Learn to identify, understand and deal with narcissistic personalities. Presented by Dr. Claudia Diez, PhD, ABPP, Jewish Community Center, New York, October 2010. Notes: video clips cannot be viewed in this mode

1. Narcissistic Personalities Identifying, understanding and relating to them Claudia Diez, PhD, ABPP Board Certified Specialist in Clinical PsychologySupervising PsychologistSt. Luke’s-Roosevelt Hospital Center Assistant Clinical Professor, Columbia University info@drclaudiadiez.comhttp://www.drclaudiadiez.com http://www.slrpsych.org

2. What is “Narcissism”? From Greek myth of Narcissus, a metaphor of self-absorption and inability to love A normal aspect of Personality self-care and self-esteem; assertiveness need to secure status for self-preservation (Hogan, 1982) Needed for self-sustainment Normal Narcissist: Competitive, Self-Assured, Bold Exists in a continuum: Normal Pathological Involves adaptive and maladaptive traits 2

3. Socio-Cultural Perspectives Lasch: The Culture of Narcissism (1979) Cultural criticism of contemporary American society as promoter of pathological narcissism Erosion in allegiance to community; condoned individuality Raskin: Narcissistic Personality Inventory (NPI, 1988) Identified seven aspects of narcissism Authority, Self-Sufficiency, Superiority Exhibitionism, Exploitiveness Vanity, Entitlement How Narcissistic am I? Quiz - NPI-40 3

4. Socio-cultural Perspectives “Generation Me” “Today’s young Americans are more confident, assertive, entitled.. . than ever before” (Twenge, 2006) Narcissism Epidemic? NPI-40 used to research trends in narcissism in America Findings: “rampant rise of narcissism” in our society Indictment of the “Self-esteem” movement of the 70’s propelled by California’s legislature "Self Esteem Task Force“ Met severe criticism, yet findings stand strong Other cultural expressions: Honor Codes/killings? 4

5. Organizational Psychology Narcissistic Leaders High Entitlement, Excessive Confidence, Fantasized Talent Focused on “getting ahead”, risks excessively, berates employees, pursues personal agendas “Emergent Leaders” (seek Self-Promotion) Not necessarily “Effective Leaders” Narcissism at the root of Managerial Derailment What about the followers? (Hogan, Robert, 2008) 5

6. Narcissism in organizations Gordon Gecko, “Wall Street” ‘If you want a friend, get a dog” Gordon Gecko to Bud Fox in “Wall Street” 6

7. Shut up, Listen and Learn! “Swimmingwith sharks”, Ch. “Sweet & low” 7

8. Pencils are more important “Swimmingwith sharks”, Ch. “you are nothing” 8

9. Narcissism as a Clinical Disorder Term coined in psychology in 1898 by H. Ellis Largely adopted by Freud and psychoanalysis Appears in the DSM-III(1) in 1980 “Personality Disorder” is: An inflexible, maladaptive, persisting pattern of behaviors Causing significant functional impairment (in the world) Or Causing significant distress (subjectively) (1) DSM: Diagnostic and Statistical Manual of Mental Disorders, now in its 4th Edition, TR (2000) 9

10. Narcissistic Personality Disorder DSM-IV TR Diagnostic Criteria Pervasive pattern of grandiosity, need for admiration, lack of empathy; beginning in adulthood, indicated by five (+) of the following: grandiose sense of self-importance fantasies of unlimited success, power, beauty, etc. believes he/she is "special" requires excessive admiration has a sense of entitlement is interpersonally exploitative lacks empathy is often envious, or believes that others are envious of him shows arrogant behaviors or attitudes 10

11. Hack it, or Pack it! The Great Santini, “failed score” 11 11

12. Narcissism as a Clinical Disorder Not all narcissists are created equal Shedler’s Typology (1) Grandiose/malignant Fragile High Functioning/Exhibitionistic Other distinctive features Emptiness, sense of “being false, fraudulent” (1) Shedler et al, 2008. Refining the Construct of Narcissistic Personality Disorder: Diagnostic Criteria and Subtypes; (Am J Psychiatry 2008; 165:1473–1481) 12

13. Faces of Pathological Narcissism Abusive Partners Rapists Celebrities Cult Leaders Con Artists Stalkers White Collar Criminals Gang Members Moderate Narcissism Overbearing/obnoxious /cruel parents, demanding or callous partners, inconsiderate coworkers, etc…. 13

14. Empathy, Shame, Envy Empathy inner capacity of sharing and comprehending the psychological state of another person Shame painful social emotion caused by the experience of feeling inferior or losing value in the estimation of others Envy painful social emotion caused by the thought of another person having something that one does not have oneself 14

15. Origins of Narcissism No known link to genetics Biological (neurophysiological paths) imprints in early childhood (1) Origins ascribed to early attachment and parenting, resulting in specific pattern of affect regulation (1) Schore, Allan (2009). Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development 15

16. Normal Human Development Parental Attunement Under normal circumstances, caregiver help child to handle intense or stressful affect Development of empathy Tolerance of shame “Monkey see, monkey do” (mirror neurons; mimicry) 16

17. Origins of Pathological Narcissism Unattuned Parents cannot model affect regulation Resulting in diminished capacity for empathy Child is in some way “Special” to the parent “Narcissistic children often occupy a pivotal point in the family structure, such as being ….the one that is supposed to fulfill family aspirations….” Child raised in overtly well-organized home, but with parent(s) present a degree of callousness and subtle aggression Child may have an inherent quality that arouses admiration or envy such as beauty, special talent, etc. ( I.e: Pageant Queen/Mother) Kernberg, 1984. Severe personality disorders. New Haven: Yale University Press 17

18. Paths to Pathological Narcissism 18

19. Narcissistic Cognitions Entitlement/Grandiosity Emotional Deprivation Defectiveness/Shame Subjugation /Control Approval Seeking Insufficient Self-Control Mistrust/Abuse Unrelenting Standards Underlying Assumptions (Schemas) Young, (1998). Schema-focused therapy for narcissistic patients. In E. Ronningstam (Ed.), Disorders of narcissism: Diagnostic, clinical and empirical implications 19

20. Extreme (Malignant) Narcissism Charles Manson 20

21. Pathological Narcissism: Origins Manson's mother was a promiscuous heavy drinker whospent years in prison for robbery. Manson was placed at reform schools and relatives while she was away. Manson did not know his biological father; his step-father was an alcoholic, abusive offender His mother’s physical embrace of him when she returned from prison was, he reported, his sole happy childhood memory 21

22. Children at Risk Children of Narcissistic Parents Abused Children Overindulged, Overpraised, Wealthy Children Adopted Children (chosen, yet abandoned) Kernberg, P. (1998). In E. F. Ronningstam (Ed.), Disorders of narcissism. Diagnostic, clinical, and empirical implications. Developmental aspects of normal and pathological narcissism 22

23. Course and Prognosis Room for improvement in certain cases As a result of significant losses/personal costs, or As a result of corrective emotional experiences (i.e., relationship, achievement) In severe cases, symptoms may worsen over time, (i.e., mid life crisis, aging parents) Narcissists do not typically seek help (as they do not find fault in themselves) Difficult to treat; may seek help because “mandated” by others 23

24. Is there a Narcissist in my life? Does the person act as if life revolves around him/her? Do I have to compliment him/her to get his attention or approval? Does he constantly steer the conversation back to himself? Does she downplay my feelings or interests? If I disagree, does he become cold, withholding or angry? Do I feel belittled, manipulated, or feel I can’t please him/her? If you answered “yes” to three or more questions, it is likely that this person’s narcissism is affecting your life Adapted from Judith Orloff’s “Emotional Freedom” (Three Rivers Press, 2011) 24

25. How to Relate to a Narcissist DO-NOTS Do not retaliate Do not shame, belittle, “pay back” Do not expect fairness or reciprocity Do not isolate from friends, other family Do not surrender to the narcissist’s attempts to control/disparage 25

27. Identify your “hot buttons” and your problematic responsesKnow your own worth, independently of his/her valuation Cultivate reciprocal, satisfying relationships Be empathic, respectful, fair Be mindful of his/her sensitivity to shame/humilliation Practice self-control and patience Use non-confrontational limit-setting 26 26

28. How to Relate to a Narcissist DO(s) Set boundaries Re-engineer the terms of the interactions What you can do, what you won’t Reinforce positive behavior (i.e., kindness, attentiveness) Avoid criticism; Try to understand his/her mind frame Agree with acceptable part of his/her statements, and add: “I wonder if…”, “how about…” “this could be of benefit for you” Discourage negative behaviors (belittling, dominance) 27 27

29. How to Relate to a Narcissist DO(s) Consider the costs (risk/benefit analysis) of staying in the relationship Assess damages/severity of behaviors If risk/damage is high, consider an exit plan Avoid/Minimize contact Seek external help Build a support network Be mindful of characteristic feelings of shame/guilt 28 28

30. Recommended Readings Ronningstan, E. Hotchkiss, S Behary, W. Twenge, J. 29

31. More suggested readings Neurobiology of Empathy ; Attachment Theory Mirror neurons and the brain in the vat. ByV.S. Ramachandran, 1/10/2006 The mind’s mirror.(on mirror neurons and its relation to empathy) By L. Winerman, Monitor Staff, 10/2005, Vol 36, No. 9. American Psychological Association Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation and Infant Mental Health. A. N. Schore, in Infant Mental Health Journal 22, 1-2 (2001): 7-66 Narcissism in organizations and leadership Leadership. By Hogan and Fico, 2009. Chapter to appear in W. K. Campbell & J. Miller (Eds.) The handbook of narcissism and narcissistic personality disorder. New York: Wiley, in press. Cultural Aspects What the Experts Are Saying Now . By K. Hymowitz, 8/25/2009,. A Review of the “self-esteem movement” as per new book, “Nurture Shock” by Po Bronson & Ashley Merryman Best Weapons against Honor Killers: Shame.By Kwame A. Appiah. 9/25/2010. On the customs of honor codes (dueling, honor killings) and public dishonor. Listen to him also in “Talk of the Nation”, NPR 30

32. CONTACT INFORMATION Claudia Diez, PhD, ABPP info@drclaudiadiez.com For more information visit us at http://www.drclaudiadiez.comhttp://www.slrpsych.org