Narcissistic personality

 The simplest definition of narcissism is self-love. Everyone is sensitive about their own person and how valuable they are. He wants to live in such a way that he feels good about himself, and he experiences the latter when he meets with recognition, praise or approval, especially when it comes from important or significant people. At the same time, everyone is touched and hurt by criticism and disapproval. Since self-love is inscribed in human nature, why has it become an object of interest for psychiatrists, and even more so for psychologists and psychotherapists? Is it really a disorder that needs treatment and help from professionals? If so, when and how can you try to help people who have crossed the imaginary line separating the so-called healthy vs pathological narcissism

Narcissistic behavior, or people who today are referred to as narcissistic, is as old as humanity. The classic description is found in the ancient myth of Narcissus, from where the name for this type of disorder was taken. In psychiatry, this concept was defined only at the end of the 19th century by Havelock Ellis, who used the term "narcissistic" to refer to a situation when a person becomes a sexual object for himself by engaging in intense masturbation. Sigmund Freud first used the term "narcissism" in 1910 to refer to a homosexual choice for the life drive. He also introduced the concept of primary narcissism to describe the state when an infant lives in a world consisting only of its own "I".

An important contribution to understanding and defining narcissism was made by Otto Kernberg and Heinz Kohut. The psychoanalytic implications of their dispute are discussed later in this article. At this point, we present a highly simplified understanding of narcissism and techniques of therapeutic work proposed by both authors. Thus, Kohut perceives pathological narcissism in terms of development and believes that up to a certain stage the development process of an individual is typical, and the disorder may occur when at some point there is a lack of appropriate reactions from the environment - admiration and confirmation of values for the child from the parents. In contrast, Kernberg defines pathological narcissism structurally. He believes that already at a very early stage of development there are serious disturbances that result in the formation of primitive defense mechanisms. The functioning of the individual is then similar to that observed in the case of berderline personality; see Borderline personality. It emphasizes the dominant meaning of envy and aggression in these people. Nancy McWilliams uses a picturesque comparison: "The narcissistic individual in Kohut's conception can be vividly represented as a plant whose development is limited due to the lack of water or sun in critical stages of development, and narcissism according to Kernberg is a plant that has undergone a mutation, becoming a hybrid." Therefore, "some believe that the plant needs to be provided with enough water and sun so that it can finally bloom", i.e. to ensure constant empathy and acceptance of the need for idealization and devaluation, others propose to prune wild shoots so that it can become what it should be. i.e. confront the patient with his excessive need for greatness and interpret the mechanisms protecting against envy and greed.

To complete the picture, it is worth mentioning two other approaches, i.e. the interpersonal and cognitive approach. A representative of the former direction, Lorna Bejamin, believes that the driving force behind the development of a narcissistic personality is parents overestimating a child or demanding perfection from him. She uses the term "His Majesty the Child", which reflects the kind of worship that parents give their child, forgetting about their own needs and feelings. Therefore, the child does not have the opportunity to learn that others are separate beings with their own identities and needs. On the other hand, expecting perfection from a child means refusing to accept any shortcomings on his part. Parents give their child conditional love - "We love you for being wonderful, but if you fail us, our love is over."

In the cognitive approach, a narcissistic person is described as someone who moves into an idealized future, replacing reality with fantasies of great success and adoration. Such a person creates his own legends, revises the facts to exaggerate his successes and minimize or justify failures in order to protect his sensitive self-esteem. Denise Davis believes that such a person's desire to be unique promotes numerous cognitive distortions. Firstly, the image of oneself and others is often perceived in black and white terms: one can be either omnipotent (idealization) or totally worthless (devaluation). Secondly, minor differences between themselves and others are often perceived, primarily to support their own sense of superiority. Examples of such a person's beliefs are: "Because I am special, I deserve special allowances and privileges", "I am better than others and they should recognize it" or "If I am not perfect, I am nothing", etc.

Narcissism, as a personality trait, is a key aspect of many, if not all, mental disorders. We are talking here about disorders in psychological terms, i.e. from the side of someone's functioning in relation to others, with their feelings, or with oneself, with one's own emotionality.

Freud first used the term narcissism in 1910 to refer to a homosexual choice for the life drive. It was about reversing the forces, desires or intentions of being in contact with others in favor of contact with oneself. Thus, we can presume that narcissists do not have contact with or attention for someone else, but for themselves.

However, it's not that simple. The reasons why someone turns their attention away from the outside world, from others and turns to themselves are important. He only pays attention to himself and becomes "narcissistic". Such a statement often sounds pejorative - as if choosing someone like you, someone similar or of the same color, or choosing yourself, was a bad choice, and the person who "makes" it is "disordered". Let's assume, however, initially that the "narcissistic choice" is a choice that limits the resources of one's personality, and it is often the result of intolerance of pain. This pain, in turn, results from what we refer to as the "narcissistic trauma" experience. It is about a certain event in a person's life (and especially - recurring events), as a result of which he was left completely alone and had (in his mind absolutely) no one to turn to.

It is worth quoting Donald Winnicott (British pediatrician, psychiatrist and psychoanalyst): “It is obvious that the characters playing the role of the mother satisfy the infant's drive needs. ... [you should] start looking at, for example, the importance of holding a baby ... once you start thinking about it, it's the first thing. You could draw a caricature in which someone smokes a cigarette and, holding a baby by the leg, swings it around and puts it in a bathtub. Somehow you know that's not what kids need. Very subtle matters are involved. I have watched and spoken to thousands of mothers, and it is known that when they lift a baby, they support the head and body. If you hold the baby's body and head in your arms without thinking that it is a whole, and you reach for a handkerchief or something else, the head falls down and the baby is in two pieces - head and body; the baby starts screaming and will never forget it. The terrible thing is that nothing is ever forgotten. After that, the child never trusts anything again. I think you could say that babies and toddlers don't remember what went right, but they remember what went wrong. They remember that the continuity of their lives was suddenly interrupted, their head flew backwards or something similar happened that broke through all the defenses, and they somehow reacted to it. What happened to them was extremely painful and they will never forget it. They will have to live with it, and if this type of event is a recurring part of their pattern of care, it will be the basis of distrust."

The injury is therefore irreversible and the experience is irreparable. However, if there is an environment that can provide a kind of support, and the injured person can accept the reality of limiting the help present, life can go on. However, it is possible that another injury will occur and there will be no environment good enough to help someone "pick up". Then we can talk about "kicking the one lying after the primary injury." It is an aggravated injury. Someone who has been traumatized meets someone who offends them again. He meets someone narcissistic who can't be bothered.

This, of course, may suggest the great hurt that those who have suffered such aggravated trauma may feel. Yes indeed it is. Such people may feel ruthlessly wronged. As much as possible. "No one was there when I fell because my mother had left me and my father came over and yelled at me why I'm crying!"

Such a person develops in a state where he feels that something terrible has happened to him (and it did) and there was no one to acknowledge his pain (and it really wasn't). She doesn't understand why someone expects something from her. She can't give anything. He is unable to help.

However, there is another option for development after the "primary injury". A battered person finds someone who wants to help them a lot because they cannot bear to see them suffer. To endure the sight of pain or "blood spilled". Someone who necessarily and quickly wants to help and say: "It doesn't hurt anymore, does it?! Tell me it doesn't hurt!" Someone who is traumatized meets someone who quickly tries to take care of that resentful person very well. This someone helps because he is unable to bear the suffering he experiences in someone. Such a person understands perfectly well what the sufferer means. I identify with her suffering.

Then the traumatized person begins to deny it in order to survive. Because she has the feeling that she suffers herself, but there is also a person next to her who helps her because she suffers. The pain is unbearable, so she denies it. It gradually develops into a state where there are seemingly no limits. She chooses some kind of life path that is perfect and above what concerns her and others suffering because she doesn't want to feel pain. Such a person slowly ceases to understand what other people mean. He is above these ordinary difficulties.

We must remember that the myth of Narcissus is not the story of one person, one character, one side. During the lack of opportunity to discuss certain social and political issues in Poland, Piotr Najsztub wrote: "Something happened to the echo ... He's gone." He referred to the political situation, noting that there are two sides (government and opposition), but there is no contact between them. One screams, screams, is furious, immersed, scared, and the other remains unmoved by it. She is deaf. Najsztub notes that in order for there to be an echo, the sound must reflect. But in his opinion we sometimes have a situation where the sound is fully absorbed. The soft material absorbs it. Nothing can bounce, so there can be no echo. Something goes unnoticed. And this, according to the common definition, means remaining unmoved, unnoticed. To leave something unnoticed means that we do not comment on something, do not react to something. It doesn't impress us. However, if something happens, a certain continuity will be broken and the structure changed. At least there will be an echo of these events.

Just like with the nymph Echo in the myth of Narcissus. Echo falls in love with Narcissus, who is just staring at himself in the lake. He sees no one but himself, and thus he is defective. He lacks the desire and simple desire to turn to someone. He doesn't feel hungry for anyone. At the same time, Echo is flawed in itself. He is unable to make any sound. It can only repeat. So, in order to come to life, to exist, Echo needs "someone". Narcissus appears and "emanates". But he only exudes himself. Echo can only be "with someone". Or rather in someone's reflection.

It would seem that the "perfect couple" was formed. But Narcissus, despite the fact that he emanates and brings Echo to life when she repeats his words (I am beautiful. I am beautiful ...), is unable to maintain this relationship alone. Perhaps because he sees and experiences someone as damaged as Echo, who can't feel like she has anything inside her. What Narcissus experiences in meeting Echo, however, is unbearable for him. So he turns to himself. He runs away from the Echo and remains "unnoticed" - unmoved. Echo is left without Narcissus. Without someone to keep her going all the time.

The myth of Narcissus and Echo is extremely illustrative for a variety of reasons. Here we have unfulfilled love, a sense of helplessness, the triumph of the sense of beauty of oneself and the defeat of one's own handicap. Both sides, Echo and Narcissus, cannot be alone to survive, but neither can they be with someone. However, Narcissus is unable to see in the Echo someone who needs him all the time. He is unable to resonate with someone who needs someone else in an ongoing relationship. This is the essence of the narcissistic option. It stems from someone's difficulty recognizing that they need someone. And from someone's difficulty in saying by themselves that you need someone. To learn, to "feed", to find oneself, to survive, to heal oneself, the presence of "lack" must be acknowledged.

Narcissistic people often do not know why they come for treatment. Someone referred them, and someone should know how to treat them. Someone was helpless enough to send them to a psychotherapist and someone should be narcissistic enough to know how to deal with helplessness. This dilemma has already been discussed in the article on borderline personality, where narcissistic difficulties are marked in personality traits. Here, however, everything comes down to the quality of the relationship, or rather "relationship".

In recent years, attempts have been made to create complex models combining various theoretical concepts, e.g. the bio-psycho-social-evolutionary model. According to this theory, the narcissistic personality is passively self-oriented. People with this personality look for gratification primarily in themselves. Their development paths may be different. One, described by the interpersonal approach, is relatively simple. Caregivers inflate the future narcissistic person's self-esteem by giving them undue attention and excessive praise, so that they do not develop or have the motivation and skills necessary to obtain such "rewards" under normal circumstances. The second may compensate for early deprivation, as described by Kernberg and Kohut. Thus, narcissistic traits can develop both when a child is overly praised and pampered and when he or she is neglected; when parents expect too much or too little from the child.

As in the case of all other personality disorders, also here different spheres of life, the developmental stage of the individual, the degree of suffering of the person and his environment should be taken into account. What are personality disorders and when you can talk about them, you can read in the articles "Personality disorders" and "Borderline personality".

ICD-10 criteria

The International Statistical Classification of Diseases and Health Problems (International Classification of Diseases 10th Revision - ICD-10) does not specify the criteria for diagnosing narcissistic personality and includes it in the so-called other specified personality disorders (F60.8) including, among others, immature and passive-aggressive personality. The condition for diagnosis is meeting the general criteria for personality disorder. Looking at these general criteria can help answer the question of when, according to modern experts, the line separating healthy from pathological narcissism is crossed. These are:

fixed patterns of experiencing and behavior of a person, which as a whole clearly deviate from the culturally expected and accepted range, i.e. from the so-called "standards"; such a deviation must manifest itself in at least two areas and concern: cognitive processes (i.e. ways of perceiving and interpreting people, things and events; emotionality, controlling impulses and rewarding needs) and/or the way of relating to others and dealing with interpersonal situations,

This deviance manifests itself in the person's whole behavior, which is inflexible and maladaptive - not limited to just one triggering stimulus or situation,

the person suffers individual suffering and/or has an undesirable impact on the social environment,

the problematic features are stable and of long duration; they usually begin in late childhood or adolescence and continue into adulthood.

DSM-IV criteria

On the other hand, the American psychiatric classification system (Diagnostic and Statistical Manual of Mental Disorders - DSM-IV) defines narcissistic personality as a fixed pattern of self-esteem (visible in fantasies or behavior), the need for admiration from others and the lack of empathy that appears in the early adulthood and manifests itself in a variety of contexts, as indicated by at least five of the following criteria:

The individual has exaggerated self-esteem (exaggerates his achievements and talents, expects recognition of his own superiority, disproportionate to real achievements).

She is consumed by fantasies about her own unlimited success, power, outstanding abilities, beauty or ideal love.

She is convinced of her own uniqueness and uniqueness that can only be understood or interacted with by other exceptional or high-ranking people or institutions.

Requires excessive admiration.

Has a sense of having special rights, i.e. unreasonably expects particularly favorable treatment or automatic submission to her expectations.

She is exploratory towards other people, i.e. she uses them to achieve her own goals.

She lacks empathy, is reluctant to recognize other people's feelings and needs, and is not willing to identify with them.

Often envies others or believes that others envy her.

His attitude and behavior shows arrogance and haughtiness.

Diagnostic tools

The SCID-II structured interview, based on the DSM-IV criteria, is helpful in establishing the diagnosis of personality disorders. Here are some examples of narcissistic personality questions:

Do you think that you deserve special treatment?

Do you think that there are really few people who deserve attention or time?

Do you consider it important to spend time with exceptional or influential people?

The described set of features, attitudes, and grandiose behaviors refers to those narcissistic people who quite openly show what makes them suspect narcissism. But Cooper and Michaels in 1988 noted that there is no reference here to those narcissistic personalities who, due to their great irritability, their sensitivity to "slippage", tend to live out of limelight and avoid it like sun vampires. This whole distinction is described in the literature in the theoretical-clinical conflict between Otto Kernberg and Heinz Kohut. Both Kernberg and Kohut described their positions in the 1970s, and their view of the narcissistic option remains valid. Kernberg referred to the narcissistic person as envious, greedy and in need of the support of others. Kohut described the narcissistic personality as very fragile and prone to decay. Glenn Gabbard referred to this division by distinguishing between insensitive and hypersensitive narcissism. Herbert Rosenfeld, in turn, wrote about thick-skinned and thin-skinned narcissism.

To refer to the modern understanding of the narcissistic personality, narcissistic people are those who have almost no relationship with anyone but themselves or live with other people who cannot imagine being without them. It's worth considering what that means.

People who have almost no relationship with anyone but themselves

These are narcissistic people who others perceive as such. They do not enter into relationships with others and oscillate towards antisocial personality. They have a very hard time recognizing someone's emotional side. It's about their difficulty being around others who feel something. They are called thick-skinned, insensitive, ruthless, cold.

Such people are unaware of how others react to them. They don't feel what they "do" to others. They tend to be arrogant and aggressive, self-absorbed. They need to be the center of attention, to have something that gives them a sense of dominance, influence and control over others. They have a "transmitter" but no "handset". They seem invulnerable to having their feelings hurt by others.

It is worth noting that this sense of and active exercise of influence on others is not – as we would call it – “healthy”. Significant and influential people, but at the same time healthy, have features in which we feel their influence or ourselves under their influence, but it is not felt as a kind of unpleasant dominance. We may be influenced by someone who is a boss, a supervisor, an artist, a doctor, but we feel that what this person exudes is just plain good. Someone is simply good at what they do, at what gives them a significant position. He gained this authority and position through sincere means and aspirations, and with the aim of establishing something creative, healthy, and good. Such a person can also calmly leave, part, because he knows that things are in good hands. Such a person, one might say, has a right to be narcissistic, healthy narcissistic.

In another case, someone pathologically narcissistic has gained something (for example, his position) through dominance and wants to hold on to it at all costs. Such a person has no successors and cannot calmly leave and part.

People living with other people who can't imagine being without them

These are narcissistic people who are not directly perceived by other people as narcissistic. Rather, they are seen as helpful, obliging, dependent, and fearful. They are always in relationships with other people or work or spend their lives in an institution without which they cannot imagine life. They often live complementary with other people who, for various reasons, can be considered grandiose (see earlier). This type of narcissistic personality is akin to avoidant personality.

Such a person is very sensitive and remains extremely sensitive to the reactions of others. He is restrained, shy. He directs his attention to others and avoids being the center of attention. He listens carefully to others for evidence of criticism and is easily hurt emotionally, embarrassed and offended. Such people spend their lives helping others, feeling their saviors, donors, "feeders". They have to care a lot about others because they are afraid that others will not be able to take care of themselves.

Such people have their “headphones” on all the time and have no sense or possibility of using their own voice or even access to the “transmitter”. They are afraid that if they "moved something" in the relationship in which they are so ruthlessly stuck, everything would collapse. So they remain in a kind of clinging, gluing and clinging. Inside, however, they feel aggrieved and dominated. They feel terrorized. It is this feeling of being "under the heavy influence of someone they have to be with" that prevents them from being in a healthy dependency. Healthy dependence is a prerequisite for ordinary modesty and then also for healthy narcissism. Someone like that works from behind the scenes, helps the one who is on stage and feels very good about it. He doesn't complain about his place. And he knows that whoever he is with, the person who plays the first violin, appreciates that he is. In this way, he realizes himself creatively in a healthy sense of his value, a very high value for this enterprise, company, family or social group in which he functions. He knows that when he leaves, there will be someone who will gladly take over the position, but it will remain significant.

On the other hand, a pathologically sensitive narcissistic person will feel that he is wronged all the time and that he cannot leave because no one else will do this "gray job". These people cannot leave because they feel "so important". They do not see the possibility of passing on to someone such a terrible experience as they have in life.

When we look at these two types of people, we can see a pattern. They are almost perfectly matched pairs. Often one type of narcissist is attracted to the other. Then, like Narcissus with Echo, someone insensitive connects with someone oversensitive. Someone thin-skinned joins someone thick-skinned.

And in healthy couples, someone who is narcissically healthy, aware of the importance of his position to someone, connects with someone else who is narcissically healthy, aware of his position to someone who is aware of him.

The basic way of treating these people is psychodynamic (psychoanalytic) psychotherapy. In some conditions and situations, pharmacotherapy is also indicated, which in this group of patients is usually temporary and symptomatic, i.e. it is supposed to affect individual symptoms of mental state decompensation, e.g. anxiety, depression, rapid mood changes.

Here are examples that will help you understand the characteristics of psychotherapeutic contact with people suffering from narcissistic personality. An important issue related to treatment is susceptibility to depressiveness, which results from self-thinking and self-awareness.

Example 1

Mrs. Adela, 32, has higher education and has always been a "successful person". At first glance, he is a well-groomed, neatly dressed person, making a good impression. But quickly, when the consultation begins and the psychotherapist, after introducing himself and after a moment of silence, says:

- "I'm listening to you..."

Adela begins to feel uneasy.

He says, "What would you like to hear?" she asks.

The consultant sees fear in this, but also an attack, a certain hostility...

“Exactly... what a ridiculous idea to come here. My doctor and previous therapist thought it was a good idea for me to come in here. What a terrible place…” the patient continues.

The Consulting Therapist wonders how he or she can help such a person. He begins to feel quite "down", although the place where he works and actually the choice of profession at the moment does not seem too fortunate to him either. Starting to feel depressed...

– “And you... do you have any reasons for reporting here? You said that someone thought it was up to you to come in here.”

- "I do not know. Apparently I'm not very good at relationships. At work and in life."

– “Apparently... so you don't feel that way yourself?”

After a moment of silence, Mrs. Adela gets up:

"You know what, I'm wasting my time. I don't know what it's for…”

– “I wonder if your difficulty in relations with others does not manifest itself in our meeting now.”

- "I do not know? But what do you actually want?”

– “I understand that it was you who came here, only if you had difficulty in asking for help.”

There is silence for about a minute.

– “You know what? I'll be going now."

Comment

Narcissistic insensitive people predispose other people to feel depressive towards them. They are then depressed and helpless towards them, towards their attitudes of absolute domination. Treatment is extremely difficult and may even be impossible. It is very difficult because dominant, thick-skinned narcissistic people are unable to "submit" to treatment while maintaining contact with themselves. Their world is "zero-one" and they feel that they will either dominate or be dominated.

Example 2

Mrs. Bogusława is 40 years old and has had numerous failed relationships, unsuccessful attempts to keep her job, a history of injuries in the form of lost opportunities and perspectives. She underwent several hospitalizations due to depressive episodes during which she was withdrawn, withdrawn and isolated from her loved ones.

In conversation, she is different from Mrs. Adela. She feels she got it right. She has a sense of wrong in life and is convinced that she only wants good.

She avoids people, and help - in her opinion - is due? after she suffered so much. She wants to be treated.

At the beginning of the consultation, he says:

“You know, this place is my last resort. No one wants to help me anymore, and I don't know why. I didn't try to hurt myself, I didn't try to kill myself. I have suicidal thoughts often, but I don't feel like I could do anything to myself. I just feel hopeless. I'm counting on help. I hope it will be different this time. Can you really help me?”

The consultant feels an unpleasant pressure to help someone who is so badly hurt and depressed. This pressure is alternately mixed with the feeling that he is actually better than those therapist colleagues who have not been able to help Mrs. Bogusława in recent years.

Comment

Hypersensitive people tend to fall into depression. They are usually treated for depressive disorders and then narcissistic personality coexists with periods of depressed mood and depressive episodes. It is characteristic that therapists dealing with the treatment of depressive patients must take into account the hopelessness and helplessness that their potential patients experience.

Coming back to Winnicott's thoughts at the end. He writes about what could have been different, or what is usually different when things are going for the better.

“If everything was going well, (children) would never say good, they would never say 'thank you' because they don't know that everything was fine. There is a great deal of unacknowledged debt in the family that should not be considered debt. Nothing is owed to anyone, but one who has reached a stable adulthood could not have achieved it if someone else had not guided him through the initial stages.

“The issue of holding and handling an infant opens up the whole problem of human dependability. What I was talking about a computer couldn't do - it has to be human reliability (which is really also unreliability). In the process of development of adaptation, the initially great adaptation of the mother to the infant gradually decreases. Because of this, the infant begins to feel frustrated and angry and feels the need to identify with the mother. I remember a three-month-old baby who, before taking the breast during feeding, first put his hand in his mother's mouth to feed her. She could imagine how the mother felt."

The last thing seems to be the most important thing - that during the treatment the patient gains the opportunity to imagine how someone else feels when being with him.

As already mentioned, the traits of a narcissistic personality can be very diverse. It is relatively rare for a person to have "pure" narcissistic traits as described in the DSM-IV criteria. Most often we are dealing with a mixed picture. At the same time, it is worth noting that all personality structures have a narcissistic function, they all serve to maintain self-esteem. During the diagnosis of narcissistic personality, differentiation with other types of personality disorders should therefore be taken into account. These disorders often coexist.

What is most characteristic of people who combine narcissistic and antisocial personality traits are: self-confidence, unscrupulousness, amorality, disloyalty, arrogance, exploitation and contempt for others, vindictiveness and manipulation, and a tendency to cheat. People with such personality traits can often be professionally successful and stay within the limits set by the law. Some of them end up in correctional houses or prisons. Still others are petty swindlers and schemers. They are all self-centered and indifferent to the truth. They derive satisfaction from a situation in which they manage to gain someone's trust and then deceive them. Such people practically never seek help on their own initiative. Sometimes they end up in therapeutic or social rehabilitation programs in various institutions where they stay. It happens that such people fall into various addictions and for this reason they end up in addiction treatment centers.

The narcissistic person with histrionic features is usually seductive, charming, sexually provocative; she is often physically attractive and articulate. She is focused on her appearance, clothes, "corporeality". She easily establishes contacts with the opposite sex and satisfies her sexual needs, but she is not interested in true intimacy or relationship. She demands adoration and confirmation of her attractiveness from her partner. He can have numerous affairs, even with several people at the same time. However, if he goes to a psychotherapist, it is more often on the initiative of the environment than on his own. It happens, however, that at some point in her life she experiences an inner emptiness or falls into depression, then she can seek help from specialists herself. Therapy is usually extremely difficult, because rarely such a person is interested in getting to know themselves, reflectiveness - changing themselves. Most often, he expects the therapist to simply restore his well-being and rebuild his self-esteem.

Another combination of narcissistic and avoidant personality traits has been described previously. The features exhibited by such people are, above all: extremely high sensitivity to the reactions of the environment, especially to all kinds of criticism. For even the smallest sign of disapproval, such people are easily offended and often for a very long time - "for the rest of their lives" - they remember the "injury" suffered. It is typical for them to "hide" behind the backs of others and withdraw from real life into the world of their fantasies, where they can spin illusions about their uniqueness and greatness.

The listed other personality disorders co-occurring with narcissistic disorders are also the most common types of disorders with which narcissistic personality should be differentiated. Due to the pursuit of perfection, narcissistic disorders should also be differentiated from obsessive-compulsive personality disorder. There are also some features similar and requiring differentiation from paranoid personality, i.e. arrogance and contempt for the environment as well as entitlement and grandiosity.

As already mentioned, the traits of a narcissistic personality can be very diverse. It is relatively rare for a person to have "pure" narcissistic traits as described in the DSM-IV criteria. Most often we are dealing with a mixed picture. At the same time, it is worth noting that all personality structures have a narcissistic function, they all serve to maintain self-esteem. During the diagnosis of narcissistic personality, differentiation with other types of personality disorders should therefore be taken into account. These disorders often coexist.

What is most characteristic of people who combine narcissistic and antisocial personality traits are: self-confidence, unscrupulousness, amorality, disloyalty, arrogance, exploitation and contempt for others, vindictiveness and manipulation, and a tendency to cheat. People with such personality traits can often be professionally successful and stay within the limits set by the law. Some of them end up in correctional houses or prisons. Still others are petty swindlers and schemers. They are all self-centered and indifferent to the truth. They derive satisfaction from a situation in which they manage to gain someone's trust and then deceive them. Such people practically never seek help on their own initiative. Sometimes they end up in therapeutic or social rehabilitation programs in various institutions where they stay. It happens that such people fall into various addictions and for this reason they end up in addiction treatment centers.

The narcissistic person with histrionic features is usually seductive, charming, sexually provocative; she is often physically attractive and flexible. She is focused on her appearance, clothes, "corporeality". She easily establishes contacts with the opposite sex and satisfies her sexual needs, but she is not interested in true intimacy or relationship. She demands adoration and confirmation of her attractiveness from her partner. He can have numerous affairs, even with several people at the same time. However, if he goes to a psychotherapist, it is more often on the initiative of the environment than on his own. It happens, however, that at some point in her life she experiences an inner emptiness or falls into depression, then she can seek help from specialists herself. Therapy is usually extremely difficult, because rarely such a person is interested in getting to know themselves, reflectiveness - changing themselves. Most often, he expects the therapist to simply restore his well-being and rebuild his self-esteem.

Another combination of narcissistic and avoidant personality traits has been described previously. The features exhibited by such people are, above all: extremely high sensitivity to the reactions of the environment, especially to all kinds of criticism. For even the smallest sign of disapproval, such people are easily offended and often for a very long time - "for the rest of their lives" - they remember the "injury" suffered. It is typical for them to "hide" behind the backs of others and withdraw from real life into the world of their fantasies, where they can spin illusions about their uniqueness and greatness.

The listed other personality disorders co-occurring with narcissistic disorders are also the most common types of disorders with which narcissistic personality should be differentiated. Due to the pursuit of perfection, narcissistic disorders should also be differentiated from obsessive-compulsive personality disorder. There are also some features similar and requiring differentiation from paranoid personality, i.e. arrogance and contempt for the environment as well as entitlement and grandiosity.

According to the DSM-IV classification, personality disorders are coded on Axis II (see Borderline Personality Disorder). However, they can coexist with Axis I disorders. Most often, these are mood disorders: depression and bipolar affective disorders. In manic states, the features of pathological narcissism are very clear, i.e. omnipotence and grandiosity. Depression, on the other hand, occurs when the belief that perfection and omnipotence are achievable breaks down. A narcissistic person is unable to consider their imperfections as "forgivable and human." Instead, she feels completely imperfect and worthless. Despondency and despair appear, which can lead to suicidal thoughts and attempts.

It is also possible that these features coexist with psychotic disorders. When a narcissistic person fails to realize his grandiose plans and encounters numerous obstacles, he may blame forces beyond his control for his failures, which in some people leads to delusions of persecution and paranoid disorders.

Another frequently coexisting problem is addiction to psychoactive substances. Alcohol or drugs help a narcissistic person break away from reality if it provides painful disappointments. These substances, at least for a moment, allow you to rebuild your sense of power and regain self-confidence. Also interesting are the observations that a narcissistic personality style increases susceptibility to the development of post-traumatic stress disorder (PTSD). Traumatic events are believed to undermine the individual's sense of grandeur and omnipotence, traits often intended to protect a fragile self-image. Dramatic events especially strongly confront such a person with the fact that he is not unique, that - like other people - he is fragile and deadly.

According to some researchers, narcissistic people suffer from anxiety disorders relatively less often than it is found in the general population. This is probably due to overconfidence and self-confidence. At the same time, these people, or at least some of them, suffer from a deeply hidden sense of inferiority and shame - often beyond the awareness of the individual. This may be conducive to the occurrence of obsessions, which are an expression of the pursuit of perfection and the fear that the environment may notice some imperfection and give a negative assessment. People with coexisting avoidant personality traits may also suffer from social phobia.

When writing about a narcissistic personality, so characteristic of the era in which we live, it is difficult to refrain from a short comment of a slightly different nature. The popular view is that narcissistic disorders were less common in Freud's time than they are today. However, we do not have any epidemiological data to confirm this. We only know descriptions of various cases. We also know that the ancients observed the Narcissus. Were there fewer than today? Or maybe today we are only able to describe such people more precisely and qualify them as suffering from such disorders? Perhaps, in the past, only kings and magnates were "affected" by these features? We do not know how it was ... However, many features of the modern world are conducive to the occurrence of narcissistic personality traits: globalization, fast pace of life, ubiquitous focus on what is external, promotion of and focus on traits that prove success, and dilution of norms once established by culture and religious tradition. The so-called first impression is much more important today than the features that show the "inside" of a person. Therefore, what is presented to the outside world is more important – what can be shown to others and what needs to be hidden from them in order to “perform well”. In superficial, short-term or virtual contacts with other people, what kind of person you are is much less important. Honesty, kindness, generosity or empathy were more valued in smaller and stable communities, when people built their opinions about others not only on the basis of fleeting impressions, but above all on the basis of long-term acquaintanceship, living together for decades in one village or town .

Perversely, one could assume that narcissistic personality traits are an expression of adaptation to the environment in which a modern man lives and accept them as normal. But what to do with the inner emptiness or suffering of people like Mrs. Adeli or Mrs. Bogusława?