Narcissistic Personality Disorder / ep51 show notes



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Put yourself first. I keep every episode as safe as I can, but just by the nature of the topics, you may experience some stuff come up. Take a break if you need to.


And these are my personal conceptualizations about how the PVT connects to the DSM. I’m not suggesting you think the same way. This is how I am viewing them in general. As a starting point.


This information is NOT meant to diagnose. If you feel like you may be experiencing symptoms of Narcissistic Personality Disorder, consult with a mental health or medical professional. We are speaking in generalities. Your specific situation, diagnosis, treatment and medication are entirely between you and your provider. So please don’t be trying to diagnose yourself or anyone else and listen to this from a place of learning or curiosity.




PERSONALITY DISORDERS

  • What sticks out to you in general? →


(Mayo Clinic) - A personality disorder is a type of mental disorder in which you have a rigid and unhealthy pattern of thinking, functioning and behaving. A person with a personality disorder has trouble perceiving and relating to situations and people. This causes significant problems and limitations in relationships, social activities, work and school.

In some cases, you may not realize that you have a personality disorder because your way of thinking and behaving seems natural to you. And you may blame others for the challenges you face.


CLUSTER B PERSONALITY DISORDERS

  • What sticks out to you in general? →

Cluster B personality disorders are characterized by dramatic, overly emotional or unpredictable thinking or behavior. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder


  • We are going to see some similarities in borderline and narcissistic

PERSONALITY FUNCTIONING CRITERIA


  • What sticks out to you in general? →


impairments in identity (experience of oneself as unique, stability of self‐esteem and capacity for and ability to regulate a range of emotional experience)


self‐direction (pursuit of coherent and meaningful goals, constructive and prosocial internal standards of behaviour and self‐reflection)


empathy (comprehension and appreciation of others' experiences and motivations, tolerance of differing perspectives and understanding the effects of one's own behaviour on others)


intimacy (depth and duration of connection with others, desire and capacity for closeness and mutuality of regard).


Obviously with the personality disorders, they’re not in a safe and social state.

Very dysregulated.


NARCISSISTIC PERSONALITY DISORDER of the DSM


The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose narcissistic personality disorder, the following criteria must be met:


(Pathological - any departure from what is considered healthy or adaptive. https://dictionary.apa.org/pathology)


A. Significant impairments in personality functioning manifest by:


1. Impairments in self functioning (a or b):


a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.


Is there an element of safety here?

  • No.

  • But there might be an intrinsic and biological urge to connect with others, like anyone. And this came up with Borderline - the urge to connect w/o the self to do so.


Is there an element of flight here?

  • Maybe. But I am not personally getting a strong sense of that.


Is there an element of fight here?

  • Maybe. And I’m feeling this one a bit more.


Is there an element of shutdown here?

  • I think so. Pretty strongly with the Identity Pathological Personality trait.

  • Whenever there is an issue in identity, I go to shutdown

  • Disconnect from the environment, from others, from the present moment and from the self

  • Numbness and dissociation may be part of someone’s shutdown


The present moment and the self

  • Again, we have to be in the present moment to be our true or truer self

  • Through tx, the client might look back and say “that wasn’t me.” and now that they are in the present moment, they are more fully their true self.

  • The narcissist is not their true self, they are what others define them as; they are not in their own body, they are very much in their thoughts and out of the present moment

  • Part of being in the present moment is to be within your body


Like borderline, the narcissistic person is using others

  • But it’s to define who they are - which may help them to regulate their sense of self-worth, to give themselves a new story and maintain the sympathetic energy, which prevents them from going into shutdown; the borderline used their connection with others to maintain their sympathetic energy and avoid shutdown

  • This is not an actual ventral vagal moment or actual co-regulation from another - this would require real connection and result in empathy, compassion, connection, calm and being in the present moment, which all lack for the narcissist

  • Probably more of an avenue for stuck freeze sympathetic energy or returning fight energy


For the borderline individual, the relationship or perceived connection with the other person was their avenue for the freeze energy, to regulate themselves and avoid the misery of rejection - the opposite of rejection was what they sought

  • For the narcissistic individual, the opinion or approval of the other person might be their avenue for regulation. Not connection with the other person, but opinion. Or maybe the other’s positive opinion of them brings them a distorted sense of connection, but the opinion or approval is sought, which is the opposite of the deflated self-esteem which comes from shutdown


Story follows state -

  • They are placing the intense freeze energy or returning fight energy into an exaggeration of the worth of the self (this is a sympathetic story)

  • Countered by the complete deflation of the worth of the self, with the absence of the energy (this is a shutdown story)

  • Parallels BPD with their judgment of the other person as all good or all bad, the narcissist is directing that energy inward

  • BPD is outward, narcissistic is inward


b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.


Is there safety here?

  • No.


Is there flight energy here?

  • I don’t think so.


Is there fight?

Yes


Goal-setting means there is some motivation and motivation requires sympathetic energy

  • Creating something like a business = self belief, energy, ability to tolerate the sympathetic activation along with risk - all from safety system along with fight sympathetic because we’re directing the energy toward something, not away from it

  • Remember, being in these defensive systems doesn’t mean we’re actually being defensive. It just means that circuitry is activated. But it’s activated along with the social engagement system. When the ventral vagal circuitry evolved, it sort of dampened the intensity of these defensive circuits, while also repurposing them when combined for pro-social interaction.

  • But this person lacks the safety system necessary for motivation and I think it turns into something else. That sympathetic, aggressive energy to get things done is used for the end of getting approval from others

  • Not for improving the lives of others

  • Not for providing for loved ones

  • But for admiration or approval

  • In the safety state, you don’t really need the admiration and approval of others

  • You can appreciate it, but it’s not the goal of using sympathetic energy


“Unaware of own motivations” corroborates this - not a conscious awareness of the thing they are after, which is the approval of others


Is there shutdown present here?

  • Not more than I have already said

  • Disconnect from the self and needing others to define the self


AND


2. Impairments in interpersonal functioning (a or b):


a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.


Empathy requires access to the safety and social engagement system

  • If we’re in danger, we’re not going to have empathy

  • This is a nervous system in a state of danger

  • Leading to “impaired ability to identify with the feelings and needs of others”


Excessively attuned to the reactions of others

  • Excessive attunement requires some energy; this is not attunement to the polyvagal state of another, matching their state

  • Could this be a shutdown to fight climb? Cutoff from the self is shutdown and the excessive needing reactions from others to affirm their existence or their worth is from fight?

  • Shutdown brings a big disconnection from the world; going up into the fight energy might be where the energy to excessively attune comes from

  • Doesn’t feel like flight and definitely not actual safety and social engagement

  • But this could also be an avenue for stuck freeze energy


Reactions of others if relevant to the self

  • Energy required to attune to the reactions is not guided by the social engagement system; is not safe and connected

  • The social interactions are very much directed toward the self and from the self

  • From relevance to the self and searching for reactions of others

  • This energy put into finding relevance to the self may be an avenue for staying out of a more disconnected and shutdown state...


If you take away the approval of others… what is this person left with?

  • Very lonely, disconnected, sad existence


b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others’ experiences and predominance of a need for personal gain


Superficial relationships/selfishness/little interest

  • No social engagement circuitry activated


Selfishness vs self-interest

  • Selfishness is benefit to the self at the expense of others

  • Self-interest is benefit to the self along with others or not at their expense

  • I give my time for interviews and editing and loads of stuff I am giving away. But I benefit from it also along with all of you, hopefully. I’m acting out of my self-interest and that’s okay, so are you… you’re listening and benefitting, but not at my expense. There’s a mutuality - the more I give, the more people listen, which increases the rankings of my podcast on the chart and maybe garners more attention for other things I want to line up. Even Steven.

  • My Polyvagal Patrons are acting out of their self-interest by giving $5/mo for my members’ content… we both win. I get the money for my efforts and they get more content for their $5… there’s benefit along with each other.


B. Pathological personality traits in the following domain:


1. Antagonism (this is the higher order structure with traits under it), characterized by:


“In two studies, antagonism was negatively associated with the ability to identify the emotional states of others.” -https://www.sciencedirect.com/science/article/abs/pii/S0092656618300461


a. Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others.


All about the self again

  • Entitlement is like something is owed to you even if it’s not

  • Self-centeredness is obviously all about the self

  • One is better than the other is about the self, inflated along with the energy of fight probably

  • Condescension probably comes from fight energy, there’s an aggression to it


Shutdown disconnect from the self

  • Inaccurate view of the self

  • Being better than others is not accurate; definitely no safety in there

  • We can be better or worse at some things or activities, like we can outperform or underperform each other

  • But none of us is inherently better than the other, we’re just mammals on the same planet, born without value


b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.


Is there safety here?

  • No.


Is there flight here?

  • No.


Is there fight here?

  • I think so. Wanting to seek out and get closer to the attention, not avoid or hide from it

  • The energy required in the “excessive attempts” is fight


Is there shutdown here?

  • Maybe, due to wanting to avoid it through the inflated sense of self that comes along with the attention in this trait


C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

  • It’s chronic, not obviously temporary


D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.


E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).


Polyvagal Patrons, let me know what you thought of this episode and the Member’s episode in the Patreon comments.


Where is the Freeze?

  • With the Borderline dx, I thought Freeze might be more underlying a lot of what we were seeing… but with narcissistic, I don’t get that same feel.

  • There were not any sx in the DSM criteria, that pertained to rage or panic, no overwhelm or frantic energy… it could still be there, but it also seems like someone could have this dx without that outward presentation.

  • Etiology suggests an over or under gratification of the desires and needs of a child, history of physical abuse, unpredictable or negligent parenting, being modeled manipulative bx from parents, which suggests some attachment issues to put it loosely… more of a chronic disruption of connectedness maybe C-PTSD than a forced immobilization shock trauma sort


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Mayo Clinic article - https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463

Personality Functioning Criteria - https://onlinelibrary.wiley.com/doi/full/10.1002/pmh.1434

Definition of “pathology” from APA - https://dictionary.apa.org/pathology


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