When Covert Narcissist is DEPRESSED (PsyPedia Conference, Russia)

No, I think uh we are here not to discuss me and my biography but to discuss covert narcissism. Thank you for introducing me and thank you of course for having me and for inviting me. It's very kind of you and today I would like to dwell upon the mood aspects or the effective aspects of covert narcissism. Now first we need of course to define covert narcissists. Covert narcissists have first been described in the 1980s. The classical uh definition clinical definition of covert narcissism is the work by Akar and Cooper the late Cooper. He died two years ago. And covert narcissists are compensatory. In other words, covert narcissists compensate for an innate shame, innate sense of inferiority by indulging in grandio, fantastic, inflated fantasies of self-concept that keeps failing in reality. The core feature of covert narcissism is failure, repeated failure. They believe themselves to be amazing, fascinating geniuses, unprecedented, unique, and yet they fail to convince anyone of this. So, covert narcissists experience repeatedly what we call narcissistic collapse. And the collapse state in in the case of covert narcissism is almost permanent. Currently in scholarly literature, we are beginning to believe that the only form of pathological narcissism is actually covert. We're beginning to believe that covert narcissists are the only real narcissist. And that what we call overt narcissists, the in-your-face, grandiose, defiant, self- assured, self-confident, um, happy golucky, egoonic narcissists are actually psychopaths. So we are beginning to reconceive of the field and to say that overt narcissist is a overt narcissism is actually a variant of psychopathy whereas covert narcissism is the real narcissism. Now in my work I suggested something that I call the grandiosity gap. We know that in narcissism there is a discrepancy between implicit self-esteem and explicit self-esteem. Implicit self-esteem is innate internal experience by the narcissist. Whereas the explicit self-esteem is a kind of publicfacing advertising campaign propaganda if you wish. And there is of course a gap, a grandiosity gap between how the narcissist would like to be perceived and how from time to time the narcissist perceives himself or herself. About 50% of all narcissists are women. When I say narcissist from now on, we're talking about people diagnosed or diagnosible with narcissistic personality disorder. I when I say narcissist I am not referring to subclinical narcissism narcissism narcissistic personality style that cannot be diagnosed that does not meet the diagnostic threshold. So I'm not referring to these people I'm referring to people actually diagnosed with NPD. And so we have a situation where the covert narcissist experiences collapse time and again fails to obtain for example attention, affirmation, applause, adulation, admiration um or even notoriety. This constant failure to elicit feedback and input from the environment renders the covert narcissist vulnerable, fragile, and some say shy. Originally the term for covert narcissism was closet narcissism. Someone hiding in a cupboard. So all narcissists go through overt and covert phases. When narcissists fail to obtain narcissistic supply, attention, they sometimes withdraw. They become avoidant. They hide themselves. They brood. They ruminate. They become depressed. That's a covert phase. So all narcissists have overt and covert phases. But in each narcissist, there is a dominant strain. So there's a narcissist who is mostly overt and a narcissist who is mostly covert. It's enough at this stage to say that covert narcissism is a failure of compensatory function. The compensatory structures are there but they are inefficacious. They do not yield outcomes. There's a failure of function. Now having gone through the introduction to this delightful creature, the covert narcissist, we can now begin to discuss the inner world of the covert narcissist. And this is a world premised and predicated on inevitable anticipated catastrophized failure, defeat, rejection, abandonment, and generally speaking, a sense of victimhood. The covert narcissist is drowning in negative effects, shame, guilt, and above all, envy. The envy is pernitious. The envy is acidic. The envy is corroding. It is the envy that defines the covert narcissist and motivates the covert narcissist to behave passive aggressively. The narcissist experiences this envy and reframes it. Narciss this covert narcissist can say people envy me. The covert narcissist projects the envy onto others and say people envy me. That's why they reject me. That's why they mistreat me. That's why they don't promote me at work. That's why they mock and ridicule me, etc., etc. All because I am vastly superior to them. They know it and they are envious of me. That's a kind of self soothing, self-bealing narrative of the covert narcissist. The negative effects in the covert narcissist are intolerable. They're unbearable. They drown the covert narcissist. They overwhelm the covert narcissists. And consequently, covert narcissists, as opposed to overt narcissists, are much more prone to emotion dysregulation. They are labile. They have ups and downs. They're highly reactive to the environment, the hypervigilant, the hyper sensitive, and they often entertain suicidal ideiation. Consequently, we can safely say that the covert narcissist is a bord borderline like state. It has borderline like features or what Otto Kenberg called borderline personality organization. That is very different to the overt narcissist. The overt narcissist is pretty stable, is not labile, is very rarely disregulated and then he becomes overt covert. So the overt narcissist is much more like a psychopath. The overt narcissist is impulsive. That part is true. But the impulsivity is egoonic. The impulsivity is perceived by the overt narcissist as an advantage, a positive adaptation. The overt narcissist is proud of his or her impulsivity. Whereas the covert narcissist is not proud of himself or herself. It's full of shame, full of self-loathing and self-rejection, bitterness. The covert narcissist is resentful and hateful and spiteful. Covert narcissist of course perceive themselves as victims and are therefore very likely to become pro-social in or communal narcissists. In other words, they're very likely to put on a facade of doodas, altruists, gurus, teachers, fixers, saviors, healers, wounded healers, um, and rescuers. That is very uncommon in overt narcissism. It's much more common among covert narcissists. And then they become pro-social. in the covert narcissist. If we if we borrow now um the methodology and the language of object relations theories, especially British object relations theories in the 1960s, the work of initially Melanie Klene and then later Fairburn and Gunrip and and Winnott and many others then we would say that the covert narcissist has an internalized bed object. object, a cluster of voices or a coalition of introjects that keep informing the covert narcissist that he or she is unlovable, inadequate, a failure, ugly, stupid, not accomplished, etc. It is in order to silence these voices, these internal voices that the covert narcissist engages in essentially fantasy. It's not daydreaming because the fantasy is all pervasive and replaces reality, supplants it. The covert narcissist is constantly in a state of fantasy and is unable to tell the difference between reality and fantasy. And so there is a self a bad object that is introjected that is interiorized internalized. And this bad object drives the covert narcissist to become selfharming, self-destructive, self-defeating, which is another borderline like clinical feature. The self- betrayal of the covert narcissist again creates a pronounced clinical resemblance to borderline personality disorder in the diagnostic and statistical manual. Indeed, in the international classification of diseases edition 11, there there are no differential diagnosis. There's no narcissistic personality disorder. There's no borderline personality disorder. But what we do have in the di in the ICD is a borderline specifier, a borderline set of attributes which when combined with trait domains yield the equivalent of the differential diagnosis in the DSM. And so in the case of the covert narcissist, we would have as one of the main features, main clinical features, a borderline, a pronounced borderline specifier. Okay, that's a psychonamic background. And now if you combine the two, an innate sense of shame and inferiority, a compensation for the shame and inferiority via the cognitive distortion of grandiosity, an inflated self-concept and a fantasy and then the compensatory structures failing to obtain the necessary input and feedback and validation from the environment. If you put all these together, it is easy to see that covert narcissists would be prone to mood to effective mood disorders and to anxiety disorders. Indeed, the coorbidity or the co-occurrence of mood disorders and anxiety disorders, incovert narcissism is such that I think they constitute a diagnostic clinical feature. In other words, all covert narcissists are a lot of the time depressed or anxious or both. This of course leads to behaviors such as substance use and so on, but that's besides the point and not the topic of today's article. The covert narcissist experiences four types of dysphoria. Four types of equivalent of depression. I'm going to use the word dysphoria because sometimes the inner experience of the effect does not meet the diagnostic threshold of a depressive illness or a depressive disorder. And yet the individual is down to some extent incapacitated um lethargic inertial unable to function. It's so it resembles a lot for example psychothermia. Yeah, but there are two four types of dysphoria in covert narcissism. Loss induced dysphoria. It's a dysphoria that is created by a loss of a source of narcissistic supply, a source of attention, a source of care, a source of compassion and empathy, a source of support including physical support like services. So any loss of any kind of source induces dysphoria in the covert narcissist because the structure of the covert narcissist, the pathological structure of the covert narcissist personality is such that as I said it's very brittle, very fragile. Anything can push it over the edge. So losing someone, usually it's a someone, losing someone or an affiliation to a group that provides the covert narcissist with a feeling of superiority, of elation, of belonging. This induces loss dysphoria. The second type of dysphoria is deficiency induced dysphoria. It's a kind of depressive malaise, kind of bad feeling. When you get up in the morning, the covert narcissist has this bad feeling because he's not getting enough. He's not getting enough attention. He's not getting enough promotion. He's not getting enough adulation. He's not getting enough recognition. He's not getting enough something. And this is deficiency induced dysphoria. It's it's a background process. It's very low intensity. It doesn't flare up. It's not reactive. It's it's a constant state. Again, very very reminiscent of psychothermia. Then we have the self-worth lability dysphoria. It's a dysphoria that is reactive to the internal fluctuations in the covert narcissist sense of selfworth. To repeat, narcissists, overt and covert, regulate their sense of self-worth, their self-esteem, their self-confidence, the narrative of their self-concept, and the cognitive distortion of grandiosity. They regulate all these using input and feedback from other people. Input that is known as narcissistic supply. Narcissistic supply is therefore a regulatory input. That's external regulation. The covert narcissist is no exception. And so when the covert narcissist fails to secure access to such input and feedback or to the sources of such input and feedback there we have another type of dysphoria which is the self-worth liability dysphoria. The covert narcissist self-esteem and self-confidence go down. uh there is a state of collapse, there is constant rumination, there is and all this leads the covert narcissist into a depressed anxious state. That's the third type of dysphoria. The next type of dysphoria is the grandiosity gap or self-concept dysphoria. It's when the covert narcissist fails despite all strainuous efforts, despite everything, trying everything, imagining everything, working with everyone fails. There's a failure, a systemic failure to obtain narcissistic supply. This creates a grandiosity gap. There's a gap between the way the covert narcissist perceives himself or herself the self-concept as perfect as a perfect being as godlike as a genius as drop deadad gorgeous as amazing as an intellectual you name it. There's this kind of narrative. The narrative could be negative. I'm the greatest victim of all. I I've had the biggest failure ever recorded and so on. So it's always a self- aggrandizing narrative. It could be positive and it could be negative. But then when it cannot be sustained via input from the outside, via external input, when the environment refuses to collude with the covert narcissist so that the covert narcissist can continue to selfdeceive. when the environment challenges the covert narcissist self-concept. When the environment um is uh is harshly critical or threatening or or whatever in all these situations we have the grandiosity selfcon grandiosity self-concept gap and it creates dysphoria. There's a feeling even in extreme cases there's a feeling of disintegration falling apart. Finally, there's the self-punitive dysphoria. Remember what I said earlier? I said that uh there is an internalized bed object in the covert narcissist. What used to be called in the 1930s the primitive super ego. There is this this voice the moral the moral uh the moral edict or the moral default. There is this voice that says you're bad, you're inadequate, you're failure and so on so forth. And these voices are negating. These voices are destructive. They push the covert narcissist to become self annihilating, selfishiating, selfharming, self-defeating and self-destructive. Of course, this self-destructiveness is this this self-punitive aspect of covert narcissism is very sad. It's tragic. And the covert narcissist reacts to this self-inflicted tragedy with sadness, profound sadness, all pervasive cellular sadness. That's the greatest dysphoria of all. Here is something to pay attention to. In the overt narcissist, there are depressive phases. The periods of depression. In overt narcissism, the periods of depression obviously, but they're brief, they're contained, they are immediately reframed away, the grandiosity reassert itself, and the overt narcissist is again top of his game, center of attention, life of the party, the one and only. Depressive episodes in overt narcissism are actually micro episodes. Whereas in covert narcissism, depression is the default. It's a constant depressive state. Covert narcissism is a depressive schizoid reaction to borrow from Melan Klein. It's a constant state of depression and it triggers of course paranoid ideiation and all kinds of attempts. I'll come to it in a minute. Now what is the solution? No one can survive with constant background depression. It would lead ultimately to severe emotion dysregulation and to suicidal ideation or suicidal attempts. So what is the solution here? Libby Libby is a scholar. She studied narcissism and she came up with the with the modern concept of narcissistic motification. Libby suggested that there are two types of solutions. The internal solution and surprise surprise the external solution. I suggest that there is an internal versus external reset based on the work of Libby. There's a kind of a kind of rebooting. Then the covert narcissist reboots himself or herself. And so the covert narcissist restarts or reboots the self-concept, the locus of grandiosity, the narrative that butresses upholds and underlies the the inflated fantastic self-perception. This is the locus of grandiosity. And there's a rebooting of the mechanism of self enhancement or self supply so that the covert narcissist at some point says I don't need other people. He devalues other people. He says other people are too stupid to understand what a genius I am. Other people are too envious and malicious. Other people should be avoided. I don't need other people. I know that I could be my own standard because I am supreme. I'm godlike. I'm superior. I'm omniscient, all knowing. I'm omnipotent, all powerful. I'm the one and only. Why do I need other people? I don't need other people. And that's a solution. The solution is known as self-supp. It's a it's a kind of restarting or rebooting the self-enhancing narrative with self-reliance rather than reliance on other people. Of course, this creates this results in avoidant behaviors, schizoid behaviors, constriction of life, isolation, and a lone wolf mentality. The other solution is to adopt one's condition as a form of grandiosity. So the covert narcissist would say, "I'm a victim. I'm a victim. People mistreat me. People mock me. People ridicule me. People humiliate me. People shame me. It's all true. But that makes me morally superior. That makes my victimhood is my grandiosity. My victimhood is my narrative. This is what makes me special. This is what makes me unique. And so there is a conflation of victimhood and grandiosity in uh in covert narcissism. And there is a total rebooting or restarting of the self-concept, rewriting it from scratch. I am now isolated by choice. I am now a hermit. I'm schizoid. I'm avoidant. I'm constricted. I don't want other people in my life. I'm supplying myself because I know how clever I am. I know how superior I am. I'm my own god. And this leads to the creation of the equivalent of a private religion where the covert narcissist false self to borrow a clinical term from Winnote. The covert narcissist false self becomes a deity a divinity and the covert narcissist sacrifices himself or herself to this divinity becomes one with his deity with his god. And by becoming by merging and fusion fusing with his god, the false self, the covert narcissist elevates himself or herself becomes the uh becomes godlike, attains and assumes the attributes of this self-created god. Now many covert narcissists attempt other types of solution. For example, they move, they relocate all the time. They move from one city to another, from one pub to another, from one church to another, from one job to another, from one marriage to another. This is called the pathological narcissistic space. They create physical or digital spaces where they can for a while obtain narcissistic supply and then when the supply begins to waines, drops, disappears, they move on. they move on and start from zero. So the biographies of these people are replete with losses, defeats, failures and on the other hand they are very itinerant. They move a lot. They're desolatory. They are they're never permanently in one place or in one job or in one profession or in one marriage or in one anything. They are constantly reinventing themselves. They're like more like a kaleidoscope. One of the reasons is that it is widely agreed in psychoanalytic theory and its derivatives later on. It's widely agreed that narcissists do not possess a self. They're ironically selfless. They don't have what Freud used to call an ego. Narcissists are not egotist because they don't have an ego and they are selfless because they don't have a self. This is because in early childhood the formation, constellation and integration of the self was disrupted. Now that is not to say that narcissism is not genetic. There's a genetic probably we don't know yet but in all probability there is a genetic hereditary component but the environment is very critical. And so because narcissists don't have a self or at least not an integrated self they have what what is known as identity diffusion similar to border lines. Because of that it's very easy to for them to start from zero to start from scratch. It's very easy to them from move to move from A to B from B to C from C to Q no problem. It's very easy for them to become totally different people. They they are narcissists especially covert narcissist are discontinuous. They are disjointed. There's no continuity. A great definition of the self is a sense of continuity in changing environments. Narcissists don't have this. And so they move from one pathological space to another. And at all times, the covert narcissist lies to himself or to herself by saying, "I am in control. I'm in charge. I'm the decision maker. I'm the puppet master. Whatever happens to me is my choice. I made it happen. And so the act of moving physically and the act of rewriting oneself, rewriting one's narrative, these acts are perceived as reassertion of mastery, as proof positive of control over one's life, internal and external. And this is of course a form of self-upply because if you are the master, especially the puppet master, if you're in charge, if you're godlike, why do you need people? You don't need people. You don't need people in this case. So you are, you know, it all it all comes from you, emanates from you, absorbed by you, processed by you and so on. This is a state of soypism. Covert narcissists ultimately become soypistic, automized, isolated, asocial, not antisocial, asocial. The sources out there are the people, the people who failed the covert narcissist, the people who could not appreciate the covert narcissist grand genius, amazing gifts and talents and skills, contributions to humanity. The people who fail to appreciate all this, they are devalued by the covert narcissist. They're stupid. They are puny minded. They are petty. They are spiteful. They're envious. I don't need them. Of course, covert narcissist engages repeatedly uh what we call aloplastic defenses. He tends to blame other people, the world, the community, the environment, institutions, his spouse, his children, you name it. He tends to blame everyone and everything around him for whatever is happening to him for the bad things that happen in his in his or her life. These are aloplastic defenses. However, when the covert narcissist experiences narcissistic motification or narcissistic collapse, there is a brief moment, a flash in the pan of autolastic defenses, realization that there is personal responsibility, that there were mistakes that mistakes were made, wrong choices were adopted and there was not much wisdom in all of this. The state of depression in in the covert borderline can also be perceived as a regulatory mechanism. The borderline the covert borderline a covert narcissist. I'm terribly sorry I I've come up with another diagnosis covert borderline and I'm trying to convince academia to adopt it. So hence the confusion sorry apologies. covert narcissist. The depression in covert narcissism is also regulatory. It's regulatory in the sense that it's motivational. When the covert narcissist experiences depression, it motivates him. It motivates him to somehow counter it. It motivates him to reinvent himself, motivates him to create a new self-concept, new narrative, to to move away, to relocate, to to get divorced, whatever, the depression in covert narcissism is highly motivational. And ironically, and I will conclude with this, perhaps we could regard depression in covert narcissism as a positive adaptation, as a way, a convoluted way, an unusual way, pathological way, but not a dysfunctional way of somehow staying alive, surviving, and motivating oneself to get up in the morning and do something. The alternative is the borderline state with its suicidal ideiation and ultimately suicide. Thank you for listening. Are there any questions or >> Oh, many hearts. >> Yes sir. Thank you very much Sam. There is a very active discussion happening in the chat. I'll try to go quickly through the chat to find the relevant questions. >> Yes, we do have loads of questions. I'm not sure we'll have enough time for all of you. >> I can use the I can use the break as well. No problem. >> No problem. No, actually Leah Leah Leah offered me offered to me to use the break to respond to questions and I accepted. So if you want I can use the break to to respond to questions. >> Thank you very much. Let's start now. So we may use the break time as well. Let's let's start let's question how do we distinguish a borderline disorder person from a covered narcissist. >> This is the most common question so far. Thank you. >> Yes. Well, as you probably all know, there is um a big debate currently um in academic circles whether we should maintain at all the diagnosis of borderline personality disorder or whether we should begin to regard it as a post-traumatic condition akin to complex trauma or complex PTSD. Having said that, the majority consensus is that BPD, borderline personality disorder deserves to remain as a separate diagnosis, differential diagnosis at this stage. And the difference between borderline personality disorder and covert narcissism is the self-concept. The covert narcissist has an inflated, grandiose, fantastic, counterfactual, and highly aggressive self-concept. The covert borderline, a covert narcissist, I'm sorry, whenever I say covert borderline, you think covert narcissist. The covert narcissist is uh identifies himself or herself with the self-concept, defends the self-concept, structures his or her life around the self-concept, reacts to the fluctuations in the self-concept, and actively solicits the input and feedback of other people. Narcissistic supply. The borderline doesn't do any of these things. People with borderline personality disorder do not have necessarily um this kind of desperate active attempts to solicit or to coersse other people to fit into or be introduced or inducted into a fantasy within which the individual the covert narcissist is supreme and godlike. Border lines don't have this. They share many there are many clinical features in common but that's not one of them. The second thing is that um border lines regulate externally exactly like covert narcissists. Covert narcissists regulate themselves via other people. But the borderline usually regulates herself through one person through the agency of one person. So you would see a borderline regulating through her in or he her or his intimate partner. The interventent partner would have the monopoly on external regulation. Whereas the covert narcissist is promiscuous. He would regulate through anyone at any time in any place. The covert narcissist mind is a hive mind. It's comprised of fragments and shards of the minds of other people. The more the better. The covert narcissist if he could externally regulate through two million people he would do that. The borderline is not like that at all. She is in some ways exclusive. She has a special person or any intimate partner and she does it through this. The third difference is that while the covert narcissist entertains suicidal ideiation from time to time and has a depressive background and is emotionally disregulated again from time to time in the borderline in the borderline patient the emotion dysregulation and the suicidal ideiation are absolute fixtures. They are clinical critical clinical features and they're always there. 11% of people with borderline personality disorder end up committing successful suicide. Suicide is the leading cause of death among border lines under the age of 45. That's absolutely not the case with with covert narcissists. And so the these are three differences. There are many others. We can safely say that there is a a absolutely wellestablished differential diagnosis between the two. They're not the same. >> Yes. Thank you very much. Can he recognize his or her mistakes in front of others or will that require therapy? As I said uh at the end of the presentation, narcissists covert and overt they have aloplastic defenses. Aloplastic defenses means mean they accuse other people of their own mistakes, failures, antisocial acts, criminal acts etc. They always accuse other people. They never accept responsibility. They never admit to having done anything wrong, having made the wrong decision, having made the wrong choice. Um, if they fail, it's someone else's fault. If they transgress, it's they were obviously provoked. It's always there's always a relegation of responsibility, accountability, uh, and control to other people. Ironically, consequently, narcissists have an external locus of control. They perceive themselves as determined from the outside. Other people do things to them. Their internal states, effects, moods are all triggered by other people. They maintain their sense of selfworth via other people. They are dependent. They they there's a dependency here. And so narcissists are the equivalent of junkies, addicts. And because they experience life with this dependency on other people, they can't assume any internal locus of control. They don't feel that anything emanated from the inside also because there's no insight. There's no self. There's no organizing principle. So the answer is absolutely narcissist can never ever accept responsibility. And by the way, not even in therapy. people. What kind of would you recommend to treat MPD? Various treatment modalities are effective in modifying the narcissist's behaviors. The behavior modification is possible and is pretty a pretty common outcome of therapy. We can reduce dramatically the narcissist's abrasive and antisocial conduct or behaviors. We can teach a narcissist to get along with other people and be less obnoxious, less rude, uh a bit. We can teach a narcissist to imitate empathy and compassion. We can program the narcissist if you wish to react in socially acceptable and appropriate ways etc etc. So to that extent therapy could be successful. However, the core of pathological narcissism is untouchable. Exactly as the diagn diagnostic and statistical manual says, pathological narcissism is an allervasive condition which affects every area of life and functioning. It is an personality disorder. So to cure it or to heal narcissism, you would need to take away the personality, which of course no one can do. There's no treatment modality that takes away your personality and you're having a personality implant. This is not liver transplant. You can't transplant a personality. So the core features are there. The need for fantasy. The reliance on external regulation. The inability to tell the difference between internal objects and external objects. The tendency for antagonism, manipulativeness, exploitation, the lack of empathy or the lack of of effective empathy, the lack of ability to react emotionally to the conditions and states of other people. All these are untouchable. Untouchable and unteable. There's nothing we can do with with any of this. Narcissists also are very frequently pathological narcissism is very frequently comorbid with other mental health issues. There's a high level of co occurrence. So we cannot treat the narcissism as an isolated unadulterated pure clinical clinical phenomenon. It's a major problem. So for example, there's a very high coorbidity between narcissistic personality disorder and antisocial personality disorder and borderline personality disorder and uh anxiety disorders, substance use, etc., etc. What do you treat first? What what would you work on first? So clever clinicians and honest clinicians, there are many who are not, but clever and honest clinicians would tell you that you can work with the narcissist to make the narcissist life and the life of people around the narcissist more bearable, more survivable. This can be accomplished. Now the modalities that I would recommend in the treatment of narcissistic personality disorder would be schema therapy uh to some extent EMDR uh transactional analysis uh internal family system um on the on the fringes on the margins gestalt these are these are the five modalities that I would start with and see where it goes. They have good they have good outcomes in behavior modification. You're welcome. >> Okay. You mentioned at the very start about psychopaths. to when how do we distinguish about psychopaths versus covert narcissists? >> First of all, uh I'm sure you know that psychopathy is not a recognized clinical diagnosis. It has been rejected repeatedly by both the committees of the diagnostic and statistical manual and the international classification of diseases has also been rejected in China and so on. It's not it's a hotly debated very controversial diagnosis. We tend to we tend to to talk about people with antisocial personality disorder, antisocial features, clinical features. Having said that, every diagnosis is on a spectrum and at the very end of a spectrum you have extreme extreme manifestations. So at the end of narcissistic personality disorder spectrum or pathological narcissism spectrum at the end you have narcissistic personality disorder and at the end of narcissistic personality disorder you have what Otto Karnburg called malignant narcissist malignant narcissist narcissism is a combination of sadism psychopathy and narcissism similarly at the end of the spectrum of antisocial personality disorder we have the Robert hair and collectly psychopath. So the difference the differences between psychopaths and narcissists are pretty pretty big and the fact that self-styled experts online keep confusing them and misleading the entire population is something to be lamented. First of all, the psychopath is grounded in reality and completely able to tell the difference between reality and fantasy. The narcissist cannot. The psychopath is not dependent on input or feedback from the environment. Is self-sufficient and is usually contemptuous of other people. And so the psychopath would never beg for narcissistic supply the way a narcissist would. Psychopath is not dependent on other people's attention, adulation, admiration. actually he's pretty disgusted with people and he would he he would see such reactions as repulsive whereas a narcissist for the narcissist this is nectar and ambrosia he needs this it's food the psychopath is absolutely capable of telling the difference between external objects people people out there and the representations of these objects of these people in his mind so the psychopath knows that there is someone out there and there is a representation of that person in his mind and he doesn't confuse the two. The narcissist does. Narcissists confuse internal objects with external objects which is one of the reasons Kernburgg suggested that narcissistic um disorders of the self are actually pseudocychotic. Narcissism is very reminiscent of psychosis because of this confusion. Narcissists are not goal oriented. The only thing a narcissist wants is narcissistic supply. End of story. A narcissist may pursue money and power and sex. But a narcissist would do this in order to obtain supply, in order to brag about it or boast about it and obtain supply. With a psychopath there is goal focus or goal orientation. Psychopath wants money. Psychopath wants sex. Psychopath wants power for their own sake. Not in order to boast or to brag or to obtain supply. It's a major difference. There are many other differences. I'll mention only one. Psychopaths are impulsive and disinhibited. That is these are main characteristics of um psychopathy. Factor one psychopathy F1 psychopath. Yeah. Primary primary psychopaths. They're impulsive and disinhibited. Whereas the vast majority of narcissists are actually not impulsive and many many of them are pro-social. They play by the rules because they need to obtain supply. So they are actually pro-social. Whereas all psychopaths are antisocial. A psychopath would do anything to obtain a goal. He would kill you. He would anything. There's no scruples, inhibitions, mores, laws, norms. The psychopath recognizes only his own codeex, his own law. He is a law unto himself. That's not the situation with the narcissist. Absolutely not. Narcissists are very attuned to the environment. They collaborate with other people. They obtain supply in a variety of ways. They manipulate other people, but they manipulate other people so as to obtain supply. They're very unlikely to, you know, alienate and estrange people and so on because then they would be left without supply. That these are major differences. These are not absolutely not the same the same diagnosis although many many unfortunately self-styled experts would tell you otherwise. Great. Thank you so much. The subject of a romantic relationship between a deficient and a narcissist. If you can do that quickly, that is >> yes. >> Uh we don't use the term deficient. We use the term covert. That's the sometimes we say vulnerable narcissist, but that's a mistake because all narcissists are sometimes vulnerable and sometimes grandiose. So with it's better not to use vulnerable and grandio. It's better not to use vulnerable and and grandio. It's better to use covert and overt. Now overt and covert narcissists are actually likely to form a bond attachment or a diad because the covert narcissist can obtain supply through the overt narcissist. The overt narcissist goes out there and gets the bacon, obtains supply and then comes back with the supply and the covert narcissist shares the supply with the overt narcissist. Um, you know, in Germany in the 19th century, if you were married to a medical doctor, you were called FRA doctor because his title applied to you. It's the same with the covert narcissist. Second thing, the overt narcissist is likely to idealize the covert narcissist, at least initially. And therefore, the the overt narcissist uh Jakov, the battery is running low. Something with the battery is a problem. It's not in the electricity. I don't know what here. Low battery. Um, so the the n the the narcissist, the overt narcissist would become the source of supply of the covert narcissist. And this would create a very strong bond between them. And uh the the longevity of the relationship is between these two is premised on this compensatory compensatory structure. Each one of them compensates for the deficiencies of the other one. Each one of them caters to the psychological needs of the other one. The covert narcissist is likely to be submissive and a willing participants participant in the overt narcissist fantasy. The overt narcissist is likely to agg narcissist and provide her or him with supply etc etc. It's a perfect perfect match and the relationship could be happy. I think one of the things one of the things people don't realize you could be happy with a narcissist. The relationship could be great and and very prolonged long time. It doesn't need to. It's just a question of compatibility ultimately. And yeah, very few people are compatible with the narcissist. Very few people are willing to tolerate the narcissist. Very few people can survive this highly toxic environment. I fully agree. But these people do exist. I recognize my parents and my family as I'm listening to your lecture. How would you structure your relationship with such relatives? Thank you. >> Well, first of all, it's exceedingly unlikely that your entire family are narcissists. The prevalence of pathological narcissism in the general population is 1.7%. and the prevalence in the clinical population is something like 9%. Now, of course, the immediate objection is it's because narcissists don't go to therapy and consequently they are underdiagnosed. Yes, this is something self-styled experts would tell you, but as most of the things that self-styled experts tell you, it would be wrong. All narcissists go through covert phases. all no exception. And when they are in the covert phase, they are more likely to attend therapy than healthy people. Actually, if you take this into account, narcissists are more exposed to therapy than healthy people, not less. And plus, we have statistical tools. We know from a sample population how to extrapolate the total population. It's not rocket science, you know. So I'm pretty certain that the real figure is 1.7% and 9% in clinical population. That means that your initial assertion that all your family and what have you are narcissists is likely 93% wrong. However, you may have a single narcissist in your family or among your relatives and how to cope with it with with such a person. First of all, if you can avoid contact with this person, do no contact is the best absolute solution. Second thing, if you cannot avoid contact, God knows why. If you cannot avoid contact, don't play the game. Don't become a source of narcissistic supply. Don't interact. Don't look interested. Don't uh compliment the narcissist. Don't don't simply don't. Like if you have to be in the same room, there's a technique called gray rock. Make yourself a gray rock. Make yourself uninteresting, unappealing, not the kind of supply the Narcissist would chase, not colorful enough, not fascinating and dramatic enough, and so avoid drama. And the third thing is never do anything in jointly with the narcissist. Never do business with the narcissist. Never help the narcissist. Never communicate with the narcissist unless necessary. Avoid all joint activities. Narcissist ask you for for a loan, say no. Narcissist ask you to borrow your car? No. Narcissist wants you to write a book together with him or her? No. The answer is no. Can you babysit the narcissist's children? No. Can you help the narcissist in his kitchen? Something is wrong with the and you are a plumber. The answer is no. No. It's a very simple word, you know, in English at least. It's two letters. has already been mentioned several times. How do we distinguish between narcissistic personality disorder and narcissistic trauma? >> Narcissistic trauma. >> I'm not I'm I'm not sure I understand the question. >> I'm sorry. Narcissistic injury. >> That makes sense. >> Narcissistic narcissistic injury is something that all human beings can experience because all human beings have um that have a traits cluster of traits of narcissism. We all have healthy narcissism. Healthy narcissism is the cluster of traits uh that underly uh the regulation of self-esteem and self-confidence in people. Healthy narcissism also allows us to distinguish ourselves from other people in other in other words to establish boundaries. So we all have healthy narcissism luckily and consequently we can all be injured narcissistically. We can all be humiliated or shamed or attacked or criticized or in a way that our healthy narcissism would be impacted and we would experience injury. So injury, narcissistic injury is not unique to pathological narcissists. It is the way the narcissist reacts to injury that is unique, not the injury itself. The narcissist reacts to injury defensively. He then begins to reframe the situation. He rewrites history. He devalues the sources of the injury. He casts himself as a puppet master. Whatever the narcissist reacts to narcissistic injury disproportionately, externalizes aggression in majority of cases, narcissistic rage, and rewrites the entire environment, other people's roles in the environment and the interaction that has happened. This fantasy defense is unique to the narcissist. Healthy people don't do that. If I were to injure you narcissistically, I could say you're ugly or you're stupid. That's narcissistic injury. If you think you're not ugly or if you think you're not stupid, that's narcissistic injury. But you're a healthy person. You would not automatically devalue me, rage on me, and creates a fantasy where you are actually a genius and drop dead gorgeous. That's not how healthy people react. You may argue with me even as a healthy person. As a healthy person, you would attempt to communicate and find out why do I think that you're ugly or stupid or whatever. Or maybe you will empathize with me as a healthy person. You would say, "Oh, I understand you're having a bad day. Can I help you in any way?" You know, narcissists don't have any of this. Forget all these reactions. Narcissists are at your throat in your jugular and will kill you. I mean, metaphorically speaking, Wow. >> No. Next question. they feel usually start thinking about suicide. >> I think I answered that in the lecture. So I wouldn't like to waste time. I dedicated almost 10 minutes of the lecture to this question. So I suggest that we focus on questions that were not answered in the lecture because our time is limited. I'm willing to be with you the next five hours. Honestly, I like the sound of my voice, but let's focus on questions that were not already answered. Yes, it's a very important question. There is a debate right now in scholarly circles in academ. I'm not a clinician. I'm an academic. Yeah. There is a debate right now between the genetic school or the medical school and the psychonamic or psychonalytical whatever you want to call it school. The genetic school says that pathological narcissism is hereditary. That we will soon find the genes that create pathological narcissism. that the cluster of traits that comprise pathological narcissism which include as I said antagonism and dissoci and anastia obsessive compulsive features these traits are hereditary they're inherited which is true all this is true so there is this school and there is the other school that says maybe there is a genetic template maybe there are genes maybe there's a hereditary component like in borderline like in psychopathy Maybe there is. But these genes would not be expressed. They would not be triggered unless there is a highly specific environment. And this environment is traumatic and abusive. The in the case histories in the anomnesis of literally all patients with narcissistic personality disorder, there's a background of childhood abuse and trauma. End of story. This applies almost equally to borderline personality disorder. In borderline personality disord disorder, we know there is a genetic component. We know there are brain abnormalities, but we also know that there is a history of trauma and abuse in the in the patient's u biography. So, nar pathological narcissism, narcissistic personality disorder is a post-traumatic condition. Exactly like borderline. It's a post-traumatic condition. However, I think one of the reasons we're having this debate is that we are not defining trauma and abuse correctly. First of all, trauma is not an objective state. You and I can witness the same event or have the same experience. I will be traumatized and you will walk away smiling. So it is a subjective thing. Maybe it is a derivative of some genetic background but it's not universal is not a clinical entity. Like if I expose 10 people to a c to the to a bacterium a certain bacterium literally all of them will become sick. That's a clinical entity. Trauma is not a clinical entity. It's an experiential entity, epistemological entity, not ontological entity. That's important to understand. It means that different people, different children experience the very same upbringing very differently and react to it differently. The same home, same family, same parents, they're twins, but they still would react to it differently. And it's definitely possible even without genetic background. Second thing, when we say abuse, it's not only about sexual abuse, physical abuse, verbal abuse, psychological abuse. It's not these are not the only types of abuse. Abuse is any situation. Childhood abuse is any situation where the child is not allowed to develop, separate, become an individual, individuate, not allowed to have boundaries, express emotions, not allowed to develop preferences, agency and independence. This is abuse. So a mother who is overprotective of the child, she would not allow the child to go out to the street. She would not allow the child to associate with peers. She would not allow the child to eat certain foods. That's an abusive mother because she doesn't allow the child to develop, experience loss, have friction with reality, establish boundaries, interact with others, get hurt, learn, grow, develop, that's an abusive mother. Similarly, a mother who treats the child as her husband or a father who treats the child as his wife, parentify the child, force the child to act as a spouse or as a parent. That's abuse. A mother or a father who used the child to realize their own unfulfilled dreams and wishes and fantasies. The mother wanted to be an actress. She failed and now she forces her daughter to become an actress. The father wanted to be a medical doctor or a pianist. He failed and now he's forcing his son to become a pianist or a medical doctor. That is abuse. So abuse is a much wider category than just beating the child up or having sex with the child. These are actually rare. There are other forms of surreptitious stealth abuse. If we put all of these together, then we are beginning to understand that pathological narcissism is a reaction to childhood abuse and trauma widely defined. And then the differential diagnosis between the post-traumatic condition of NPD, narcissistic personality disorder, and other post-traumatic conditions, they exist. Complex trauma, CPTSD, other borderline personality disorder. You know, the differential diagnosis relies on the clinical features that I've described. The need for fantasy, the inability to tell apart reality from fantasy, the inability to distinguish between internal and external objects, the incapacity for intimacy, lack of empathy, etc., etc. When we see this confluence of trait domains, behaviors and effective and cognitive features, when we see all of them together, cognitive distortions for example, like grandiosity, then in this situation we can diagnose narcissistic personality disorder, that doesn't mean that we can dismiss the traumatic background. We can't. It's part and parcel. It's a post-traumatic uh condition. a compensatory post-traumatic condition. The child tries to compensate for the impossible, terrifying environment by becoming someone else and by trying to convince people to acknowledge and accept this new entity. It's like the child says, "Don't hurt me anymore because I'm not me. I'm someone else." And then the when the child grows up, this child as an adult approaches other people and says, "Can you confirm to me that I'm someone else? Can you tell me that my belief that I'm someone else is real?" Correct? Can you participate in my fantasy, please? For example, I think I'm a genius. Can you tell me I'm a genius? Can you participate in my fantasy that I'm a genius? Can you constantly affirm to me that I'm a genius? So it's just a little child. The emotional child of emotional age of narcissist is two, three years old. Very evolved narcissist. Mild narcissist are like six years old. It's a kid. These are children, infants, toddlers who found themselves in an environment that is nightmarish in a horror film. And the only way to cope and to survive was either to become what the parents wanted them to become and then they they become people pleasers and border lines or to or to emulate the parents to identify with the aggressor. Fancy called it identifying with the aggressor to identify with the aggressor become the aggressor. Godlike omnipotent I mean a child sees the parents as omnipotent. The parents are all knowing, all all powerful. They are they never make mistakes. They are infallible. And so the child adopts this view of the parents. And this is a great definition of narcissism. I need I need a break for for three minutes. I'm going to do something that unfortunately I cannot mention in public >> and