Narcissism and Narcissistic Abuse in Relationships (Part III)

Clinical and research aspects

Narcissistic personality disorder

Narcissistic personality disorder affects an estimated 1% of the general population.   Although most individuals have some narcissistic traits, high levels of narcissism can manifest themselves in a pathological form as narcissistic personality disorder (NPD), whereby the individual overestimates his or her abilities and has an excessive need for admiration and affirmation. NPD was revised in the DSM-5. The general move towards a dimensional (personality trait-based) view of the Personality Disorders has been maintained. Some narcissists may have a limited or minimal capability to experience emotions.

Treatment and management

The Cochrane Collaboration has commissioned two reviews of the evidence for psychological and medical treatments for Narcissistic Personality Disorder (NPD).   In both cases, they suspended their initiatives after the authors had made no progress in over a year. There are no clear treatment strategies for NPD, neither medication, nor psychotherapy.  There is evidence that therapies effective in the treatment of other personality disorders do not generalize to NPD.

Required element within normal development

Karen Horney saw the narcissistic personality as a temperament trait molded by a certain kind of early environment. She did not see narcissistic needs and tendencies as inherent in human nature.

Craig Malkin called a lack of healthy narcissism "echoism" after the nymph Echo in the mythology of Narcissus.  Healthy narcissism might exist in all individuals.

Freud said that narcissism was an original state from which the individual develops the love object.  He argued that healthy narcissism is an essential part of normal development.  According to Freud, the love of the parents for their child and their attitude toward their child could be seen as a revival and reproduction of their own narcissism.  The child has a megalomaniac omnipotence of thought; the parents stimulate that feeling because in their child they see the things that they have never reached themselves. Compared to neutral observers, parents tend to overvalue the qualities of their child. When parents act in an extreme opposite style and the child is rejected or inconsistently reinforced depending on the mood of the parent, the self-needs of the child are not met.

Freud contrasted the natural development of active-egoistic and passive-altruistic tendencies in the individual with narcissism, in the former, and what Trevor Pederson referred to as echoism, in the latter.

This is the place for two remarks. First, how do we differentiate between the concepts of narcissism and egoism? Well, narcissism, I believe, is the libidinal complement to egoism. When we speak of egoism, we have in view only the individual's advantage; when we talk of narcissism we are also taking his libidinal satisfaction into account. As practical motives the two can be traced separately for quite a distance. It is possible to be absolutely egoistic and yet maintain powerful object-cathexes, in so far as libidinal satisfaction in relation to the object forms part of the ego's needs. In that case, egoism will see to it that striving for the object involves no damage to the ego. It is possible to be egoistic and at the same time to be excessively narcissistic—that is to say, to have very little need for an object, whether, once more, for the purpose of direct sexual satisfaction, or in connection with the higher aspirations, derived from sexual need, which we are occasionally in the habit of contrasting with 'sensuality' under the name of 'love'. In all these connections egoism is what is self-evident and constant, while narcissism is the variable element. The opposite to egoism, altruism, does not, as a concept, coincide with libidinal object-cathexis, but is distinguished from it by the absence of longings for sexual satisfaction. When someone is completely in love, however, altruism converges with libidinal object-cathexis. As a rule the sexual object attracts a portion of the ego's narcissism to itself, and this becomes noticeable as what is known as the 'sexual overvaluation' of the object. If in addition there is an altruistic transposition of egoism on to the sexual object, the object becomes supremely powerful; it has, as it were, absorbed the ego." (Freud, Introductory Lectures (1919), pp. 417–18)

Where the egoist can give up love in narcissism, the altruist can give up on competition, or "the will," in echoism. The individual first has non-ambivalent relations of fusion with authority or love figures, which are characterized by the egoistic or altruistic drives. Second, the individual can move to defusion from authority or love figures which leads to repetitions of ambivalent, narcissistic or echoistic relations. In the third movement the individual becomes the dead or absent parental figure that never returned love to the echoist, or the perfect, grandiose parental figure in narcissism.  While egoism and narcissism concern dynamics of power and inferiority/superiority, Pederson argues that altruism and echoism concern dynamics of belonging and inclusion/exclusion. Pederson has two types of echoists: the "subject altruist" and the "object altruist", with the former being concerned with the belonging of others and loving them, and the latter being concerned with their own belonging and being loved. The subject altruist is self-effacing, a people pleaser, and sacrifices her desire to help others who are outsiders become insiders, or to be the submissive helper of an insider. The object altruist is gregarious, a people person, and wants to be interesting which is based on wanting to fit in and not be an outsider or wanting to be unique as an insider. Both types of echoists show issues with being submissive, having problems saying no, and avoiding conflict.