Narcissistic Personality Disorder: A Basic Guide for Providers

NPD in DSM-5

NPD is diagnostically defined in the DSM-5 (APA 2013; pages 669-672) as a pervasive pattern of grandiosity, need for admiration, and lack of empathy, with interpersonal entitlement, exploitiveness, arrogance, and envy. Five out of nine of these criteria need to be present to meet the diagnosis of NPD.

The nine criteria are:

• DSM 1: Grandiose sense of self-importance (e.g., exaggerates achievement and talents, expects to be recognized as superior without commensurate achievements);
• DSM 2: Fantasies of unlimited success, power, brilliance, beauty, or ideal love;
• DSM 3: Belief in being “special” and unique and can only be understood by, or should be associated with, other special or high-status people (or institutions);
• DSM 4: Requires excessive admiration;
• DSM 5: Sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations;
• DSM 6: Interpersonally exploitive, i.e., takes advantage of others to achieve his/her own ends;
• DSM 7: Lacks empathy; is unwilling to recognize or identify with the feelings and needs of others;
• DSM 8: Envious of others or believes that others are envious of him/her;
• DSM 9: Arrogant, haughty behaviors or attitudes.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (2013). American Psychiatric Association.

The NPD diagnosis in DSM has been criticized for being one-sided and relying primarily on external socially and interpersonally striking and provocative features.

As such, it has failed to capture the full range of narcissistic personality pathology, especially the internal vulnerability and insecurity characterized by severe self-criticism, insecurity, confusion, shame, aloneness, and fear.

Instead, the diagnosis has primarily emphasized external characteristics related to boasted grandiosity, and obviously adverse interpersonal functioning.

Important aspects of the patient’s internal distress and painful experiences of self-esteem fluctuations, identity diffusion, and emotional dysregulation have not been included.

In addition, recent research studies have proven that individuals with NPD have compromised empathic functioning with intact ability to recognize and understand others’ feelings and needs, but fluctuating ability or motivation to attend to and engage in others’ emotional experiences.

In other words, people struggling with NPD or pathological narcissism do not lack empathy, but they either chose to refrain from or have difficulties tolerating empathic engagement with others.

In sum, the DSM diagnosis is not considered informative and guiding, neither for patients and people close to them, nor for clinicians and psychotherapists who have been increasingly reluctant to use it.

While some patients strongly oppose being “labeled” NPD, conceiving it as unfair and prejudicial, others have chosen to embrace or identify with the NPD diagnosis as a means for self-definition, power, or attention, and the diagnosis has unfortunately become a practice in combats.

In other words, there is a strong need for explicit explanations and clarifications about the diagnosis and the way the narcissistic pathology influence functioning on the individual, internal as well as mutual interpersonally.

Both clinical and empirical studies have confirmed that emotional distress, interpersonal vulnerability, a sense of inadequacy, need for control, avoidance, and fear, pain, and anxiety are important facets of narcissistic personality functioning.

Co-occurrence and fluctuations between self-enhancing grandiosity and self-depreciating vulnerability are also present in narcissistic pathology.

Typical indications of narcissistic vulnerability include inferiority and insecurity, avoidance, shyness, hidden aggressive reactions, shame, and persistent self-negativity.

Paradoxically, hidden excessive self-negativity can also serve empowering, protective, and controlling functions.

Additional characteristics frequently found in patients with NPD are perfectionism and high standards accompanied by self- and other-directed criticism, as well as by preoccupation with fear of not meeting standards and of failing.

In addition, chronic envy, rage, boredom, and emptiness can co-occur with hyper-vigilance and defensive emotional reactivity, especially aggressivity, criticism, and dismissiveness.

NPD – An Alternative Model

A proposed hybrid model with combined diagnostic dimensions and traits was included in DSM-5, Section III Alternative Model for Personality Disorders, AMPD, (APA 2013).

This diagnostic model identifies specific difficulties and impairments in personality functioning, i.e., in identity and self-direction related to self, and empathy and intimacy in relation to others. In addition, there are specific personality traits that signifies each personality disorder.

The typical features of NPD (pages 767-768) attend primarily to the vulnerable and fluctuating self-esteem and the range of interpersonal patterns.

Moderate or greater impairment in NPD is found in the following areas of personality functioning:

1. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal—inflated or deflated or vacillating between extremes; emotional regulation mirrors fluctuations in self-esteem.
2. Self-direction: Goal-setting based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.
3. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimates own effects on others.
4. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others’ experiences and predominance of a need for personal gain.

Two personality traits identify NPD:

1. Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending towards others.
2. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (2013). American Psychiatric Association.

This NPD diagnosis is defined as a combination of significant problems within the 4 areas of personality functioning and at least 1 of the two personality traits.

In addition, impairment in functioning and trait expressions should be persistent across different personal and social situations, stable over time, not explained by other mental or medical conditions, and evaluated in the context of the individual’s developmental stage and sociocultural context.

This new diagnostic model is more clinically meaningful and informative for both patients and clinicians. It is descriptive and captures a broader range of narcissistic personality functioning, including fluctuations and variations in both context and severity of pathology.

It also invites attention to individual motivation and self-regulatory internal as well as interpersonal patterns and intentions. It connects fluctuations in self-esteem, i.e., superiority and inferiority, with identity problems, and inconsistent goals and motivation.

Foremost, this model focuses on the complex interpersonal functioning, i.e., the need for others’ support of own self-esteem and sense of identity, combined with self-preoccupation, compromised ability for empathy, and inattentions to others’ needs and reactions. In sum, fluctuations in personal, internally driven self-enhancement co-occur with intense needs for others’ attention and admiration, as well as with distancing and disinterest in relationship to others.

Still being a proposed model for diagnosis of personality disorders, this model is presently guiding continuing research on identifying pathological personality functioning and disorders.

Individuals With Pathological Narcissism or NPD

Individuals struggling with pathological narcissism or NPD can come across quite differently; there is no real standard prototype.

Some individuals are professionally successful, consistently high-functioning, and socially well-connected, only showing reactivity, distancing, and avoidance in certain contexts.

Others can present with functional fluctuations or specific impairment, either with severely disabling narcissistic traits and character functioning, or with accompanying mental disorders, such as mood disorder (major depression, dysthymia, bipolar disorder), substance use disorder, or eating disorder, or obsessive compulsive disorder.

Some individuals can have accompanying somatic conditions that in different ways affect their self-esteem, motivation, or sense of identity. Still others can engage in occasional illegal behavior, and those with more severe malignant narcissism can have antisocial or psychopathic behavior such as violent revengefulness, exploitation, and hostility.

Fluctuations in pathological narcissism and changes towards worsening as well as improvement in narcissistic personality functioning are often influenced by real life events (e.g., vocational, social, interpersonal, marital, or family, medical, or financial).

Such events can be perceived or experienced by the individual as threatening or corrosive in ways that escalate pathological narcissistic traits and functioning.

Alternatively, they can also be experienced as supportive, confirming, and encouraging or even corrective, leading to new realizations, stabilized self-esteem, and decreases in pathological narcissistic functioning.

People with pathological narcissism or NPD may have strengths and abilities in certain areas, i.e., in their professional or social lives, or in certain types of relationships, which they find supportive of their self-esteem, sense of identity, and/or interpersonal functioning.

However, they can still present with severe vulnerabilities or external pathological narcissistic patterns in other areas: especially in intimate relations, parental roles, certain social, professional, or work-related situations, or in their moral and ethical standards or behavior.

Consequently, people with NPD can experience themselves and come across differently in different social or interpersonal contexts. The same person may feel confident and competent, or act in a convincingly dominant and assertive way in one setting. In another they may feel shy and avoidant, or insecure, easily humiliated, and struggling with loss of control, feelings of envy or resentment, or with fear of failing or being exposed.

In addition, certain circumstances and experiences can evoke or aggravate narcissistic traits in response to challenging or traumatic experiences. This can evoke interpersonal provocative, critical, and aggressive behavior.

Some experiences can be perceived as traumatic because they take on a subjective frightening meaning, or can activate earlier narcissistic trauma, which consequently can threaten the person’s self-esteem, and sense affiliation, coherence, stability, and well-being. On the other hand, certain events and experiences can readily be seen as organizing and consoling, and hence enabling access to proactive confidence.

Some people choose to take on narcissistic pathology as a sense of identity, presenting themselves as “I am a narcissist,” especially in response to being told or accused of “being narcissistic” or having NPD.

Such self-characterization may paradoxically serve an empowering function that can help to shield actual internal vulnerability or interpersonal struggles related to self-esteem and emotions.

Ability for self-reflection and forming coherent meaningful narratives of deeper personal experiences is often compromised.

Recognizable Individual Variations

When people with pathological narcissism or NPD seek treatment they can present in many different ways. Some match the typical expectation of a narcissistic personality by being self-promoting, self-absorbed, and interpersonally provocative. Others effectively hide their narcissistic characteristics and can initially be friendly and tuned in, but gradually turn distant and aloof.

Some individuals present with corrupt and antisocial traits, while others take pride in their high moral and ethical standards. Some are boastful, assertive, and arrogant; others can be modest and unassuming with an air of grace; and yet others can present as perpetual failures while constantly being driven by unattainable, grandiose aims.

One person can be charming and friendly, another shy, quiet, and vulnerable, yet another domineering, maneuvering, aggressive, and manipulative.

When people with pathological narcissism or NPD seek treatment they can present in many different ways.

Some are intrusive and controlling; others are evasive and avoidant. Some can openly and bluntly exhibit most extreme narcissistic features and strivings, but still hide more significant narcissistic personality problems. Others are perfectionists, driven by high standards, and extreme demands both related to themselves and others.

Absence of symptoms and experiences of suffering can be a paradoxical blessing for some people with NPD. Others, however, can struggle with severe internal suffering, including harsh self-criticism, self-doubt, fear, shame, insecurity, and anger that may or may not be expressed.

Some individuals can provide well-informed and articulate accounts of their pathological narcissistic functioning with insights in interpersonal patterns or contributing developmental experiences. Others may be totally oblivious of their problems, assigning blame on others, or even feeling forced to seek treatment.

Nevertheless, the common indications of narcissistic personality functioning include apparent or concealed self-enhancement with self-esteem fluctuations, vulnerability, and inferiority, and fear of losing control and failing. Avoidance, control, and distancing are key patterns.

Ambiguity and fluctuations in sense of identity are common. Some may be aware of their limitations in interpersonal relationships, with compromised empathic functioning and intense reactions to criticism and threats to self-esteem, with strong need for control.

Others tend to primarily externalize and criticize others. Still others may take charge of their diagnosis and identify with several of the common traits without identifying and taking ownership of their own real problems.

Internal Struggle and Reactivity

Contrary to the external confidence, arrogance, and insensitivity, people with pathological narcissism and NPD tend to struggle with a shifting and conflicting sense of self and identity. Underneath a more noticeable self-praising or self-enhancing outward facade they can be excessively self-critical and judgmental. Some struggle with perfectionism and exceptionally high standards for themselves, and sometimes for others too.

Strong reactions to perceived threats to self-esteem, such as humiliation, defeats, criticism, failures, or others’ envy, are common.

Such reactions can include intense feelings that are either openly expressed or hidden (anger/hostility, envy, shame, or fear), mood shifts (irritability, anxiety, depressive symptoms, or elation), or deceitful or retaliating behavior (aggressive, antisocial, or suicidal behavior).

Strong reactions indicate fluctuations in self-esteem, which can alter between states of overconfidence, superiority, and assertiveness, and states of inferiority, insecurity, and incompetence (grandiosity and vulnerability).

In addition to not knowing their own motivations, people with NPD can also have a compromised sense of identity and not knowing who they really are or what they want. Their sense of self-agency, i.e., goals, directions, and determination, is influenced by a need for internal control, a sense of self-sufficiency, and avoidance of threats or challenges to self-esteem, with a reluctance or inability to rely on others.

Self-enhancement and self-preoccupation serve as a protective armor by shielding or hiding low self-esteem, harsh self-criticism, insecurity, inferiority, shame, loneliness, detachment, and fear.

This excessive internal self-negativity, often mistakenly perceived as depressive disorder, can paradoxically be part of the narcissistic self-enhancement by providing self-defining control and justifying avoidance (“I am a failure,” “I do not deserve,” “Nobody can understand or help me,” “I am my own worst enemy,” etc.).

Interpersonal Functioning

Signs of individuals’ narcissistic traits or functional patterns have often been identified in their interpersonal interactions.

Spouses, relatives, friends, or colleagues can notice an avoidant distancing pattern with lack of motivation to relate closely, or alternatively, an eager attention seeking preoccupation with expectations or demands on others to satisfy their needs and longings.

Entitled, arrogant, aggressive, or competitive ways of relating can be typical for some. Others can be extraordinarily attentive, reliable, and tuned in as long as they feel they get the approval or support they need, while some typically show a more consistent critical, dismissive, or devaluing attitude or way of relating.

People with pathological narcissism or NPD can be both vulnerable and insensitive to others’ feedback. They are vigilant to perceived rivalry and rejections and may readily take on an empowering victim role, blaming others for not being able to measure up to their own standards.

Tendencies to combat and retaliate towards alleged criticism or disagreement is common, but retreat into self-sufficiency or self-absorption without noticeable reactions can also be an engrained pattern. Longstanding envy, resentment, or animosity can spur further distancing.

Especially in long-term relationships, enduring combative, retaliating patterns can co-occur with dependency and even love.

Some people may easily feel criticized, degraded, mistreated, or ignored by the person with pathological narcissism, but some may feel, at least partially or intermittently, highly valued, idealized, and relied upon.

In higher functioning people with more compartmentalized pathological narcissism, longstanding constructive, collaborative relationships may co-exist with other deeply conflictual, distant, or contentious personal relationships.

Difficulties to access, identify, tolerate, and verbalize emotions are typical for individuals with pathological narcissism or NPD.

Such deficits affect their ability to maintain close, mutual relationships. Tendencies to extract, avoid, or isolate from others can be a way to sustain superiority and self-enhancing fantasies, i.e., a “splendid isolation,” but such removal from others can also be driven by shame and fear of exposure or failure.

Vocational Functioning

The ability to work, and to remain devoted to professional commitment both in times of success as well as during challenges and setbacks, are significant indications of agency and sustainable competence that can be present in higher functioning people with NPD.

For those who successfully worked under stable conditions for decades, sudden changes, setbacks, or interruptions in their work context can be narcissistically traumatizing, leading to excessive self-doubts, self-criticism, and loss of professional identity.

Some individuals can have exceptional abilities in creativity, innovation, or leadership and be more project oriented. Others can present with temporary achievements and a history of occasional or irregular accomplishments, or a one-time top achievement under favorable circumstances.

All of this can indicate actual or potential capabilities that are hampered by changes in vocational conditions or by fluctuations or vulnerabilities in self-esteem or interpersonal relations.

However, such transient achievements can, for some people with less sustaining capability, be the result of favorable temporary circumstances that support self-enhancing and self-serving behavior.

Individuals whose work includes both own expertise as well as team collaboration or leadership can repeatedly find themselves in unmanageable situations, feeling threatened, dismissed, or intruded upon by others’ opinions and demands.

Aspirations and envisions of outstanding success and accomplishments are common and natural in young people facing the beginning of their educational and professional careers.

The balance between self-esteem and direction, and the integration of experiences of success and disappointments with realizations of competence and limitations are essential for continuing functioning and developing of vocational identity and direction.

Explanations of Some Narcissistic Dimensions and Facets

Grandiosity – Vulnerability

Grandiosity has long been considered the core trait and the most outstanding characteristic for NPD. However, studies have shown that not only is grandiosity reactive and dependent upon mental state, but it also co-occurs and fluctuates with vulnerability, inferiority, and insecurity.

Grandiosity, superiority, and other self-enhancing strategies can be spurred by external experiences that concur with ideals, aspirations, and perfectionism, but it can also be hidden in internal convictions or fantasies that support the sense of special, unique, or exceptional qualities. Interpersonal experiences can affect the grandiose self-esteem depending upon whether they are perceived as potentially supportive or threatening.

A continuous and often determined search for others’ approval or admiration is typical, as is the use of interpersonal self-regulatory strategies such as taking advantage of others, entitlement and expecting special treatment, or blaming others for failures. In the context of self-esteem and self-regulation, grandiosity signifies these types of self-enhancing patterns that are central to pathological narcissism and NPD.

Vulnerability, on the other hand, can relate to insecurity, shame proneness, underlying psychological trauma, or general inconsistency or unreliability of own capability and thinking. The grandiosity-vulnerability range is often accompanied by an uncompromising “black or white,” and “either-or” thinking, especially related to “success or failure,” and “winning or losing,” which add to internal insecurity, self-condemnation, and fear.

Sudden threats to self-esteem or to more favorable self-images can temporarily increase defensive grandiose thoughts and behaviors, such as fantasies and aspirations, competitive or bragging behavior, and hostility or devaluation of others.

Alternatively, such threats can also cause unexpected fluctuations in or loss of self-esteem with shame, fear, and detachment.

Grandiosity can be challenged by brief depressive reactions or a major depressive disorder causing a more self-critical and humbler attitude. Moving from late adolescence to adulthood with expectations of reality anchored competence with demands and outcome can involve another challenge to grandiosity.

Likewise, aging and facing retirement with accompanying changes and limitations can also cause increases in defensive or enhancing pathological narcissism. In addition, changes in appearance, beauty, physical competence, or health, which can occur at any time in life, may cause significant narcissistic reactivity and shifts in self-esteem.

Perfectionism – Self-Criticism

Perfectionism with high standards and ideals have long been considered a significant part of narcissistic personality functioning. Some readily talk about their perfectionism, while others are more hesitant and keep it secret.

Perfectionism has several forms and meanings, i.e., the mandate to feel or be perfect, a requirement coming either from oneself or from outside. This can contribute to vulnerable self-esteem and to problems in relationships and accomplishments, leading to shame, self-criticism, and hypervigilance.

Perfectionism can also relate to self-presentation, i.e., to appear perfect, which becomes more interpersonally problematic as it involves hiding and concealing everything that is non-perfect. Especially, it can lead to a reluctance to recognize or admit own imperfections and to seek help.

A third aspect of perfectionism relates to achievement, i.e., to perform perfectly, like getting an A+ on a paper, winning the prestigious award, or getting the aspired promotion, which can become an unconditional measure of self-worth.

As perfectionist standards often can be unrealistic or unattainable, perfectionism is usually accompanied by self-criticism, which can develop into an ongoing inner judgmental process, leading to self-deprivation, withdrawal, and feelings of severe insecurity and inferiority.

Exposure – Avoidance

Being and feeling seen and attended to can for some people with narcissistic personality functioning be very important, and they desire and feel confident facing exposure and publicity. Their sense of identity and self-esteem are strongly related to visible performance, with directions and goals.

Some individuals can sustain such devoted functioning even for a long period in their lives.

Sudden loss of this identity defining attention, caused either by failing or being disapproved of or competitively sidelined, can cause a personal crisis with significantly escalating narcissistic pathology and accompanying depressive reactions, substance misuse, or even suicidality.

For others who are more hypervigilant and sensitive, publicity inevitably involves the risk of either or both exposing shortcomings or imperfections, with failure to meet standards and expectations, or anticipating facing others’ negative judgments.

This makes exposure in public or interpersonal situations extremely uncomfortable or even threatening, and avoidance or even isolation become the consistent and effective way to protect against the anticipated risks of being seen.

Anger – Shame – Fear

Anger and rage have long been considered central affects in NPD, especially indicated by assertive, forceful, defensive, or critical reactivity, and by arrogant, inconsiderate, exploitive, or retaliatory interpersonal behavior. Anger in the context of pathological narcissism can have either a motivational or a reactive cause.

In interpersonal context it can serve to protect against perceived danger, or to restore self-esteem and internal power. When driven by entitlement or feelings of envy, it can result in attacking, injuring, or defeating others.

Turned towards self, anger and rage can lead to severe self-criticism, self-hatred, and suicidal ideations with intentions to end life.

Narcissism related anger and rage may be effectively controlled, hidden, denied, or compartmentalized in individuals with pathological narcissism or NPD. It can also be integrated in a skillful, well planned, and accomplished way for personal gain or interpersonal damage.

Shame can be experienced as intrusive, tormenting, and sometimes paralyzing, but can also be hidden, bypassed, and not felt or identified at all. Shame can also be expressed in chronic low self-esteem, feeling undeserving, bad, or worthless, or in aggressive reactive behavior, rage outbursts, and suicide.

Shame in the context of perfectionism is a painful response to facing unacceptable, imperfect aspects of oneself as they could be seen and judged by others in social interpersonal contexts. This can even be experienced as traumatizing by the individual.

Shame in the context of anger, on the other hand, can serve both as a trigger of aggression, i.e., shame-based aggressive reactions, or as a disguise where the shame contributes to hiding or avoiding the anger.

Feelings of fear is often considered counterintuitive to narcissism and seemingly contraindicating to typical narcissistic traits, such as assertive self-enhancement, aggressive dominance, and competitive achievements.

Nevertheless, fear can underlie achievements and perfectionism, and serve both as a motivator to succeed and as the core of insecurity and anticipation of loss or failure. Fear can also counteract exposure, i.e., “fear of being seen,” and lead to procrastination and avoidance.

Anger, fear, and shame often co-occur and can sometimes interact in complex and confusing ways, making it difficult to separate and identify which is which and what cause and contribute to each emotion.

Anger can evoke shame, and shame can evoke anger as well as powerlessness and fear. On the other hand, fear can also evoke anger as well as shame.

Compromised Empathy

Empathy refers to the ability to recognize and understand the emotional state of others, and to identify and feel their feelings and needs. Empathy requires both tolerance and appreciation of own as well as of other’s emotions.

Recent research has identified empathy as a complex process involving both internal psychological, interpersonal, and neuro-cognitive factors.

Empathy is an important part of self and self-esteem regulation, and crucial for the ability to manage interpersonal relationships.

Studies have shown that people with NPD can notice and understand others’ internal states and feelings but may not be able to emotionally engage in and respond to them. In other words, people with pathological narcissism or NPD have compromised and fluctuating empathy, but they do not lack empathy.

Self-centeredness, emotional dysregulation (insensitivity or difficulties tolerating and processing some of one’s own and others’ emotions), self-esteem dysregulation (fluctuations between self-enhanced grandiosity and self-vigilant depreciating vulnerability), or difficulties feeling deeper care and concern can contribute to compromised empathy.

Individuals with pathological narcissism or NPD may be able to appropriately empathize under certain circumstances, when feeling in control or when their self-esteem is unchallenged or even promoted by their ability and motivation for empathic responses to others. Their motivation and desire for empathizing may also vary depending upon the interpersonal context and perceived advantages.

Some can empathize more with others’ positive feelings and success-related experiences than with others’ negative feelings or defeats, and vice versa. Those influenced by envy can be unable to tolerate others’ positive events and experiences, while those who tend to mirror themselves in the light of others may perceive others’ success as an opportunity for self-enhancement.

Similarly, those who readily feel contempt can find others’ defeats and losses despicable. As a result, they chose to secure their own superiority or perfectionism in the comparison between self and the suffering other.

Some individuals can empathize under certain circumstances, e.g., when asked for advice by a friend who has marital problems but being unable to relate to own marital problems as pointed out by the spouse.

Others have limited ability to tolerate the emotions they see in others and feel in themselves, resulting in their dismissing and withdrawal from attention and care for someone struggling.

In sum, compromised empathic functioning in individuals with pathological narcissism or NPD can cause interpersonal conflicts, fluctuating or low self-esteem, and underlying insecurity.

The perception of others’ feeling states can evoke overwhelming powerlessness, disgust, shame, or loss of internal control, and trigger strong critical, dismissive, or aggressive reactions, or even emotional and/or physical withdrawal.

Some individuals are aware of and want to respond to others but feel overwhelmingly provoked or incapable. Others deliberately ignore others’ feelings or needs based on their own prioritizing. The individual him/herself may or may not be aware of such deficits or choices and their interpersonal consequences.

The Narcissistic Trauma

An external life event, which not only threatens the individual’s self-esteem but also bring loss of hope, ideals, and meaning, can cause a narcissistic trauma.

Such trauma is characterized by a sense of failing competence with loss of values and self-worth, or loss of connections or affiliations to others. This may potentially become overwhelming, intolerable, and even terrifying.

It is the individual’s own internal perceptions and interpretations of the external event, as well as his/her own accompanying overwhelming reactions that become narcissistically traumatic, mainly because they challenge or damage supportive or sustaining experiences and functions of both self and others.

Especially difficult for the self-esteem are sudden unexpected experiences of demotions and other work-related failures, financial setbacks and bankruptcies, personal rejections or betrayals, infidelity, divorces, or legal problems.

Although not necessarily inherently traumatic, the specific subjective meaning assigned to such events contributes to an inner psychological traumatic experience.

This differentiates a narcissistic trauma from a trauma in which the actual external event, i.e., abuse, terror, torture, accidents, catastrophes, losses, or illness, i.e., conditions that cause social, physical, and mental challenges or hardship, defines and contributes to an internal impact and experience of suffering.

The first type of trauma cause trauma associated narcissistic symptoms, TANS, including overwhelming shame, humiliation, and rage, while the second type of trauma is related to post traumatic stress disorder, PTSD, primarily associated with severe anxiety.