Too selfish?

When narcissism is pathological

Created: 03/08/2022 15:41

No compassion, fear of criticism: People with narcissistic personality disorder make themselves big and others small.

Experts explain what characterizes the disease.

Selfish, conceited, narcissistic.

That's how most people would describe narcissists.

Such people literally crave attention and admiration.

They are often ambitious too.

In fact, they often hold a management position - and achieve outstanding things.

And they are very confident in themselves.

Such a personality style is not necessarily pathological.

"To a certain extent, narcissism is just another term for a healthy pursuit of self-esteem," says Hamburg psychiatrist and psychotherapist Prof. Claas-Hinrich Lammers.

However, we speak of a narcissistic personality disorder when the narcissism leads to suffering in the person affected and those around him.

Lammers estimates that about one percent of the population has narcissistic personality disorder.

Self-promoter, with a tendency to overestimate their own abilities: Anyone with a narcissistic personality disorder considers themselves big - and others small.

© Kniel Synnatzschke/dpa

Unstable self-esteem in narcissists?

Those affected have an inflated but at the same time unstable self-esteem.

They try to compensate for this with exaggerated and reality-distorting self-portrayals.

They tend to overestimate their skills and achievements.

"They increase their self-esteem by having an exaggerated attitude of entitlement," says Lammers.

People with this disorder place themselves above others.

Specifically, they try to dominate and control others and minimize or devalue their achievements and accomplishments.

"Such behavior inevitably leads to conflicts," says Prof. Sabine Herpertz, Director of the Clinic for General Psychiatry at Heidelberg University Hospital.

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They show little compassion and concern for others.

If their wishes are not fulfilled, criticism rains down.

If failures occur, they react with anger, aggression or derogatory statements.

"Those affected are only interested in others if they contribute to the achievement of their goals or if they are admired by others," explains Claas-Hinrich Lammers.

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Narcissism: The dilemma of those affected

According to Lammers, this leads to a dilemma: as little as people with narcissistic personality disorder show interest in other people, they depend on their attention and admiration to stabilize their self-esteem.

This is how suffering develops: Firstly, from the tensions and conflicts with others.

And secondly, from the ever-widening gap between reality on the one hand and entitlement and self-idealization on the other.

If those affected are put in their place, they can get into existential crises.

Those affected are often hardly aware of the illness

"A big problem is that those affected often have very little awareness of the disease," says Sabine Herpertz, who sits on the board of the DGPPN (German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology).

Anyone who suffers from a narcissistic personality disorder often only seeks psychotherapy because of complications such as depression, eating disorders or addiction.

The challenges in therapy

Beginning therapy can be difficult.

"Therapists often need a lot of time to get to the patient at all," says Claas-Hinrich Lammers.

Pathological narcissists initially treat them in the same way as other people around them: they want to demonstrate their superiority by devaluing their counterpart.

Therefore, the therapist must first get the patient to open up and build trust.

In addition: "For those affected, critical self-reflection is often difficult," says Sabine Herpertz.

They are usually not aware of how bad their behavior and appearance is for others.

But it's not just about those affected learning to empathize with others.

They should also be given new behavioral strategies in order to get along better with others.

Those who place too high demands on themselves are shown achievable goals.

Psychiatrist Claas-Hinrich Lammers gives the example of a man who works more than necessary and regularly works overtime.

"During therapy, it turned out that the man worked excessively because there was nothing else in his life that really interested him."

In this case, it was not least about helping the patient to find meaningful alternatives to work - such as a nice hobby.

Many are looking for security

In general, according to the expert, the focus of the therapy is on what the affected person is actually missing.

Self-idealization and the devaluation of other people is often "only a substitute satisfaction".

Many simply feel a need for belonging and security.

Here it is important to show those affected individual possible solutions.

"In many cases, it makes sense to involve relatives in the therapy," says Sabine Herpertz.

In the course of the treatment, the relatives would have to learn, for example, to formulate their own interests - without devaluing the person with narcissistic personality disorder.

Is the disorder curable?

Claas-Hinrich Lammers says: "You can't fundamentally change a person."

Rather, therapy is about illuminating and modifying extreme behavior and ways of thinking.

"This improves the patient's quality of life and reduces suffering," says Lammers.

Also for its environment.