Transcription
[Music] Dr. Romani 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 is Narcissistic Personality Disorder? What is it?
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 meanings to them. This one's 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, at work, at home. It's not just like they're narcissistic to only you, and they're nice, 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 two 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'm a problem with drugs." But I do have five DUIs, and they did find me in the gutter, and from my mom's house. So, I guess, Mom, 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? These are being a jerk.
So, Dr. Alan 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 because 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, boss might just be a jerk. There might be a jerk. And they may say, "Why should I go get a diagnosis? Nothing wrong with me." And if they're walking around saying, "There's nothing wrong with me, and I'm fine," then, P.S.M., they're not. They're not. They're not an art. They don't have any ID. No, 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 a narcissistic person here?" I'm like, "No, 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. You're gonna 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's as unhealthy as doing it yourself. Whoa, that is a great metaphor. NPD is the second-hand smoke of psyche. Hi. And I'd say narcissism is the second. Most of our time of our time. You stand close enough to it, you're gonna get sick. Even that's a huge deal for people because somebody might not get the diagnosis, but there's still have all these toxic behaviors that are effective. Absolutely.
And you know what? In some ways, the diagnosis is irrelevant because all it is, all that's doing is saying the person that'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 right in the presence of. And then it takes us back to that more critical issues. Why are people like this or like this? Because they're insecure. And that makes people feel guilty. Well, if he's insecure, this is why he's doing this. And that's what we're gonna 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 who 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 nurse, NPD. But I'll give everyone a preview from the original video we did. The communal narcissist. When you said it's that person who goes and volunteers on a Saturday but takes selfies the whole time and a full perfect face of makeup. I go, "Oh, I so know that person." You know? And yeah, it's also the person who you say, "Like, let's throw a gala." And you're like, "But the gala is gonna cost $10,000 and you're only gonna make $500 for the charity. Why not just write the full $10,000 for the charity?" Like, "But I need the gala." They need galas, celebrations.
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. Well, I think if you want to get down to the core of it, they are suffering because they're deeply insecure. Yeah. And that's where, you know, I mean, what do they experience it as suffering?
I'll tell you this, like I said, 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 because 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 PPD? 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, 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 dawn on you're like, "Oh, this isn't depression at all."
So, actually, quite frankly, we'll often treat the depart. Well, we'll think they're depressed. Now, for, we'll think there's no wrong. Wrong. Yeah. Again, just highlighting how important is to get the right diagnosis. It really is. Because 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, the narcissism collide. So, you'll see that too.
And I, when I've worked with families of, 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 eat for them because I'll, their thinking their child's gonna 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 gonna go away. That's the narcissism. Maybe even more so. Even more so.
I'm, you see this a lot in substance abuse treatment circles. That you see a lot of it to get. Yes, exactly. Because the, the substance use was sort of helping them kind of shore up their defenses. Yeah. And so, it can make treatment much, much more complicated. You'll also see a greater likelihood of, for example, like patterns that are sometimes labeled love and sex addiction, kinds of like compulsive sexuality, compulsive like relationship patterns. You'll see that it, so existing with narcissism as well. It just makes everything that much harder to treat. Yes. That's what it is. Because you don't tend to get as much motion. 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 translates 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, right? But if we were really to look at it, in five patterns that I've 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 there are different kinds of patterns we see of narcissism. And I think it's important to see the differences because it shows us this 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 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 I'll make it right." Whereas the psychopaths 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 had, they really know how to work a system.
Well, 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, 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" narcissists. You know, "If the world could see how great I am, I'd be one of the great ones, but nobody gets me because 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 because they almost feel like the world doesn't get them. They're hyper, hyper sensitive to criticism. 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 listen to that, and I, when you would first meet somebody like that, you think, "Oh, they just have low self-esteem." I've been go, "But all narcissists have low self-esteem." That's why they're doing 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. They'll say, "Yeah, I went to that college, but I guess nobody cares." And they'll do that weird thing, you know? Like, "Okay, was a little bit strange, but it's a." They're like, "Yeah, I already read that book, but why would you care?" You know? It's like, there's 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, yeah, random examples, I still feel the pain for that person. Oh, they're there. They feel the world pass them by. Yeah. But I don't feel the same way with a grandiose narcissist. You know, they, the covert narcissist, though, ultimately will get to the point where they feel the world owes them something. Mm-hmm. The world owes me. And there'll be a real edge to them, you know, because 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 because 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 down." There's a hashtag narcissist. But like, it's all about their, their goals for helping the world. And, and like, you'll see them, I'm in your net, 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 husbands. 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 their faith, their immediate family, or the people who work under them. There can be absolutely awful to them. And people say, "Oh my gosh, are still lucky you work with him. He's so charitable." And the people are just like, "Oh no, this is that's one of many characteristics. He is so, so."
So, the communal narcissist is a very, it's a, it takes a while to sort of on to peel off that layer. And then just 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 because 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 is sort of kind of a good nature. I'm gonna call them the benign narcissists. The benign narcissist is like this sort of clueless, an insightful 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 really dismissive of others. This sounds like every 16-year-old in many ways. If 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." 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 because 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. Who would you most want to be in a relationship with? Those are your five. Oh, mama. You know, and just solitude and the cabin isn't because I'm gonna take solitude in the cabin is my option. I'm going with that. Okay. So, it's not an option. I don't think you have to choose. You have to choose one. I might choose the communal narcissist and just be glad they're doing nice things for my God. They're nice to me. Yes. But I have to tell you, that can be exhausting because when the whole world is saying, "You're so lucky, he's so charitable." 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 feel like you're forever in a relationship with your high school boyfriend, right? That's not nice, right?
So, if you're, if I, if the cabin by myself for the rest of my life is, is a possibility, I'm going communal. I get it. I can have the cabin from you like two acres away. Yeah. And we can just meet when we want to hang out. I don't recommend any of these types for a relationship. What about my idea? I'll have a cabin one acre away from yours. That I'll do. Okay. Because you're shaking. I won't be a narcissist. You have to be. If you don't know we're talking about ghosts in the previous episode. Okay.
Out of those five types, is there one that's most common? I would have to say probably the grandiose, the classical narcissist. Okay.
What am I not asking you about Narcissistic Personality Disorder as it is defined from understanding it that I need to be asking you? You know, 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, to put, to 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 views their own identity. And the narcissist's 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.
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 I'm never gonna meet, or they set their goals a little too low so they know they're always going to surpass them. Mm-hmm. 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, 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, because he needed you as a sales contact." 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 because that makes them look good to the world. They might get a wealthy partner because that will make sure they have lots of money. They might get a famous partner so that they look good to the world. I mean, 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's, but it comes down to that core insecurities, that sense they cannot regulate themselves from the inside out. They, 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. Yeah. Really, really fascinating.
In our next video, we are going to dive deep into what causes Narcissistic Personality Disorder. [Music]