Narcissism | What You MUST Know

We've talked with Dr. Romani about narcissism before, but we've never gone this in-depth. Welcome to the MedCircle series, Narcissistic Personality Disorder, the second-hand smoke of mental health. You were one of the first people ever come on MedCircle. You have made such a huge impact, I'm so glad.

Yeah, I I can see that. We're getting lots of emails. I'm so happy 'cause it's helping people understand this and sort of remove some of the responsibility from themselves and and come up with a realistic game plan, which is so important to me. That's why I'm in this. I'm here to help people. Almost like help people save themselves and move into a far more bright future. Yes.

And we did one video on this topic. I don't even know how long it was, like 10 minutes, something like that. And now we're dedicating an entire series to the topic. Good 'cause I think that's going to help a lot of people. Have a lot of questions and I'm hoping we'll be able to dispel some of that and and create some more understanding.

Before I sat down with you the first time, I did not know that narcissism was a personality disorder. Narcissism is actually not a personality disorder. See, that and that's already one of the big misconceptions out there and why people get their sort of themselves all up in a froth is narcissism is a pattern. I don't know that I call it a trait as much as a collection of patterns or traits. Um, narcissistic personality disorder is a disorder. And if you look at existing epidemiological studies, 1 to 3% maybe. Mostly 'cause these folks don't get into treatment 'cause they don't think there's anything wrong with them. So, it's very difficult to get meaningful statistics on what the true rates of narcissistic personality disorder are in the population. Narcissism, whole other game. Much more endemic. It's a pattern. People say, "Well, that don't label people." I'm like, "That's no different than saying, he's agreeable, he's sweet, he's funny, he's narcissistic. They're patterns."

The first video we did on narcissism, millions and millions of views. Still even growing at the time of filming this, every day. Why is this topic resonating with so many people? It's the topic of our time. There's no two ways about it. It's the topic of our time. It's misunderstood and it is absolutely destroying people. The fact is, because people don't understand it, they don't understand that they're even in it. It's almost like you're it's like having an illness and you don't know why you're getting more and more tired every week and then you finally go see a doctor and the doctor's like, "Oh, you have da da da or you're being exposed to da da da." And they're like, "Thank you for the explanation." The number of people I have worked with who said to me, "Had I not come and consulted with you clinically and understood what this pattern was, I would have stayed living like this forever and probably ended up in an early grave." I mean, this is For when you say that, not because they have narcissistic personality disorder, but because they're letting somebody with it.

Issue of our time and here's where it gets tricky. We've actually in we've we've rewarded it in our society. We're saying like, "Behave badly, treat people badly, throw people under the bus, let's reward you. Behave in a way that's uncivil and unkind and be mean and we'll give you your own TV show." So, that's what's happening.

You said something to me and I don't remember if it was on or off camera, but you said the book on narcissism could be titled "How to Be a Man in Today's World and Succeed." Yeah, absolutely. The same exact the same. It would be like a rule book. I actually had a student once come to me after class and say, "You know, I'm trying to succeed in business and after learning about narcissism, I now realize that if I do all these things, I'll be really good at sales. Can you teach me?" I was like, "No."

Wait, teach him how to be a narcissist? No, that no. Okay, but just for fun, can you teach someone how to be a narcissist? Not really. I'll be frank with you. I'd be doing a lot better financially if I was a bit more narcissistic. And they'd make so much money. Oh, they do. The research is actually quite clear. The a trait called agreeableness, which is actually quite opposite to narcissism. People who are agreeable are friendly, warm, open, gregarious, helpful to other people, they make significantly less income than people who are more antagonistic and narcissistic. Yeah. I mean, it it costs you. Think about it. You know, like, "Oh, no, that's okay. You don't need to pay me for that." You know, that kind of thing. You're like the doctor who takes your payment in pies rather than money. Uh-huh. So, just a nice thank you will do. I will take a cherry pie from time to time. You're not a narcissist. Uh, what a Can you still though be strict and successful and aggressive and s- and make a ton of money and all these things without being a narcissist? I'm not sure. Even that answer is a really strong answer. You're not sure. Sure. I haven't seen much evidence of it. I've seen some people really, really make it, but even they'll acknowledge, "I had to play a little bit of hardball. I had to put my needs way ahead of someone else and not stop to think how this may hurt them." I mean, there was definitely an a relative empathy deficit compared to a far more agreeable person. I just don't see it's a business by large is a zero-sum game. Yes. And I think when you're working in a corporate structure and you're having to answer to folks like shareholders and there's they don't care about sort of the rank and file employee, that that's when the game change. I still think when you had company towns and the guy who ran the factory still knew of the lives of the others, there was a bit more empathy. That's kind of gone. You throw in other societal trends like social media where it's all about, you know, who can sort of it's social comparison, who can look better, that kind of thing. It becomes more superficial. I think all of that is colluding that we don't value empathy anymore. We really In fact, especially in boys and men, we're not teaching our boys to be empathic. We're actually saying empathy is a weakness in boys and men and that's really one place where we can really see a correction if we could do that, but we're actually going in the opposite direction. I mean, empathy is really kind of gone the way of the eight-track. Mhm. Like not cool. Not hip.

You said 1 to 3% of the population has been diagnosed with narcissistic personality disorder. Studies show. And you know what? I think we get caught up and like people say, "It's my boyfriend, it's my husband, it's my wife." When you really open that net to mothers and fathers, brothers and sisters, bosses and co-workers, aunts, uncles, you name it, you'll see I actually don't know a single human being whose life hasn't really been touched by pathological narcissism. What's interesting is that for some people it comes late in life. So, they had great parents, nice husband, good friends, but then their sister marries a narcissist. And that's actually worse, like when your first encounter of it is when you're a full-blown adult 'cause then you really don't know what to do. It's like trying to learn to speak French when you're 50. Mhm. Yeah. You know, so whereas others of us who have started early in this training, in fact, in this new book I'm writing, I say, "Who was your first narcissist?" For some people it was mom. Like you met her on day one. Ooh. The first narcissist 'cause there's going to be one. A first. Wow.

Uh, for your people who don't know who you are, why should they listen to you when it comes to narcissism? You know, they should listen to me because actually my way of coming into this area was through multiple pathways. The research in my lab at California State University, Los Angeles, we focus on personality disorders there and narcissism was the one pattern where we saw it but wasn't behaving in a consistent manner. But at the same time in my private practice, I was astounded at the number of people who were coming in and literally saying the same thing. And I'm like, "Okay, there's something going on here." And I really di- dug into it. And said, "These these partners of them, they're all narcissistic people and these people are so frustrated. They keep trying everything. Their partners don't change. They get up every day thinking and hoping it'll be different. It's not. It's devastating." And so, then I did research into it and I'm like, "Wow, this is really not very treatable than the the person with narcissistic personality disorder." And even the pattern really wasn't that changeable. And that just set me into a deep kind of deep dive into the literature. I interviewed people all over the country. In fact, all over the world about their experiences with narcissistic husbands, wives, boyfriends, girlfriends. And then that culminated in my second book, which is called, "Should I Stay or Should I Go? Surviving a Relationship with a Narcissist." And and then it was kind of off to the races from then. I think some things change in our world and narcissism became more and more and more of a topic and I'm surprised at how many smart people just don't get it. And and it's such a pattern. I said, "You should almost be reassured." A lot of people say narcissists are unpredictable. I said, "Unpredictable? They're the most predictable person in the room." We know exactly what they'll do. that they say Jekyll Hyde. I said, "Jekyll Hyde is kind of predictable. You know they're going to be mean and then they're going to be nice." So, that's the you know, once you get that pattern into place and you know it, you know what you're dealing with. I think our problem is we it's all about second chances that we give them. We're a little bit too heavy-handed with the forgiveness and I'm hoping we can sort of help folks work navigate those waters in a way that's healthy for them and their families.

So, we know what people who are in a relationship with a narcissist or know a narcissist will get from this series. Oh, yeah. Yeah. It's the hope, it's the education, it's actionable steps. If there is a narcissist out there who stumbles upon this video because everybody in their life has told them, "You're a narcissist." And they have even a little bit of self-awareness, maybe I am. What do you think they will gain out of this series? This has become the question of the year 'cause I get emails almost every day from a person. Some of them are angry, some of them are downright threatening and some of them are really contrite where they're saying, "I'm this person and I don't want to be this person anymore and I've hurt people." Give me that person and we might have a little hope. Now, here's the rub. A person, let's say, a lifelong narcissist, they're 30, 40, 50 years old. This is how they've always treated people. It's a tough fix. It's almost like trying to take someone who's really sweet and making them mean. Not easy to do. It's the same thing. We're just trying to flip it out in the other direction. Take a narcissist and turn them into someone who's more self-aware and kind. What you might see is that you might get some small fixes from them, but I do think it all is not lost. I think if somebody is narcissistic and is willing to do the hard yards and put their head down, commit with a good therapist, really commit to mindfulness every day, you might get someone that way. You might get enough of a change where their family notices a difference. They may become a somewhat better parent. They might become a somewhat better partner. I mean, I think Are you ever going to make them the sweet agreeable teddy bear? Probably not. I think what I see is when narcissists do enter treatment and become self-aware, the thing that they become self-aware of, and this is where it gets painful, is the emptiness and how insecure they really are. And that is one really tough look in the mirror. That's what they were avoiding all along. That's why they're so grandiose. I don't want to see the emptiness. So, when we strip away that veil, and I've worked with many clients where we finally got to the core of the insecurity, they actually became down like downright depressed. Wow. And that's what they were trying to avoid all along. So, it's a it's a very complex, nuanced, long-term treatment plan. But listen, if you're self-aware and you're like, "I want to turn this around," I think that commitment is most of the variance. That's where it's at. I think something can be done. It's just a slow burn.

Dr. Ramani describes narcissism as the second-hand smoke of mental health. But why? And why is narcissism more dangerous than just being self-confident? What exactly narcissistic personality disorder is? What is it? Yeah. Okay. All people with narcissistic personality disorder are obviously narcissistic, okay? Not all people who are narcissistic may have narcissistic personality disorder. So, it's a fine point, but it's an important point since everybody's throwing this word around these days, right? You know, it's not Unlike other diagnoses that have different meaning to them, this one sort of this is like a character assassination, right? So, when we talk about narcissistic personality disorder, there's a long list of patterns and they have to have five of the nine on that list. It has to be something we call pervasive, meaning it cuts across situations with a variety of people, in at work, at home. It's not just like they're narcissistic to only you and they're nice to everyone in the world. It tends to be pervasive. But here's the rub. It has to involve what we call social and occupational impairment and subjective distress. That's a fancy way of saying it is messing up that person's life. They're aware it's messing up their life and they're uncomfortable with it. And that's where you don't see as many people with narcissistic personality disorder. So, if their style of not having empathy, of being entitled, of being grandiose, of being arrogant and superficial, all that is working out for them, they're not going to walk around saying, "I'm having a problem." They're not going to walk around saying, "This is causing me problems." So, if they don't acknowledge that piece of it, then really they're a narcissist, which is sort of a clinical term for being a jerk. And we don't get to diagnose people for being a jerk. We may not like them, but that's not a condition we diagnose. We diagnose people because they're bringing in something that they're uncomfortable with or that's causing them problems. The best example I can give you is let's say somebody's been using drugs for 2 years and their drug use results in DUIs and other problems in their lives, okay? When that happens, they may themselves say, "I know I have a problem with drugs, but I do have five DUIs and they did find me in the gutter in front of my mom's house. So, I guess maybe there's a problem." In narcissism, they may they may recognize that, "Yeah, sure, I got in trouble at work and I was called out on this and that problem and I did cheat on my wife several times, but it's working out for me." Is that distressing? He's being a jerk.

So, Dr. Allen Francis, Dr. Francis is actually one of the architects of this diagnosis originally in the DSM. And he he himself has come out very clearly and said, "We don't get to diagnose somebody 'cause we don't like them." That's not what this diagnosis is for. It's for somebody who's actually having discomfort and distress because they're behaving in this narcissistic manner. It's a fine point, but it's an important point. And here at MedCircle, I really want to be careful as we use these two terms because I think a lot of the listeners don't know if their friend, family member, or boss has the diagnosis and may never find out unless that person that other person gets into treatment. And their friend, family member, or boss might just be a jerk. They might be a jerk and they may say, "Why should I go get a diagnosis? There's nothing wrong with me." And they're walking around saying, "There's nothing wrong with me and I'm fine." Then according to the DSM, they're not. Not. They're not a narc They don't have NPD. That's it. And so, and that's where people get upset. I get emails every day, "Will you talk to my husband and tell him he has narcissistic personality disorder?" I'm like, "No." Please. Please. I would love to do that. No win there. So, that's a lot of the struggle here is that And you know what? The pattern of narcissism, it's awful. They may be fine with it, but you as the recipient of that pattern, it's not it's You are you're going to struggle with it. It's uncomfortable. It's one of those patterns that's really unhealthy for the people around it. I call it the second-hand smoke of psychiatry. Like being near a person who's narcissistic, it it's as unhealthy as doing it yourself. Woah. That is a great metaphor. Mhm. NPD is the second-hand smoke of psychiatry. I And I'd say narcissism is the second-hand smoke of our time. Of our time. You stand close enough to it, you're going to get sick. Even that's a huge deal for people because somebody might not get the diagnosis. Yeah, they just don't know. But they still have all these toxic behaviors that are affecting you. Oh, absolutely. And you know what? In some ways the diagnosis is irrelevant 'cause all all that's doing is saying the person's having problems because of it. But if they're lying, manipulating, exploiting, raging at you, who cares if they have a diagnosis? That's not good for you to be in the presence of. And then it takes us back to that more critical issues. Why are people like this? They're like this 'cause they're insecure. And that makes people feel guilty. Well, if he's insecure and this is why he's doing this, and that's what we're going to have to get to the core of.

When does normal self-confidence cross the line into grandiosity? Self-confidence is a healthy state. And people who are self-confident don't need to blast their achievements from every rooftop and every social media platform. People who are truly self-confident don't need to talk over other people and their achievements. People who are self-confident don't require their achievements to be front and center and ahead of everybody else's. People who are self-confident are so confident in them their sense of self and their achievements that they actually can stay quiet about it.

In another video in this series, we'll talk about the different types of narc NPD, but I'll give everyone a preview from the original video we did, the communal narcissist. Ah, the communal narcissist. When you said it's that person who goes and volunteers on a Saturday, but takes selfies the whole time in a full perfect face of makeup, I go, "Oh, I so know that person." And you know it's also the person who you say like, "Let's throw a gala." And you're like, "But the gala is going to cost $10,000 and you're only going to make $500 for the charity. Why not just write the full $10,000 for the the charity?" Like, "But I need the gala." They need galas. They need galas. They need parties. They need celebrations. And and you know what? I'm smiling when you say that because I think smiling is one of my coping mechanisms, by the way, like laughter and smiling because these are very deep and heavy topics and they're affecting a lot of the everybody who's in a relationship with a narcissist. Which is almost everybody. Which is almost everybody. And in a lot of cases, there are narcissists or in people with NPD who who are suffering. They Well, at the if you want to get down to the core of it, they are suffering 'cause they're deeply insecure, yeah. And that's where, you know, I mean, but do they experience the suffering? I'll tell you this, with the people with NPD or narcissism, where we start peeling back the layers, by the time you get down to layer 10 and you start looking in the gaping hole, it's not comfortable for them. And you do your heart does ache for them 'cause there's such There's almost a childlike emptiness to them. I'm not saying I'd want to be in a relationship with them now. I can tell you that right now. I mean, I can handle it for an hour at a time, but my god, for a person who actually has to live with that day in and day out, it's a nightmare.

Are there common co-occurring disorders with people with NPD? People who have narcissistic personality disorder or even narcissistic traits, there are several co-occurring patterns we can see that are more likely to happen. All forms of substance use disorders. You know, a lot of times it's to fill the emptiness or to enhance the grandiosity. So, alcohol use, cocaine use, you know, a stimulant use, that kind of thing. So, you'll see some of that. Depression. Interestingly, narcissism and depression can hang out together. A lot of it is that insecurity and that emptiness. It's not unusual to see those two kind of hanging out together. But are they getting diagnosed with depression? Sometimes they're getting diagnosed with depression because they might be very irritable. We'll see that in men. What will happen is you'll sometimes confuse the two as well because the type of narcissism we're going to be talking about today is called covert narcissism. People who are covert narcissists, they're a little bit like Eeyore from Winnie the Pooh. It's like, "Woe is me. No one understands me. How come the world is so unfair to me?" And they seem so downtrodden that they look depressed. And then all of us will treat them as though they're depressed and we're making absolutely no headway. And then one day you you dawns on you, you're like, "Oh, this isn't depression at all." So, actually quite frankly, we'll often treat the we'll we'll think they're depressed Yeah. before we'll think they're narcissistic, but wrongly so. Yeah, again, just highlighting how important it is to get the right diagnosis. It really is 'cause these personality patterns also make treating other mental health conditions, for example, it's not unusual for narcissism to also be found coexisting with bipolar disorder, which is also a very messy kind of issue to treat because the grandiosity of the mania and the grandiosity of the narcissism often collide. So, you'll see that, too. And I do when I've worked with families um when they have adult children who are substance abusers and the adult child goes into rehab, I'll also know that adult child has narcissism and I'll I'll be I'll ache for them because I'll they're thinking their child's going to go to rehab not only come out sober but sweet. They come out sober but they're still as irritable, invalidating, sort of mean as they always were. That part's not going to go away. That's the narcissism. Maybe even worse so? Even worse so. And you see this a lot in substance abuse treatment circles. You see a lot of it to get Yes, exactly 'cause the the substance use was sort of helping them kind of shore up their defenses. And so, it can make treatment much much more complicated. You'll also see more a greater likelihood of example like patterns that are sometimes labeled love and sex addiction kinds of like compulsive sexuality, compulsive like relationship patterns. You'll see that coexisting with narcissism as well. It just makes everything that much harder to treat. Yes. That's what it is 'cause you you don't tend to get as much emotion. There's a lot more defensiveness. I know more than the doctor. There is a lack of empathy. There's a lot of projection. All this stuff really makes it hard to do really deep psychotherapy with somebody.

How many different types of NPD are there? Well, there's there's different kinds of narcissism. Okay. Whether those translate into subtypes of narcissistic personality disorder. I once said there's nine possible symptoms of narcissistic personality disorder, which means there's thousands and thousands of possible combinations. But if we are really to look at it in five patterns that I type sort of broken down in my book and this is based on the theoretical work on narcissism drawing from other people's work. When we talk about the types of narcissism, they're not really subtypes of narcissistic personality disorder, but they're different kinds of patterns we see of narcissism. And I think it's important to see the differences 'cause it shows us it doesn't look the same across everyone. And then some people say, "Well, that's not narcissism. The person I know acts like this." And I'll say, "Ah, but it's a similar pattern." Let's get down to the brass tacks of what all narcissists look like. In all narcissism, we tend to see a lack of empathy, grandiosity, entitlement, superficiality, chronic seeking of validation outside of them, arrogance, and a real tendency towards rage, as well as a tendency to manipulate or exploit other people. Those you tend to see across the board to varying degrees. So, let's start at the top with what I consider to be the most severe and problematic narcissistic pattern. And that's the malignant or the toxic narcissist. These are the folks that almost look like psychopaths. They are they'll exploit other people. They take advantage of other people. They lie. They cheat. They they work the system to their advantage. They can often be quite successful. You might wonder why am I not calling them psychopaths. They can sometimes feel remorse for what they're doing. They're like, "This isn't cool, but I just got I just got to get this part done and then I'll make it right." Whereas a psychopath wouldn't need to make it right. So, there's just a really manipulative, mean-spirited edge to them that can be very unsettling. But but when you first meet them, they're extraordinarily charming, extraordinarily charismatic, confident, successful. So, that's sort of your malignant toxic type. You'll often see these folks running big companies, you know, at the heads of government, all of that. Like they have they really know how to work a system. Wow. The next in the in the group is what I call sort of your classical grandiose narcissist. And that's what most of us think of. The person who's braggy, who really is entitled. "I'm special. I deserve special treatment." It's almost like your celebrity narcissist. That's what your grandiose narcissist. They brag a lot. They show off a lot. Look at my new car. Look at my new this. Look at my new girlfriend. It's a lot of show and tell. They suck all the oxygen out of the room. All the usual traits, but they don't tend to be as exploitative and as mean as a malignant narcissist. But they are sort of your classical kind of narcissist. The next narcissist on the list and this is probably the most mysterious one and maybe the most revealing to MedCircle listeners is the covert or vulnerable narcissist. These are the woe is me narcissist. You know, if the world could see how great I am, I'd be one of the great ones. But nobody gets me 'cause I'm ahead of my time. And so, they'll you'll often find them sort of at home huddled over their computer being like a troll or like coming up with their next big plan, but they almost have a failure to launch a lot of the time. They can often look depressed. There's a real they seem vulnerable 'cause they almost feel like the world doesn't get them. They're hyper hyper sensitive to criticism. They're but they lack empathy and they can be very entitled. Like, "I deserve special treatment because, you know, the world doesn't know this, but I'm the best." What's interesting about that is I I listen to that and I when you would first meet somebody like that, you think, "Oh, they they just have low self-esteem." Yeah, bingo. But all narcissists have low self-esteem, right? That's why they're doing that. Exactly. So, the covert narcissist, they lead with that, but it looks like it's almost like they they feel like they're they have this sort of strange I always say that the covert narcissist has this sort of weird pause. I'll say, "Yeah, I went to that college, but I guess nobody cares." And they'll do that weird thing. You know, like, "Okay, well, this is a little bit of a strange pause, but it's a They're like, 'Yeah, I I already read that book, but why would you care?'" You know, it's like one of those. You feel like, "Oh, this is a little bit There's a there's an edge." It's almost like you're sticking your hand into a bucket of barbed wire. It doesn't feel good. It's like Even with those examples, even though they were just, you know, random examples, I still feel the pain for that person. Oh, they're they're they feel the world pass them by. Yeah, but I I don't feel the same way with a grandiose narcissist or much. No, they feel the covert narcissist, they'll ultimately will get to the point where they feel the world owes them something. Mhm. The world owes me. And there'll be a real edge to them. You know, 'cause they but it is they seem really sad and you'll often try to help them and you'll wonder why they're so ungrateful. Well, That's why that can feel really uncomfortable for other people who are so sympathetic to them and wonder why are they not ever saying thank you or recognizing all we did. Yeah. Now, number four is the communal narcissist. The communal narcissist can be very confusing 'cause they're out there volunteering and flying all over the world and doing their own personal rescue missions and you know, after every hurricane, they're posting online hurricane goals, hashtag hurricane goals. And like, "Let's all raise enough money and let's send lots of stuff to animals." They're the hashtag narcissists. They're the hashtag narcissists. But they're like it's all about their their goals for helping the world and and like you'll see them I mean, you know, you know, about animal rescue people. Like they're always holding their rescue dogs, but then they go home and they're really mean to their husband. Yeah, yeah. They love going to galas and they want buildings named after them. And if they do give a donation, they have to hold 20 gold shovels and have lots of pictures taken. Like it's all about the they do all these things to get validation. That's their tool for getting validation. Are often really unkind to the people they their their immediate family or the people who work under them. They can be absolutely awful to them. And people say, "Oh my gosh, you're so lucky to work with him. He's so charitable." And the people are just like, "Oh, no. This is really not one of many characteristics he has." So, so the communal narcissist is a very it's a it takes a while to sort of to peel off that layer and then to sort of That's why I always say, "Pay attention to how a person treats the person who don't have as much power as them in that situation." 'Cause that's going to teach you a lot. So, they'll be really sweet to the recipient of the charitable dollars, but really mean to the person who's working with them. And that doesn't add up. The last narcissist sort of kind of a good nature. I'm going to call them the benign narcissist. The benign narcissist is like this sort of clueless, uninsightful person who just says really vapid things, very superficial, only cares like, "All I want is like a fast car." And you know, you're driving a piece of junk. Like they'll be very dismissive of other people. like every 16-year-old I've ever met. ways, it's there's an adolescence, there's an immaturity. But they really aren't that mean-spirited and you can actually kind of say, "That's not a nice thing to say." And they're like, "Yeah, I guess so." But then they'll go back and say it the next day. I always say it's nice to have a few benign narcissists on deck 'cause they're fun to have at a party. You know, like just keep them on that list, but never turn to them at a time of need. Just because I'm curious and I get to ask questions, which you know, somebody put me in charge to do this. It you Who would you most want to be in a relationship with? I think those are the five. Those are your five. Oh, mama. You know, and and just solitude and in a cabin isn't enough. 'Cause I'm going to take if solitude and a cabin is my option, I'm going with that one. Okay, so it's not an option. I prefer I don't think any of those are a good choice. I'm going to go with solitude. You have to choose one. To choose one. I might choose the communal narcissist and just be glad they're doing nice things for other people. Hope to god they're nice to me. Yeah. But I I have to tell you that can be exhausting 'cause when the whole world is saying, "You're so lucky. He's so charitable." You're like, "Oh my gosh, he hasn't said something nice to me in 15 years." They're all painful. Maybe the benign one, but even that you would feel like you're forever in a relationship with your high school boyfriend. That's not nice. So, I I if you're if I if the cabin by myself for the rest of my life isn't a possibility, I'm going communal I get it. with therapy. I can have a cabin from you like 2 acres away and then we can just meet when we want to hang out. Recommend any of these types for a relationship. What about my idea for I'll have a cabin 1 acre away from yours? That that I'll do that. Okay, 'cause you were shaking your head no like this. I was like, "Wow, just You might be a narcissist, so we have to be aware. Like bit like bit sensitive. Before I it out on my neighbor. If you don't know what we're talking about, go see the previous episode. Okay.

Out of those five types, is there one that's most common? I would have to say probably the grandiose to classical narcissist. Okay. So that's why I think of it because it is the most common. Okay. Um, what am I not asking you about narcissistic personality disorder as it is defined from understanding it that I need to be asking? All the all the patterns I gave you are what are what you see of the nine characteristics that a diagnostic manual like the DSM would require. What's really interesting is that our diagnostic manuals are now taking sort of a new direction in how we think about these personality patterns. And in the most I mean, not to make two put two kind of bookish a point on it, but the DSM now views narcissism and all of the personality disorders through a new kind of a lens. And it looks at, for example, how a person uh views their own identity. And the narcissist identity is very much caught up in how they're viewed by other people. So they don't have a core sense of self. Their sense of self is governed entirely by the world outside of them. That's actually a terrifying feeling. Like the only way I'm good is if everyone tells me I'm good today. That's very unstable. Right. We also look at goal setting. How do they How do they set their goals? And narcissists set their goal in a way that will get them approval from the world. So either they set their goals unrealistically high so they can talk about the big goals they have which they're never going to meet. Or they set their goals a little too low so they know they're always going to surpass them. Mhm. So but no matter what their goal setting once again is based on how they can talk to the world about these things. Then when we look at other areas, we look at empathy and their lack thereof. So uh now DSM is looking at this across all personality patterns. And people with narcissism don't have empathy. They look at people as existing to serve their needs. What can you do for me? And then I'll make a relationship with you. So that's why a lot of people say, "But that narcissistic guy was really nice to me." I'm like, "Yeah, 'cause he needs you as a sales contact." Yeah. They're like, "Oh." Or they like the fact that you live in the right neighborhood in town. There's a need being served. And then finally, DSM is looking at narcissism through the lens of intimacy. And that's one thing that narcissists are not good at. They're not good at intimacy. They're not good at close relationships. By and large, their relationships are superficial and are really engaged in for personal gain. So they might get a very attractive partner 'cause that makes them look good to the world. They might get a wealthy partner 'cause that will make sure they have lots of money. They might get a famous partner so that they look good to the mean, the the the characteristics on which they choose the partner are deeply deeply superficial. And so that's how a narcissist chooses. And so when we look at those areas, self, goal setting, empathy, and intimacy, that's another way to view narcissism. No matter what, it's just really that it comes down to that core insecurity. That sense they cannot regulate themselves from the inside out, that they don't have a good sense of identity, and that they're really reliant on the world for telling them what they're about, which makes them actually quite resentful.

A recent study suggests that one in 16 Americans has been affected by someone with narcissistic personality disorder. So what causes NPD and can it be unlearned? What causes narcissism? It's It's There's actually a lot of pathways to this and it the city of Oz that we call narcissism. There's a lot of ways you get there. Um, a lot of people The big question everyone has is are you born this way or are you made? Mhm. It's mostly made, but there's a little bit of born. What's the percentage on that? I I I you know, I I if I were to spitball, I'm going to go with like an 80/20 or a 90/10 in terms of made versus born. I mean, the inborn part is that because the fact of the matter is, we see people come from invalidating early environments or overindulged or spoiled early environments and they don't turn out narcissistic. So there's got to be something else at play, right? And that's probably where that temperamental piece comes in. Kids who are likely more hypersensitive, hyperemotional. Um, if you look at Marsha Linehan's work on borderline personality disorder, she actually talks about that mix between the biological vulnerability plus the invalidation of the early environment. There's likely something like that happening in narcissism too, but it's mostly made. So let's let's view it as almost concentric circles. And let's start at the middle circle, which is really what happens in the family when the child is first growing up. Children who children who don't get consistent emotional mirroring for the from their parents, that's a setup for becoming a narcissist later on. Because that's how children learn to regulate their emotional worlds. They learn how to self-soothe their emotions. They learn how to take responsibility for their emotions. They learn how to understand their emotions from how they're mirrored by their parents. And if their parents have consistent, appropriate reactions and are available to them, that's how the child learns that. So if a child for any number of reasons doesn't have that kind of consistent feedback from their parents parents are distracted, the parents are absent, the parents don't care, the parents are addicted to drugs and are not available in that way. All of those could be contributors to that. Parents just are abusive in some way. Obviously, that can be a contributor too to inconsistent kinds of mirroring. And then the child doesn't learn, like I said, to sort of regulate their own emotion. They keep looking to the environment for validation 'cause frankly, they're confused. We also think about narcissism in the early environment as a function of attachment. Children who have secure, healthy attachments tend to go on to adulthood and make more secure, healthy attachments. But kids who have more anxious or avoidant attachments, that can set the tone for attachment issues in adulthood. And they're not able to make those kinds of successful attachments in in adulthood. So their relationships are really fraught with lots of in and out, back and forth rather than the consistency you'd see from a secure attachment with a parent. Um, the other thing I often say is that parents who are narcis- parents who create narcissistic kids who go on to become narcissistic adults, we see a pattern of simultaneous overindulgence and underindulgence. And what I mean by that is these are the kids where if they do the sport their parent wants or get the straight A's or the prima ballerina dancer or whatever it is they do, the best violin player, whatever or they want to take over dad's business. Whatever the thing they say they want to do, if the parents can get a good public face from it, they will overindulge the kid in that way. They'll drive them to every practice. They'll go out of their way. But when that child has an emotional need that needs to be met, the parents are nowhere to be found. Like they're interested when their kids on stage. They're interested when their kids on the field. They're interested when the child's getting an honor or doing what they want them to do. But when that kid really needs their emotional needs to be met, it's it's completely an impoverished environment. That's what I mean by being over and underindulged. Um, it's also what we call modeling. It's what they see in their environment. If they watch a parent constantly be entitled, they're going to learn to be entitled. If they watch a parent who has no empathy, they're not going to learn empathy. Empathy is learned in childhood. You cannot teach a 30-year-old how to be empathetic. That's an early game. So that That was my question 'cause if if you were saying that 80 to 90% of becoming a narcissist was taught, then certainly later we could unteach it. But we can't think No, because you know what ends up happening is that ultimately, these these environments for children are inconsistent. They're invalidating. At the worst of it, they can be abusive and dehumanizing. And that's the heartbreak is that I've worked with more than a few folks who are adult narcissists who did come from abusive, invalidating, downright dehumanizing have narcissistic personality disorder. Who have narcissistic personality disorder. So their early lives were really really sort of wretched. And and that's heartbreaking, but that's still not a a get out of jail free card for treating other people badly. Like I'm not getting I'm not down with that. And so, but now, let's take that Now we're in the family, but we got to push this out a little bit. Society is to blame, too. We tell kids it's okay at some level to behave as long as you win. You got into Harvard, Junior? Great. Whatever it took to get there. As long as we start saying that you can shelve important qualities like compassion, kindness, respect, mutuality, empathy, as long as you're telling people it's okay to put that stuff away as long as you succeed, our achievement-oriented culture is a contributor to these patterns for sure. 'Cause we're almost saying empathy is a waste of time as long as you get straight A's. You know, who needs kindness when you can write code? That's not going to fly. You know, so that's the other reason we're seeing more and more of this. And then you add things like social media and the kinds of things society values into the mix, then that that's it. I mean, it's a perfect storm. That's what I'm saying. We've got You've got the family, you've got the community, you've got the culture at large, and then you have a little bit of individual temperament thrown in there. Forget about it. When you hear how narcissists narcissism is conditioned, I'm surprised that it's only 1 to 3% of the population that has it. Remember, that's narcissistic personality disorder, which requires that person to have had problems in their life because of it, awareness of it, and feel like it's caused them trouble. Because narcissism works as a pattern in our society too often, they don't feel a lot of distress. So when you were talking about parents mirroring or kids mirroring their parents, there are certain behaviors that I grew up with, right, in my parents that I did until my mid-20s. And then I thought, "I'm not going to do this anymore. This is not healthy for me. It's not nice. I'm not going to do it." And so I changed. So why is it that I can change an undesirable behavior, but someone who has narcissistic personality disorder can't change? Because you've got because the core conflict is that insecurity. That discomfort with themselves. That sense of emptiness. That's what has to be addressed. So you may have seen that, but it clearly didn't result in that kind of core insecurity perhaps, in you. So, when you were doing the yelling, it's like, "Well, this is how it's done." And then you're like, "Whoa, maybe this other person feels sad when I'm yelling at them. This isn't okay." So, you were able to have that correction because, A, you were able to engage in empathy, and B, you may not have had that core insecurity. Remember, the narcissist is absolutely reliant on the world for validation at all times. When we need someone, we resent them. You know, a child

doesn't, but the child grow. Think about an adolescent. Every adolescent out there, um, resents their parents. Why do they resent their parents? 'Cause they kind of still need them. They kind of still need them to be a mom, like, "I want you to be my mom. I don't want you to be my mom." And they go back and forth, and then they hate you. You know, so it's that resentment comes from need. And it's one thing to be five, of course you need your parents. That's built in. But when you're 35, 45, and you need people to tell you you're great all the time, you may not be aware of that need, but you are aware that you're reliant on the world, and that if you're having a bad day, that the only way to spring out of it is to get validation from the world. That stinks. So, that's why it's very difficult to change. It's not just about modeling empathy.

And there is, there is an interesting concept out there, and it's something actually even in my social media, something that we've engaged on about this idea of cognitive empathy. You can teach people, like, "That's how he feels. Okay, got it. Do you understand why that would be feel bad? Got it." That's almost intellectualized, and it's a little bit different than being in the emotional muck with someone. Is it like acting? It's not. No, it's not acting. It's knowing, but it's not getting. You see what I'm saying? No, I don't understand. I know I know why this person would feel upset right now. I know that. I might even get it a little bit, but I'm not feeling it so much so that it'll stop my behavior in the future. So, it's like a half of a fix. And when you're really in a close intimate relationship with someone, and the best they can come up with is like, "I suppose I understand why you feel that way," but they're still not like, and they're not emotionally there with you. That's incredibly unsatisfying. It's kind of like when somebody says, "Well, I'm sorry if you feel that way." Yes, narcissist mantra. Yeah. "I'm sorry you feel that way." That's not an apology. That's not an I'm That's not an apology, exactly.

You have been in a relationship with a narcissist? I myself, yes. Yes, of course. I in different areas, too. Intimate relationships, familial relationships, um, work relationships, but just so all of them is a total no. It's not my ex-husband. He's actually a great guy. We love We love the ex-husband. We love my ex-husband. So, but because I'm curious, because if if 80 to 90% is taught, Mhm. Were you hyper-aware raising your kids to not raise a narcissist? My the My ex-husband and I, when we were raising our kids, the one thing we 100% agreed upon, he's like, "Ramani, we have a lot of things we have to get right." But we looked at each other and said, "The one thing we must make sure we focus on above all else, 'cause we only get one chance to get this right, is empathy." Is empathy. We didn't care how they did in school. We didn't care if they didn't eat their vegetables. We didn't care if they watched television 10 hours a day. We just needed them to be empathetic. And there was that fine day when they were about eight or nine years old, and I was like, "That's it. We got it."

Was your Wait, was your Hold on. I have so many questions. Was your ex-husband a a mental health professional? Okay. So, you Yeah, it's not like that. kids have two Yeah. like world-renowned mental health experts parenting them, and the two of you both agreed that empathy was number one. Empathy is everything. This is huge for parents to get. Because I'll tell you, it's the core of why kids bully. All the problems we have with kids, it has to be about empathy. Am I telling you my kids have had the most smooth ride? No one's kids are. I mean, and they're horribly mean to me, 'cause they're teenagers. But I will say that I can see in their face when they go one line too far as a teenager, and they say that one mean thing, and they see my face change immediately. The empathy overtakes them quicker than their words do. Their face changes. I've watched my daughters interact with people, and I'll watch how quickly their face will change when they sense another human being in need. And at those points, I do heave that sigh of relief. Whatever path they take, I do know that they're hyper-aware of Not hyper-aware like in a neurotic way, but they're very aware of the the needs and the feelings of other people, and they will shape their behavior in that way. And that was the only thing that mattered, because I wanted to put two decent, kind human beings into the world. Mhm. That's really beautiful. I bet if I lined up 100 parents and asked them, "If you could only give your kid one thing, what would it be?" I don't think it one of them would say empathy. That's terrible, because I'll tell you, I would The world has enough smart people. And they turns out they do well in school. But if I had to choose, if somebody said, "You could give up your kid getting into like a top college or something, and trade that out for empathy," I'd be like, "Hell no." Empathy? She could go I don't care what she does, but I would not let her give that up. Maybe parents are concerned they're sharing, you know, kindness, being honest, diligent, hard-working. I've never heard empathy. Yeah, it's It was everything the way I raised them. In fact, even how I breastfed my kids, I'm like, "I'm going to stare at them face-to-face. I'm never going to be distracted as much as I can." In the middle of the night, I would I would fall asleep. I would stare at them face-to-face. Like, I started that when early. I'm like, "I'm mirroring these kids." That important to you and your husband? It was that important. Guys, this is huge for the parents out there getting that, because this is this is the leading expert on narcissism and a lot of other mental health topics, and her ex-husband both had that shared goal. That means narcissist. I mean, it Yeah, right. It had to be empathy. Wow. Because I think that that's That's the pay-it-forward. That's going to make them better mothers. It's It's going to make them better partners. It's going to make them better workers. It's going to make them better leaders. It's going to make them better friends. They win everywhere on that one. That's the only quality to me that matters in a human being. And so, there from From there, all other things would be built out, whatever they do.

Now, you briefly mentioned that around the age of eight or nine, there was a moment that you said, "Ah, they got it." What was that? There was I was actually watching my daughter play with another child. And then something happened with what the child was eating or interacting with, and so that child no longer had that thing, and my daughter still had it. Might have been like ice cream or something fell out of a dish. Oh, okay. And her face, you could see that she She almost got She expect She experienced that person child's feeling before that child experienced their feeling. And you could see the hurt in her face, and then she's like, "We have to help them. We have to help them." And I'm like, "Go, sweetie, don't worry about it." I think she was worried about the cost. And she was even being empathetic. She knew I was struggling a little financially at that point, and to buy another ice cream was going to cost money. She's like, "Is it going to be okay to get them another?" I said, "Of course, sweetheart." And then we ameliorated the situation and got a new ice cream. But her caring for me having enough money, that child suffering, it was like it really, you know, she was with me like, "Should I cut mine in half, but I already put my germs in it?" You know the way a kid thinks. It was so It was absolutely automatic for her. And you know, and we were very lucky. They Our children went to an infant care center actually at UCLA, where empathy was the main thing taught to them all day long. So, you can build this into caregiving models of, you know, and I think that started in infant care. It was in their preschools. It was in their K through I mean, and I maybe even in high school. It gets harder, but it's you know, we'll see how it goes for them. Like I say, there's teenagers, it doesn't always feel like empathy, but I see it with their friends. Everyone but me. And I'm fine with that. For now. For now. They'll become your friends later.

Um so, eight or nine years old, you saw this empathetic these empathetic traits. but then it was clicking. It was automatic for them. When are you When do people start to exhibit signs of narcissism? Here's where we need to be careful. Almost by definition, all teenagers look narcissistic. They're deeply entitled. They're arrogant. They think they know everything. Uh What's the type of narcissist I compare them to? They fit them. You would call them maybe one of the benign narcissists. narcissist, yeah. And I think that's what it is. It is more of the benign narcissism. And I think that's why I'd be very loath to use that term with an adolescent. I always say that adolescence is like wearing a sweater that's way too big for them. They're just growing into their personalities. They're trying to figure it all out. Their bodies are changing. The world treats them like an adult for one hour, as a child for another hour. So, it's just hard to be a teenager. It really, really is. And it's hard to interact with a teenager. So, that combination means like we're just trying to put a label on it all. So, I say, "Don't even use that word with adolescents, even though the pattern seems to fit." I wouldn't start really sort of saying, "Mhm, this pattern's making me super uncomfortable," probably until their early 20s, like it's really in place, and they haven't kind of grown out of it, whether they've gone to college or military service or like trains in a job or something. Some of that should be correcting at that point. And that's where I would really, really look for it in earnest. But I would still look for some of the key issues that they are empathetic as adolescents when they need to be. They may not be to the parents, but they should be with their friends and other folks in their purview. You know, are they really entitled? They really believe they deserve special treatment? Or, you know, kids making noise in a restaurant, sure, that's going to happen. But like a kid walking up and saying, "Hey, why should I have to wait in line? You know, I'm too important." That's a problem.

All right. Well, that That was such a wonderful explanation of of causes. And there are seven signs to look out for when spotting a narcissist. We're going to go through those one by one. First one? The first one's lack of empathy. Okay. And that's a defining characteristic. That's a defining characteristic of narcissism. In fact, if I see that somebody has really well-preserved empathy, I'm like, "Nah, not even happening." So, that That to me almost is the requirement. It's the bedrock of this pattern. The second is entitlement. Entitlement is that sense is that that somehow someone is should deserve special treatment, even if it's to the detriment of other people, that somehow they are different than everyone else. Again, sort of special by dint of their their existence. Mhm. Yeah. Um the third is grandiosity. It's sort of an unrealistic assessment of one's capacity or abilities or they talk about a grandiose world that they don't even live in. The things that they may someday do. You know, someday I'm going to climb Mount Everest. So they talk about it as though it's something they're actively doing or have already done. So it's It is a It is again a very unrealistic almost fantasy like version of the world. They'll often talk about having one day the greatest love affair or the greatest love story or the greatest wedding or the greatest career. It's Everything is just bigger and larger than life. Number four is superficiality. There's a very vapid quality to narcissism. They're really only concerned about appearances, how a person looks, what a person owns, where they live, what they drive, what they carry, the shoes on their feet. It's very very superficial to the detriment of other characteristics. Somebody out there might say, "Oh, but I love fashion." But they're a very sweet, kind person. That's not what we're talking about. We're talking about superficiality with absolutely no depth behind it or judging people solely on superficial characteristics and quality. Number five is chronic seeking of admiration or validation. It's the constant need to be get be receiving praise, recognition, and nowadays that's really amped up because of social media that they have to get likes and they have to get lots of traction on their social media page and they need lots of followers and all of that. So it's that constant need but it it never stops. If you're even close to them like you you're their child or you're their partner, you have to constantly be telling them how wonderful they are and how great they are and way beyond the the thing that they've done. It's almost a nuisance to get a gift from a narcissist because you have to thank them for it so many times. It'd have been easier to buy it yourself. Number six is their tendency to rage. They don't They don't have good command of their emotions. They tend to be all over the map and the one emotion they tend to manifest the most often is uncontrolled rage. That's often because they're so frustrated and they're so insecure and they don't have good ways of dealing with their feelings. So it's not unusual for them to just come out when things don't go their way. They don't have any tolerance for frustration. So you'll see a lot of rage that comes out. And number seven I'd really say is arrogance. It's "I'm better than you." And in in that some ways that sort of draws from the grandiosity, it draws from the entitlement, but it can come off as a snobbery, as a dismissiveness, as a devaluation, as an invalidation of other people. Just sort of like sweeping them away. And so those are some of the seven key character characteristics. In my book I actually lay out what I call 31 characteristics. It's like I think it's a lot more than just the seven and it takes in a lot more territory. Jealousy, envy, getting pleasure out of other people's misery, lying, cheating, you know, things all a lot of really negative interpersonal patterns. People who are narcissistic often engage in projection. They make their faults and flaws yours. Like, "I didn't say that. I didn't do that. You did." They'll accuse you of something they did and they'll be like you You'll often be quite confused. They engage in dynamics like gaslighting where they question your reality and make you feel like you're literally losing your mind. Like that never They'll say things like, "That never happened." And you'll be like, "But it did. But it did." And then you'll start questioning yourself. And people who spend enough time with narcissists find themselves plagued with self-doubt because narcissists so question their Oh, so often question their reality.

So with those seven, do they have to have all seven of those? You know, the DSM has a list of nine which takes in most of those. You know, you only need five of the nine plus this idea that life isn't going well, that distress, to get it in the DSM. I often I'm actually a little more generous. I say like you need to have like If you have all If you have five of those seven, you're in trouble. But the But the lack of empathy is the requirement to me all everything. So it's like that plus four or five others and not so good. And a huge takeaway for me was in our last episode when you talked about empathy and how it related to raising your kids. So if you haven't seen that episode, make sure you go back one and take a look there because that was just absolutely for me phenomenal phenomenal.

How quickly, if I'm just at a party and I meet people, can I find out if someone's a narcissist? I'm a pro and I'm in and out in 15 seconds. Like I got this. Like 15 I've got this. Like I before I even got to the second part of the question. Our session is going to be 15 seconds? You can You know what is at a party? It's almost easier, right? Because I know it's kind of mean. I probably like cast out a few. I I might take me longer. Some people you If they're a narcissist, you're going to be able to tell quickly. Sometimes it takes you a little longer if it's a bit more subtle or covert or something like that. But it can happen pretty quickly. You know, watch the back and forth of the conversation. Is there a genuine curiousness about you? Like do you Do you walk up to them and say, "Hi, nice to meet you. I'm Ramani." And you'll say, "Hi, I'm Kyle." And then it's the Kyle show. And by the time this conversation is done, there's no sense of anything about me and not even an opportunity for me to have offered that. You know, it also might be how they conduct themselves in that. Like do they just keep talking about themselves and only in these sort of unrealistically glowing terms? Do they almost seem too But at the other extreme, they also may be a little bit too slick and too smooth. Like, you know, maybe not like they're coming on to you but like it's just almost too charming. I find charming people terrifying because I know that's often like the soft sign that psychopathy or narcissism's coming around the corner. So charming people I actually like uncharming people. Like the more socially awkward you are, the more I'm like, "This could be a real sure thing." Like this is great. Wonderful. Sign me up.

So if I meet somebody and I suspect they're a narcissist because they're only talk about their selves, they're not interested in me at all, they're very grandiose in their the content that they're putting out there. Are there any questions I could ask them that could give me some instant feedback? You know, what you can do is ask them something that has more that pulls them away from talking about their work. Like let's say they're talking bragging about work work work. They're sort of like only talking about one thing. Try to change it to something else. Like, "What are the things that bring you joy?" Like really ask them like a feely question. And then if they're like Like they just sort of like become like, "Huh? Feeling? I'm going to go get another martini." Like they run away, that's probably a sign. Like if you I It's sort of a game for me at a party. If I think I've met a narcissist, I'll say, "Can you tell me about a little bit about your inner world?" Because I know what you do now and they'll they'll I'll often get people look at me like I just I'm speaking in tongues and they'll often say, "I see someone over there. I got to go." And they'll often really cut the conversation. People are going to be so nervous when they meet you at a party now. They're like, "Hey, by the way, I'm not a narcissist. I I saw you on That's So Random. Like I'm out. I'm not talking That's also a show I would definitely watch. You with a hidden camera just meeting people. Yeah. In In LA it's actually it's it's blood sport here 'cause it's like you can cut it's like it's like it's going on. It's like seashell collecting. By the end of a party, you've got like enough I mean, it really I know we joke about how narcissistic LA is but it really is true. Yeah, we live here. We work here. It's insanity. It really is. Yeah.

But here's one thing I you'd want to be I mean again, I don't want people dismissing people in like the first 15 seconds they meet them. Let's say someone does talk about themselves a lot. The other thing you do want to be mindful of is they may be socially anxious. So they may have trouble kind of taking and rolling with it. That's why I'm saying if you could slow the conversation down, maybe even make it about something that's happening around you. Like something very sweet. Like something they you know, they're they're drinking or something special they may be wearing or they But making them make it more special. Not like, "Well, this is the designer label." But try to make it about the moment, what's personal and see where they can go with it. To share a little of yourself. Also, start talking about yourself a little. They've done their whole dog and pony show. See what happens when you start talking about yourself. If they glaze over or they start using their phone at that point, not a good sign.

If I do find myself in a situation where I'm in a relationship, whether it's romantic or otherwise, with a narcissist, what can I do? Okay. Well, that's you know, here it is It's going to It's going to be painful. If you really And by the time a lot of people detect these patterns, it's been years sometimes. Um if we're lucky, they don't have kids together. Because that can start getting messy if the relationship goes south. Because a custody battle with a narcissist is is It's war. It's It's one of the most painful things I've ever witnessed. If you sense that that's where things are going, you need to get yourself into therapy right away and you want to get the couple into therapy. The challenge with couples therapy with a narcissist is unless you've got one very skilled therapist, that narcissist can really play the therapist. And I've seen that happen many many times. You want to be really really careful. How do they play the therapist? They win them over. They charm them. And sometimes the narcissist is sort of the more materially successful or the more successful seeming partner and they'll kind of Again, they'll they'll charm them. They'll charm them. You have to be somebody who just dislikes charm to really not be charmed, right? So they'll really play them and work them and and and flatter them. And narcissists actually are quite good at sort of sniffing out how to validate another person 'cause they are they need it so much. They're really good at dispensing it when they need to. Wow. So they can really work the game but it's important you get therapy, you consider getting yourselves into therapy, you pay attention to the patterns, and you really have to do some hard looks into the mirror on if if this is as good as it's ever going to get, which is probably the case, can you live with this forever? Mm. That's the question. And if it's If it you don't like that, then you got one of two paths. Either you got to adjust your expectations to this is how it's always going to be or you got to get out.

Well, and those two paths is what we will be discussing next. You You mentioned to me off camera that there are people in a relationship with a narcissist and they don't even really realize that they're being abused. Explain that. There's a couple of reasons that could happen. One is what I call sort of the historical reason. They may have come from a family where one or both parents or someone significant in the family system was narcissistic or abusive. So for them, abuse and relationships go together. to the mirroring thing. Right. So they just don't even like everyone's going to say I deserve it. This is how I'm treated. And so they're often a easy mark for getting in with a narcissist whereas other people might have already broken up with the narcissist they end up with. They stick it out because it's almost a sense of they they were sort of raised up in that. Mhm. And so they don't even think they deserve more or they just don't question it. And so they're used to saying, "Well, maybe if I try harder they'll love me. Maybe if I try harder." So it can it becomes a sense of they're it's a self-blame. The self-reproach. I this is my fault. They're telling me that they're yelling at me because I didn't keep the house clean or I don't look good or the kids were noisy or I don't make enough money or I'm out of the house too much or whatever the reasons are. And they actually blame themselves. They keep thinking if I fix this, this, and this, then maybe this will turn around.

In what types of relationships do you find narcissism a problem the most? I would say where you know listen the two sets of relationships where I think it is most problematic is in an intimate partnership like a husband-wife um boyfriend-girlfriend kind of thing or a parental relationship when it is your parent. Because the parental relationship is you know if you have a narcissistic mother or father or perhaps step parent that sets a tone that you're going to take into adulthood. And it's going to color how you choose a partner, what you endure in a job, it just your your own sense of self-worth. So many things in the long term can get harmed by having a narcissistic parent. It's not a it's by no means a sentence and I've seen many people who have had brutally narcissistic parents who go on to enjoy So it's not like you're doomed but it definitely is a vulnerability. Then in the flip side is obviously when you meet someone and you think you believe you've fallen in love with them and you try to make a life with them and they spend their days dehumanizing you, invalidating you, yelling at you, putting you down, disrespecting you. That's miserable and you really you might stick it out because you feel like you have to or I'm not loving them well enough. It's you know sort of what I call the beauty and the beast fantasy. Maybe if I love the beast enough he'll turn into a prince. And there's a lot of people who sort of fall into that bucket. And so it those are the two relationships where I see it's the most harmful. But you know listen if you have a narcissistic boss it can throw off your career. If you have a narcissistic sibling you might feel like you don't have a confidant but I do think the parents, the partners, that's really where the rubber meets the road.

What triggers narcissist narcissistic abuse? Well, what triggers narcissistic abuse is the insecurity in the ego of the narcissist being threatened and they explode with narcissistic rage. The problem is for a while you can't figure out what it is that's setting this narcissist off. It can often be the littlest slight. It could be that they had a bad day somewhere else and they're taking it out on you. It's like coming home and yelling at a pet because you can't yell at your boss kind of thing. So you don't know what the thing that set it off but all you do know for sure is somewhere along the day their ego got injured. They felt out of control. Their insecurity boiled over and it's the people closest to them that often feel like they're easiest targets especially if you keep forgiving them and giving them second chances. Then they're like, "Ooh, this is great. I can keep coming home and doing this, get all my rage out. This person's still sticking around. Great."

Would a narcissist date somebody for let's say 5 years, then get married, and then start the abuse? No. A lot of people say, "Well, they became narcissistic after we married." I was like, "Oh, no they did not." That's good to know though. date it was there. Narcissism is a pattern that's that they you bring into it from early adulthood on. I mean it was developing all along, right? But it's there from the jump. And when we do sort of the autopsy on the relationship and really go right back to the beginning they'll say, "Yeah, I guess he was late to all our few first few dates and there was a lot of really poor boundaries and one time he got screamed at me because I mistakenly ate his order of fried rice or whatever it may be." That the patterns were there. They just were romanticizing it 'cause like and he wanted to spend all this time with me. He wanted to be with me 24/7. That to me is an alarm bell. That's really controlling. This this series is about narcissism as a general topic. However, I look at this a lot as the the the series to watch if you're going to start dating. Amen. This knowing this information, having this power, having this education allows you to avoid 5, 10, 15, 20, maybe 40 years of disaster. believe that prevention in this case is the best cure. If we could keep people from getting these relationships in the first place because what you got to remember is I've known people who actually were well put together, kind, empathic, relatively confident. They'd get into a relationship with a narcissist. 15 years later they're a shell of their prior selves. They're riddled with self-doubt. They they complete and utter loss of self-esteem. They don't know which way is up. They completely think they're undeserving. I mean it really does a number on them from the inside out. So if we could stop it from the first place because what ends up happening is once a person's in people will often fight for a relationship. So that's where you want to stop them from getting in in the first place. And especially if you have kids. Oh, once you have kids it's even worse. dependent on that person. And many narcissists try to make their partner financially dependent on them. They ensure that they quit their jobs or you know make it so that because that's one way that can make sure that person doesn't leave them and allows them to control them because control is a big part of the narcissistic dynamic. Yeah. It's it's I'm I'm so thankful that I'm learning all this.

Um if you find yourself getting getting abused by a narcissist in a romantic relationship, what are your tips for that person? If you're being abused in a narcissistic relationship, first of all I'm always going to say especially to MedCircle listeners, if you're being physically abused or any other abuse that's putting yourself or other or children or other dependent adults in that environment at danger, you must get help. And I'm hoping MedCircle might even be able to put like a connection to the national domestic violence hotline. Because you've got to get help immediately. Um that's that's that's a a danger and a risk situation. Beyond that we're really getting also into psychological abuse which and emotional abuse which to me are equally harmful, equally harmful as physical abuse that you need to ensure that you're getting appropriate mental health services. Uh perhaps even through a support group that other people being affected by this narcissistic abuse like kids are getting mental health services 'cause they're seeing this happen. Make sure that you take care of you 'cause it's very easy for your health to fail when you're in a a relationship with a narcissist. I've seen people get very very ill due to a variety of stress-related illnesses and I had to wonder how much of this was really due to years of being in a relationship with a narcissist. Cultivate other support networks. People who are narcissistic often try to isolate their partners. They don't want them to get the support and validation of other people. So break out of that isolation. If it's friends at work, friends that you're a spiritual community or church or temple whatever, you know but find a way to get those people. You can someone at the gym. Somewhere create friendships in other spaces so you don't get too far down the rabbit hole. Family members just to get that dose of reality. That kind of thing. All of those things become important. You need a reality check. Yes. people it's almost like you want people to see you with that person. But here's the thing. A lot of time narcissistic people don't verbally abuse their partners in front of other people. They're smart enough to know they got to look good to the public and they save that for behind closed doors or in the car or whatever. Mhm. Yeah, that that's what I was was just thinking is first having the courage and education and wherewithal to know I'm in this scenario. This is this is bad. This is hurting me and it's likely because of this. I think people are afraid to admit that. They're very they're ashamed. There's a lot of shame. It's so sad. I've worked with many people who are in a relationship with a narcissist and they were horribly ashamed and embarrassed that they let it get this far. And I said, "You know what? It's not like it went from this to this in a day. This has been happening over time and you almost sadly slowly been adjusting to this change in the climate and now you're here and yes it looks gruesome from here but this didn't happen overnight." And we're not going to be able to undo it overnight. Yeah, it's the frog sitting in a pot of water. Yeah. But the frog can still jump out. So Yeah, but until the frog gets boiled to death. That's the problem. We're trying to catch people before that. Yes, we are.

What about people who are in a who have a work relationship and they're their coworker is narcissistic and abusing them? How do they handle that? When you have a coworker who's behaving in that way, you've really got to protect your interests because most HR departments can't do much without documentation. I tell people when you're in that situation, you as soon as you start a new job create little email folders for everyone you work with and save everything. Hopefully you never need it. it. And 40 years down the road you had the most exam wonderful career and you just they clear out your account and it's done. That's not going to be most people. So you save everything and it starts to get a little wonky and you have to be very careful 'cause if it's a company server you may need to print hard copies of these emails. You may not have the access to that. You may not be able to do stuff with that at work. Make sure you create files. When you work with difficult coworkers save every email. Save text messages. Yes. I mean we're talking everything. Um when you try to avoid meeting with them one-on-one alone if that's possible. If you can have someone else in the room with you. And you know, it may sound weird. You don't have to make it hostile, but try to make it that there's other people present because then that gives you, you know, again another another set of ears. However, if you can't have that, one thing I recommend people who have a narcissistic co-worker they're concerned about, create a memo after the meeting. Send the memo say, "I just want to make sure that this is a very clear review of what we just met." Use quotes wherever possible. Put a read receipt on the email so you know they received the memo, and then keep that as a keep these things as records. And so, you really want to ensure that you have that because you can't do much in terms of HR or with an attorney until you have all of that. But, we also know that workplace stress is actually the type of stress most associated with developing physical illness. So, it really is important that you manage your workplace stress. Once again, consider getting therapy. Have a safe confidential space. Don't don't don't make this about workplace gossip. It's so easy to have those whispered conversations. Then you're the one who might end up getting into trouble. Don't post your workplace Not going to fix anything. Don't put your workplace strife on social media. If you have a narcissistic co-worker and they don't go and they decide to go there, don't get in the mud with them. Yeah. You've got to play a clean game when it's this kind of situation. Make sure you engage in self-care. And then you might want to slowly but surely, if you feel like the writing's on the wall, let's say this narcissistic co-worker has outlasted everyone. Yeah. Maybe that the culture of the company is that they're not going to get rid of this person. Maybe it's the boss. Exactly. And if it's the boss, you have even more problems. Same rules, but you may need to start working on an exit strategy, sadly. We do know that there's some interesting research that has come out that when people work in a narcissistic with a toxic narcissistic boss, that you'll sometimes find that they band together and do some interesting work together. Can actually cause like when you're united around a common enemy, that can create some interesting The boss is narcissistic and the co- the workers might actually all unite. So, that can sometimes be a nice downstream effect. Make sure you have allies at work, you know. People you can turn to, not for gossip, but just to ensure that you're protecting yourself. But, also realize you may need to cut your losses. It may be the dream job, but it's not the dream job if you're working with toxic colleagues. Slowly craft an escape strategy and do it quietly because in some places they may be vindictive enough to stop you from trying to get a new position. It can get really dark really really fast. I hope people had their pen and paper out for that 'cause that was a lot of actionable amazing tips.

What about the support Okay. I have a friend who's in a relationship with a narcissist. How do I help that friend? Number one, do not call their partner out 'cause that person's going to feel the need to defend their partner. Don't Okay, don't call that Don't call the partner out. You don't No. No, definitely point out the patterns and the behaviors and listen non-judgmentally. It can be very overwhelming. It's so hard 'cause you want to say, "Here's my phone. Text me right now. I'll pick you up right now." And to say, you really want to say, "It it hurts to hear this. It must be hurt even more to be experiencing it." That's good. You know, so when someone you love is telling you that they're being hurt in a relationship, your temptation is just want to go tear that person's throat out. Be with your friend's pain, but don't give them an unrealistic plan to say, "Right now, we're going to your house. We're getting your stuff. We're getting out." They may not be willing to do that, and that might scare them to even talk with you more. Listen. Listen non-judgmentally. Tell them like, "This doesn't feel okay. This feels like abuse to me. Are you okay?" And then ask them the million-dollar question. "How can I help?" We all want to give advice. We all want to get in there and fix it. "How can I help?" Your friend may say, "You know what? You're helping just listen." You know, and I'm going to be calling you in the middle of the night and say, "I'm here." Instead of saying, "Okay, let's rent you an apartment right now. Let's do this right now." You know, that's overwhelming and a person may be really really freaked out. So, when our when our our loved ones are struggling, we often want to get in there and do what I call casseroling. Like, "Somebody died. Here's a tuna casserole." Like, I don't know that they want that. Maybe they just need you to listen. And if they want a tuna casserole, trust me, they'll let you know. Yeah. So, ask them, "How can I help?" In conducting all these interviews with you and lots of other experts, the power of asking a question Mhm. to somebody you love is probably the best way to show support. Mhm. If you ask it without judgment, if you ask it with sincerity, and if you ask it without trying to get anything from them. Not like, "Well, do you think moving would help?" That's not the right question. But, "How can I help?" "I'm sorry you're going through that. That must be tough." Those questions, I mean, are so simple. So easy. huge and also don't second-guess them. A person in a narcissistic relationship is being second-guessed and doubted 100 times a day. Huge. last thing you want to do is say, "Are you sure that's happening?" That's gaslighting your friend. That's And that's you Now you're participating in the abuse. Yes. You know, I mean, you listen to your friend. Why is your friend going to lie about this? And if this is their track record of lying about this stuff, you need to find a new friend. Get a new friend. Right. so I mean, but you really if this is 'cause odds are by the time they're coming and telling you this, it's been going on for a while. Yes. Wow. Uh I loved everything that you put out here because it gave me one big sigh of relief that there is hope. There is hope. If people are out there dealing with a narcissist. You know, the thing that happens to people who are narcissistic relationships is a phenomenon we call learned helplessness. It is a you know, theoretical model that came out in the 1970s. But, when it plays out here, a person in a relationship with a narcissist feels that nothing they do helps. No matter what they say, what they do, how they communicate, how they look, anything ever changes anything. So, they start feeling helpless and they get paralyzed and then they get stuck. And many times they often become can also become depressed because learned helplessness is considered to be part of the developmental model of depression. So, it is a it's that sense of nothing I'm doing is working. When you're in a relationship with someone and you feel like nothing you're doing is working, that could be a real ringer that you're in a relationship with a narcissist. Well, luckily you provided plenty of tips, plenty of actionable steps for people to take. But, the question remains, is there hope for the narcissist themselves, Dr. Ramani? Okay. So, first of you got to you got to get him into the therapy room, right? So, most narcissists do not come into therapy saying, "Hi, I'm a narcissist and I want therapy." Yeah. I had I did have one person in my career do that. And Literally walked in the door. That's what he said. "I'm a narcissist and I want therapy." I said, "Have a seat. Let's see what we can do." And Well, hold on. And was he a narcissist narcissist personality disorder? And what kind of help did he get? it's long-term insight-oriented work, but it's slow. It's really really slow. And he's very committed to growing, to to doing better. He wants this. And it's it's an incredibly slow process. And this is a guy who wants it. Mhm. So, when people say, "Is there a treatment model that works well with them?" I would say we typically learn a person is narcissistic in therapy because they came in with some other problem. "I'm having problems with my girlfriend." It might be substance use. "I've been feeling sad. Work isn't going well. I'm not getting along with my boss. I'm mad at my mother." So, they'll come in with something else. And then they'll tell you their story and maybe by the first or second session they'll be like, "Oh, I'm getting this." You might even notice it in the first session because there'll be a real antagonism from them to you. Is Sorry to interrupt you, but we mentioned in a previous episode very quickly you can spot if someone's a narcissist. You specifically, if you're at a party. In a therapy session, it takes you one to two Is it because they're guarded? They're guarded and we're having a very curated kind of conversation. history and all of that. You might pick some of the top notes up pretty quickly. Like, they'll talk about all their achievements. And I once had somebody say, "You want to know how many cars I own? Let me tell you how many cars I own." And one person even said, "I could buy and sell you 20 times over." And I was like, "And more like 40, but like right out there. Like, you'd really your reaction when someone says that? Uh you know, I mean, utter humility. I'm like, "That You know, that's so interesting, but I actually don't care." So, let's you know, so let's just Okay, and then you say you don't care and then what do they say? They'll say they'll look offended. I'll say, "You know, I'm actually trying to learn your inner world. That stuff that's that's all fluff to me." You know, so please tell me about it. We're going to work on this inside. And that's of course terrifying 'cause those shells are a lot more empty. Yeah, that's why they have 20 cars. Exactly. That's why they have 20 cars, but you know, there's no kind of there's nothing but room at the end kind of thing. So, it's that that's the struggle. But, I have to say that you often end up working on the thing they came into therapy with. The relationship problem, the substance use issue, whatever it is, okay? But, then

You start working backwards on the other, you know, we, we dig deeper. What was childhood like? What was, you know, how do they manage frustration? How do they manage anger and rage? A lot of the work of therapy and working with a narcissistic client is building a trusting therapeutic alliance. You got to like them. And I got to tell you, I've worked with some people brutally, brutally narcissistic. I like them. I mean, some of them I've really liked. I could, I'm like, "Wow, I see the vulnerability." And I'll even say that. I'll say, "I see the beautiful little boy. And I'm so sad the world missed out on this." And they'll cry. And they'll cry a lot. You know, like, and I'll see it. Like, there's something vulnerable about them. There's no point. I'm going to get paid the same whether or not I'm saying nice stuff. You know what I'm saying? Like, it's not like I get a paid on per compliment basis, right?

So, you're trying to, you want to, you want to get them to come in every week 'cause something's happening. Sometimes they try to outplay you or outwit you and tell you, "I know more things than you." And I said, "You know what? I'm always, I'm always a student. So, teach me." So, what I don't do is get in the mud with them. I don't defend myself. You know, if they don't feel, you know, if they don't feel I'm good enough, and I heard that like, "you know, you're not that good." And I'll say, "That's absolutely important you feel I am good," and I have a list of referrals and I pull it out of my desk and I say, "I actually highly recommend these therapists as well." So, they're used to people going, you know, going, you know, head-to-head with them. I don't play that game, and I think good therapists who work with narcissists don't.

So, it's really that you work on the current issue, you work backwards, you try to create a strong, consistent, empathic therapeutic alliance. When they tell you a sad story, you genuinely feel sadness. You'll say, "My gosh, that's so sad." And you know what I'll often get is, "I never thought of it that way." And I'll say, "Really? 'Cause I'm actually feeling that inside." And then we'll break that down. Wow. The the difference in our two emotional experiences. So, you sort of learn in the moment. Um, I try to work on mindfulness techniques with them. Like, how do they catch themselves before they say the hurtful words? How do they manage the anger? What's the source? We ask them what the source of the anger is. So, it's really about, it's cognitive behavioral work, but a lot of it's humanistic work. There is something good in there. And my job, it's almost like being a prospector. We're going to find it. We're going to show it to them, and we're going to cultivate it. And so, it's some of it's existential work. Can they learn to start taking responsibility for the hurts they perpetrate on other people and perhaps try to find another path next time?

If you're willing to do that kind of depth work, we might be able to get you somewhere, but it is, they're baby steps. Let's say a really high-functioning, empathic, solid person is sitting up here. The kind of person is going to take care of you if you're sick and is there for you and doesn't need validation all the time, okay? And a narcissist is down here. Okay? Or even down here. We're not getting them here. Right. We're not getting them here. We're going to get them here, and maybe that's enough. That might be enough to say, "All right, I'll stay in the marriage. I realize it's not satisfying." Or someone's like, "All right, I'll try to cultivate a relationship with my dad, but realize it may not be what I wanted," or, "Yeah, okay, like, you know, I can try to keep working with this person." If you getting them from here to here is Herculean. This isn't possible, and if this is the standard, it's not going to fly.

One of the traits of a narcissist is that they lie. Mhm. And one of the keys to successful therapy is honesty. Yeah. So, how do you make that happen? Depends on what they're lying about. Mhm. Depends on what they're lying about. Um, they may lie about certain ridiculous kinds of achievements. They might exaggerate the carat weight of a diamond ring or the price of a purse. It's such nonsense. I wouldn't know. You know what I'm saying? Like, you can tell me the the bag or the car cost this much. It, it's irrelevant. It's really things like, are they lying about whether or not they're using substances? Um, are they being honest about something we made an agreement to be honest about? And be make it that a high-stakes game. Like, it's almost like a contract you make with them. Say, "This is only going to work if you're honest with me."

The confidentiality brought about by therapy helps a lot. Mhm. Because you can't say like, "Hey, I'm going to call all your friends and say that blah blah blah, you're having an affair or something like that." That's not, I'm not going to do that. So, it sort of stops kind of there. And, um, so, it is, it's about creating that becomes an honest space. The lying, really, there's no incentive. They're not trying to date me, so I'm not going to be impressed by their car. You know what I'm saying? 'Cause nothing like that is happening. So, in some ways, you might have to catch them in their pants and say, "Gosh, you come in here a lot and you talk a lot about all the stuff you have. And while I'm sure you enjoy it and while I'm sure it's beautiful, it's really not relevant in here and it's getting in the way of me getting to know you." Mhm. You know? And so, you're kind of taking away their usual, um, their usual tools.

Are there medications that can work? Depends on what else the person with narcissism is living with. Everyone wishes there was a magic pill. Of course. Everyone begs, "There's got to be something he can take." There's no jerk pill. Yeah. Like, if there was the anti-jerk pill, big pharma would be making more money than they already are. Trust me, okay? So, sometimes people will try things like antidepressants with people with narcissism because they are having sort of an irritable edge. Sometimes it works, sometimes it doesn't. Sometimes people will use anti-anxiety medication with narcissists because they're having anxiety about a specific situation in their life, typically 'cause they're not getting enough validation. Sometimes there'll be drugs used to manage issues around addiction, but that's much more specific to the addiction, and it's not going to address the narcissism. But it would be the other things kind of hanging out with the narcissism that you'd use medication for. There is no known medication out there that is labeled for use to manage or treat narcissistic personality disorder or narcissistic traits.

If a couple is in therapy or couples that you've personally had, have you ever suggested to the non-narcissist in the in the couple leave? If I'm working with a couple, I've never done that, but God, I've been tempted. I mean, like, you almost wanted to slip them a note like on their way out, right? Ethically, it's not how I roll. If there's a case of domestic vi-.