Tag: NPD: Narcissistic Personality Disorder

What is Cognitive Distortion?

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Introduction

A cognitive distortion is an exaggerated or irrational thought pattern involved in the onset or perpetuation of psychopathological states, such as depression and anxiety.

Cognitive distortions are thoughts that cause individuals to perceive reality inaccurately. According to Aaron Beck’s cognitive model, a negative outlook on reality, sometimes called negative schemas (or schemata), is a factor in symptoms of emotional dysfunction and poorer subjective well-being. Specifically, negative thinking patterns reinforce negative emotions and thoughts. During difficult circumstances, these distorted thoughts can contribute to an overall negative outlook on the world and a depressive or anxious mental state. According to hopelessness theory and Beck’s theory, the meaning or interpretation that people give to their experience importantly influences whether they will become depressed and whether they will suffer severe, repeated, or long-duration episodes of depression.

Challenging and changing cognitive distortions is a key element of cognitive behavioural therapy (CBT).

Brief History

In 1957, American psychologist Albert Ellis, though he did not know it yet, would aid cognitive therapy in correcting cognitive distortions and indirectly helping David D. Burns in writing The Feeling Good Handbook. Ellis created what he called the ABC Technique of rational beliefs. The ABC stands for the activating event, beliefs that are irrational, and the consequences that come from the belief. Ellis wanted to prove that the activating event is not what caused the emotional behaviour or the consequences, but the beliefs and how the person irrationally perceive the events that aids the consequences. With this model, Ellis attempted to use rational emotive behaviour therapy (REBT) with his patients, in order to help them “reframe” or reinterpret the experience in a more rational manner. In this model Ellis explains it all for his clients, while Beck helps his clients figure this out on their own. Beck first started to notice these automatic distorted thought processes when practicing psychoanalysis, while his patients followed the rule of saying anything that comes to mind. Aaron realized that his patients had irrational fears, thoughts, and perceptions that were automatic. Beck began noticing his automatic thought processes that he knew his patients had but did not report. Most of the time the thoughts were biased against themselves and very erroneous.

Beck believed that the negative schemas developed and manifested themselves in the perspective and behaviour. The distorted thought processes lead to focusing on degrading the self, amplifying minor external setbacks, experiencing other’s harmless comments as ill-intended, while simultaneously seeing self as inferior. Inevitably cognitions are reflected in their behaviour with a reduced desire to care for oneself, to seek pleasure, and give up. These exaggerated perceptions, due to cognition, feel real and accurate because the schemas, after being reinforced through the behaviour, tend to become automatic and do not allow time for reflection. This cycle is also known as Beck’s cognitive triad, focused on the theory that the person’s negative schema applied to the self, the future, and the environment.

In 1972, psychiatrist, psychoanalyst, and cognitive therapy scholar Aaron T. Beck published Depression: Causes and Treatment. He was dissatisfied with the conventional Freudian treatment of depression, because there was no empirical evidence for the success of Freudian psychoanalysis. Beck’s book provided a comprehensive and empirically-supported theoretical model for depression – its potential causes, symptoms, and treatments. In Chapter 2, titled “Symptomatology of Depression”, he described “cognitive manifestations” of depression, including low self-evaluation, negative expectations, self-blame and self-criticism, indecisiveness, and distortion of the body image.

Beck’s student David D. Burns continued research on the topic. In his book Feeling Good: The New Mood Therapy, Burns described personal and professional anecdotes related to cognitive distortions and their elimination. When Burns published Feeling Good: The New Mood Therapy, it made Beck’s approach to distorted thinking widely known and popularised. Burns sold over four million copies of the book in the United States alone. It was a book commonly “prescribed” for patients who have cognitive distortions that have led to depression. Beck approved of the book, saying that it would help others alter their depressed moods by simplifying the extensive study and research that had taken place since shortly after Beck had started as a student and practitioner of psychoanalytic psychiatry. Nine years later, The Feeling Good Handbook was published, which was also built on Beck’s work and includes a list of ten specific cognitive distortions that will be discussed throughout this article.

Definition

Cognitive comes from the Medieval Latin cognitīvus, equivalent to Latin cognit(us), ‘known’. Distortion means the act of twisting or altering something out of its true, natural, or original state.

Main Types

John C. Gibbs and Granville Bud Potter propose four categories for cognitive distortions:

  • Self-centred;
  • Blaming others;
  • Minimising-mislabelling; and
  • Assuming the worst.

The cognitive distortions listed below are categories of automatic thinking, and are to be distinguished from logical fallacies.

All-or-Nothing Thinking

Refer to Splitting (Psychology).

The “all-or-nothing thinking distortion” is also referred to as “splitting,” “black-and-white thinking,” and “polarised thinking.” Someone with the all-or-nothing thinking distortion looks at life in black and white categories. Either they are a success or a failure; either they are good or bad; there is no in-between. According to one article, “Because there is always someone who is willing to criticise, this tends to collapse into a tendency for polarized people to view themselves as a total failure. Polarized thinkers have difficulty with the notion of being ‘good enough’ or a partial success.”

  • Example (from The Feeling Good Handbook): A woman eats a spoonful of ice cream. She thinks she is a complete failure for breaking her diet. She becomes so depressed that she ends up eating the whole quart of ice cream.

This example captures the polarised nature of this distortion – the person believes they are totally inadequate if they fall short of perfection. In order to combat this distortion, Burns suggests thinking of the world in terms of shades of gray. Rather than viewing herself as a complete failure for eating a spoonful of ice cream, the woman in the example could still recognise her overall effort to diet as at least a partial success.

This distortion is commonly found in perfectionists.

Jumping to conclusions

Reaching preliminary conclusions (usually negative) with little (if any) evidence. Two specific subtypes are identified:

  • Mind reading:
    • Inferring a person’s possible or probable (usually negative) thoughts from their behaviour and nonverbal communication; taking precautions against the worst suspected case without asking the person.
      • Example 1: A student assumes that the readers of their paper have already made up their minds concerning its topic, and, therefore, writing the paper is a pointless exercise.
      • Example 2: Kevin assumes that because he sits alone at lunch, everyone else must think he is a loser. (This can encourage self-fulfilling prophecy; Kevin may not initiate social contact because of his fear that those around him already perceive him negatively).
  • Fortune-telling:
    • Predicting outcomes (usually negative) of events.
      • Example: A depressed person tells themselves they will never improve; they will continue to be depressed for their whole life.
    • One way to combat this distortion is to ask, “If this is true, does it say more about me or them?”

Emotional Reasoning

In the emotional reasoning distortion, it is assumed that feelings expose the true nature of things and experience reality as a reflection of emotionally linked thoughts; something is believed true solely based on a feeling.

  • Examples: “I feel stupid, therefore I must be stupid”. Feeling fear of flying in planes, and then concluding that planes must be a dangerous way to travel. Feeling overwhelmed by the prospect of cleaning one’s house, therefore concluding that it is hopeless to even start cleaning.

Should/Should Not and Must/Must Not Statements

Making “must” or “should” statements was included by Albert Ellis in his rational emotive behaviour therapy (REBT), an early form of CBT; he termed it “musturbation”. Michael C. Graham called it “expecting the world to be different than it is”. It can be seen as demanding particular achievements or behaviours regardless of the realistic circumstances of the situation.

  • Example: After a performance, a concert pianist believes he or she should not have made so many mistakes.
  • In Feeling Good: The New Mood Therapy, David Burns clearly distinguished between pathological “should statements”, moral imperatives, and social norms.

A related cognitive distortion, also present in Ellis’ REBT, is a tendency to “awfulise”; to say a future scenario will be awful, rather than to realistically appraise the various negative and positive characteristics of that scenario. According to Burns, “must” and “should” statements are negative because they cause the person to feel guilty and upset at themselves. Some people also direct this distortion at other people, which can cause feelings of anger and frustration when that other person does not do what they should have done. He also mentions how this type of thinking can lead to rebellious thoughts. In other words, trying to whip oneself into doing something with “shoulds” may cause one to desire just the opposite.

Gratitude Traps

A gratitude trap is a type of cognitive distortion that typically arises from misunderstandings regarding the nature or practice of gratitude. The term can refer to one of two related but distinct thought patterns:

  • A self-oriented thought process involving feelings of guilt, shame, or frustration related to one’s expectations of how things “should” be.
  • An “elusive ugliness in many relationships, a deceptive ‘kindness,’ the main purpose of which is to make others feel indebted,” as defined by psychologist Ellen Kenner.

Blaming Others

Personalisation and Blaming

Personalisation is assigning personal blame disproportionate to the level of control a person realistically has in a given situation.

  • Example 1: A foster child assumes that he/she has not been adopted because he/she is not “loveable enough.”
  • Example 2: A child has bad grades. His/her mother believes it is because she is not a good enough parent.

Blaming is the opposite of personalisation. In the blaming distortion, the disproportionate level of blame is placed upon other people, rather than oneself. In this way, the person avoids taking personal responsibility, making way for a “victim mentality.”

  • Example: Placing blame for marital problems entirely on one’s spouse.

Always Being Right

In this cognitive distortion, being wrong is unthinkable. This distortion is characterised by actively trying to prove one’s actions or thoughts to be correct, and sometimes prioritising self-interest over the feelings of another person. In this cognitive distortion, the facts that oneself has about their surroundings are always right while other people’s opinions and perspectives are wrongly seen.

Fallacy of Change

Relying on social control to obtain cooperative actions from another person. The underlying assumption of this thinking style is that one’s happiness depends on the actions of others. The fallacy of change also assumes that other people should change to suit one’s own interests automatically and/or that it is fair to pressure them to change. It may be present in most abusive relationships in which partners’ “visions” of each other are tied into the belief that happiness, love, trust, and perfection would just occur once they or the other person change aspects of their beings.

Minimising-Mislabelling

Magnification and Minimisation

Giving proportionally greater weight to a perceived failure, weakness or threat, or lesser weight to a perceived success, strength or opportunity, so that the weight differs from that assigned by others, such as “making a mountain out of a molehill”. In depressed clients, often the positive characteristics of other people are exaggerated and their negative characteristics are understated.

  • Catastrophising – Giving greater weight to the worst possible outcome, however unlikely, or experiencing a situation as unbearable or impossible when it is just uncomfortable.

Labelling and Mislabelling

A form of overgeneralisation; attributing a person’s actions to their character instead of to an attribute. Rather than assuming the behaviour to be accidental or otherwise extrinsic, one assigns a label to someone or something that is based on the inferred character of that person or thing.

Assuming the Worst

Overgeneralising

Someone who overgeneralises makes faulty generalisations from insufficient evidence. Such as seeing a “single negative event” as a “never-ending pattern of defeat,” and as such drawing a very broad conclusion from a single incident or a single piece of evidence. Even if something bad happens only once, it is expected to happen over and over again.

  • Example 1: A young woman is asked out on a first date, but not a second one. She is distraught as she tells her friend, “This always happens to me! I’ll never find love!”
  • Example 2: A woman is lonely and often spends most of her time at home. Her friends sometimes ask her to dinner and to meet new people. She feels it is useless to even try. No one really could like her. And anyway, all people are the same; petty and selfish.

One suggestion to combat this distortion is to “examine the evidence” by performing an accurate analysis of one’s situation. This aids in avoiding exaggerating one’s circumstances.

Disqualifying the Positive

Disqualifying the positive refers to rejecting positive experiences by insisting they “don’t count” for some reason or other. Negative belief is maintained despite contradiction by everyday experiences. Disqualifying the positive may be the most common fallacy in the cognitive distortion range; it is often analysed with “always being right”, a type of distortion where a person is in an all-or-nothing self-judgment. People in this situation show signs of depression. Examples include:

  • “I will never be as good as Jane”.
  • “Anyone could have done as well”.
  • “They are just congratulating me to be nice”.

Mental Filtering

Filtering distortions occur when an individual dwells only on the negative details of a situation and filters out the positive aspects.

  • Example: Andy gets mostly compliments and positive feedback about a presentation he has done at work, but he also has received a small piece of criticism. For several days following his presentation, Andy dwells on this one negative reaction, forgetting all of the positive reactions that he had also been given.

The Feeling Good Handbook notes that filtering is like a “drop of ink that discolours a beaker of water.” One suggestion to combat filtering is a cost–benefit analysis. A person with this distortion may find it helpful to sit down and assess whether filtering out the positive and focusing on the negative is helping or hurting them in the long run.

Conceptualisation

In a series of publications, philosopher Paul Franceschi has proposed a unified conceptual framework for cognitive distortions designed to clarify their relationships and define new ones. This conceptual framework is based on three notions:

  1. The reference class (a set of phenomena or objects, e.g. events in the patient’s life);
  2. Dualities (positive/negative, qualitative/quantitative, …); and
  3. The taxon system (degrees allowing to attribute properties according to a given duality to the elements of a reference class).

In this model, “dichotomous reasoning”, “minimisation”, “maximisation” and “arbitrary focus” constitute general cognitive distortions (applying to any duality), whereas “disqualification of the positive” and “catastrophism” are specific cognitive distortions, applying to the positive/negative duality. This conceptual framework posits two additional cognitive distortion classifications: the “omission of the neutral” and the “requalification in the other pole”.

Cognitive Restructuring

Cognitive restructuring (CR) is a popular form of therapy used to identify and reject maladaptive cognitive distortions, and is typically used with individuals diagnosed with depression. In CR, the therapist and client first examine a stressful event or situation reported by the client. For example, a depressed male college student who experiences difficulty in dating might believe that his “worthlessness” causes women to reject him. Together, therapist and client might then create a more realistic cognition, e.g. “It is within my control to ask girls on dates. However, even though there are some things I can do to influence their decisions, whether or not they say yes is largely out of my control. Thus, I am not responsible if they decline my invitation.” CR therapies are designed to eliminate “automatic thoughts” that include clients’ dysfunctional or negative views. According to Beck, doing so reduces feelings of worthlessness, anxiety, and anhedonia that are symptomatic of several forms of mental illness. CR is the main component of Beck’s and Burns’s CBT.

Narcissistic Defence

Refer to Narcissistic Defences.

Those diagnosed with narcissistic personality disorder tend, unrealistically, to view themselves as superior, overemphasizing their strengths and understating their weaknesses. Narcissists use exaggeration and minimisation this way to shield themselves against psychological pain.

Decatastrophising

In cognitive therapy, decatastrophising or decatastrophisation is a cognitive restructuring technique that may be used to treat cognitive distortions, such as magnification and catastrophising, commonly seen in psychological disorders like anxiety and psychosis. Major features of these disorders are the subjective report of being overwhelmed by life circumstances and the incapability of affecting them.

The goal of CR is to help the client change their perceptions to render the felt experience as less significant.

Criticism

Common criticisms of the diagnosis of cognitive distortion relate to epistemology and the theoretical basis. If the perceptions of the patient differ from those of the therapist, it may not be because of intellectual malfunctions but because the patient has different experiences. In some cases, depressed subjects appear to be “sadder but wiser”.

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What is Narcissistic Mortification?

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Introduction

Narcissistic mortification is “the primitive terror of self dissolution, triggered by the sudden exposure of one’s sense of a defective self … it is death by embarrassment”.

Narcissistic mortification is a term first used by Sigmund Freud in his last book, Moses and Monotheism, with respect to early injuries to the ego/self. The concept has been widely employed in ego psychology and also contributed to the roots of self psychology.

When narcissistic mortification is experienced for the first time, it may be defined as a sudden loss of control over external or internal reality, or both. This produces strong emotions of terror while at the same time narcissistic libido (also known as ego-libido) or destrudo is built up. Narcissistic libido or ego-libido is the concentration of libido on the self. Destrudo is the opposite of libido and is the impulse to destroy oneself and everything associated with oneself.

Early Developments: Bergler, Anna Freud, and Eidelberg

Edmund Bergler developed the concept of narcissistic mortification in connection with early fantasies of omnipotence in the developing child, and with the fury provoked by the confrontations with reality that undermine his or her illusions. For Bergler, “the narcissistic mortification suffered in this very early period continues to act as a stimulus throughout his life”.

Anna Freud used the term in connection with her exploration of the defence mechanism of altruistic surrender, whereby an individual lives only through the lives of others – seeing at the root of such an abrogation of one’s own life an early experience of narcissistic mortification at a disappointment with one’s self.

Psychoanalyst and author Ludwig Eidelberg subsequently expanded on the concept in the fifties and sixties. Eidelberg defined narcissistic mortification as occurring when “a sudden loss of control over external or internal reality…produces the painful emotional experience of terror”. He also stressed that for many patients simply to have to accept themselves as having neurotic symptoms was itself a source of narcissistic mortification.

Kohut and Self Psychology

For Heinz Kohut, narcissistic injury – the root cause of what he termed narcissistic personality disorder – was broadly equivalent to the humiliation of mortification. Kohut considered that “if the grandiosity of the narcissistic self has been insufficiently modified…then the adult ego will tend to vacillate between an irrational overestimation of the self and feelings of inferiority and will react with narcissistic mortification to the thwarting of its ambitions”.

Object Relations Theory

Unlike ego psychologists, object relations theorists have traditionally used a rather different, post-Kleinian vocabulary to describe the early woundings of narcissistic mortification. Recently however such theorists have found analogies between Freud’s emphasis on the sensitivity of the ego to narcissistic humiliation and mortification, and the views of Bion on ‘nameless dread’ or Winnicott’s on the original agonies of the breakdown of childhood consciousness. At the same time ego psychologists have been increasingly prepared to see narcissistic mortification as occurring in the context of early relations to objects.

Physical Sensations and Psychological Perceptions

An individual’s experience of mortification may be accompanied by both physical and psychological sensations. Physical sensations such as: burning, painful tingling over the body, pain in the chest that slowly expands and spreads throughout the torso, dizziness, nausea, vomiting, sweating, blanching, coldness and numbness can be experienced by the individual suffering from mortification. The psychological sensations described are feeling shocked, exposed, and humiliated. Descriptions of this experience can be, for example: “It feels like I won’t survive” and “I have the absolute conviction that he or she hates me and it’s my fault”. These sensations are always followed by shock, although they may have happened on various occasions, they also prompt the need for the individual suffering to do something both internally and externally, to effect a positive self-image in the eyes of their narcissistic object. Narcissistic mortification is extreme in its intensity, global nature, and its lack of perspective, causing the anxiety associated with it to become traumatic.

Normal versus Pathological

In Eidelberg’s view, a normal individual would usually be able to avoid being overwhelmed by internal needs because they recognise these urges in time to bring about their partial discharge. However, Eidelberg does not view occasional outbursts of temper as a sign of disorder. An individual experiencing pathological narcissistic mortification is prone to become fixated on infantile objects, resulting in an infantile form of discharge. He or she cannot be satisfied by the partial discharge of this energy, which takes place on an unconscious level, and this in turn interferes with their well-being. According to Eidelberg, the denial of an infantile narcissistic mortification can be responsible for many defensive mechanisms.

Internal versus External

Narcissistic mortification can be:

InternalOccurs when an individual is overstimulated by their emotions. For example, while debating with classmates on the importance of stem cell research an outspoken student loses his temper causing an uproar. The student has just exhibited an overstimulation of his emotions and used this outburst to relieve internal tension.
ExternalOccurs when something out of one’s control influences a situation, for example, an individual who is held at gunpoint while having their wallet stolen. This individual does not hold any control over the scenario nor the actions of the gunman, but their reaction to being held at gunpoint influences the next scenario and what the gunman does next.

In Cult Leadership

To escape the narcissistic mortification of accepting their own dependency needs, cult leaders may resort to delusions of omnipotence. Their continuing shame and underlying guilt, and their repudiation of dependency, obliges such leaders to use seduction and manic defences to externalise and locate dependency needs in others, thus making their followers controllable through a displaced sense of shame.

Death, Anxiety, and Suicide

Because in Western culture death is sometimes seen as the ultimate loss of control, fear of it may produce death anxiety in the form of a sense of extreme shame or narcissistic mortification. The shame in this context is produced by the loss of stoicism, productivity, and control, aspects that are highly valued by society and aspects that are taken away as one ages. Death according to Darcy Harris:

‘is the ultimate narcissistic wound, bringing about not just the annihilation of self, but the annihilation of one’s entire existence, resulting in a form of existential shame for human beings, who possess the ability to ponder this dilemma with their higher functioning cognitive abilities.’

Individuals who hold this anxiety are ashamed of mortality and the frailty that comes along with it; and may attempt to overcome this reality through diversions and accomplishments, deflecting feelings of inferiority and shame through strategies like grandiosity in similar fashion to those with narcissistic personality traits.

Narcissistic mortification may also be produced by death of someone close. Such a loss of an essential object may even lead through narcissistic mortification to suicide.

Among the many motives behind suicidal activities in general are shame, loss of honour, and narcissistic mortification. Those who suffer from narcissistic mortification are more likely to participate in suicidal behaviours and those who do not receive the proper help more often than not succeed. Suicide related to narcissistic mortification is different from normal sorrow in that it is associated with deep rooted self-contempt and self-hatred.

Treatment

According to a paper presented by Mary Libbey, “On Narcissistic Mortification”, presented at the 2006 Shame Symposium, long-term goal of psychoanalytic treatment for those who suffer from narcissistic mortification is to transform the mortification into shame. She says by transforming it into shame it enables the sufferer to tolerate and use it as a signal; the process of transforming mortification into shame entails working through both the early mortifying traumas as well as the defences, often unstable, related to them. If an individual sufferer does not go through this transformation, he or she is left with two unstable narcissistic defences. Libbey says these defences are: self-damning, deflated states designed to appease and hold on to self-objects, and narcissistic conceit, which is designed to project the defective self experiences onto self-objects. Both of these defensive styles require a continuation of dependence on the self-object. Transforming the mortification into shame makes it possible for self-appraisal and self-tolerance, this ultimately leads to psychic separation and self-reliance without the need to sustain one’s mortification, according to Libbey’s paper.

In the 21st Century

Postmodern Freudians link narcissistic mortification to Winnicott’s theory of primitive mental states which lack the capacity for symbolisation, and their need for re-integration. Returning in the transference to the intolerable mortification underpinning such narcissistic defences can however also produce positive analytic change, by way of the (albeit mortifying) re-experience of overwhelming object loss within an intersubjective holding environment.

21st century American analysts are particularly concerned with the potential production of narcissistic mortification as a by-product of analytic interpretation, especially with regard to masochistic personality disorder.

Literary Uses

  • Narcissistic mortification at injuries to self-esteem has been seen as pervading Captain Ahab’s motivations in his confrontation with Moby-Dick.
  • Mortification at one’s self is seen in Mary Shelley’s Frankenstein when the Creature stares at his reflection in a pool of water. This is where he becomes convinced that he is in fact the Creature and becomes filled with despondence and mortification.

What are Narcissistic Defences?

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Introduction

Narcissistic defences are those processes whereby the idealised aspects of the self are preserved, and its limitations denied.

They tend to be rigid and totallistic. They are often driven by feelings of shame and guilt, conscious or unconscious.

Origins

Narcissistic defences are among the earliest defence mechanisms to emerge, and include denial, distortion, and projection. Splitting is another defence mechanism prevalent among individuals with narcissistic personality disorder, borderline personality disorder, and antisocial personality disorder – seeing people and situations in black and white terms, either as all bad or all good.

A narcissistic defence, with the disorder’s typical over-valuation of the self, can appear at any stage of development.

Defence Sequences

The narcissist typically runs through a sequence of defences to discharge painful feelings until he or she finds one that works:

  • Unconscious repression.
  • Conscious denial.
  • Distortion (including exaggeration and minimisation), rationalisation and lies.
  • Psychological projection (blaming somebody else).
  • Enlisting the help of one or more of their co-dependent friends who will support their distorted view.

Freudians

Sigmund Freud did not focus specifically on narcissistic defences, but did note in On Narcissism how “even great criminals and humorists, as they are represented in literature, compel our interest by the narcissistic consistency with which they manage to keep away from their ego anything that would diminish it”. Freud saw narcissistic regression as a defensive answer to object loss – denying the loss of an important object by way of a substitutive identification with it.

Freud also considered social narcissism as a defence mechanism, apparent when communal identifications produce irrational panics at perceived threats to ‘Throne and Altar’ or ‘Free Markets’, or in English over-reaction to any questioning of the status and identity of William Shakespeare.

Fenichel

Otto Fenichel considered that “identification, performed by means of introjection, is the most primitive form of relationship to objects” a primitive mechanism only used “if the ego’s function of reality testing is severely damaged by a narcissistic regression.”

Fenichel also highlighted “eccentrics who have more or less succeeded in regaining the security of primary narcissism and who feel ‘Nothing can happen to me’….[failing] to give up the archaic stages of repudiating displeasure and to turn toward reality”.

Lacan

Jacques Lacan, following out Freud’s view of the ego as the result of identifications, came to consider the ego itself as a narcissistic defence, driven by what he called “the ‘narcissistic passion’ …in the coming-into-being (devenir) of the subject”.

Kleinians

Melanie Klein, emphasised projective identification in narcissism, and the manic defence against becoming aware of the damage done to objects in this way. For Kleinians, at the core of manic defences in narcissism stood what Hanna Segal called “a triad of feelings—control, triumph and contempt”.

Rosenfeld

Herbert Rosenfeld looked at the role of omnipotence, combined with projective identification, as a narcissistic means of defending against awareness of separation between ego and object.

Object Relations Theory

In the wake of Klein, object relations theory, including particularly the American schools of Otto Kernberg and Heinz Kohut has explored narcissistic defences through analysis of such mechanisms as denial, projective identification, and extreme idealisation.

Kernberg emphasised the role of the splitting apart introjections, and identifications of opposing qualities, as a cause of ego weakness. Kohut too stressed the fact in narcissism “vertical splits are between self-structures (among others)—’I am grand’ and ‘I am wretched’—with very little communication between them”.

Neville Symington however placed greater weight on the way “a person dominated by narcissistic currents…survives through being able to sense the emotional tone of the other…wearing the cloaks of others”; while for Spotnitz the key element is that the narcissist turns feelings in upon the self in narcissistic defence.

Positive Defences

Kernberg emphasised the positive side to narcissistic defences, while Kohut also stressed the necessity in early life for narcissistic positions to succeed each other in orderly maturational sequences.

Others like Symington would maintain that “it is a mistake to split narcissism into positive and negative…we do not get positive narcissism without self-hatred”.

Stigmatising Attitude to Psychiatric Illness

Arikan found that a stigmatising attitude to psychiatric patients is associated with narcissistic defences.

21st century

The twenty-first century has seen a distinction drawn between cerebral and somatic narcissists – the former building up their self-sense through intellectualism, the latter through an obsession with their bodies, as with the woman who, in bad faith, invests her sense of freedom only in being an object of beauty for others.

Literary Parallels

  • Sir Philip Sidney is said to have seen poetry in itself as a narcissistic defence.
  • Jean-Paul Sartre’s aloof, detached protagonists have been seen as crude narcissists who preserve their sense of self only by petrifying it into solid form.

What is Decompensation (Psychology)?

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Introduction

In medicine, decompensation is the functional deterioration of a structure or system that had been previously working with the help of allostatic compensation.

Background

Decompensation may occur due to fatigue, stress, illness, or old age. When a system is “compensated,” it is able to function despite stressors or defects. Decompensation describes an inability to compensate for these deficiencies. It is a general term commonly used in medicine to describe a variety of situations.

Physiology

For example, cardiac decompensation may refer to the failure of the heart to maintain adequate blood circulation, after long-standing (previously compensated) vascular disease (see heart failure). Short-term treatment of cardiac decompensation can be achieved through administration of dobutamine, resulting in an increase in heart contractility via an inotropic effect.

Kidney failure can also occur following a slow degradation of kidney function due to an underlying untreated illness; the symptoms of the latter can then become much more severe due to the lack of efficient compensation by the kidney.

Psychology

In psychology, the term refers to an individual’s loss of healthy defence mechanisms in response to stress, resulting in personality disturbance or psychological imbalance. Some who suffer from narcissistic personality disorder or borderline personality disorder may decompensate into persecutory delusions to defend against a troubling reality.

What is Malignant Narcissism?

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Introduction

Malignant narcissism is a psychological syndrome comprising an extreme mix of narcissism, antisocial behaviour, aggression, and sadism.

Grandiose, and always ready to raise hostility levels, the malignant narcissist undermines families and organisations in which they are involved, and dehumanises the people with whom they associate.

Malignant narcissism is a hypothetical, experimental diagnostic category. Narcissistic personality disorder (NPD) is found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), while malignant narcissism is not. As a hypothetical syndrome, malignant narcissism could include aspects of NPD alongside a mix of antisocial, paranoid and sadistic personality disorder traits. The importance of malignant narcissism and of projection as a defence mechanism has been confirmed in paranoia, as well as “the patient’s vulnerability to malignant narcissistic regression”.

Brief History

The social psychologist Erich Fromm first coined the term “malignant narcissism” in 1964, describing it as a “severe mental sickness” representing “the quintessence of evil”. He characterised the condition as “the most severe pathology and the root of the most vicious destructiveness and inhumanity”. Edith Weigert (1967) saw malignant narcissism as a “regressive escape from frustration by distortion and denial of reality”, while Herbert Rosenfeld (1971) described it as “a disturbing form of narcissistic personality where grandiosity is built around aggression and the destructive aspects of the self become idealized.”

On 11 May 1968, psychoanalyst Otto Kernberg presented his paper Factors in the Psychoanalytic Treatment of Narcissistic Personalities, from the work of the Psychotherapy Research Project of The Menninger Foundation, at the 55th Annual Meeting of the American Psychoanalytic Association in Boston. Kernberg’s paper was first published in hard copy on 01 January 1970. In Kernberg’s 1968 paper, first published in 1970 in the Journal of the American Psychoanalytic Association (JAPA), the word ‘malignant’ does not appear once, while ‘pathological’ or ‘pathologically’ appears 25 times.

Developing these ideas further, Kernberg pointed out that the antisocial personality was fundamentally narcissistic and without morality. Malignant narcissism includes a sadistic element creating, in essence, a sadistic psychopath. In his article, “malignant narcissism” and psychopathy are employed interchangeably. Kernberg first proposed malignant narcissism as a psychiatric diagnosis in 1984. So far it has not been accepted in any of the medical manuals, such as the ICD-10 or the DSM-5.

Kernberg described malignant narcissism as a syndrome characterised by a NPD, antisocial features, paranoid traits, and egosyntonic aggression. Other symptoms may include an absence of conscience, a psychological need for power, and a sense of importance (grandiosity). Psychoanalyst George H. Pollock wrote in 1978: “The malignant narcissist is presented as pathologically grandiose, lacking in conscience and behavioral regulation with characteristic demonstrations of joyful cruelty and sadism”. Of note, M. Scott Peck uses malignant narcissism as a way to explain evil.

Kernberg believed that malignant narcissism should be considered part of a spectrum of pathological narcissism, which he saw as ranging from Hervey M. Cleckley’s antisocial character (what is now referred to as psychopathy or antisocial personality) at the high end of severity, through malignant narcissism, and then to narcissistic personality disorder at the low end. So according to Kernberg’s hierarchy, psychopathy trumps malignant narcissism as a more extreme form of pathological narcissism. Malignant narcissism can be distinguished from psychopathy, according to Kernberg, because of the malignant narcissist’s capacity to internalise “both aggressive and idealized superego precursors, leading to the idealization of the aggressive, sadistic features of the pathological grandiose self of these patients”.

According to Kernberg, the psychopath’s paranoid stance against external influences makes him or her unwilling to internalise even the values of the “aggressor”, while malignant narcissists “have the capacity to admire powerful people, and can depend on sadistic and powerful but reliable parental images”. Malignant narcissists, in contrast to psychopaths, are also said to be capable of developing:

“some identification with other powerful idealized figures as part of a cohesive ‘gang’…which permits at least some loyalty and good object relations to be internalized… Some of them may present rationalized antisocial behavior – for example, as leaders of sadistic gangs or terrorist groups…with the capacity for loyalty to their own comrades.”

Psychopathy

The terms malignant narcissist and psychopath are sometimes used interchangeably because there is little to clinically separate the two. Individuals with narcissistic personality disorder, malignant narcissism, and psychopathy all display similar traits which are outlined in the Hare Psychopathy Checklist. The test has 20 items scored on a three-point scale, with a rating of:

  • 0 if it does not apply at all;
  • 1 if there is a partial match or mixed information; and
  • 2 if there is a reasonably good match.

With a maximum score of 40, the cut-off for the label of psychopathy is 30 in the US and 25 in the UK. High scores are positively associated with measures of impulsivity and aggression, Machiavellianism, persistent criminal behaviour, and negatively associated with measures of empathy and affiliation.

Malignant narcissism is highlighted as a key area in the study of mass murder, sexual, and serial murder.

Contrast with Narcissism

The primary difference between narcissism and malignant narcissism is that malignant narcissism includes comorbid features of other personality disorders and thus consists of a broader range of symptoms than pathological narcissism (NPD). In the term “malignant narcissism”, the word “malignant” is used in the sense of the word described by the Merriam-Webster Dictionary as “passionately and relentlessly malevolent: aggressively malicious”. In malignant narcissism, NPD is accompanied by additional symptoms of antisocial, paranoid and sadistic personality disorders. While a person with NPD will deliberately damage other people in pursuit of their own selfish desires, they may regret and will in some circumstances show remorse for doing so. Because traits of antisocial personality disorder are present in malignant narcissism, the “malignant narcissist” suffers from a more pervasive lack of empathy than someone with NPD alone and will lack feelings of guilt or remorse for the damage they cause. Since sadism is often considered a feature of malignant narcissism, an individual with the syndrome may not only lack feelings of guilt or remorse for hurting others but may even derive pleasure from the gratuitous infliction of mental or physical pain on others. These traits were formerly codified in the DSM-III under sadistic personality disorder (SPD).

Therapy

Typically in the analysis of the malignant narcissist, “the patient attempts to triumph over the analyst by destroying the analysis and himself or herself” – an extreme version of what Jacques Lacan described as “that resistance of the amour-propre… which is often expressed thus: ‘I can’t bear the thought of being freed by anyone other than myself'”.