ME ME ME. No, you.

October 9, 2011 1:07 PM

How do you deal with and overcome Narcissistic Personality Disorder?

Many years ago, a psychiatrist told me that he thought I have mild NPD. This has been a source of difficulty for me in my relationships all my adult life. I am currently in therapy and working on my issues, but I wanted to see if other Mefites out there could share their stories or advice for how to deal with NPD, either from the perspective of someone diagnosed with the condition or from friends and family of narcissists.

posted by Saxon Kane to Human Relations (19 answers total)

Just a point I've gotten via osmosis: people are kinda narcissistic normally, so I'm not sure what to make of "mild NPD."
posted by rhizome at 2:20 PM on October 9, 2011

From what I've heard NPD is being written out of the DSM and isn't being taken seriously as a diagnosis. I'd question your diagnosis with your therapist.
posted by sweetkid at 2:38 PM on October 9, 2011 [2 favorites]

Response by poster: rhizome: Point taken. I guess the difference between me and someone who displays "serious NPD" comes in terms of my behavior, which isn't as dramatically self-destructive, and I have greater empathy than extreme narcissists.

I'll put some info from psychcentral.com on NPD, with my own comments:

"Individuals with narcissistic personality disorder often will seem to have a grandiose sense of self-importance. ... Often implicit in the inflated judgments of their own accomplishments is an underestimation (devaluation) of the contributions of others."

I actually try to downplay my sense of self-importance, but I do often silently judge myself to be better than others, even my close friends.

"People with narcissistic personality disorder are often preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. "

"Individuals with Narcissistic Personality Disorder believe that they are superior, special, or unique and expect others to recognize them as such. They may feel that they can only be understood by, and should only associate with, other people who are special or of high status and may attribute “unique,” “perfect,” or “gifted” qualities to those with whom they associate. Individuals with narcissistic personality disorder believe that their needs are special and beyond the ken of ordinary people. "

Yes, and I can be very snobbish and dismissive of others as a result. Often this actually comes from my fear of rejection by others, so I reject them first.

"Individuals with narcissistic personality disorder generally require excessive admiration. Their self-esteem is almost invariably very fragile. They may be preoccupied with how well they are doing and how favorably they are regarded by others. This often takes the form of a need for constant attention and admiration. ... They may constantly fish for compliments, often with great charm."

Especially from my partner, I pretty much demand constant attention and affirmation of my self-worth.

"A sense of entitlement is evident in these individuals’ unreasonable expectation of especially favorable treatment. They expect to be catered to and are puzzled or furious when this does not happen."

Again, this is characteristic of my relationship with my partner. I demand that I be the center of her attentions, that everything we do caters to my desires. If she doesn't like something that I like, I take it as a personal insult and pout or get angry. In turn, I am dismissive of her needs and likes.

"This sense of entitlement combined with a lack of sensitivity to the wants and needs of others may result in the conscious or unwitting exploitation of others. They expect to be given whatever they want or feel they need, no matter what it might mean to others. "

It is definitely unwitting and unintended, but I pretty much try to (and usually succeed at) getting everything my way.

"Individuals with Narcissistic Personality Disorder generally have a lack of empathy and have difficulty recognizing the desires, subjective experiences, and feelings of others."

I actually thing that I am fairly empathetic with others, in that if I can tell that someone is suffering I feel intensely for them. But I often cannot read people and just assume that they think exactly like I do. If they don't, I find it shocking and even stupid.

"When recognized, the needs, desires, or feelings of others are likely to be viewed disparagingly as signs of weakness or vulnerability. Those who relate to individuals with Narcissistic Personality Disorder typically find an emotional coldness and lack of reciprocal interest."

I am often very disparaging of the "weakness" I see in other people, particularly if it is something that I see in myself. I can be very cold to even those that I care about, with no real reason for the emotional distance except my irritability.

"These individuals are often envious of others or believe that others are envious of them. They may begrudge others their successes or possessions, feeling that they better deserve those achievements, admiration, or privileges. They may harshly devalue the contributions of others, particularly when those individuals have received acknowledgment or praise for their accomplishments. Arrogant, haughty behaviors characterize these individuals."

sweetkid: yes, certainly it is something I'm discussing with my current therapist. But even if NPD isn't "real" (and what of these sorts of things are "real" anyway?) it does in many ways describe my behavior accurately. In addition, there are a few characteristics of borderline personality disorder that could apply to me:

"The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, emotion, thinking and behavior. Someone with borderline personality disorder will be very sensitive to things happening around them in their environment. They experience intense abandonment fears and inappropriate anger, even when faced with a realistic separation or when there are unavoidable changes in plans. "

Part of my demand for my partner (among others) to cater to me comes from the desire to never be alone.

"People with borderline personality disorder may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not “there” enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will “be there” in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficient supports or as cruelly punitive."

I am very hot-and-cold with my partner and other people that are very close to me. I can be intensely devoted, but I often feel as though the person whom I have idealized hates me, is intentionally trying to hurt me, etc.

"Individuals with Borderline Personality Disorder display impulsivity in at least two areas that are potentially self-damaging. "

I am extremely reckless with money, and I would say that's my only real impulse control problem. I can at times be bad about eating binges, and in past relationships I have felt compelled to seek outside affairs, to varying degrees of "success."

"Individuals with Borderline Personality Disorder may display affective instability that is due to a marked reactivity of mood "

Yes, I have strong mood swings; I can go from elated to enraged very quickly. While I'm never physically violent, I can be quite intimidating.

"Individuals with Borderline Personality Disorder may be troubled by chronic feelings of emptiness. Easily bored, they may constantly seek something to do. Individuals with Borderline Personality Disorder frequently express inappropriate, intense anger or have difficulty controlling their anger. They may display extreme sarcasm, enduring bitterness, or verbal outbursts. The anger is often elicited when a caregiver or lover is seen as neglectful, withholding, uncaring, or abandoning. Such expressions of anger are often followed by shame and guilt and contribute to the feeling they have of being evil."

ESPECIALLY the last part.
posted by Saxon Kane at 2:56 PM on October 9, 2011 [3 favorites]

Actually, one of the things I found most helpful when dealing with my issues in the past (BPD-ish stuff) was learning to NOT focus on the diagnosis. Focus on working on your actual issues instead of the name used to categorize/legitimize your problems for the insurance companies. Focusing on the diagnosis can mean that you are intellectualizing your issues and stepping outside of them, instead of really delving into them.
posted by imalaowai at 3:43 PM on October 9, 2011 [11 favorites]

First, the narcissist in my life was in complete denial that his behavior could ever cause any problems for anyone else. The fact that you are asking this question seems very hopeful to me.

I know that Dialectic Behavioral Therapy has been amazingly effective for Borderline (which used to be considered incurable) - it give people a lot of very practical tools to managing their thoughts and feelings, very CBT. If you aren't already doing it, you might talk to your therapist about whether a DBT group would be a good adjunct your individual work.

By the way, "personality disorders" in general were thought of a sort of permanent conditions but that is most certain NOT true. They do seem to a response to relationships and view of self that was learned (too well) at a very young age so it becomes a deeply entrenched pattern. But for people like you who have enough insight to see how they are creating problems for themselves, it is complete possible to develop new, more postive and more flexible patterns that serve you better.
posted by metahawk at 3:50 PM on October 9, 2011 [4 favorites]

Very few people with NPD have the self-awareness to acknowledge that their behavior is an issue. I think it's really admirable that you have the maturity to do so, and it's a good indication that you will be able to do some constructive work on these thought and behavior patterns.

I'm not sure what the treatment options are for NPD, though it sounds like CBT could really help, insofar as you have a good idea of what your issues are and could use some tangible, targeted help in changing specific aspects of the way you see the world and go about being in it. DBT is now the "industry standard" for treating BPD, and I'm sure it could only help to also address some of the NPD-ish issues you've observed.

Kudos again for your self-awareness and your willingness to explore and seek out treatment. Like previous posters said, these "disorders" aren't permanent personality disabilities, and it sounds like you have what it takes to be a better, happier person.
posted by foxy_hedgehog at 5:01 PM on October 9, 2011 [1 favorite]

Your ability to empathize with others, especially those who are suffering, makes me think you don't have NPD, just a few traits.

You actually sound a lot like my boyfriend. He requires A LOT of attention, which I'm fine with because I'm not somebody who needs much space in a relationship and I'm nurturing by nature. Instead of trying to change yourself, maybe look for a partner who can give you what you need.
posted by timsneezed at 5:26 PM on October 9, 2011 [3 favorites]

What you can do to be less narcissistic: be more other-directed, selfless, unselfish. Listen more, a lot more. You're so focused on yourself, your possible narcissism, your flaws, analyzing your behavior. Focus on others. In small ways: Happy Monday, Chris - how was your camping trip? and big ways: Terry, I remembered that your brother died this time 2 years ago. You must think about him a lot. Give credit to other people. I work with a narcissistic who takes credit for group efforts. Look for ways that other people contribute, and credit them. Lee, you make the best tuna sandwich of anyone I know. Jody, your contribution on the whatsit project was rock-solid; we couldn't have done it without you. When you do that, you start to see that there are different ways to approach life, problems, relationships, work, and that diversity is a real value. The different strengths people have really do contribute to a stronger whole, especially when their individual strengths are nourished.

I have pretty volatile emotions. I've learned that emotions can be tolerated. Extreme sadness, anger, etc., - you can experience them and be okay. You don't have to have a person to validate you and make you feel okay about yourself. It's wonderful to share your life with someone, but you don't have to be submerged in that person, or they in you. Learn to disengage. It's not the same thing as giving up.
posted by theora55 at 5:40 PM on October 9, 2011 [6 favorites]

Mefi's own thelastpsychiatrist has written more about narcissism than anyone else in the internet. He's got an unique take on it, and is a great writer.
posted by falameufilho at 5:42 PM on October 9, 2011 [3 favorites]

Have you been treated for NPD since you were diagnosed? I guess I'm wondering if you have undergone therapy specifically for that diagnosis, or have you been in therapy working on the other traits that you mention but not specifically under the diagnosis? I'm going to nth focusing less on the label and more on what traits about yourself you want to change. Mostly because I think it would be far more difficult to ever say "I am officially cured of my narcissism" whereas you can better see when you've made progress on fixing specific problems.

I read a pretty interesting book about narcissism and basically there seems to be a sliding scale for traits such as empathy(I believe the most extreme end of the scale is psychopathy). Everyone falls somewhere on the scale, it just depends on whether or not it is impacting your quality of life and those around you.
posted by fromageball at 6:32 PM on October 9, 2011

Best answer: "Often this actually comes from my fear of rejection by others, so I reject them first."

This, I think, is the key. If you think of these objectionable feelings and behaviors as defensive, you can then begin to look at the insecurities that they are attempting (unsuccessfully) to cover up.

The puffed-up-edness (grandiosity) and contempt for others is an attempt to compensate for feeling like crap (low self-esteem). So the next step is to muster up the courage in therapy to look at the feeling-like-crap that underlies these defenses.

But therapy is hard work. The defenses developed for good reasons. But maybe you don't need them as much as you used to, and maybe you've reached a point in your life where you want to change. Maybe you would be interested in the exploration of The Story of You, and have compassion for how you developed these particular knotty parts of your personality. The results can really be enlightening and life-changing.

And a word about Narcissism: first, the "personality disorder" that is listed in the DSM (which is a descriptive, not explanatory, and kind of dumb book mostly used for insurance purposes and not for any kind of real understanding of anything) is a kind of stereotype. Many many people have "features" of all these personality disorders. Second: in the psychoanalytic world there's a ton of stuff written about how the MAIN problem middle-class Western-type people are being treated for IS narcissism -- that is, lack of real connection, a feeling of stuckness, fragmentation, feeings of emptiness (also found in "borderline" features, as you point out above) -- that are compensated for by the kind of brittle hypercriticalness toward others (AND yourself, I would imagine), striving for "fame" and material success, obsession with celebrity culture, feeling that you are either the Greatest or you are Nothing, etc.

You may manifest extremes of this, in that this may have developed into your basic style of dealing with the world, whereas maybe other people have a more extensive repertoire. But, again, it's really great that you are seeing what you are doing and what it's doing to you and others. sorry to ramble.
posted by DMelanogaster at 6:33 PM on October 9, 2011 [1 favorite]

I've known people with BPD, and NPD. I'd classify them as both of them as real, kind of related, and similarly destructive. By which I mean 'very'.

P.S. I used to think they were both bullshit psychological diagnoses. Then I learned.

I've known people to have BPD, and NPD. Someone I know relatively closely (not too closely, which meant they would generally be ok with me. Whew!) had mild BPD - and the major thing that made it 'mild' was that they, like you, actually had enough self-awareness to recognise that they had it.
And that is BIG. No really, you're at a huge freaking headstart.
It's not a very flattering thing to think about oneself, or one's relationships with others, therefore isn't really something that you, but especially someone with BPD/NPD would want to admit to.

On the other hand, a couple of people then suggested to my BPD friend when she first opened up about it, that she didn't really have it, and (from a really lame counsellor) if she was admitting it, then she really couldn't have it.
Instead, she needed as much encouragement as possible at the progress she was making. Actually, many of them wise up when they read up on BPD (she was pretty classic otherwise, a cutter, suicide attempts, suicide attempts over webcam to get back at ex/current-boyfriends etc, just - bing, bing, bing through the lists of symptoms and case studies).

Anyway, I see BPD and NPD as very, very closely related (literally - ie NPD & BPD in same family, or NPD parent, BPD child, etc). Sometimes it's just a slightly gendered (& family role etc), manifestation of the same underlying problems.
(My suspicion - if they do remove NPD, it would only be to roll it in with BPD, frankly).

Anyway, this is all great, because there *is* treatment for BPD!

Dialectal Behavioural Therapy.

As with BPD, a lot of the behaviour like, rejecting people before they reject you first, or putting partners through discomfort as "that they must really, actually care if they're putting up with this, it's PROOF they love me! - until next time I feel insecure' (which turns into unintentionally torturing the people you love most, and really how much does that suck?), is really feeling like there's no other choice, that those emotions are too hard to bear otherwise.
From what I've heard, DBT is all about learning new ways to cope with those feelings of rejection, and insecurity, so that you can feel more secure ALL the time, not just when a partner 'proves' something for you. Developing better empathy skills, and a happier way of interacting with the world.

Also, you'll see statements about 'DBT works for BPD, not NPD'. That's not true. It's related to traits like, whether you have any self-awareness of the problem (which you do), whether you have *any* empathy (which you do), and of course, whether you actually want to change (see well, many NPD's settle into co-dependent relationships, with no desire to change as long as everything is going their way) - and you've reached out here. You recognise that the current situation is sub-optimal. Actually, life can be better - for you and the people around you.

I cannot overstate what a fantastic step I think you are making for reaching out like this. I don't think you'd be asking about this unless it was something you'd seriously thought about, and were now reaching out for advice.

DBT. Find a DBT therapist locally. A support group locally, or even find a cheap therapist who won't always agree with you (that's the tricky bit), and buy a cheap DBT workbook to go through online.

And Frankly, as I said before, I think there's less difference between BPD & NPD than people think, it's just the ways in which it is expressed through gender-roles, and that there is more social support for NPD's to maintain the status quo. Look up BPD and NPD resources online, and use what you can.

Good luck.
posted by Elysum at 1:21 AM on October 10, 2011 [2 favorites]

I like this quote by (sorry) Derrida:

There is not narcissism and non-narcissism. There are narcissisms that are more or less comprehensive, generous, open, extended. What is called non-narcissism is in general but the economy of a much more welcoming and hospitable narcissism. One that is much more open to the experience of the Other as Other. I believe that without a movement of narcissistic reappropriation, the relation to the Other would be absolutely destroyed, it would be destroyed in advance. The relation to the Other, even if it remains asymmetrical, open, without possible reappropriation, must trace a movement of reappropriation in the image of one's self for love to be possible. Love is narcissistic.

posted by mbrock at 2:18 AM on October 10, 2011

From your followup, you sound like at least one person I've known in the recent past, and others I've known in the more distant past.

I've personally found it very hurtful, indeed traumatic, to be on the receiving end of these narcissistic behaviours. So, regardless of whether anyone thinks the concept of NPD has any validity, there is a recognizable pattern of behaviours there.

I would be thrilled if this person, or any of the others before him, had cared enough to seek treatment. Maybe this guy would be able to help you find somebody in your area who could treat you.

From what I understand, it will be tough and require a lot of commitment, but I really admire you for caring enough to try.
posted by tel3path at 2:54 AM on October 10, 2011

Best answer: I grew up in a household with an adult who has a serious personality disorder. Its origins and its manifestations are not particularly important. (They're awful. And sad.) But from a mostly-but-not-quite-entirely objective standpoint, I can list some things that could/should have been done to improve our relationship, and to re-write the script that plays in every new situation.

- Listen. Become an active listener. Practice active listening, and use this as an opportunity for thought experiments. How might you feel if you didn't know the things you know? What information is someone else basing their feelings/assumptions/beliefs/assertions on? This could be like a puzzle that you try to figure out. The net result is greater intimacy, as you begin to identify yourself with someone and begin to explore their perspective. Rather than being instantaneously dismissive of anything they say or think or do, instead ask yourself, "Now why might someone think/decide that?" You may find your perspective changing. You may not. If you do not find their position convincing, again resist the urge to be dismissive. Instead, enter into a dialogue with them, sharing your perspective so that they might also be able to consider the issue more fully - AND listening to their perspective for your own consideration. Speaking to my boyfriend when we disagree about something is a refreshing experience. I am trained to expect him to dismiss my perspective immediately, and then probably berate me for being so wrong. But he's a teacher, so he knows every kind and gentle way there is to say "I think you're wrong." He'll start a difficult conversation by saying something like, "Can you help me understand..." That's an excellent way to frame a disagreement, because it encourages cooperation and sharing.

- Play the long game. Realize that if you are intensely afraid of being alone, narcissistic behavior is only going to ensure that fate. Ask yourself how important something is. Do you really care that the dish mat in the bottom of the sink is upside down, even though your partner swears that is the "right" way for it to be positioned? (This is actually something my parents fought about regularly.) This changes the goal from "I need to be right about this thing!" to "I need to not drive this person away from me!" Condition yourself to have emotional responses to things that are proportionate to their importance. DBT seems to really work to break the cycle of unhealthy thinking that plagues folks with personality disorders. It seems to attempt to stop the process as it is ramping up, and supplants it with a new, healthier, behavior.

- Practice giving up control, but don't set yourself up for failure. Like going to the gym for the first time in a year and deciding that you're going to run a marathon, you shouldn't have false expectations for yourself. Cede control over something small that you know will turn out fine. Or something unimportant, just in case it all falls apart. And then just go with it. It wont be comfortable at first. But until you force yourself to give up control, you'll just keep your iron grip on those around you. And while people may fear and respect a despot, they can't love them.

- Finally, work on accepting the fact that you've got problems. I had a watershed moment in college when a friend and I went out to dinner, and he finally, exasperated, he said, "Sweetheart, you realize the world doesn't revolve around you, right?" Previously? No. I hadn't realized that. And unfortunately, because we are actually the centers of our own little universes, my feelings of importance seemed perfectly normal. It was gentle and hilarious, but it was the first time that I really thought much about it. We've all got problems. We're all good at some things and bad at others. I read a quote attributed to Einstein the other day - and whether he said it or not, it's an important one: Everybody is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid. Look at the things you're good at to cultivate your self-esteem, and don't berate yourself for lacking skills, but learn to accept them as natural limitations that are neither good nor bad. Does a fish need to berate itself for not climbing a tree? Do you need to berate yourself for not being ____? Probably not.

In the end, I echo everyone else's sentiments: it's promising that you've recognized your bad behavior, and that you've recognized that it is a problem. This is always the first step, and I wish you luck in learning healthier coping strategies!
posted by jph at 8:23 AM on October 10, 2011 [2 favorites]

And don't read The Last Psychiatrist - on *this* topic at least, too complex an issue, and too big a grindstone topic.

And aw jeez, ignore the stuff/people saying 'BPD' is treatable, 'NPD' isn't.
(The Last Psychiatrist (TLP) says this, despite agreeing that BPD's often switch between NPD & BPD - which makes the difference, what?).

In your case, I think DBT would be fine, or you are otherwise:
a) Most NPD's psych's see are even more severe than the BPD's, as BPD's often have self-mutilating behaviour which gets *more* of them into therapy land. Unless NPD's are a danger to others, they won't end up there. Therefore people like TLP will be seeing more severe cases.
b) NPD's have to want to change - in many cases they don't. You recognise this isn't how you want to be, you're in a different category.
c) You have some empathy, and awareness of the situation. Again, this makes a big difference.

Hope that helps a bit.
posted by Elysum at 11:45 PM on October 10, 2011

From what I've heard NPD is being written out of the DSM and isn't being taken seriously as a diagnosis.

1) Your information and conclusion here are vastly oversimplified.

2) The work being done by the DSM 5 committee is being widely debated, and widely castigated, throughout the mental health treatment community. Unless you're privy to some of those debates, I wouldn't start suggesting that a previous diagnosis is likely incorrect.
posted by OmieWise at 1:06 PM on October 11, 2011

I suggested the OP discuss with their therapist, OmieWise. I didn't say anything was incorrect. it just sounded like the original diagnosis was a while ago, in which case it makes some sense to revisit it.
posted by sweetkid at 7:10 PM on October 11, 2011

it just sounded like the original diagnosis was a while ago, in which case it makes some sense to revisit it.

That's not quite all you said. You implied that the diagnosis itself has lost currency. This is untrue, and provides a false sense to the OP of the status of mental health diagnosis. Quite apart from whether or not NPD is going to be in the DSM V, it's very much in the current manual, and is therefore firmly part of our diagnostic nosology.

The suggestion to revisit the diagnosis with a therapist or psychiatrist is a good one, but not because of any inside baseball fights over NPD.
posted by OmieWise at 4:49 AM on October 12, 2011