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by Dr. Becky Spelman on 11/08/2014

The term “narcissism” has its origin in a classical Greek myth about Narcissus, a young man who fell in love with the image of himself he saw reflected in the water. He was so taken with his self-image that his fate was to become rooted in the spot and transformed into the narcissus flower. In Psychology, the term narcissism is used to describe both the normal phase of a child development and personality trait on which individuals vary from one another. Individuals with Narcissistic Personality Disorder or NPD are those who score high on the narcissism scales.


Narcissistic Personality Disorder is a psychiatric diagnosis associated with a distorted self-image, unstable and intense emotions, excessive preoccupation with vanity prestige, power and personal adequacy, lack of empathy and an exaggerated sense of superiority. A common belief, both in psychology and in popular culture, is that narcissism represents a form of excessive self-esteem but evidence in developmental Psychology have challenged this belief by showing that narcissism differs markedly from self-esteem in many ways and especially on the divergent of socialization experiences that give rise to them.

From a developmental view point Narcissism and self-esteem first emerge in late childhood, from about age 7 when children have fully acquired the cognitive capacities to form global self-evaluations, which underlie both narcissism and self-esteem. Also at this age, children readily use social comparisons to evaluate and compare themselves to others, enabling narcissistic views of themselves from “I’m special” to “I’m more special than everyone else!” These contrasting views are mostly shaped by significantly distinct socialization experiences. Narcissism is nurtured by parental overvaluation or how much they see their child as a special individual entitled to privileges by contrast, self-esteem is nurtured by an environment where parents do express fondness for their child, share positive affect and foster in their children the feeling that they matter. This enable children to internalize the view of themselves as worthy, instead of superior, individuals, which is at the core of self-esteem.

Therefore, although narcissism and self-esteem both entail positive views of the self, yet these views are qualitatively different and show only a weak correlation. Indeed, many narcissists do not have high self-esteem, they may see themselves as better than others but not necessarily they are happy with themselves. Conversely, many individuals with high self-esteem are not going to develop NPD, they value themselves but don’t see themselves as better than others. These disparities between narcissism and self-esteem become especially apparent in the social realm, in that individuals with NPD do not have a burning desire to establish deep, intimate bonds with others; rather, they strive to surpass and dominate others or to use them to attain social status. Individuals with NPD aspire to get ahead rather than to get along with people and crave for respect and admiration to feel good about themselves and avoid falling into depression. Because of this they are easily triggered and prone to explode in aggressive outbursts they are also more likely to commit criminal acts.

Although very good at initiating social relationships attaining external validation and admiration due to their charm and charisma, individual with NPD are unable to connect at a deep level and struggle with closeness and intimacy. As a result, as they relationships grow closer and their antagonistic, arrogant,manipulative and often condescending orientation towards others become apparent. Inevitably, the validation they crave for becomes increasingly at risk, which may in turn, escalate a self-perpetuating spiral of validation seeking, often dramatic behaviours aiming to reaffirm control, prove that they right, that they know better and that their partner is wrong or incompetent. This leave those involved in narcissistic relationships feeling lonely, unimportant and often objectified which may lead them to either becoming angry, constantly trying to defend themselves, or severely depressed and anxious due to the identification with a negative self-image with a severe impact upon their physical and mental health.


It is very rare for individuals with severe narcissism to actively seek therapy due a lack of insight into their difficulties. In my clinical experience, when they do this, it is often for related disorder such as depression, alcohol and substance abuse, eating disorders and risk taking behaviour including suicide attempts or other self-harming behaviours.

Working with NPD pose major challenges, in that even when in distress narcissistic clients present as strongly ambivalent about treatment and often reluctant to engage in self–evaluation because this threatens to activate negative core beliefs.

Furthermore, working on self-awareness clashes with their acquired strategy of externalizing the source of distress which may cause getting “stuck” in therapy due to client’s impossible dilemma of wanting things to change but being unwilling to take any responsibility for it or to engage in meaningful actions to make this happen.

Sadly, any attempt to reflect upon this with the client carries the high risk of raising unhelpful power struggle and increase defensive resistance which typically result in high rates of early drops out. For less severe forms of NPD, once the therapeutic alliance is established, key target areas may include: improving goal-attainment and meaning of success; increase awareness of boundaries and the perspective of others; exploring believes about self-worth and emotions; experiential exercise can be used to explore self-aggrandizing beliefs and assumption and to develop a more compassionate, valued based alternative.


Finally, because it’s well established that Narcissism become increasingly more difficult to address as children move into adolescence and adulthood, due to personality traits becoming firmly established and the lack of insight. Early interventions at both individual and community level would appear represent a more effective way of addressing the increase of narcissism and self-absorption among young people in our society. Therapy can have a crucial role in providing parents with guidance and training on how to raise their children’s self-esteem while at the same time limiting their narcissism for example, by teaching them how to express affection and appreciation to their children without fueling a sense of superiority and addressing children’s early socialization practices enabling them to distinguish between different types of regard and their potential impact on child self- development.

THERAPISTS WHO treat Narcissistic Personality Disorders AT PRIVATE THERAPY CLINIC