostic and Statistical Classification Manual of Mental Disorders (3rd ed., rev.), ( Diagnostic and Statistical Manual of Mental Disorders(3rd ed., rev.). American Psychiatric Association, 1987, Washington, DC: Author, p. 351). ©1987, American Psychiatric Association. Reproduced with permission. Historical review.The development of psychoanalytic ideas.

The term "narcissism" comes from the classic Greek myth of Narcissus, a young man who fell in love with his reflection in the water. His fate was such that he died out of unsatisfied desire and turned into a narcissus flower. The first reference to this myth in the psychological literature came from Havelock Ellis (Ellis, 1898), who described the masturbatory or "autoerotic" practice of a young man.

Freud subsequently included the term "narcissistic" in his early theoretical essays on psychosexual development (Freud, 1905/1953) and later developed the idea of ​​narcissism as a distinct psychological process (Freud, 1914/1957). He interpreted narcissism as a stage normal development which follows the autoerotic stage and eventually develops into object love. Fickle, unreliable guardians in early age or parents who value their child too much were seen as the main obstacles to the development of object love, causing fixation at the narcissistic stage of development. Narcissistic personalities were considered incapable of forming lasting attachments due to fixation on the self-infatuation stage.

Subsequently, psychoanalytic theorists focused on the interpersonal aspects of narcissism, and the concept of the "narcissistic personality" began to emerge (for example: Waelder, 1925). Akhtar and Thomson (1982) point to controversy as to whether narcissism is a component of neurosis, psychosis, or character disorder. In the research of the current generation of object relations theorists, narcissism is viewed as a personality or character disorder. Among them, the works of Kernberg (Kernberg, 1967, 1970) and Kohut (Kohut, 1966, 1971) stand out.

Kernberg sees the narcissistic personality's sense of grandiosity and exploitative tendencies as evidence of "oral anger," which is a pathological process in libidinal (psychosexual) development. This is presumably due to emotional deprivation caused by the mother's chronic indifference or secret malice. At the same time, some unique talent or role gives the child a sense of being special, which in turn becomes an emotional safety valve in a world of indifference or danger. A sense of grandiosity or special entitlement is necessary to hide the "split" "true self" or awareness of the real circumstances. The true self is believed to contain strong but largely unconscious feelings of envy, fear, deprivation, and anger. Since, according to Kernberg's theory, a sense of grandiosity develops as a result of a pathological process, his approach to treatment requires the identification and interpretation of unconscious conflicts in order to restore intrapsychic structures damaged as a result of developmental delay.

Kohut, on the other hand, sees narcissism as a form of the normal development of the libido, and not as a pathological deviation in the development of the libido. In Kohut's theory, pathological narcissism is the result of a developmental delay that occurs when such important personality structures as the "grand self" and the "idealized parent image" are not properly integrated. It occurs as a result of a traumatic disappointment caused by a mother who was not assertive enough in her emotional reactions on the child or, conversely, did not allow the child to assess its real limits. Thus, the archaic sense of grandiosity and the idealized parental image are separated and become the cause of repeated subconsciously motivated attempts to realize them. Kohut's approach to treatment requires a compassionate psychotherapist who works to solve developmental problems by reducing the patient's sense of grandiosity and accepting the frustration that comes with realizing that idealized people have realistic limits.

Other psychoanalytic writings describe in detail the various emotional and behavioral manifestations of clinical narcissism (eg Bursten, 1973; Modell, 1976; Svrakic, 1985). Some of them contain observations that are relevant to cognitive-oriented psychotherapy. Bach (Bach, 1977), for example, considers a "narcissistic state of mind" that is associated with a variety of cognitive distortions. These include the dominance of a self-oriented perception of reality and a tendency to over-stimulate oneself. The speech and thinking of the narcissistic personality fluctuate between extreme forms of the abstract and the concrete. Narcissistic personalities are difficult to engage in the learning process because of their emotional reactions to the lack of certain knowledge. To regulate their mood, narcissistic personalities usually rely on certain external circumstances, such as frequent praise or attention from others. Time, place, and causality are also interpreted in a personal rather than an interpersonal context. Horowitz (1975) pointed to a defective information processing style, consisting in too much attention to sources of praise and criticism, which leads to the emergence of incompatible psychological attitudes. These attitudes obviously contribute to the formation of a subjective feeling of insecurity and a need for approval.

Thus, the theme of self-love and self-indulgence has evolved from an explanation of masturbation to a description of a wide range of character disorders, united under the name "narcissism". The psychoanalytic literature on narcissism describes in detail the phenomenology of this disorder. But the psychoanalytic theory of the etiology of narcissism seems to be limited by an overemphasis on the alleged inadequacy of the mother's emotional responses.

It is important to note that there is no empirical evidence that unequivocally links childhood neglect with characteristics of narcissism in adulthood. Studies of early parental deprivation in animals and humans indicate the development in such cases of emotional apathy, withdrawal, inappropriate social behavior (Harlow, 1959; Provence, & Lipton, 1962; Yarrow, 1961) and developmental delay syndrome, which also has been termed "growth impossibility" (Cupoldi, Hallock, & Barnes, 1980; Gagan, Cupoldi, & Watkins, 1984; Oates, Peacock, & Forest, 1985). These disorders are incompatible with the exploitative nature of narcissistic individuals, their sense of grandiosity, and the need for constant admiration.

Studies of personality adaptation in adulthood in people deprived of parental care in childhood have not been conducted at all. In one recent longitudinal study of 456 men prone to delinquent behavior in youth (Vaillant & Drake, 1985), it was reported that the "immature defense mechanisms" associated with personality disorders in adulthood were independent of the individual's childhood in terms of clinical assessments. home environment and belonging to a “problem family”. Thus, psychoanalytic assumptions about the etiology of narcissism do not find any direct empirical support, apart from descriptions of individual cases. Indeed, relevant studies appear to refute the assumptions about the causal role of maternal inappropriate behavior.

The possibility of distortions related to the sex of the studied sample should also be noted as a factor influencing the psychoanalytic theory of the etiology of narcissism. Existing observations have been made on male patients (Akhtar & Thomson, 1982) and mostly by male investigators. Akhtar and Thomson suggest that perhaps men are somehow especially vulnerable to narcissism. A full exploration of narcissism is probably hampered by a lack of understanding of traditional theoretical assumptions and their uncritical acceptance. For example, mothers continue to be held responsible for the development of narcissism. One recently published psychoanalytic work puts forward the idea that the future narcissistic personality is born as a replacement for the mother of the significant other after his death; she thus regards the child as "special," but unreacted sadness renders her maternal care inadequate (Volkan, 1981).

Blaming the mother is a serious and widespread problem that certainly influences the professional clinical literature (Caplan & Hall-McCorquodale, 1985). It has become clear in research on deprivation that it is more appropriate to study deprivation of parental rather than maternal care, and that lack of maternal support and care is an important aspect of this problem (Gagan et al., 1984). Thus, the psychoanalytic theory of narcissistic personality disorder may be influenced by the gender of the researcher and the subject of study, as well as underlying assumptions about causes. Alternative approaches need to be developed that take into account such influences. Application of social learning theory.

Millon's (1969) treatment of narcissism in terms of social learning theory is not related to the maternal deprivation hypothesis and focuses primarily on the overvaluation of the child by parents. According to Millon, when parents react to a child in this way, it overdevelops the child's sense of self-worth, and the child's internal self-image grows to such an extent that he cannot find confirmation in external reality. This exaggerated image of the "I" is the basis for the development of a narcissistic personality style. Parents (not only mother) still play a major role. But their impact is related to the information they give the child directly - through feedback, and indirectly - through modeling. The considered intrapsychic structures are limited by the image of the "I" of the child. Cognitive comprehension.

Cognitive theory can extend social learning theory to narcissism. Using the concept of the cognitive triad formulated by Beck, Rush, Shaw, and Emery (Beck, Rush, Shaw & Emery, 1979), we propose that NPD develops as a result of a combination of dysfunctional schemas of self, world, and future. The groundwork for these schemas is laid early in life through direct and indirect influences from parents, siblings, and significant others, as well as experiences that build a belief in one's own uniqueness and worth. The cumulative result of these influences is a multitude of distorted beliefs that are difficult to overcome and highly active. Narcissistic personalities see themselves as special, exceptional, and entitled to a reward; they expect admiration, respect, and approval from others, and their expectations for the future are centered on the fulfillment of grandiose fantasies. At the same time, they noticeably lack convictions about the importance of other people's feelings. Their behavior is influenced by a lack of cooperation and social interaction, as well as an excess of demands on others, self-indulgence and sometimes aggressive behavior.

A sense of one's own uniqueness, importance, and difference from others can develop as a result of a variety of experiences. Obviously, emphasizing flattery, condescension, and favoritism can contribute to the development of narcissism. A belief in one's own uniqueness can also develop as a result of experiencing deficits, limitations, or rejection. Some examples of such experiences might include parental abuse, parental treatment as weak or sickly, or community treatment of the entire family as "different" based on ethnic, geographic, racial, or economic status. This self-image based on rejection or deficits is similar to the pattern of narcissism, which Francis (Frances, 1985) considers a more subtle form, characterized by feelings of inferiority, envy, fantasy proneness, and attachment to powerful others. The common denominator for lower and higher beliefs about oneself may simply be the perception of oneself as being different from others in some important way. This difference can then be associated with too intense emotional reactions, as it is considered wonderful or terrible.

The actual presence of a talent or physical feature that is valued (or not valued) in a given culture will elicit social reactions that reinforce the "superiority/importance" schema. Feedback that would change such a scheme may be absent or distorted. For example, narcissistic personalities may receive very little feedback about their similarities to other people. Parents may also systematically deny or distort negative feedback given to their child from outside. Isolation from negative feedback provokes hypersensitivity to evaluation, which is characteristic of narcissistic personalities. Conversely, in a more subtle way, constant negative feedback can produce experiences that support extreme, catastrophic reactions to perceived criticism and hypervigilance to other people's attention. Problems arise mainly when these schemas of the self become overly active and are not balanced by more integrative judgments.

Cognitive assessment.General clinical context.

Narcissistic people usually seek treatment when they develop an embarrassing Axis I disorder or when they face some serious relationship problem. The main reason narcissistic patients seek treatment is depression. For narcissistic personalities the following forms of depressive disorder are characteristic: adjustment disorder with depressive mood, dysthymic disorder, and sometimes major depression. Narcissistic people do not tolerate discomfort well, so they usually seek treatment for their depression. But the more severe the depression, the more difficult it is to accurately assess the presence of a personality disorder.

Factors contributing to the development of depression often include some kind of relationship problem or breakup, trouble at work, or some kind of crisis in which the sense of grandiosity is stifled as a result of disappointment or insult. Sometimes for certain time unfulfilled grandiose expectations accumulate, and this leads to dysphoric conclusions that big dreams will never come true. A sense of grandiosity and uniqueness can continue to be expressed through the emphasis on the exclusivity of despair.

Narcissistic depression usually involves a discrepancy between expectations/fantasies and reality. Automatic thoughts reflect a constant focus on the unfulfilled expectations, shortcomings and inferiority of others and the uniqueness of the patient's problems. There may be a sense of doubt that things will ever go "really well", as well as avoidance of pleasurable activities and contacts. The narcissistic patient may also feel humiliated by being depressed.

A narcissistic patient may also seek treatment for other than depression, symptomatic disorders or problem behaviors. Significant others may get tired of tormenting themselves with a narcissistic personality and may give such a person an ultimatum that will force him to resort to psychotherapy. Occasionally, narcissistic individuals may seek treatment to relieve the discomfort caused by a symptomatic disorder other than depression. Such disorders typically include social phobias, hypochondria and stimulant substance abuse. Hypersensitivity to evaluation by others can manifest itself in the form of social phobia. Excessive preoccupation with perceived shortcomings in appearance contributes to phobic behavior because people are both seeking attention and fearing judgment.

In the case of hypochondria, excessive self-interest turns into a focus on protecting your body and satisfying physical needs. This provides a socially acceptable way to spend time and energy on oneself and allows for the classic secondary benefit of the attention and empathy of others. Physical vulnerability is the basis for the need for special treatment and an explanation of why reality cannot match imagined abilities. Illness, or potential illness, provides an acceptable explanation for why things are not as "could be".

Substance abuse may develop as part of a general narcissistic pattern of self-indulgence and self-indulgence. Drugs such as cocaine, which are a sign of "high status", are also particularly attractive to narcissistic personalities. Immediate relief from discomfort and a sense of self-worth and power can sometimes be achieved with the help of chemicals. The unconscious tension caused by hypersensitivity to judgment can be easily relieved with a little alcohol or pills. Belief in their own uniqueness prevents narcissistic individuals from admitting their dependence on alcohol or drugs. It also makes them think that they will avoid the negative effects of the addiction and can easily stop using these drugs.

In some cases, paranoid tendencies may develop in the thinking of narcissistic patients. At the same time, the “me against the world” attitude prevails, since narcissistic personalities perceive other people as envious of their special talents and therefore ready to “get to them” or somehow humiliate them. Information that contradicts the grandiose fantasies of narcissistic personalities can cause intense anger, verbal or physical aggression towards other people, and active actions aimed at self-defense. In extreme cases where reality checks are not available, paranoid narcissists may violently attack people they perceive as a threat to their superiority.

An example of this is the following tragic case. The person who was later diagnosed with NPD went through a series of stresses that caused various difficulties and isolation from others. He was divorced from his wife, but retained custody of four young children, two of whom bore his last name. He had problems at work. He had financial difficulties, which ended with the seizure of furniture for non-payment. He worked at night and took care of the children during the day.

The man's ex-wife, he says, called him several times, taunting him with stories about her new friend's sexual virtues and material wealth, such as his new gun. The man became increasingly irritated and worried at the thought that this friend “had a bigger gun than I had” and that the wife and her friend conspired to steal the children one weekend. To prevent this, he bought a rifle from a discount store and planned to kill his ex-wife and her friend. On the day he was about to do so, he "took care" of his four children as well, killing each one so that his wife and her lover would not get them. He then killed his wife as well as her mother. Then he waited six hours for his wife's lover at his work and shot him when he appeared, but only wounded him.

After careful evaluation, it was concluded that this extreme act of violence was primarily an attempt to prevent further blows to the man's self-esteem and was driven by a desire to avenge those who had humiliated him and regain his sense of superiority and dominance. He was declared sane and responsible for the murder of his wife and mother-in-law and the wounding of his wife's friend, but temporarily insane in the murder of children. This case indicates the need to be prepared for aggressive behavior, especially when a suspicious, angry narcissistic person is plotting revenge.

The presence of NPD tends to complicate the standard treatment of an Axis I comorbid disorder. Quite often, an additional diagnosis of a personality disorder is made when treatment for the symptomatic disorder is blocked or there is no expected improvement. We recommend simultaneously analyzing Axis I and Axis II disorders when both are present. In practice, this may mean that some time should be allowed to develop cognitive interventions for both disorders in the same session. Axis I disorder should be treated in the standard way, increasing the amount of time allotted for this, depending on the severity of the symptoms. But if at the same time not enough attention is paid to narcissism, the overall improvement in the patient's condition will be minimal. Separate evaluation procedures.

An accurate assessment of NPD is difficult, especially when there is an Axis I disorder in addition to it. In addition, the patient may have features that are characteristic of other personality disorders. Histrionic, antisocial, and borderline personality disorders are most commonly associated with narcissism (Stangl et al., 1985). Perhaps the most important assessment tool in diagnosing narcissism is the discreet clinical interview. Including another person as an additional source of information in the interview process is also very helpful.

The severity of the patient's condition can be assessed using standard symptomatic measures such as the Beck Depression Inventory. Other standard psychometric tools can help determine the level of discomfort and the presence of certain personality characteristics. Profile MMPI, is likely to show clinical elevations on individual scales that are consistent with the complaints presented. Scale 4 (psychopathic deviance) is likely to be markedly elevated due to the fact that narcissistic personalities see themselves as special, exceptional, and tend to do things their own way. Scores on scales 6 (paranoia) and 9 (mania) are also sometimes modestly elevated due to the hypersensitivity and grandiosity of narcissistic personalities. Data from non-clinical student samples suggest that increases in scores on the 8 (schizophrenia), 9 (mania), and validity scales produced a profile most typical of narcissistic personality style (Raskin & Novacek, 1989). The Dysfunctional Attitudes Survey is likely to confirm beliefs about achievement, perfectionism, and approval.

Direct questioning about narcissistic features is difficult because of the patient's limited ability to objectively evaluate these characteristics (eg: "Do you exaggerate your achievements?") or his unwillingness to admit that he has some forms of behavior (for example, exploitation of people). Alternatively, the therapist may systematically assess the patient's narcissistic features in sessions, self-reports of social relationships, and self-reports of work performance or professional achievement. The following descriptions give some general guidelines for what to look for in each of these areas. Behavioral manifestations

An attentive psychotherapist can spot potential signs of narcissism based on their first impression of a new patient. Often, new patients demonstrate their claim to special rights by making detailed arrangements for their first visit to a psychotherapist. Upon meeting, the therapist may first notice a very elegant or attractive appearance, which is the result of constant attention to one's appearance, the condition of one's body and wardrobe. Excessive concern for one's appearance and comfort, however, is a more reliable diagnostic sign than good looks or good looks alone. Patients show this over-concern in numerous details of verbal and non-verbal behavior. In some patients, this manifests itself in the fact that they often shake dust off themselves, smooth their hair, straighten and check their appearance. Some may adopt exceptionally relaxed postures or sit pointedly upright and maintain an expression that appears haughty. Minor physical deficiencies, such as a broken nail, or minor physical inconveniences, such as a slight feeling of hunger, cause them to have a characteristic overreaction. When one of these behavioral signs is detected, a brief examination of the patient's thoughts and feelings can help determine whether this is a sign of narcissism or just a random feature caused by some other circumstance (for example, hunger can be an important problem if the person has sugar diabetes).

The narcissistic person may be dissatisfied with or resist diagnostic testing, both because it requires some effort, and because it categorizes the problem in a certain way, which implies that it is ordinary, just like any other person. Resistance to testing or feedback procedures can also be a sign of hypersensitivity to evaluation and potential negative feedback. Narcissistic people have difficulty taking feedback, reacting with characteristic anger or shame. Patients may be quite comfortable talking about themselves, sometimes overtly exalting themselves. They may often mention their talents, achievements, connections, or material wealth. A self-confident attitude towards difficulties and a tendency to complain about the shortcomings of others is also a characteristic of narcissism.

How the patient interacts with the therapist is a source of important diagnostic information. In more obvious cases, patients willingly describe themselves as arrogant, arrogant, or brash. They may emphasize their high position, their family's fame, or their celebrity status and expect special respect in return. Narcissistic personalities may also try to manipulate the therapist in order to maintain their sense of grandiosity or their claim to special rights. In addition to waiting for compliments, possible signs of this disorder are multiple questions about the therapist's qualifications (“Are you sure you can work with someone as unique or complex as me?”) and a constant desire to discuss in detail the time of meetings with the therapist and the terms of payment for his services. These patients may become resentful when they are not satisfied with the time or terms of payment.

The narcissistic tendency to idealize or devalue others will usually be evident in interactions with the therapist. The therapist may understand that he is being treated as special person. Conversely, the psychotherapist's interventions may automatically be criticized or rejected. Narcissistic patients sometimes even insult the therapist. In addition to his own experience, the therapist can also discover these attitudes from the patient's description of his treatment with other psychotherapists. Examination of previous psychotherapeutic contacts can help to understand how patients relate to such experiences and how they experienced the end of psychotherapy. One would expect a pattern of high expectations followed by disappointment and abrupt termination of treatment.

A person with this disorder does not have empathy for other people. From all those around him, he expects special attention.

All about the causes of pathology

Narcissism is not a congenital mental disorder. At the same time, its formation occurs from childhood, the cause of which most often becomes the wrong upbringing of the child.

it personality disorder can develop as a result of one of two factors: a) excessive love of parents, which often becomes the cause of permissiveness, b) absolute indifference (lack of attention).

The cause of a personality disorder in a child may be upbringing in an incomplete family, where he is not given due attention. Lack of parental love causes a child to feel dissatisfied, which makes it work defense mechanism. As a result, these children begin to develop confidence in their uniqueness, they expect admiration from the people who surround them.

Narcissistic disorders are often formed in children whose parents show their love in permissiveness, admiration for them. Especially often such mistakes in education are made in families with only or “late” children. Parents encourage every action, any, even the most insignificant achievements of their child. Over the years, a sense of exclusivity is strengthened, which, as a rule, leads to an overestimation of one's own merits and often to the development of narcissism.

About the symptoms of the disease

The main manifestation of narcissistic personality disorders is inflated self-esteem. A person faced with such psychopathy tends to fantasize about such topics as unlimited power, wealth, beauty. He needs constant admiration from everyone around him.

The symptoms that the described mental disorder has do not end there. A person who considers himself exceptional is characterized by a special selectivity in friends, most often he chooses those like himself. Narcissistic disorder manifests itself in the absence of such qualities as empathy and empathy for people. The narcissist often uses those around him to his advantage, which allows him to achieve his goals. Such people do not leave the thought of the envy of others. They often show their dismissive attitude to those around you. Arrogance does not allow them to easily find a common language with new acquaintances, and therefore, in most cases, narcissists have few close friends.

A person who has developed a narcissistic disorder not only needs success, he needs universal recognition, praise, agreement with his superiority. People who in childhood did not have to experience the love and support of their parents, or, on the contrary, those who are accustomed to excessive attention, begin to experience a special need for self-admiration over the years.

The question of the negative impact of this psychological disorder per person is controversial, because experts still note several positive factors. Narcissists are characterized by such qualities as diligence, purposefulness, exactingness to themselves. Negative side is the neglect of people, the use of them for their own purposes, the lack of interest in other people's achievements.

About relationships with others

People who are prone to narcissism choose their professions very carefully, most often their occupation is aimed at winning public recognition, quick fame. Narcissists often become big bosses, while they bring a lot of benefits to their companies, enterprises. Subordinates are forced to put up with all the so-called peculiarities of their boss.

Individuals with the described personality disorder rarely develop strong relationship As already mentioned, they do not know how to be friends. Also, such qualities as caring for someone, respect for others are not characteristic of them.

For obvious reasons, harmonious marriages are extremely rare among narcissists. In marriage, such people require a lot of attention, they need admiration and constant compliments. However, they are unable to reciprocate. To indifference should be added excessive demands on people. Women who connect their lives with narcissistic men rarely face material difficulties, but they have to forget about such components as care, love, respect and support.

According to many experts, narcissism has some similarities with such a disorder as hysterical psychopathy. People with this pathology are also characterized by the need for attention and admiration of others, which they achieve by their actions.

At the same time, the hysteroid can be compared with an actor who needs an audience for self-expression, main goal of all his actions is the manipulation of people. It should be noted that hysteroids, unlike narcissists, are characterized by such feelings as empathy and respect. They are able to rejoice in the achievements of others and show sympathy for the failures of friends.

People with narcissism are somewhat reminiscent of borderline individuals. Both the first and second personality disorders are the cause of the desire for achievement and acute reaction to others' criticism.

Borderline personalities are characterized by the absence of such a quality as purposefulness; they usually quickly get bored of any kind of activity. Their anger can be caused not only by someone else's criticism, but also by minor failures.

About weaknesses and consequences

Self-esteem of narcissists can be called fragile. They carefully monitor their appearance and strive to be the best in everything. Failure to achieve your goals can lead to deep depression. Any, even insignificant achievements cause a feeling of happiness in a person with a narcissistic disorder. Narcissists are envious, the acquisitions or achievements of other people can be a reason for their irritability.

Fundamentals of pathology treatment

Due to the fact that narcissism is a type of mental disorder, it can only be treated with psychotherapy. Exposure to such a person with the help of medications is not required.

In such cases, the specialist faces the task of changing the patient's attitude and perception of the world.

People with this disorder are unaware that they have any mental disorder. Accordingly, they usually do not seek the help of a specialist on their own. At the reception with a psychotherapist, they most often end up at the insistence of loved ones.

The actions of the psychotherapist during the reception of a patient with narcissism are aimed at helping him overcome childhood psychological trauma. Treatment also helps to learn to empathize with people, to listen and consider their opinion. In rare cases, after attending such psychotherapy courses, significant changes occur in the life of narcissists - for example, the appearance of friends, family. Treatment of narcissistic disorders does not always lead to visible results. Psychotherapeutic correction requires a long time and serious work on oneself.

How Narcissistic Personality Disorder Occurs. Methods of diagnosis and treatment

The ancient Greek legend about Narcissus, cursed by the nymph Echo, and who died because of unrequited love for his reflection, has found continuation in modern psychology. Narcissistic personality disorder is a pathologically exaggerated sense of superiority and worth.

The most obvious feature of people with narcissistic personality disorder is an excessive sense of their own worth, their skills, and self-worth. This disorder is stable, its manifestations do not decrease with age, and often, on the contrary, are aggravated.

Symptoms

The American classification of diseases DSM identifies nine criteria for narcissism, the presence of five or more of which allows us to speak of the presence of a personality disorder.

1. Fantasizing on the themes of success, wealth, attention of the opposite sex. Narcissists like to imagine themselves surrounded by beautiful women/men, in high society, in a nice house and an expensive car. These fantasies almost always have absolutely nothing to do with reality.
2. High need for approval and praise from others. Narcissists often believe that they should be praised for even the smallest achievement, admired.
3. Exaggeration of self-importance. People who have narcissistic personality disorder are convinced that they can easily cope with any task, that without them a company or enterprise cannot work, that they are outstanding leaders, artists, musicians, or all at once.
4. Confidence in one's uniqueness, originality, exceptional talent, which can only be seen by equally talented people or representatives of the "elite" of society.
5. The belief that he has more rights and fewer responsibilities than others, so that others must adapt to the expectations of the narcissist and behave in accordance with his requirements.
6. Tendency to envy. A person who does something well is the object of extreme envy for a narcissistic person. Accordingly, they are convinced that those around them envy them.
7. People with narcissistic personality disorder do not hesitate to use others to achieve their own goals, and do so quite willingly, believing that others should be grateful to them.
8. Purposeful demonstration of one's superiority, arrogance and arrogance in communication, condescending attitude towards others.
9. Insufficient understanding of the feelings and motives of others, and unwillingness to understand them. Unwillingness to delve into the experiences and feelings of others, their life situation.

Characteristic of people with narcissistic disorder is the desire for wealth, power, attempts to settle on the "top of Olympus" of the modern world, or at least active statements about such intentions. Any, even the most insignificant achievement, is regarded by them as a step towards this peak. They actively talk about these achievements, you can even say that they brag about them, they say that the hour is already close when the presidency / first million dollars / championship in sports will submit to them and be recognized by the whole world. Because of this, they are arrogant and arrogant, reluctant to communicate with those whom they consider below themselves, in every possible way show their superiority.

Individuals with narcissistic personality disorder are often angry and irritable, perceiving others as hindering their success and advancement in life. Anger in their case is a kind of protective tool that compensates for the insufficient (from the point of view of the narcissist) admiration of others.

Most individuals with narcissistic disorder have poor personal relationships. They tend to use others to achieve their goals, regardless of the opinion of the latter, which is negatively perceived and hinders the construction of long-term relationships. In addition, narcissists refuse to understand the feelings of other people, their needs, put themselves at the center of relationships and insist on the need to satisfy only their own interests.

Also, narcissists are immune to criticism - it only causes them rage or irritation, it is impossible for them to constructively perceive criticism.

Self-esteem of such people is very easy to hurt, despite the extreme self-confidence, there is a deep dissatisfaction in them. This can lead to deep, prolonged depression. Narcissistic people do not handle stress well.

The reasons

There are no physiological or organic causes of narcissistic personality disorder. Most psychiatrists admit that its causes lie in early childhood education and the attitude of parents towards the child.

Unfavorable factors in education is the desire of parents to realize their dreams through the child. For example, a woman who dreamed of becoming a ballerina sends her daughter to a ballet school, while the girl does not want to dance at all, but wants to do karate. Moreover, it is important to combine such a situation with upbringing in the “good child” style, in which the child is instilled with the need to study well, to be neat and beautiful, to be smart, to be someone else in order to earn the approval of parents.

That is, a common characteristic of the upbringing of a person with a narcissistic character is ignoring the child as a person and replacing him with the “transferred” personality of the parent. A child is raised for a specific purpose - to become a lawyer, a doctor, to please parents, and so on.

In the process of such upbringing, the child's own personality is replaced, displaced by the image that his parents have invested in him, and to which he will unsuccessfully strive all his life.

Narcissism in terms of psychology

Psychologists explain the manifestations of narcissistic personality disorder as a violation of self-identification. A person with this disorder has been trying to answer one question throughout his conscious life - “What am I?”. He is looking for the answer in the opinions of others about him, in reviews, written sources. Moreover, the reliability of all this information does not suit him and he continues the search. As a result, his self-esteem is highly dependent on the opinions of others and can change significantly.

These prerequisites lead to demonstrativeness of narcissists, a tendency to stick out their abilities and be interested in the opinions of others. At the same time, he is afraid of receiving a negative response and therefore demonstrates his abilities even more strongly.

The narcissistic character has strengths– his commitment to excellence leads to the implementation of really successful projects, they are often creatively gifted and talented people. Dependence on the opinions of others makes narcissists good listeners and interlocutors. Envy motivates for further work and achievements. They easily find a common language with people, make friends due to their great openness, and are prone to introspection.

Diagnostics

Based on a survey and analysis of the patient's behavior. Pronounced disharmony, capturing different areas of life, especially if the patient himself denies it, is a sign of the presence of a personality disorder. Also significant indicator is a reaction to criticism - too sharp or inadequate reaction is considered pathological.

Narcissistic personality disorder must be differentiated from antisocial, hysterical, and borderline personality disorder. There are often cases of their combination, which makes diagnosis difficult. Antisocial personalities are characterized by the presence of episodes of alcohol or drug addiction, a history of delinquency. High anxiety and suicidal tendencies are in favor of a borderline disorder. Hysterical personalities are characterized by a tendency to gross manipulation of others and exhibitionism.

In most cases, relatives of the patient turn for help, from whom you can get a lot of information about the features of his condition. While the patient himself categorically denies the need for treatment and claims that he feels great.

Treatment

People with narcissistic personality disorder often resist treatment and deny the need for it. And in the event that their career goes uphill, ambitions are satisfied, and others admire - they really feel great. The process of treatment should never be forced - if forced, narcissists can sabotage treatment, lie about its results, and not comply with the doctor's requirements.

The main method of treatment is psychotherapy. The goal of the therapist is to convey to the patient that you need to accept people as they are, not to use them, not to be afraid to express their feelings.

There is no specific treatment for narcissism. It is selected in each case individually and depends on the skills of the therapist and the personality of the patient. The psychoanalytic approach, which helps to identify pathological patterns of upbringing in early childhood, is enjoying great success.

Also common behavioral and cognitive psychotherapy, group classes, often involve relatives in treatment.

In case of severe depression, phobias or panic attacks possible connection drug therapy- depending on the severity of the condition, it can be herbal medicine or the appointment of antidepressants, tranquilizers. However, this method can only help eliminate individual threatening symptoms but not eliminate narcissism.

Narcissism Syndrome, or Narcissistic Personality Disorder

The syndrome of narcissism or narcissistic disorder is a fairly common self-esteem disorder of a person.

Pathological self-attention in narcissistic personalities is accompanied by demands for such attention from others.

The ambitions of such patients, as a rule, are very high, they strive to achieve maximum success (according to their own scale of values, formed in the parental family). The basis for a narcissistic disorder may be external attractiveness, a high level of intellectual development position in society (today this factor is less significant than the two previous ones).

In order to protect themselves from possible comparison with other people and evaluation of their success, patients with narcissistic personality disorder refuse emotional closeness with other people, show no interest in others and their success. In turn, interest in their own success and compliments in their address are taken for granted. Child psychology considers this disorder as a “legacy” of relationships in the parental family, where rather high demands were made on the child, but the emotional connection between him and his parents was minimal. As a rule, people suffering from the syndrome of narcissism are incapable of empathy (experience, sympathy), because they did not learn this from their own parents. There is also a theory that the cause of the narcissistic syndrome may be organic lesions brain in which emotional connections cannot be formed for biological reasons.

Causes of Narcissistic Personality Disorder

There are several groups of causes for the development of narcissistic personality disorder: anatomical, psychological.

To anatomical reasons include:

• thickening of the cerebral cortex;
• thickening of the outer shell of the brain;
• a decrease in the amount of gray matter in the brain area responsible for empathy;
• a change in the activity of the brain area responsible for empathy.

To psychological reasons development of the syndrome of narcissism include:

• low self-esteem (the main reason for self-centered behavior);
• improper upbringing in the parental family (lack of discipline and boundaries for the child causes serious stress and negatively affects its further development; by analogy with a tree that needs support in order to grow even);
• lack of healthy self-esteem, not formed by parents.

The syndrome of narcissism in the vast majority of cases is formed in people who did not receive enough support from their parents in childhood, approval from their side. Compensation for this deficiency is assigned to a narcissistic disorder.

A distinction must be made between narcissistic traits and narcissistic disorder. If the former are quite common, especially among adolescents, then the latter is serious violation and needs to be corrected. There is a theory according to which the formation of the syndrome of narcissism occurs precisely in adolescence. The lack of parental support (as well as indifference and permissiveness generated by it) leads to the launch of compensatory mechanisms, one of which is the syndrome of narcissism. In some cases, the syndrome of narcissism can be one of the manifestations of another mental illness, such as schizophrenia, a schizophrenia-like disorder.

Symptoms of Narcissistic Personality Disorder

• a superiority complex, i.e., an exaggerated sense of self-importance caused by an inferiority complex and low self-esteem, which the patient hides from others with all his might;
• fantasies about achieving great success (depending on the type of narcissism - in the field of public activity, love, power, etc.);
• an idea of ​​one's own uniqueness, which only the elite can know;
• ambition, arrogance in relations with other people, caused by the fragility and hypertrophy of one's own "ego";
• the need for constant admiration from others, as well as the satisfaction of one's own desires "by proxy";
• immunity to criticism, angry reactions (for the same reason of the exceptional soreness of one's "ego");
• envy of other people and its projections: patients believe that everyone around them is actually jealous of them;
• inability to empathize, as well as to one's own experience of strong emotions;
• fear of thoughts about one's own social, professional, physical inferiority, insolvency.

Diagnosis and treatment of narcissistic disorder

Narcissistic manifestations in and of themselves are not a serious problem. However, if narcissistic disorder becomes a problem for you, you should address it as soon as possible. First, you need to see a doctor - a psychotherapist or psychiatrist who can diagnose the problem. Second, pass necessary treatment, outpatient or inpatient. If the symptoms of the disorder are chronic and severe, leading to the destruction of the personality, it is recommended to place the patient in a hospital.

Treatment is prescribed individually for each patient, in accordance with the picture of the disease and concomitant disorders. Shows himself most productive individual therapy, as well as behavioral therapy carried out individually or in a group.

Features of Narcissistic Personality Disorder

The syndrome of narcissism is characterized by personality changes in which a person is convinced of his superiority over other people. His actions and aspirations are aimed at seeking the admiration of his own person from the environment. Narcissistic personality disorder predominantly occurs in men. The syndrome affects less than 1% of the world's population. Such personality changes often occur during childhood. In the treatment of pathology, methods of psychotherapy are mainly used.

Features of the syndrome

Narcissistic personality disorder is a mental disorder in which all the actions of the patient are aimed at elevating themselves against the background of the environment. Such patients:

• convinced of their uniqueness;
• sure that they are superior to other people;
• have an overestimated opinion of their own talents and skills;
• constantly fantasize about achieving certain results;
• expect that the environment will unquestioningly obey them;
• incapable of expressing sympathy;
• raving about the idea that their environment would be jealous of them.

In narcissists, all of these ideas prevail over the rest. Due to the fact that such people are constantly looking for a reaction from the environment to their person, they are constantly gnawed by the fear of being deceived.

It is important to understand that narcissistic personality disorder is precisely the obsessive desire to rise above the environment.

The above ideas are often visited by most people. However, they cannot be diagnosed as having mental disorders.

Another trait that narcissists have is the fear of experiencing shame again. As a result, the patient feels bad in the eyes of others. That is, the sense of self-esteem in such patients is controlled not by internal attitudes, but by the external environment.

Narcissists tend to idealize everything about them. For example, if they own electronics, then only the best. At the same time, the attitude towards objects, events and people of narcissists can change diametrically.

All of the above leads to the following conclusion: people with such disorders become unable to love anyone.

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As with other mental disorders, the mechanism of development of the syndrome of narcissism is not fully understood. Most researchers believe that the roots of the problem lie in the upbringing of the child. Also, the attitude of parents has a certain influence on the formation of pathological changes.

However, narcissistic personality disorder can develop as a result of anatomical features person. In particular, a relationship has been established between the amount of gray matter in the brain and the likelihood of a syndrome: the smaller the first, the greater the chance of developing the second.

It is believed that one of the main factors contributing to the emergence of narcissism is the desire of parents to realize themselves through the child. In the event of a conflict of interest, children develop a defensive reaction that changes their mental state: self-esteem decreases, the desire to achieve approval develops.

Narcissism is the result of improper upbringing. So, if a child is constantly allowed to do everything, then he develops a sense of permissiveness. As a result, an incorrect system of values ​​is formed, which does not correspond to the norms established in society.

It should be understood that the manifestations of narcissism intensify during adolescence. But in the future, as the personality of a person forms, the symptoms of the syndrome may subside, and the psyche will recover.

Factors affecting the development of the syndrome

Researchers believe that narcissistic disorder develops under the influence of cumulative factors. The appearance of the syndrome is facilitated not only by the peculiarities of the upbringing of the child and genetic disorders: plays an important role in this psychological impact. In particular, the problem under consideration is revealed in the following cases:

1. Hyper-care. If parents overestimate the child's abilities, idealize his actions and decisions, then the likelihood of developing a narcissistic syndrome increases dramatically.
2. Psychological trauma in childhood and adolescence. During these periods, children are especially susceptible to the negative influence of the external environment.
3. hereditary factor. A certain relationship has been established with the frequency of the spread of narcissism in one family. However, this circumstance can be explained by the child's desire to imitate his parents, in connection with which they involuntarily develop a syndrome of narcissism.
4. The presence of idols and the work of the media. They form a certain system of values, according to which each person should rise above the others. Otherwise, you cannot achieve success in life.
5. Mental illness. In particular, a person suffering from schizophrenia is out of touch with reality. And some hallucinations characteristic of this mental disorder can form an attitude that a particular person is a link between people and the other world.

Although modern science well studied the nature of narcissists, she still has not been able to identify the factors that provoke narcissistic disorder. Often this syndrome develops in the only children in the family.

Clinical picture

A characteristic feature of a narcissistic disorder is an inadequate assessment of one's own personality. In most cases, it is men who have an inflated opinion of themselves, in connection with which they form a superiority complex over others.

With narcissistic disorder, the following phenomena come to the fore:

• the presence of a hypertrophied (exaggerated) sense of importance;
• fantasies about achieving success, power and other goals prevail over other thoughts;
• a sense of one's own uniqueness, incomprehensible to "ordinary" people;
• the desire to ensure that the environment constantly admires the narcissist;
• arrogance and excessive ambition, which often manifests itself in the form of cruel jokes;
• inability to empathize and sympathy;
• the presence of envy and confidence that the environment is envious;
• inability to perceive criticism from the outside;
• low self-esteem, which is hidden under the mask of self-confidence;
• manifestation defensive reaction any words or actions that could negatively affect self-esteem;
• aggressive behavior in response to opinions or actions that do not correspond to internal attitudes;
• the desire to hide their own shortcomings by any means;
• the desire to manipulate people in order to satisfy their own needs.

The latter concerns mainly attempts to rise above the environment and increase one's own significance in the eyes of people. The danger of narcissistic disorder is that the person cannot identify himself. Patients with this mental disorder seek to find the answer to the question of who they really are in their own environment. And this applies not only to the opinions of loved ones.

Narcissists try to identify themselves through various written and other sources, which sometimes have nothing to do with the patient himself. It is also important that patients are never satisfied with the answers they receive and continue to look for them further.

Although the syndrome of narcissism is pathological deviation, it forms certain positive traits in a person:

• striving for excellence ensures the achievement of positive results in many endeavors;
• the desire to get approval from the environment makes narcissists good listeners;
• the presence of envy provokes in patients the desire to achieve something new.

Together, all the disorders in the psyche of the narcissist contribute to his development of a tendency to introspection.

Treatment and diagnosis

plays an important role in the diagnosis of narcissistic disorder. A complex approach which covers a significant part of the patient's life. The doctor takes into account the changes that have taken place on different stages personality formation. The presence of disharmony, which the patient denies, is an important indicator in favor of a narcissistic disorder. In addition, this disease is confirmed in the case when the patient does not perceive criticism well.

In the diagnosis of pathology, it is also important to differentiate it from other types of mental disorders. The difficulty in this case lies in the fact that such changes often occur in one time period.

Treatment of the narcissistic syndrome involves many sessions of psychotherapy. They include activities aimed at:

In view of the fact that treatment for narcissistic disorder usually begins after the treatment of the patient's immediate environment, the doctor needs to establish a trusting relationship with the latter. Otherwise, the patient will defensive position, because of which the psychiatrist will not be able to make the narcissist realize that he has a disorder. In such circumstances, the doctor, above all, maintaining the patient's opinion about his exclusivity. Only after mutual understanding is reached, work begins to correct mental attitudes.

The main task facing the doctor at the initial stage is the formation of a sense of empathy for him in the patient.

Similarly, they do when sessions of group psychotherapy are held. This approach demonstrates quite good results, since during the treatment narcissists are constantly in contact with each other, and therefore their intensity of experiences gradually decreases.

If psychotherapy is not carried out, then against the background of a constant desire for self-assertion, which is combined with low self-esteem, the likelihood of developing neurosis and depression is high. The latter together can lead to suicide. In such cases, the main treatment is supplemented by taking antidepressants and tranquilizers.

The emergence of narcissistic disorder is mainly facilitated by improper upbringing (overprotection or complete neglect) of the child. Treatment of mental disorders is carried out through psychotherapy, which in rare cases is supplemented with drugs.

Narcissism as a psychological disease: symptoms, treatment

Narcissism is a mental disorder that is expressed in a person's inflated self-esteem, complacency and narcissism. Such a pathological love for one's own personality is expressed in close attention to one's own person, while a person cannot control his ambitions, strives for wealth and external attractiveness, infantilism is manifested in manners and actions.

A bit of history

The term "narcissism" comes from the name of the ancient Greek mythological hero Narcissus. The young man was incredibly handsome: the narcissistic hero rejected the love of the nymph Echo, for which he was punished. The ancient Greek gods sentenced Narcissus to lifelong admiration of his face through the reflection on the water surface.

According to Sigmund Freud, narcissism is a manifestation of specific intimate behavior. Many children in the early stages of life show a narcissistic feeling, admire themselves. At the same time, if the personality of the child develops harmoniously and correctly, and the parents participate in the full-fledged upbringing of the child, such narcissism does not bring any harm and disappears on its own as it grows older. In the process of creating the methodology of psychoanalysis, Freud finally introduced the concept of narcissism into psychiatric practice.

Narcissistic personality disorder and its causes

This mental disorder can have various causes. When examining the brains of patients, scientists found a thickening of the cortex and an altered structure of some nerve cells. Deviations affect the part of the brain that is responsible for the feeling of compassion.

According to experts, the feeling of empathy depends on the concentration of gray matter: in narcissists, its amount is significantly less than in healthy people.

Narcissism is a mental illness that occurs for the following reasons:

1. Low self-esteem in childhood. At the same time, such features of behavior can be laid by the parents or the environment of a person, constant reproaches and censures provoke the emergence of protective mechanisms.
2. The absence of parental restrictions in childhood, excessive praise and idealization of the child's personality by parents.
3. Permissiveness, in which the child does not understand what he can do and what is forbidden to him.

Please note that certain features of narcissism often appear during puberty, but this does not mean that such a phenomenon will develop into a mental disorder.

Some theorists believe that narcissism is a pathology that is also hereditary. An important role is played by the presence of an idol in a teenager. In some cases, this phenomenon is associated with a more serious mental illness (for example, with schizophrenia), in which case the patient completely loses touch with reality, considers himself a messenger of a deity or another idol.

Signs of Narcissism

Below are the symptoms of this disease, on the basis of which the psychiatrist makes a diagnosis.

1. An exaggerated sense of self-importance.
2. Constantly emerging fantasies of overwhelming success and fame, incredible wealth.
3. Conviction in one's own uniqueness, the desire to communicate with people only with a high social position.
4. Demanding admiration and reverence from other people.
5. Arrogant and ambitious (some narcissists make mean and cynical jokes about other people).
6. Lack of empathy and compassion.
7. Negative attitude towards criticism.
8. Inflated self-esteem is just a mask for other people; deep down, such patients are weak personalities with many psychological complexes.
9. Careful disguise of their own shortcomings.
10. Using other people for your own benefit.

All people who suffer from this disease are trying to protect themselves from envious feelings towards others, so they are often not interested in the personal life and professional activities of their friends and acquaintances. A sick person often expresses uncertainty in his opinion: at first he perceives this or that person as an idol or idol, and then expresses contempt for her and considers this or that person unreasonable.

Narcissists are people who are addicted to praise, very often they do not react in any way, do not respond with gratitude when they hear compliments. In most cases, patients show no interest in generally accepted values ​​(moral or aesthetic).

Narcissism in women and men: features and main differences

The psychology of narcissism in men is deep, and the reasons lie in children's upbringing. Moreover, this disease is most often found in the representatives of the stronger sex. Male patients are trying with all their might to achieve their own importance in the eyes of society. By all means they achieve career growth and a high financial position. When the desired goal is achieved, the patient's joy from the received lasts only a few minutes, after which their needs increase again, and they begin to want more.

Before reaching adulthood, growing goals and needs do not disturb the patient, he gradually realizes certain tasks and sees no reason to worry. Later, however, the narcissist begins to realize that he never achieved happiness. Men with such a diagnosis are not able to build full-fledged relationships with people, they destroy families, while the children of the narcissist also begin to suffer from the negative influence of their father.

As for female narcissism, it is expressed in the inability to understand your child, the inability to enjoy simple things and, as a result, in dissatisfaction with one's own life. Patients force their children to study day and night, to get only excellent grades, conflicts often occur against the background of the fact that the child did not live up to the expectations of his mother.

Personal inter-gender relationships also suffer from female narcissism: patients choose exclusively caring and attentive men as partners, but they themselves do not respect them, because they consider them to be weak-willed and incapable of anything. If in a couple both people have signs of narcissism, a relentless struggle of characters begins: these people will compete with each other in absolutely everything, while such a tense relationship is unlikely to last long.

Features of diagnostics

It is possible to determine such a pathology already during a personal conversation with the patient. The format of the conversation in the form of an interview is best suited for these purposes. Based on the results of the survey, points are given, on the basis of which the psychiatrist determines whether the patient has a serious personality disorder or a borderline condition, which is expressed in high self-esteem.

Among the questions are the following:

1. Why do you think you deserve close attention and special treatment of your person?
2. In your opinion, who might deserve your attention, and why exactly?
3. What kind of people are you willing to sacrifice your free time for?
4. Is it important for you to spend time exclusively with influential people with a high social position?

At the same time, it is important to distinguish narcissism from the usual inflated self-esteem, as well as from the symptoms of other diseases (for example, from schizophrenia).

Why is narcissism dangerous? If the correction of the individual's behavior is not started in a timely manner, the mental disorder may progress. As a result, the patient will be unable to maintain social ties and engage in professional activities, gradually moving away from social life, which leads to the development of other mental disorders. In some cases, aggression and psychosis appear, the patient ceases to control his behavior. Treatment in such situations is possible only in a hospital.

Disease testing

In modern psychiatry, there are several effective methods aimed at identifying narcissism. One of these methods includes a special questionnaire, which includes 163 questions of a different nature. When studying the answers to them, the specialist studies the so-called Likert scale.

The patient must express the degree of his approval or the degree of disagreement with a particular statement. As a result, the psychiatrist calculates the coefficient of narcissism. It is worth noting that this technique also has contraindications: for example, it cannot and is not advisable to use during a period of severe depression or acute psychosis.

How to treat narcissism?

Treatment of this mental disorder is ineffective at home. If signs of such a disease appear, it is necessary to contact a psychotherapist who will conduct the necessary diagnostics and prescribe an effective therapy that allows you to normalize self-esteem.

At the same time, doctors are not recommended to show weakness in the presence of the patient, since he can take advantage of the uncertainty of the specialist and exert his influence on the course of therapy, as well as pressure on the medical staff. At the same time, the psychiatrist must treat the patient with respect, so that the patient cannot constantly demonstrate a sense of self-importance.

The treatment of narcissism in men and women includes individual psychotherapeutic techniques. During psychotherapy, the specialist must refrain from excessive criticism of the patient, otherwise his self-esteem will be further violated. You should not show a feeling of pity and sympathy: such a person may simply not understand the compassion of a doctor.

It is worth noting that not all patients are aware of their problem, so the specialist needs to act very carefully and first identify exactly what signs this disease has (it is best to do this using the example of other narcissistic people).

Of no small importance is group psychotherapy, during which the patient develops a healthy and adequate personality (rather than pathological narcissism): regular group conversations with the right bias will allow the patient to get rid of inflated self-esteem, begin to correctly understand other people and consider them full-fledged personalities.

In some cases, therapy also includes medication. The patient may be prescribed psychotropic drugs to eliminate increased excitability and anxiety (if such symptoms are present). If the patient has depressive conditions associated with deep psychological complexes, a course of antidepressants is prescribed. All these drugs are prescribed only by the attending physician. If the treatment takes place in a hospital, there should be control of medical personnel over the intake of medications. Medicines are prescribed in strictly defined dosages, since they have many side effects.

Only in severe cases, therapy is carried out in stationary conditions. As his well-being improves, the patient can be treated on an outpatient basis, that is, at home with regular visits to a specialist for psychotherapy sessions. The exact duration of such sessions and their number are determined on an individual basis, depending on the specifics of the mental disorder. Often, it is not possible to completely get rid of the manifestations of narcissism and inflated self-esteem, however, with the help of complex therapy, it is possible to correct the patient’s judgments and personal characteristics, help him begin to fully communicate with other people, make family and friendships with a minimum of conflict situations.

Preventive measures

How to act so that the child grows up as a full-fledged personality with adequate self-esteem? The following preventive measures will help prevent the development of narcissism:

1. During puberty, children are especially vulnerable, prone to excessive shyness and psychological complexes. In order for the growing personality to fully develop, it is important to maintain in the child a sense of dignity and independence from the opinions of others.
2. Children often cry, expressing their dissatisfaction with something. Let the child do this, because that is how he will understand that not all needs can be met immediately. It is important to firmly refuse the child if he makes high demands and is capricious (of course, this does not apply to natural needs).
3. It is better to confess your love to your child more often, while not focusing on his beauty. Otherwise, the person will develop an unpleasant feeling of vanity.
4. It is normal to praise a child for really worthy things. However, too frequent and exaggerated praise is guaranteed to lead to further narcissism.
5. You should not brag about the positive qualities and actions of a son or daughter in his presence, it is better to do this when he does not hear.
6. You don't have to practice the good and bad parenting technique. Such an imbalance will upset the child's value system, causing him to not distinguish between positive and negative actions.
7. The child must understand that he will have to live in society, while society should not live for him.

Thus, narcissism is a personality disorder that is expressed in excessively inflated ambitions, a tendency to narcissism and a lack of compassion. In most cases, such a disease develops in childhood and adolescence, as a result of which an adult remains infantile and unable to maintain normal social ties. Treatment of such a mental disorder is carried out under the supervision of professional psychotherapists, treatment is provided both in inpatient and outpatient settings.

How not to grow a Narcissus and how not to become one?

An overestimated sense of one's own uniqueness and significance causes such a pathology of the psyche as narcissistic personality disorder. It is practically impossible for such people to normalize self-esteem and attitude towards themselves and others.

What is narcissism?

Narcissistic personality disorder (narcissism) got its name from the hero of ancient Greek myths, Narcissus, who could not stop looking at himself. Mostly men suffer from this pathology. At first, narcissism was seen as a negative character trait. However, over time, psychologists have come to the conclusion that narcissistic personality disorder is a rather severe pathology of the psyche. People suffering from this disorder need medical attention and support from loved ones.

What caused the disorder?

The reasons for the development of narcissism, as a rule, do not have an organic or physiological background. Therefore, they are not caused by one or another pathology of the internal organs.

Most often, narcissistic personality disorder begins to form in childhood, when the following points take place:

• spoiled child;
• permissiveness;
• excessive praise and encouragement of the most ordinary actions of the child;
• ignoring the child's own personality and the desire of parents to fulfill their unfulfilled dreams through him;
• the constant persuasion of the child by the parents that he is better than other children.

In such conditions, the only, the youngest in the family and late born children are most often brought up. Especially if the parents had to be treated for a long time so that the child was born.

However, very often narcissistic personality disorder is diagnosed in children who have not received parental attention, growing up in complete indifference to them from adults.

Very often, children who grow up in an incomplete family or are brought up by one of the relatives in the absence of parents for various reasons are prone to narcissism.

Signs of pathology

Narcissistic personality disorder is revealed primarily on such grounds as excessively high self-esteem, firm confidence in one's superiority over other people. A person suffering from this disorder has the following symptoms:

• an increased need to receive praise for the smallest actions;
• constant fantasies about their own success in personal life, in business and in other areas;
• exaggerated conceit, confidence in one's own indispensability;
• confidence in having fewer responsibilities and more wide opportunities and rights in comparison with other people;
• achievement of personal goals by using relatives and friends for this;
• confidence that others are jealous, and their own envy in relation to other people;
• constant demonstration of one's own superiority, boasting, arrogance and arrogance in communication;
• misunderstanding of the motives and feelings of relatives and friends and unwillingness to pay attention to their life problems, situations, etc.

For people with this mental disorder, the desire for wealth and power is characteristic.

Even a slight success is regarded by them as a step towards their intended goal. They tell everyone about their achievements, that is, they brag about them. As a result, they are arrogant and consider it unworthy to associate with someone below them.

How is the disorder treated?

Treatment of a person suffering from narcissistic personality disorder should be started very carefully.

Such people often do not recognize themselves as sick and resist any attempts to apply any therapeutic measures to them.

A psychotherapist deals with the treatment of such a mental disorder. Methods of treatment are selected strictly individually, taking into account the personal data of the patient. The most commonly used method is psychoanalysis, which helps to identify the erroneous stereotypes instilled in the patient from early childhood.

During the sessions, the psychotherapist can use cognitive and behavioral methods of working with the patient. A good effect is achieved during group classes. The closest relatives of the patient are necessarily involved by the psychotherapist during the treatment of narcissism. Under the guidance of a specialist, family members can create the necessary environment around the patient to stabilize his condition.

If necessary, a course of symptomatic treatment is carried out with the following means:

• tranquilizers;
• antidepressants;
• medicinal plants;
• sedatives.

Treatment with the above means may be necessary when serious difficulties arise in the life of the patient and stressful situations. In this way, it is possible to avoid the development of neurosis, depression and other pathologies of the psyche in a person suffering from narcissism.

I live with a diagnosis of Narcissistic Personality Disorder (NPD). What does it mean? First, it took a lot of effort for me not to put my real name under this article. After all, even a repentant story about how unbearable I am for my relatives would flatter my sick pride. Second: only I (well, okay, and another 1% of the male population of developed countries) really have the right to be called a narcissist and an egoist. My diagnosis is, in fact, the medical definition of selfishness.

I brought to depression - real, clinical - two of my failed wives. Therapists are reluctant to work with me, afraid of hurting their own psyche in the first place. I need to take pills just to not act like a scum (and yes, at the end of the article I will reveal the secret of what these wonderful pills are). And I will also pass on my egoism by inheritance with a gigantic probability. Like this. And what your women are offended by is most likely a healthy indifference, well, or is there the usual redneck ...

Here's my confession. If you find the same thing - welcome to the ranks of NRL carriers! If not, then thank God, believe me.

5 Signs You Have NPD

All this information can, in principle, be gleaned from the Internet, but I have flourished it with examples ... In addition, not a single real egoist voluntarily admits that he is sick and does not get into the Internet to read something supposedly about himself. At least not before the onset of personality decompensation, when the disease itself becomes a self-object ... stop! My five signs are also different in that I do not use buzzwords that are really only confusing.

Feature 1
Do you have empathy issues?

Sympathy, willingness to help, concern for others - not that the owner of the NRL was completely deprived of all this. The narcissist understands what his interlocutor is thinking (sometimes better than himself). But - it understands, but does not feel! Putting yourself in the place of another person is already an impossible task for him. For example, I usually know that they are worried about me. I can see that they are not happy with me. However, the emotions of the interlocutor, whether it be a girlfriend, cohabitant or even a mother, are an empty phrase for me. I do not experience TOGETHER with people. And therefore I cannot “discharge” them - give them what they achieve by expressing this or that emotion. To say what they want to hear from me, I still somehow can. But to support a quarrel with screams, when a person wants to scream ... Or stroke his hair and pat on the shoulder ... I don’t know how. If only by chance.

At the same time, I'm not some cracker with whiskey with ice instead of a heart, like Kai from a children's fairy tale. I can cry over The Green Mile and The Lion King, I can be restless when it's two in the morning, and someone doesn't answer the phone and I don't know where. But in order to feel anxiety for another, I have to “wind”, “tighten” or, as they say, “irritate” myself. But even then my emotions are only an appearance, a tribute to social etiquette. I really don't care. Even when the little lion cub tugs on his dead dad's ear and cries, "Get up, let's go!"

I am by no means proud of this feature of my psyche. I'm ashamed of her. And by the way...

Feature 2
You often feel ashamed

Not guilt, but shame - this is important! Because guilt is when you're having fun in the family bed with an intern from the legal department, and your wife suddenly walks in the door. And shame is when you are having fun on the same bed with the same trainee, your wife is definitely in Istanbul, but the thought is still in your head: “What am I doing? What if the wife comes in ?!

Shame is always mixed with fear: "What will they think of me?" They laugh nearby, and you tensed up: isn’t it over you? it typical manifestation NPD ... In the early stages of the disorder, shame and fear provoke only real failures or strong feelings on the topic "have I pierced." Thus, it is difficult for a novice narcissist to cheat on his wife: shame is so strong that it can cause erectile dysfunction(leave it out of brackets, how do I know this).

It's hard to take criticism. It's hard to hear jokes addressed to you, even the most harmless ones. For example, I still remember all the jokes addressed to me over the past 20 years! Especially one. At work, someone asked: “There is someone’s book “How to live with a small penis” on the table, Igor, yours?” It is clear that such a book does not exist. It is clear that even if she had been lying on the table, she would not have been mine. But the instantly rolling shame “what if someone thinks that this is true” does not go away for years, destroying the psyche. Narcissus is first and foremost a Samoyed. A seemingly cynical snake that secretly constantly eats its own tail.

If treatment is not started in time, the disorder drags its owner into such a black thicket of shame, where any stump begins to seem like a terrible monster. Simply put, over time, you begin to react painfully to the most innocent remarks. You stop doing something for fear of making a mistake and feeling ashamed of a future puncture. You drive the intern out into the street in the middle of the night in only her underwear and throw the family sheets into the wash - although no one even stained them that evening ...

Worse, the realization that you are entangled in the chains of shame itself begins to provoke shame: what if someone finds out that I am helpless and cannot cope with myself? This recursion can continue indefinitely.

Feature 3
You can't conflict

In essence, this is a consequence of the features already listed. The narcissist all the time, on the one hand, does not guess other people's emotions, and on the other hand, he tries to understand what they think about him. This creates an insidious, albeit rather stupid, trap. Narcissus, as our president's speechwriter would say, is a typical "tolerant". He is able to marry an unloved woman. Travel to hateful relatives. Bend under a stupid boss. And all this - out of fear that they will think badly about him when he tries to change the situation. A person with NPD is afraid of being thrown in the face with an “ungrateful pig!” - and as a result endures such treatment of himself, which turns out to be more traumatic than rebellion, conflict.

On the other hand, when the narcissist still finds himself in a situation where he does not depend on the opinion of the conditional “enemy”, he brings down on him such anger that he did not deserve! Fortunately, at the beginning of my adult life, I realized that asserting myself at the expense of waiters was “not cool”. However, before the start of treatment, I often caught myself talking too rudely with a taxi driver or secretary. Yes, and domestic despotism was not alien to me ... Fortunately, this is one of the most easily corrected symptoms. Unfortunately, he is not the only one.

Feature 4
You are always dissatisfied with something

This feeling should not be confused with perfectionism, a craving for excellence. A perfectionist has a clear ideal, a plan, a scheme in his head. For example: an article about NPD should be six pages long, five signs should be listed, then the treatment regimen, etc. Having imagined such an ideal, a perfectionist will be dissatisfied with himself only if he cannot achieve it. “Well, Danila-master, doesn’t a stone flower come out?” is perfectionism.

At the same time, the narcissist, the clinical egoist, is dissatisfied in principle. Not only by the results of your work, but also by everyone around you - and first of all by yourself. Salary, sporting achievements, another girlfriend's foot size - all this irritates and even infuriates the narcissist, not because "it could be better." And because of the constant awareness that it can be OTHERWISE. You have probably experienced this feeling in its small manifestations. For example, when you are trailing in the tail of a half-dead traffic jam, it always seems that the next row is going a little better, a little faster. Here you go. And I always have. For any reason. Yes, I'm dating a model. Well, he could - with a gymnast! Not that the model is bad ... Although ...

Everything that the narcissist has already achieved is instantly devalued. Everything that cannot be obtained right now, on the contrary, is idealized. I am like a child who was let into a toy store and told: take what you want, but you can take one thing. Any situation of choice destroys the psyche. Makes me wonder if I made the wrong choice.

Most often, the narcissist begins to "sort out" women. Why - science does not yet know. Personality disorder guru Nancy McWilliams believes that the narcissist cripples the psyche of women because he does not know how to get rid of them in time. To extend the toy analogy, you love your new car. But you know, they won't buy you a new one until this one breaks. And as soon as feelings for the toy begin to weaken, you break it yourself in order to get a new one faster. There is even a name for this: Don Juan syndrome. Of course, not every womanizer is a narcissist. However, if this is so - well, as they say, lock up your daughters ...

Feature 5
You don't have a true inner self

The most terrible secret that is unlikely to be revealed to you at the first session of psychotherapy. All of the above signs are, in essence, symptoms, side effects. But the fifth sign is the root of the disorder. And the secret lies in the fact that there really is no narcissist! ..

That is, there is nothing inside the personality that would constitute its core. The narcissist is brought up (see below) in such conditions that in the place that in other adults is occupied by his own "I", he has a black hole, a funnel closed on itself. An emptiness that feeds self-doubt - and a doubt that sucks everything good and good out of the emptiness. The whole life of a narcissist is an illusion. All the objects of his pride are the external attributes of fame, wealth, success.

In psychiatry, this is called the "external locus of self-esteem." Not being able - at least without treatment - to be proud of himself and love himself, the narcissist creates the so-called self-objects. These are completely external things, people, phenomena with which the carrier of NPD associates himself. "I work in a cool design bureau" - instead of "I'm a designer." “And this is me in front of my car” - instead of just “and this is me.” "I'm dating a gymnast" - instead of "thank you, everything is fine with my personal life." All of these are typical NRL formulations.

For the time being, creating dozens of such self-objects is easy. Narcissus can even give the impression of a super-successful minion of fate and almost a child prodigy. Ah, he is the winner of Olympiads in seven subjects! Ah, he was awarded such and such a medal at the age of fifteen! Ah, he is the youngest winner of anything in history! Don't be deceived: these are all just attempts to fill a void. At some point, the mechanism for creating self-objects breaks down - this becomes the moment when a recently healthy narcissist (there are some, although this is a temporary stage) gets upset.

This is where the name of the disease comes from. As you probably remember from Kuhn's book "Myths Ancient Greece”, Narcissus’s problem was not just that he fell in love with his reflection and died from it. Self-admiration is still half the trouble. In fact, Narcissus was under a curse: he was doomed to love an object that was unable to return his love! So appreciate the evil wit of the psychotherapists who came up with the name for my disorder. I idealize objects, pump them up with my self-esteem - and as a result I create a false "I", based, for example, on work, money, relationships, well-being.

And then, at the very first crisis, I understand that all these years there was a cold something in front of me, flowing through my fingers along with my self-esteem.

How is it treated

First and foremost, under the supervision of a doctor! Self-medication is generally contraindicated in personality disorders, and even more so in narcissistic ones. Besides, not a single dealer, let alone wine supermarkets, will still have the assortment of magical elixirs that a psychiatrist owns.

Take at least alimemazine antipsychotics. Of course, in business this is not the best assistant: the feeling is that carpet bombing was suddenly allowed in a pillow fight - and you were covered with about three tons of caked fluff. There is fog in the eyes, the head is wadded, the movements are slow. But! No Don Juan syndrome (such nonsense as women simply does not bother, except in a dream - if you suddenly forget to take an evening pill). No sense of shame. And most importantly, no desire to attract attention to oneself, to obtain a surrogate for love: no antics, no scandals, no self-criticism, no accomplishments ... Hmmm, a miserable semblance of a former life. But I warned you: you better not find signs of NPD in yourself.

Of course, neuroleptics alone are not enough. Following them, antidepressants, nootropics, and psychostimulants are sent into the furnace of a broken body. The complexity of the cocktail and the intensity of intraday sensations depend on whether you still need to work in the process of treatment - or you prudently sold your assets or simply quit with an entry in your work: "Due to extreme intolerance" ...

One way or another, the pharmacological period is only a prelude to a long and mutual brainstorming, which you will be doing with a psychotherapist in the next year (minimum). At the same time, it is pointless to choose a prettier specialist, because in a couple of months he will probably refuse you anyway. But maybe the second or third will sooner or later discover the cause of the disorder, which - no surprise here - most likely dates back to childhood. In my treatment, this moment has not yet arrived. Therefore, I am still able to write with narcissism about my sore.

How to water daffodils

Since NPD begins in childhood, I recommend reading Alice Miller's Gifted Child Drama: even healthy man he will find himself in it, and the book is read almost faster than the instructions for an air freshener. Miller believes that narcissism in a healthy, rudimentary form is characteristic of most children. Using their example, we will consider how to deal with small narcissistic bastards so that big bastards and intractable bastards do not grow out of them.

If a child shows signs of narcissism, the worst thing you can do with him is to start loving, encouraging and praising him not just like that, but for SOMETHING. “What, you’re not a man, can’t you throw a lure normally?”, “If you don’t wash behind your ears, not a single girl will even look at you”, “Well, how many fives did you bring today?” These and similar phrases get stuck like nails not only in the brain, but also in the lid of the coffin. A coffin in which the true "I" of the future narcissist will writhe in agony. Just love a child. Whatever he brought from school, even chlamydia.

Play ahead of the narcissist. If a child brings you a plasticine craft or shouts: “Dad, look how I can” and “Mom, mom, I masturbate without hands!” - that means it's a mess. He ALREADY didn't get any attention. Do you remember the feeling of shame and eternal discontent? Giving compliments to a narcissist only when he himself asks for them will only give him reason to suspect that he is doing something WRONG. They don't praise me?.. Maybe I'm doing the wrong thing? Maybe I'm not crying out loud enough for lack of attention? Maybe something needs to be blown up in this house so that dad will break away from the TV and chase me a little? .. If you “water” the narcissist without waiting until he starts to dry, his craving for self-expression can be channeled into a healthy direction.

The narcissist needs to be taught to speak in time. Not in the sense of all sorts of “but how does the cow speak? That's right: mu-mu. We are talking about a more complex process of articulating emotions. When you talk to a child who is a candidate for NPD, a complex bouquet of shame, resentment, conspiracy theories, dissatisfaction (with himself and you), fear and a thirst for greatness is ALWAYS blooming in his head. If you teach a child to express these feelings freely already at the age of 7–10–12, you will save the life of not only him, but also that poor fellow, whom he would eventually bring to depression. The main thing is to show that the child HAS THE RIGHT to resentment, anger, jealousy, disobedience. Remind more often that people may not always be good. Moreover, they SHOULD NOT be like that. If the narcissist learns to love not only his beautiful reflection in the water, but also the back of his head and his hairy back, this will save him. Well, or at least delay the first intake of alimemazine for a couple of years ...

Well, what about adult daffodils, you ask? How to be with the narcissistic girlfriend? Well, in fact, she will have to be dealt with in the same way as with a painfully self-obsessed child. With one difference: from a woman, unlike a child, you can escape in time. And that is exactly what I recommend you do if you suspect that you have come across a genuine narcissist. Jokes aside.