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What is Pathological Narcissism?

Pathological narcissism is frequently misunderstood and misdiagnosed in popular culture. The last decade has seen a significant shift in public consciousness about narcissism and narcissistic personality disorder, with more attention paid to the disorder and its impact on individuals and society.


Thought to develop in response to early and traumatic empathic failures by caregivers, individuals with pathological narcissism are heavily reliant on external validation to cope with desperate yearnings for admiration and approval, manage negative emotions, and control interpersonal behaviors. Increasingly recognized as a disorder that encompasses a broad spectrum of personality impairments beyond its stereotyped grandiosity, pathological narcissism includes dimensions of narcissistic vulnerability characterized by a brittle sense of self, emotional instability and reactivity, and impaired empathic functioning, coupled with excruciating feelings of shame and self-doubt, rage, envy, and loneliness. In a self-protective response, individuals employ maladaptive, self-enhancing, and self-serving strategies to bolster a view of themselves as exceptional and deflect recognition of their vulnerabilities. These expressions of narcissistic grandiosity impede meaningful relationships with others including the capacity for mutuality and reciprocity.  

The impact of untreated pathological narcissism on partners, family members, and children is significant. Through the projection and transmission of their intolerable feelings of inadequacy into others, narcissists perpetuate cycles of intergenerational trauma and cause devastating downstream social effects. This has led to a greater awareness of the need for mental health support and treatment for those affected by people with pathological narcissism. Treatment for those who have pathological narcissism is usually sought only after an acute personal or professional failure, loss, or crisis (e.g., excessive interpersonal conflict with family and/or employers, increasing feelings of dissatisfaction with one’s life, etc.). To date, the mainstay of treatment for pathological narcissism is individual psychotherapy – specifically, psychoanalytic treatment – which is usually long-term in nature.

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