![]() ![]() Can you expand on some of the clinical presentations?ĭr. My challenge was to help him to acknowledge that his behavior, if unchanged, could very well ruin his plans for the future, beginning with expulsion. He showed up at my office, and his first question was, “Are you any good at this?” He didn’t want to be there, and he was completely oblivious to the seriousness of the situation he was in-namely, that he was about to be kicked out of school. A dean at a local university referred a young man to me who was failing classes because he was staying up late with a classmate working on a get-rich-quick scheme. TCPR: Do you have any case examples you could share?ĭr. Extreme exploitation and entitlement are strongly linked to increased suicidality and lowered or fluctuating self-esteem (Ackerman at al, Assessment 2011 18(1):67–87). In fact, high levels of exploitation and entitlement are tied to just about every negative behavior we see with pathological narcissism-the rage when criticized, the tendency to blame others for their failings, the intense envy of others. People with the core of pathological narcissism (triple E) suffer deeply when their belief that they’re exceptional or unique in some way is challenged. Malkin: If you are dependent on feeling special, the world is going to prove you wrong at some point. In other cases, they come willingly because they’re in distress their defenses are breaking down.ĭr. Sometimes they see us because someone else, like a partner or the courts, insisted that they come. TCPR: What do these patients present with when they come to see a clinician for treatment?ĭr. Triple E: The Core Pathology of NarcissismĮxploitation: Getting needs met by exploiting othersĮntitlement: Acting as though people owe you somethingĮmpathy impairment: Disregarding others in the quest to feel special When people become so addicted to feeling special that they’d lie, steal, cheat, and even hurt others to get their “high,” they’ve tipped into pathology. Exploitation is getting your needs met by taking advantage of and manipulating others, entitlement is acting as though other people owe you something, and impaired empathy is disregarding others in your quest to feel special. A convenient way of remembering the core of pathological narcissism is to use the mnemonic “triple E”-exploitation, entitlement, and empathy impairment. Malkin: It becomes pathological when patients engage in destructive behaviors, like arrogantly insulting people, constantly blaming others, or becoming enraged when they feel criticized. TCPR: How does this need to feel special become a pathology?ĭr. In both extroverted and quiet narcissism, instead of turning to other people for mutual caring and support to soothe themselves, they depend on feeling special narcissists soothe themselves with this feeling much like substance abusers might turn to alcohol or heroin. They tell themselves, “I’m more sensitive most people don’t understand my problems,” focusing on a sense of uniqueness based on their pain and their problems. ![]() The quieter narcissist may depend on being the most deeply misunderstood person in the room. This version is called communal narcissism. Others may believe themselves to be the most helpful person they know, and will corner you and tell you about all the altruistic things they’ve done. Malkin: Extroverted narcissists feel special by possessing things, by amassing power, by fancying themselves the smartest person in the room. TCPR: Tell me more about this addiction to feeling special.ĭr. There are plenty of introverted narcissists (often called vulnerable or covert in the research), and these are the patients who often show up in our office. The reality is many narcissists couldn’t care less about looks or fame or money and can be very quiet. The confusing thing is that we tend to focus on one presentation, which is the loud, arrogant, conceited narcissist, but that’s only one type. Malkin: At its heart, pathological narcissism is a desperate need to feel special-in fact, you can call it an addiction to feeling special. I’d like to start by asking you to define narcissism.ĭr. Malkin, it seems to me that in psychiatry we’ve gotten out of the habit of diagnosing narcissistic character traits in our patients, yet many patients do have these traits, and this can cause a lot of distress. ![]()
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