Narcissism Primer

Narcissism has been a popular topic of discussion in recent years. The term “narcissistic” refers to people whose personalities are organized around maintaining their self-esteem by getting affirmation from outside themselves. This can be done through things such as approval from others or avoiding criticism. Some people have a disproportionate degree of self-concern, to the point where it may be considered excessive, and this is what is referred to as “pathological narcissism.”

Freud’s view and our understanding of narcissism today

Narcissism is something that Freud gave recurrent attention to, and while he had little to say about therapy for those with narcissistic concerns, attention to concepts like self-esteem regulation, attachment, separation, and affect regulation has contributed to our understanding of narcissism and how to treat it.

It is thought that when Freud was writing, narcissistic problems of the kind that are epidemic today were less common. However, psychoanalytically influenced theorists have argued that the vicissitudes of contemporary life reinforce narcissistic concerns. In mass societies and in times of rapid change, the immediate impression one makes may be more compelling than one’s integrity and sincerity.

There are many different types of narcissistic personalities. What narcissistic people of all appearances have in common is an inner sense of, and/or terror of, insufficiency, shame, weakness, and inferiority. Their compensatory behaviors might diverge greatly yet still reveal similar preoccupations.

How is narcissism developed?

There is little research on the topic of constitutional and temperamental contributions to narcissistic personality organization in adulthood. However, it is speculated that people at risk of developing a narcissistic character structure may be constitutionally more sensitive than others to unverbalized emotional messages. Additionally, it has been suggested that people with a narcissistic personality disorder may have either an innately strong aggressive drive or a constitutionally determined lack of tolerance for anxiety about aggressive impulses. There is little that is known about the etiology of narcissistic personality disorder, but it is speculated that it may be due to a combination of constitutional sensitivity and early environment. Shame and envy are two of the main emotions associated with narcissism.

What are the effects of narcissism?

Narcissistically structured people use a range of defenses, but the two they depend on the most are idealization and devaluation. These processes are complementary in that when the self is idealized, others are devalued, and vice versa. Kohut originally used the term “grandiose self” to capture the sense of self-aggrandizement and superiority that characterizes one polarity of the inner world of narcissistic people. This grandiosity may be felt internally, or it may be projected.

There is a constant “ranking” process that narcissistic people use to address any issue that face them. For example, a person may be determined to go to the “best” college and pull strings to get into the most prestigious school. However, the subordination of other concerns to issues of general valuation and devaluation is of note here. For example, a mother knew that professors in her son’s chosen field considered Harvard inferior to Princeton in that area; she also knew that Harvard undergraduates tend to receive less attention and aid in their studies than those at Princeton. Nevertheless, she persisted that her son must attend Harvard since Harvard was unequivocally “better” in her eyes.

A related defensive position in which narcissistically motivated people are trapped concerns perfectionism. They hold themselves up to unrealistic ideals and either convince themselves that they have attained them (the grandiose outcome) or respond to their falling short by feeling inherently flawed rather than forgivably human (the depressive outcome). In therapy, they may have the ego-syntonic expectation that the point of undergoing treatment is to perfect the self rather than to understand it and to find more effective ways of handling its needs.

Sometimes, narcissistic people handle their self-esteem problem by regarding someone else—a lover, a mentor, a hero—as perfect and then feeling inflated by their identification with that person. Some have lifelong patterns of idealizing someone and then sweeping that idol off the pedestal when an imperfection appears. Perfectionistic solutions to narcissistic dilemmas are inherently self-defeating: One creates exaggerated ideals to compensate for defects in the sense of self that are felt as so contemptible that nothing short of perfection will make up for them, and yet since no one is perfect, the strategy is doomed, and the depreciated self emerges again.

How does narcissism affect relationships?

It is often discussed how relationships with narcissistic people are often burdened by the self-esteem issues of the narcissistic person. Narcissists may be aware that something is wrong in their interactions with others but may not understand what it would be like to accept someone nonjudgmentally and without expecting anything in return. A narcissistic person often needs other people to bolster their own sense of self-worth, and their love for others is usually shallow. This can be a result of having been used as a narcissistic extension by their parents or other caregivers when they themselves were growing up.

Narcissism is characterized by an excessive need for self-esteem, approval, and a lack of empathy for others. Narcissistic people, therefore, tend to have very high standards for themselves and others and often have difficulty genuinely loving others due to their need for constant reassurance about their own self-worth. They may also have been raised in an environment where they were constantly evaluated and criticized, leading to a sense of insecurity and fraudulence. As a result, they may be unable to see others as anything other than narcissistic extensions or extensions of themselves.

What are the different types of narcissism?

There are two different types of narcissism, a personality disorder and a reaction to a situation. A person with a narcissistic personality disorder will always act narcissistic, while a person with a narcissistic reaction will only act narcissistic in certain situations.

Discriminating between a predominantly psychopathic personality structure and one that is essentially narcissistic is important. Psychopathic people do not emotionally understand compassionate attitudes; they scorn a sympathetic demeanor as the mark of weakness, whereas a psychopathically organized person would more respectfully assimilate the grandiose self. Confrontation of the grandiose self is consistent with the recommendations of therapists who have specialized in working with psychopathic clients.

The essential difference between narcissistic and depressive personalities is that narcissistic people are subjectively empty, whereas depressive people are subjectively full. The narcissistic depressive feels devoid of a substantial self; the melancholic depressive feels the self is real but irreducibly bad. In other words, narcissistic people are mostly empty inside, while depressive people are full of negative emotions.

Narcissistic and obsessive-compulsive personality disorders can be easily confused because both involve a quest for perfection. However, narcissistic patients often do not respond well to traditional forms of therapy that focus on control and guilt. Since the 1970s, theories of pathological narcissism emerged that have helped therapists better understand and treat patients with narcissistic personality disorders.

Narcissistic and histrionic personality types can be difficult to distinguish, but it is important to do so because they require different treatment approaches. Narcissistic patients need to be shown appreciation for their self-object phenomena, while histrionic patients benefit from focusing on object transferences. The difference between the two lies in the fact that narcissistic patients are driven by shame, while hysterical patients are motivated by anxiety.

How can narcissism be treated?

A narcissistic personality disorder is characterized by long-standing, automatic, and situation-independent patterns of subjectivity and behavior. It is often misdiagnosed by clinicians as people having situation-specific reactions and psychopathic, depressive, obsessive-compulsive, or histrionic personalities.

Therapists treating narcissistic patients need to be patient and mindful of the person’s latent self-state. They must take care to frame interventions sensitively, as narcissistic individuals are easily overwhelmed by shame. It is also important to be aware of the difference between shame and guilt in the narcissistic person’s experience, as they may go to great lengths to avoid acknowledging their role in anything negative.

In order to treat a narcissistic patient, therapists must be patient and mindful of the person’s latent self-state. They must also be aware of the power of shame in the narcissistic person’s experience and be careful not to diminish the person’s fragile self-esteem. Furthermore, therapists must be able to frame interventions sensitively and help the person expand their awareness of their own behavior.


Narcissism is a complex topic with many different facets. Its many different types can make it difficult to diagnose and treat. However, with a better understanding of the different types of narcissism and how they develop, we can begin to provide better help to those who suffer from this disorder. A better understanding of narcissism can also help us to be more aware of the warning signs and the distressing effects it can have on our relationships.