Misconceptions about Pathological Narcissism and NPD | Dr. Igor Weinberg

so I think let's start with having you introduce yourself what you do why you think you're here why don't you start by introducing yourself I'm Igor Weinberg I'm a psychotherapist and outpatient program at McLean Hospital also assistant professor of psychology and Department of Psychiatry at Harvard Medical School I guess I'm here because I've been specializing in the last few years and treatment of people with pathological narcissism and narcissistic personality disorder and I was invited to share some thoughts about that both of us are probably on the same page about trying to do or that I want to do by having you here is I would like you to describe what the public thinks narcissism is from the outside it's presentation and what your experience is as a clinician vis-a-vis the internal experience that a lot of people who have an NPD diagnosis have and because I think they're pretty different you know the the yeah all the axes level that the people with the diagnosis that's a that's a very good question and I think I can talk about this for a very long time so I'm gonna have to uh censor myself and try to be concise um there is a sort of a stereotype another sort of there is a real stereotype of what narcissistic personality is which coincides with what we know in a literature is a grandiose description of narcissism which is not the only description that we have in the grandiose description usually talks about people with exaggerated sense of self-importance a sense of entitlement that are bold that are rude that are aggressive in their approach to others that are inconsiderate they lack sensitivity and quite aggressive in terms of their approach and that many times that's the stereotype that I suspect was somewhat supported by the way in which our pathological narcissism is defined in DSM which is the only definition that we have in in the diagnostic statistical manual for psychiatry that's not the only way in which pathological narcissism expresses itself and today we know that this is only tip of the iceberg there are a lot of people that are suffering from um what we call pathological narcissism they do not really fit this definition which is um many ways caricature and actually is the disservice to understanding people with pathological narcissism it's actually quite shaming in fact many times when we do talk about this diagnosis with patients they immediately say does it mean that I'm like this it doesn't mean that I'm like that and many times I have to clarify no it doesn't mean you're like this what it means is that you have difficulty regulating self-esteem in a way that is consistent and and doesn't get you in really trouble however it still has a very shaming and connotation that is I'm hopeful I'm hoping it will ultimately be removed and that has to do with the New Movement of trying to humanize narcissism and trying to see the person behind the diagnosis and trying to see that the person behind the diagnosis is actually suffering there is a lot of research today that is pointing out to what we all knew clinically that people that are suffering from pathological narcissism experience a lot of internal suffering and internal difficulties that are very real um and the way it's getting expressed on the outside may not really match what's happening with the inside and that's one of the reasons that the definition that we have today um of pathological narcissism is actually based on external characteristics if we look at the symptoms of of narcissistic personality disorder it's only based on external characteristics it's not really based on internal experiences almost none of that is based on internal experiences when in fact we do know that there is a lot of distress a lot of fluctuations of self-esteem difficulty relating to other people in a way that feels meaningful and those are very painful experiences that people are trying to deal with and hide and manage why do you think the DSM um has such a focus on the external I mean that's a problem to me I don't know I'm not a clinician so it's you know but so many people now they are looking at the we US citizens as private citizens who are not you know Specialists or professionals look at the DSM to try to figure out what's wrong with us so certainly for those those of us out there like that which are many more than the clinicians uh it's a tremendous disservice because you can't identify yourself in those words right it's an issue and it's an issue for two reasons I think that there's an historical reason that this definition exists and um I think it has to do with the need to incorporate more of a newer research that is coming out not just about other descriptions and other manifestations of pathological narcissism that also describe not just the grandiose expression of pathological narcissism but we also we today there is a very well described vulnerable version of fix and manifestation we also know that those manifestations coexist we also have to think about overt versus covert expression of pathological narcissism that's also important to incorporate there's a lot of clinical literature about this however it's still not in the psychiatric description um and I think it's a matter of time and a matter of advocacy and incorporation of new research to make it uh part of the official definition I also think that introduction of dimensional understanding of personality disorders and pathological narcissism makes it more friendly to those definitions and those manifestations so that's certainly something that is a hopeful development in our field the other thing is how the public uses the definition of different disorders I think that that's a very difficult dilemma because a lot of times people are looking for information about what the disorder is and the problem is that there is very little friendly and evidence-based information online a lot of information that is available online is very negative in terms of description what narcissistic personality disorder is one day I decided to look it up and look what type of a books amazon.com makes it available for people to understand what narcissistic pathology is and um I snakes in suits uh well how to kill a narcissist that was one of the times how to kill a narcissist is one of the titles and other titles don't get any better A lot of the titles are written from very understandable perspective of people that may have experience to somebody with this disorder in their lives and this literature has its place but there is almost no literature that takes a more sympathetic view about the internal experiences which is something that people start to evaluate and incorporate today and I think that it's a matter of time for this literature to show up and I think what happens in absence of such literature people look at the official description of the of the disorder and DSM and say okay well this must be the official version this is the knowledge of that and you know this is really the difficulty with any diagnostic criteria as we know because a lot of diagnostic criteria they're designed to diagnose the disorder they're not designed to understand the essence of the internal experience a good example is we diagnose heart attack based on certain physical symptoms but those physical symptoms do not explain what's happening during the heart attack and we all know this that so the same thing is true about the criteria so it's important to remember that criteria may be descriptive and they may help Define a certain group of people and that's the value of those criteria in diagnosing this group of people however this is not the essence of the disorder that's different can you talk about when you have a new person client come to see you and you suspect they may have a narcissistic personality disorder diagnosis and NPD diagnosis what do you say to them I have heard read been told seen I don't know if I've seen statistics like psycho educating people that in and of itself helps people I mean that's a very valuable approach the psycho education about disorders is a very helpful approach um it certainly was validated in treatment of many psychiatric disorders including bipolar disorder and depression and now we also have literature about psycho education for people with borderline personality disorder there is a there's some literature that it could be quite helpful and the same effort to educate people about presence of narcissistic personality disorder is also starting to develop and we know today that there is a there is some complexity in how we approach that subject there is a recommendation in literature today that it's helpful to educate people about their condition and so it would be really important to explain to people that they have this particular disorder however with certain individuals it has to be taken with uh with a certain sensitivity to who they are and how they're going to take that disclosure and stay more descriptive so with some people I might tell them that I see that you made criteria for what we call narcissistic personality disorder and this is why we can walk through the characteristics of the disorder and explain through their own narrative why this disorder makes sense in explaining their difficulties with other individuals it may be more difficult to use the label and in those cases I might stay with the explanation of that they have difficulties regulating self-esteem and those are the manifestations and this is how this is affecting their daily experience interpersonal relationships and how they approach situations or cognitive style for example and so it has to be carefully assessed who is who and who would be more likely to benefit from more direct disclosure of a diagnostic label and some people might not be um but that seems to be helpful and a lot of people actually appreciate this it doesn't catch them by surprise they say I know that I'm a narcissist I know that those are my difficulties and the same time for some people could be very shaming and they feel are you same and narcissist is that even possible this is so disastrous this is terrible that I have this disorder and that's also where it's important to not just explain the presence of the disorder and explain the personal experience and how it relates to diagnostic criteria and why this can be defined as narcissistic personality it's also important to provide psycho education about the disorder and about the etiological factors and longitudinal course and also available treatments that do exist today and that's really working

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Length: 12min 6sec (726 seconds)

Published: Tue Feb 21 2023