- Narcissistic personality disorder evolves as a multi-factorial process.
- Psychiatric diagnostic methodology is somewhat different from what's found in regular medical settings.
- Neuro-developmental issues, as well as genetics, parenting, and trauma can contribute to the emergence of NPD.
- Ultimately the emergence of NPD—and associated traits—is a bit of a mystery that can be understood best in good psychotherapeutic treatment.
You can’t go a day without hearing the word. "Narcissism." "Narcissist." "Narcissistic." It’s become a label. A method to differentiate, to self-protect, and a way to attack. Eons ago we’d call someone a "Communist," a "Fascist," or an "Atheist," all cancelling labels of a different era. Now it’s narcissism, those selfish, self-serving manipulative people.
So, welcome to complexity. Labeling someone with a psychiatric diagnosis when you are not a professional is not okay. It is even worse when you are a professional, but the person is not your patient. A-Hole suffices for most folks who are selfish, charming, manipulative and vindictive. So, now that we’ve made this clear, let’s dive into the origins of difficult folks who satisfy the criteria of narcissism (or narcissistic traits) within the confines of a professional office.
To be clear, there is no doubt there are those in the general population who suffer from these traits: self-importance, lack of empathy, using other people as pawns, grandiosity and a knee jerk reaction to attack viciously when critiqued, all held by a puffed up ego hiding the volatility (and vulnerability) of a brittle self-esteem.
This is a conversation worth having.
The Heuristic Value of Labels
Many people have pieces of narcissism within. That is not psychiatric, but human. However, if a person consistently lives this way, year by year, it may well be a psychiatric disorder defined by DSM-V as a Narcissistic Personality Disorder (NPD).
Where do these traits and this disorder come from? How do people become narcissistic? The truth is that no one really knows.
Let’s start with the heuristic value of labels. In medicine we use the term “diagnosis” to describe physical ailments. A broken humerus (arm bone), for instance, is something we can all agree on by examination, tests (like an x-ray) and history.
A psychiatric diagnosis is more subjective. There is no x-ray for NPD—and our examinations, even when thorough, often carry subjectivity. There is no narcissistic spot in the brain (at least not now) and no hard evidence aside from psychological testing (which is helpful) and a history that reveals a trail of hurt and lost relationships defended by an entitlement that blames everyone but oneself for what is going on.
In other words, the diagnosis is there. It is just more varied and shaky than what is typically found in the medical world.
The Origins of Narcissism
Now let’s take a big picture point of view. Vulnerability to developing narcissistic personality disorder (or traits) is probably multi-factorial; genetic, developmental, and sometimes trauma related.
Recent research, for instance, points to the idea that some children are genetically wired to be more grandiose and entitled than others. Yet, a propensity to grandiosity and entitlement does not necessarily lead to NPD. There are people who are naturally grandiose and entitled who instead become strong leaders, parents, clergy, doctors, politicians and such. From an evolutionary point of view, one can argue that these traits, when used in a socially positive way, actually serve the community. As such, they carry an adaptive value that continues in the gene pool. Certainly food for thought.
Good parents can teach these aforementioned kids (and all kids) how to care about others; to internalize right and wrong. But, when left unattended by poor parenting, it is no great leap to imagine that some genetically based traits, which could have been mobilized for good, instead find expression in the desperateness we can find in narcissists. Parenting counts.
Now let’s discuss a difficult-to-document element of a developing child. There are 80 billion neurons in a human brain. That accounts for radically different ways to process information, feelings, sights, sounds and relational moments. Some of us intuit the world more accurately—some less. Some of us attach with ease and trust, and some of us, for many reasons, don’t trust or have difficulty perceiving (idea of mind) the good will or intentions of others, including one’s parents.
If we are unable to internalize a sense of safety, either because we are inherently anxious, read the world poorly, are raised chaotically, or knuckled under by a controlling parent, one’s self-esteem can be injured and one’s empathy for others stunted.
- Imagine a chaotic home. It is every man (or child) for him or herself.
- Imagine a controlling home. It is also every man (or child) for him or herself.
- Imagine a traumatic home (or early experience). A self-preoccupied sense of self-protection is not hard to imagine as a psychological consequence.
The sensibility of having to win at all costs, that you are on your own (with little empathy for others), is a core feature of narcissism which emerges, yes, from a completely unique multi-factorial mix that includes the neuro-developmental component just discussed, now added to parenting, genetics and trauma. Once again, that broken humerus is a far easier problem to understand.
To be clear, not all kids from chaotic, controlling, or traumatizing environments are likely to become narcissistic. There are many other ways to adapt to these experiences, including growing up to be like most folks on this planet who are not narcissistic.
The mystery of pathological narcissism as a developmental phenomenon is in the mix of neuro-development, genetics, parenting and psychological challenges that can be unraveled in psychotherapy after the fact, but hard to predict in advance for any individual person.
Finally, there is the issue of social re-enforcement in narcissism.
Success and Failure
Narcissists often succeed early on in life.
The ability to get over on people because of looks, charisma, or talent can augment a youngster’s increasing sense of entitlement (and grandiosity). As a consequence, such kids may lose out on the value of normal frustration; the healthy, growth enhancing value of moderate disappointment. If anything, all this success can make the developing narcissist vulnerable to emotional brittleness when things don’t go his or her way.
We can really only speculate about how any particular person ends up struggling with narcissistic personality disorder (or traits). It’s not something predictable a priori, but it can often be teased out reasonably well in treatment. The methodology of this work has been refined over the years by important thinkers like Heinz Kohut, Otto Kernberg, Glen Gabbard, and others. The message for the general public? There are qualified therapists out there who can help.
That being said, most experts in the field would agree that developmental factors play a huge role, as well as success in narcissistic strategies like manipulating people, leveling anger at those who frustrate you and managing a brittle self-esteem by grandiose aspirations and entitlement.
Some narcissistic men and women rise to high places in society, often with injured colleagues, partners, congregants, political constituents and family along the way. Every sentient being alive has been burnt by such figures. We know it in our bones.
Yet, many fail in their attempt to win at any cost, injuring the wrong person, finding themselves caught in some scheme, or lonely, with scorched earth all around them.
Going back to the narcissist playbook, failure usually leads to anger and bitterness at the world. But there is a sweet spot in all this pain; a failing narcissist can be open to the possibility of change if they are willing to engage in a long—but useful—psychotherapy.
Such therapy requires something truly new for these folks; to examine their insecurities, to own how they hurt those they love, how they betray their stated values—and find a way to love themselves not by achievement, but rather as flawed beings who wish to be better people.
As the story goes, this is the unusual but hopeful developmental end of the narcissistic journey. People do go for treatment and take on real change. More often, these burdened individuals fall back to blaming others, possessing too much pride to look within or to trust, and the cycle goes on and on.
Suffering is suffering, even for a person struggling with narcissistic personality disorder. It is my hope and prayer that more of these folks get the help they need.
After all, they didn’t plan on ending up this way.
To find a therapist near you, visit the Psychology Today Therapy Directory.