Showing posts with label Emotional abuse. Show all posts
Showing posts with label Emotional abuse. Show all posts

Sunday, May 29, 2016

Dear Narcissist Problems: "Enlightened"

Dear Narcissist Problems,

I work with the local domestic violence advocacy group to help my children and I deal with their father and my ex. Our counsellors have expressed that in the addition to his abuse he displays behavior characterized by narcissistic personally disorder. Of course, they cannot make an official diagnosis without him as their client, but from books I have read to help cope there may as well be a picture of him. I stumbled across this sight yesterday and I can't believe how your posts and statements hit the nail on the head. It's a struggle to deal with this and seeing your posts brings some relief knowing I'm not losing my mind and there are people out there like this. I just wish law enforcement and child protection groups could be more educated in recognizing this type of behavior. The narcissistic is adept at putting on the act and getting away with crime. Thank you.




Dear “Enlightened”,

            I would like to say Kudos to your local Domestic Violence Advocacy group because they even considered that you could be being abused by a narcissist!  Give those women and men a medal!  As you have probably realized by now you are one of the very few people who found their way without doing that infamous google search looking for answers.  This is exactly why I do what I do here because not many people do know or have heard of Narcissistic Abuse.  This traps victims in situations of abuse for YEARS because they start to believe the problem really is them after years of the narcissist eroding their self-esteem and perception of reality.  Sana Loue, J.D., Ph.D., M.P.H., wrote an article on the legal implications of emotional and psychological abuse which stated; “Emotional abuse, a label often used synonymously with the terms emotional maltreatment, psychological battering, psychological abuse, and soul murder, has been called “the most elusive and damaging of all types of maltreatment for a child” and represents “the core issue and most destructive factor across all types of child abuse and neglect” (Loue 2005).  Here we have one of the most destructive forms of abuse and there is little recognition of it in the healthcare field or legal systems.  The article further illustrates that “The very elusiveness, however, of the identification of emotional and psychological abuse casts doubt on the accuracy of available data relating to its occurrence, and it is likely that the incidence and prevalence of such abuse are subject to significant underreporting”(Loue 2005).  So not only is this type of abuse very difficult to identify victims are also not reporting it.  The ones who have reported it are left feeling disbelieved, discouraged, and shattered.  This is how and why many of us in this community have reached out into the public to share our stories and offer support to others living through hell.

 I know you didn’t really ask a question but you said something that I would really like to highlight “seeing your posts brings some relief knowing I'm not losing my mind and there are people out there like this. I just wish law enforcement and child protection groups could be more educated in recognizing this type of behavior.” (Enlightened 2016).  Dealing with a narcissist we know they will destroy our lives and the way in which they do it leaves us looking insane, unstable, irrational, and the list goes on.  While we try to maintain any resemblance of being the normal rational human beings we are once a narcissist gets their hands on someone who has control over your life such as a lawyer, police officer, or judge it usually means game over for us.  Some of us have watched our therapists be manipulated against us through couples counseling and then that same therapist will be utilized for court.  Some narcissists will call child protective services on us and then play the role of caring adult in our children’s lives to manipulate the state against us resulting in the loss of our children. It was seen that “definitional issues further compound the difficulties associated with the identification, documentation, prosecution, and prevention of emotional and psychological abuse” (Loue 2005).  It’s no wonder that nothing is being done in the legal field to prosecute abusers and protect victims as we can’t expect laws to be written when there is no clear definition on what it means to have your soul murdered.

 What is my point here?  It is essential that when you find out what narcissistic abuse is and that you have been abused you need to spread awareness of this type of abuse.  More than that, as many of us do, go out of our ways to support each other when we see a victim getting abused further by people in positions of power or authority because they don’t fully understand or recognize what emotional or psychological abuse looks like.  You will see many survivors going to court to show support, campaigning for funds for court cases, starting petitions, or simply blogging to get the word out.  It’s imperative that we take on this responsibility, when ready, so that narcissists do not get away with their crimes.  You do not need a special degree or a certification to become an advocate for victims of Narcissistic Abuse.  All that you need is your voice, your story, and your passion.  The more who get involved with this effort the sooner we will see legislation and policies being passed that not only recognize this type of abuse but also the prosecution of the abusers.  The way to do this is to just get out there and get involved by finding and joining others with a similar cause which is typically experience specific.  Good luck to you on your healing journey!


Narcissist Problems



Loue, S. (2005). Redefining the emotional and psychological abuse and maltreatment of children: legal implications. Journal Of Legal Medicine, 26(3), 311-337 27p.

Sunday, January 3, 2016

Dear Narcissist Problems, "Oy Vey!"

Dear Narcissist Problems,
     Just wanted to thank you for creating this wonderful resource! For the past 10 months my biological family has ex-communicated me, my husband and our 3 special needs kids. Most of the posts you post relate to my story. Lately, my Mother has been sending round the message that she wants to reconnect "just the 2 of us" now that she has firmly secured the opinions of my family and extended family.     This week, after hearing that I had been in a near-fatal car accident, she decided to call me. I cannot begin to tell you how much your page has empowered me and clarified the Narcissistic behavior pattern. I had the ability to distance and "check through the checklist." Classic tactics et. all.
Still very hard to deal with the fact that this IS my family - but clarity goes a long way...
Thank you!
A week after the phone call, my mother wrote me, I responded, and then my father monkey danced at me and I debated if/how to respond. Considering full 'no contact' but a little anxious.
Below is the exchange:
Dear A****a,
     I’ve been thinking about our conversation a lot. I am so sorry for the pain that I have caused you. I’m sure we both never meant to hurt each other or anyone else. The question is what happens now. A*a and I are not in favor of the group mediation idea. But I am happy to work with you with the aid of a therapist of your choice. I think we can attack the main issues that are bothering you from my understanding of the phone conversation. I would also be happy to visit the kids at your in-laws, for example, so that you are comfortable with the arrangement. I truly love and care about you and will try to do the best that I can in the interest of shalom. You can call any time to arrange a visit or pick up money if and when you are ready to do so. I wish only health and happiness for you and your family. Much love always.
Dear I******a,
     I accept your apology for the past, though I find it somewhat frightening that someone with your life experience would not realize that ostracizing one's own flesh and blood through fallacies would be hurtful. Am I to understand that A*a is not interested in reconstructing a relationship with me? Or that, you are not interested in having A*a be part of the process? Since my husband and I have been punished as a unit for each other’s fictitious "wrongdoings", I believe that it is only right to repair the relationship as a unit, as well. I don't know that I would call it "group therapy" so much as clarifying the rules of our relationship, for the benefit of the future. This is not about the past, so much as about the future. A trained family mediator would be able to clarify to us healthy patterns of behavior so as not to create hurt in the future. Although I appreciate your good will, I do not believe it to be prudent to re-introduce the children at this point. I would like to know that there was security in the relationship first - they have suffered greatly from rejection and I would not want them to have to go through this again. As of now we have not experienced a parental relationship with you over the past 11 months, we do not feel that it would be appropriate to accept your thoughtful financial offer at this point. Thank you for your good wishes, wishing you all the best,
A***a Dear A***a, I*a has nothing to do with me in this. My position has been clear from the start – you created this machlokes (fight) for no reason. And you are incapable of hearing anyone else’s point of view. If you had a drop of humility you would say “gee what did I do to drive my parents and siblings away? MAYBE I made a mistake. MAYBE I did something wrong. Instead you blame everyone else. EVERYONE is lying, EVERYONE has done me wrong. NO ONE has ever done anything for me! You know that van you just wrecked? I paid for it out of my own pocket, just like I paid for your first van. But no one has done ANYTHING for you. You have left a paper trail. You wrote several people how you want nothing to do with your family. YOUR FAMILY!!!! You created this for no reason. It was none of your business. You have spoken to relatives in America badmouthing us and M******m. I CAN PROVE IT! I spoke to the people. You have been incredibly disloyal, a true kofei tov. Nothing that anyone has ever done for you, not the HUNDREEDS of hours that I*a spent on the phone with you, nothing is appreciated. No A***a, I WILL NOT play your game. So keep beating up on I*a the only one who has been your advocate in the family to try to get them to see you in a positive light. The family is OUTRAGED by your behavior. Only I*a tries to defend you. After all you have said and done you have the gall to accuse I*a of lying! Halevi (I wish) I*a made it up! I wish you had never said or did all the things you did in the past YEAR. If at some time in the future, perhaps with the help of a professional. You can look yourself honestly in the mirror and say “Maybe I did something wrong” then I will be willing to discuss it. But I will not descend into the insanity that you have created. When a sibling is in trouble, the family rallies around them. Everyone did that (and does that) except you. What kind of a mother uses their own children as pawns in their twisted game? Of all you have done that is the most horrific. I pray for you and C*****a and the children every day. May Hashem (God) be good to all of you.
Love, A******a (Yes I still love you in spite of all you have done)
machlokes = fight,
Hakoros Ha'tov = gratitude
Halevai = I wish
Hashem = G-d
“Oy Vey!”
Dear “Oy Vey”,
     Thank you for following the page and I am glad to hear the posts have been helpful for you in your situation.  I felt extremely unsure of how to tackle this message because of the mixture of a religion I have no experience with.  I do not know what is culturally “acceptable” and then I realize these issues really do cross every cultural barrier so let’s start with the unwillingness to go to group therapy on your mother’s part as she would rather get you into therapy….alone…with her.  It seems a common tactic of manipulation for a narcissist to get their victim into therapy alone with them.  This allows for the further manipulation through the therapist.  I do believe most therapists will recognize this but there is always the chance that they won’t.  I think your suggestion to keep all involved so there wouldn’t be any “misunderstandings” was a great.  Also, the fact that you wanted to keep your husband involved was great.  If anything I would seek therapy on your own without the involvement of others.  As for the mediator I am unsure why this is necessary?  Are we talking of a legal mediator because there are children involved or a spiritual mediator to heal the rift in the family?  I will go under the assumption that it is to mediate the family rift.  Again, mediation should involve all parties and should not be done in secret with only your mother and who she picks and choses to be present.  Anyone affected by the situation should be present so there aren’t any future misunderstandings.  As for the children, it is a good idea to keep them out of the circus.  To my understanding your mother is trying to control you from across an ocean so I can only imagine what goes on when she is up close and personal.  While we are on the topic of “No Contact”, this is a deeply personal choice.  We go no contact with our family for many different reasons, usually when the situation is so emotionally or physically abusive that we are pushed into a corner and we have a “fight or flight” reaction.  I can’t really give advice on this for your situation as this will be a decision that you will have to mull over with your husband and/or a therapist.  The bottom line being “The best interest of the children”.  It seems as if you have a really good handle on the situation with the low contact so I would keep monitoring it. The main issue I see is putting the involvement of flying monkeys at bay and the recruitment of flying monkeys. In my own family I did have to go no contact so I know how hard this is for you.  Try not to make any decisions out of spite but a good look at the reality of your relationship with your family. Good luck to you in the New Year and if you need any support just let me know!
Narcissist Problems

Friday, January 1, 2016

Dear Narcissist Problems "Sick and Tired"

Dear Narcissist Problems,

     I have read tons on narcissistic behavior, and have a couple of questions. My family has an individual who displays mostly passive narcissist traits, but we have been at our wits end for years dealing with her being an extreme hypochondriac. She also has an insatiable need for attention. She will drink, pop pills, and then call everyone for days complaining of how sick she is. If we try to change the subject, or avoid "feeding the monster", we are accused of being insensitive and cruel. Also, if we try to make suggestions for getting well, she shoots them down immediately. She is highly skilled at using guilt of all kinds to try and get her needs met. ANY suggestions are welcome! Thank you for offering your time and effort with this group!


“Sick and tired of being sick and tired”


Dear “Sick and Tired”,

    Let me just make my first statement of the year be: I am not a psychiatrist nor will I ever claim to be.  What I will say is that I can totally relate with your situation!  With that said “Happy New Year”!!!!  The insatiable need for attention seems to be the calling card of all narcissists.  This is why I like to refer to them as emotional vampires.  They will suck you dry and leave you believing that you are the one who is tragically flawed for not feeding into whatever need they are trying to have met by you.  Narcissists in general will do many things to get their needs fed whether it be to manipulate you, scapegoat you, triangulate your entire family/friends, ruin your life, or play the pity card.  It seems like your narcissist has a need to be fed by playing on your sympathy and getting attention by either feigning an illness or down right making themselves sick.  What happens when we are sick?  People who care about us want to make us comfortable, they want to help us, and they will usually go out of their way to do this.  I know I usually do when someone I care about is sick.  I guess what I’m wondering about right now is if this narcissist has recently created some rifts in the family by causing drama or ruining relationships. Did she spend the holidays solo? Has she lost any sources of supply for her ego?  You might be surprised to notice that this person tends to get ill if other people in their lives have been staying away from them due to their toxic behavior and general destructiveness.  In my own experience with my Narcissistic mother she loved to create storms of drama.  She wasn’t able to function if there wasn’t some tragedy going on in her life.  When there was something awful going on she was at her best.  Happy, energetic, smiling, and on that phone gossiping with whoever would listen.  As we know about gossip and human nature people usually love to listen to what is going on with others.  Now when she couldn’t stir something up she became depressed and would stay in bed until 2 or 3 p.m.  She would come down with chronic illnesses acutely. Mark my words, as soon as some shit storm was stirred up again her illness was cured!  During the times she was ill she needed a caretaker, me.  Someone not to offer advice but to take care of her needs.  I took care of the household, I took care of her emotions, and I took care of her own responsibilities like caring for other family members or getting a job at the age of 14 to make sure the bills were paid.  If I were not taking care of her needs there would be hell to pay.  If I suggested she see a doctor there would be hell to pay.  If I told anyone outside of our home what was going on there would be hell to pay.  My point, it is not your job to take care of this person’s needs.  She needs help and it’s a help you will never be able to offer or suggest if this is a true narcissist.  This is the way it is.  If you suggest that she seek medical help and then refuses there is nothing more you can do for her.  We are all adults and we all have the responsibility to take care of ourselves, including our own needs.   Back away slowly and keep your distance until/unless she decides she will take the action necessary to make herself well again.  As always, this post will be shared.  Comments from readers as well as suggestions, advice, or a “me too” is always appreciated!


Narcissist Problems

Edit: After posting this a member of one of the groups used a the term "Help reject complain" which fits this behavior to a T.  Here is an article if anyone cares to understand this further.

Sunday, October 4, 2015

Dear Narcissist Problems, "Stuck"

Dear Narcissist Problems,

     I need advice/help. I'm in a very unhealthy relationship, but I feel stuck. I don't know how to get out. He is manipulative, controlling, and abusive (more verbal and sexual with occasional physical). I've tried multiple times in the last year to make him leave and it never works. I got a better job in August and was hiding money so that I could leave and he started doing little things (unplugging my alarm clock, calling me at work saying my daughter was in the hospital so I'd leave early [she wasn't] and once even leaving in MY car and taking the keys to his truck and not coming back until an hour after I was supposed to be at work) all of which have resulted in my losing my job. When I was working, he would take money out of my purse, he's told me that he paid certain bills and actually just blew the money, one of which was a traffic ticket, resulting in my license being suspended. He has cheated on me more times than I can count, but I'm the one with the problem because I'm "jealous" and "insecure" and I make him cheat because I'm so awful. I have 2 children and I can't keep putting us thru this. I don't have anyone who can help me or that we can stay with. I have a car payment and insurance now a suspended license and no income w/o him. I've been distributing my resume and filling out job applications since I lost my job 2wks ago with no luck. I'm at my wits end and I don't know what to do




Dear “Stuck”,

     When I read through this I literally felt the burn of pure anger I felt with my own narcissist.  The first step in getting out is usually the hardest and that is to accept that there is a problem.  You are 60% of the way there.  The first thing I would do is print this letter up as a starting point and heading down to the local courthouse and seeking the help of a victims advocate.  I am really sorry to hear that you lost your job and I am not going to lie to you:  This next year will probably be the hardest year of your life but I know you can get through it!  The hardest part of these relationships whether it is a family member, friend, or significant other is wriggling out of their tentacles.  You need a support system.  Think really really really hard and try to see if there is anyone in your life who is willing to help. If not seek help just as you have done here.  You are not alone! All of these problems seem really overwhelming but the important thing is to work through them.  When you go to the court house talk to them and see if they can’t point you in the right direction regarding the abuse AND your license situation.  The longer you put either situation off the worse it will be later.  Try to be as proactive as possible even if you have no money.  I know that here in Chicago we are having an amnesty week for parking ticket violations.  I don’t exactly know what that means but I’m assuming either having the ticket dissolved completely or setting up a very small payment schedule.  If you lose the car; I know that will only make the situation worse but remember this isn’t the end.  You are being abused mentally, sexually, physically and financially.  This person is sabotaging your job, your income, and your ability to take care of yourself and your children.  I would not, under any circumstances, leave the children with him as a babysitter.  The children have already been through enough.  While you have a car let your determination to survive and later thrive be your guide.  Seek out community support.  Go down to the office for family and child services and see if they can assist you in finding daycare options.  I wouldn’t go into too many details but keep it strictly regarding money.  I would also see if they can possibly help you find some certification classes so that you can get a higher paying job later.  You are in a jam and the longer you stay with this person the more he is going to tear you down.  The most important thing to do is take the first steps toward your safety and independence.  Good Luck to you!  You can do this!  Further, document the crazy.  Get the police involved.  Get a restraining order against this person before you end up losing your children because of him.  The most important thing to do is to stay safe and get out as quickly as possible!  None of this is going to be easy.  You are going to need to be filled with so much fear and determination that it forces you to break the barriers of “out there” being scarier than where you already are.  Know this, you are capable enough and strong enough to do this you just need to start!  It will help to seek emotional support in a support group and you can find them on Facebook.  Also see if there are any free services for counseling in your area.  Get out there and get talking.  When we talk with others who have been there not only can they help guide us out of the nightmare but it helps to get out the pain and frustration.  You got this!  Finally, I would avoid any conflict or threatening your partner that you will leave if he doesn’t change his behavior.  Make the plans to leave as silently as possible otherwise he will sabotage those plans and he may actually hurt you or the children.


Narcissist Problems

Monday, September 7, 2015

Dear Narcissist Problems: "Suddenly Slapped"

Dear Narcissist Problems,

Hello, I'm needing some advice concerning my wife. After much reading and honest thought, I believe she may be somewhere on the spectrum of NPD. I've been hit in the face multiple times, hard (to which she says, "it was a slap, my hand was opened")....well, I'm a 200# man, and my ears were ringing. She changes into someone else when she's mad. After following her around the country for her PhD (in psychology no less), supporting her all the way, only to have her abandon her dissertation at the last minute, and blame me for her quitting. Recently I believe that we've entered into the devaluation/discard phases. Over the past two years, I've been working on being my best, and feel I've made big improvements. 5 weeks ago, shortly after her getting a big raise, I noticed her not needing me emotionally anymore. She's always been very attention needy, so I knew something was wrong. I checked the phone records and discovered an hour/day phone relationship with a lawyer "friend". It quickly became her primary emotional relationship, and when confronted, she yelled at me for things in the past, and showed anger, not remorse. She's stated repeatedly that she "doesn't have much empathy", and that she "wants a man who would go to the ends of the Earth for her"- which I do. After asking the lawyer to stop talking with her, twice, with no reply, I threatened him with a lawsuit and he cut it off. Now she's angry at me, stringing me along with enough charm to get what she wants, and distant coldness, especially after intimacy. I could go on....but I'm trying to figure out if she is indeed on the spectrum of NPD or something else.

 Thanks much,

Suddenly Slapped

Dear Slapped,

    I would first like to say I do not hold a degree in psychiatry the only thing I can do is give advice from experience and help dig up some research.  Before I get into the research I would like to ask: “What in the hell are you doing with this woman”?  I see so many men stay in abusive relationships and I really need to understand this more.  I already understand why but are you seriously thinking of sticking around to salvage this train wreck?  It sounds to me like it doesn’t really matter how far on the spectrum she is with any disorder she is abusing you physically and financially. I was just participating in a conversation earlier in a group for people who support men who are abused.  This man posted a picture of what his girlfriend did to him.  I’m sure it started out with slaps but over time this escalated to being stabbed with a fork and onto a butcher knife.  He almost died!  This woman has also confessed to you that she has very little empathy, thank god she didn’t finish her dissertation in psychology.  My point is that this woman is toxic and I have seen from experience what an aggressive woman with no empathy is capable of.  They are capable of stabbing you, running you over with a car, and trying to smother you with a pillow in your sleep.  They will make your life a living hell and then tell the police and the courts that YOU were the aggressor.  You stated that you are a 200 pound man and I’m sure as soon as she turns on the water works the authorities will buy her story of self-defense.  Get away from her and make sure you document the crazy!

    As for how far on the spectrum she is According to the DSM-5 there are two criteria that must be filled to diagnose a person with a personality disorder.  Criterion A is used to test an individual’s level of personality functioning.  This is further diagnosed by assessing an individual’s pathological personality traits, Criterion B.  So if you are looking for how far down the spectrum your wife is you would want to ask how extreme her personality traits are.  It can be noted even by experts in the field of psychiatry that “numerous potential inconsistencies in the conceptualization of narcissism, including variants in describing its nature (normal, pathological), phenotype (grandiosity, vulnerability), expression (overt, covert), and structure (category, dimension, prototype). In all four of these areas of conceptualization, DSM descriptions of the concept have been limited.” (Skodol, Bender, & Morey 2014).  It is also noted in this article that there is very little research on narcissistic personality disorder, its manifestations, and treatment available.  As far as psychiatry is concerned the study of this personality disorder is lacking.  This is why you will find so many of these support groups and pages popping up all over the internet.  Victims of Narcissistic Abuse usually have no idea that they were abused or they blame themselves for the abuse and rationalize it away.  Moreover, the topic has such little research into it that when we do go to therapy we are further invalidated in our experiences. 

So what does it take to be diagnosed with NPD?

Narcissistic Personality Disorder (NPD) - The DSM Criteria

Narcissistic Personality Disorder (NPD) is listed in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM) as an Axis II, Cluster B (dramatic, emotional, or erratic) Disorder:

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)

Requires excessive admiration

Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

Is often envious of others or believes that others are envious of him or her shows arrogant, haughty behaviors or attitudes

I suggest visiting the above link.

There has been research springing up here and there that recognizes the need to further explore this personality disorder and the conclusion to a recent study was that “Conclusions: These findings suggest that DSM-IV criteria for narcissistic personality disorder are too narrow, underemphasizing aspects of personality and inner experience that are empirically central to the disorder. The richer and more differentiated view of narcissistic personality disorder suggested by this study may have treatment implications and may help bridge the gap between empirically and clinically derived concepts of the disorder.”(2008). This article goes on to say that “Despite its severity and stability (1 , 2) , narcissistic personality disorder is one of the least studied personality disorders.”

Attached is a useful study into the subject that will help you further explore what could be going on.


Narcissist Problems

 By: Elsa Ronningstam
Harvard Medical School;

Pathological narcissism is characterized by fragility in self-regulation, self-esteem and sense of agency, accompanied by strong self-protective reactivity, emotion dysregulation, and a range of self-enhancing and self-serving behaviors and attitudes. Areas or periods of proactive and healthy narcissism coexist with pathological narcissism. Self-regulatory fluctuations and accompanying shifts in self-esteem are context dependent and affected by situational, that is, interpersonal or event triggered reactivity. The phenotypic presentations of pathological narcissism and NPD range from interpersonal pretentiousness, arrogance, and assertiveness, to insecurity, shyness, and hypersensitivity (Cooper, 1998; Russ et al., 2008). Notable is also that narcissistic individuals’ internal experiences may differ significantly from their overt behavior and descriptive accounts. From an attachment perspective narcissistic personality style and pathological narcissism are suggested to be anchored in a detached-dismissing pattern (disliking attachment to others and preferring investment in interpersonal space and own agency), or in an avoidant pattern (defensive self-sufficiency). In addition, sensitive, vulnerable narcissism has been associated with anxious or fearful preoccupied attachment style (aspiring attachment but anticipating disappointment or rejection; Fonagy, 2001; Dickinson & Pincus, 2003).

Grandiosity and accompanying self-enhancing and self-serving incentives and behavior are part of a self-regulatory spectrum of narcissistic personality functioning. Overt as well as covert signs of both grandiosity and vulnerability coexist and affect narcissistic personality functioning in each situation (Pincus & Lukowitsky, 2010). Sense of competence, control, standards, and achievements are crucial for self-evaluation and self-esteem (Zeigler-Hill, Myers, & Clark, 2010).

Self-agency conceptualizes the subjective awareness and ownership of goal setting, and planning, initiating, executing, and controlling one’s own thoughts, intentions, actions, and accomplishments (Fonagy, Gergely, Jurist, & Target, 2002; Gallagher, 2006; Knox, 2011). It signifies implicit as well as explicit initiation, mastery, and self-direction, and it is a fundamental part of self-regulation and self-esteem. As such self-agency is a potential base for evaluating self-esteem regulation including grandiosity and inferiority. In social-psychological studies of narcissism, self-agency has been introduced to conceptualize narcissistic interpersonal and self-regulatory strategies, such as attention seeking, competitiveness, and self-esteem-enhancing relationships (Foster & Brennan, 2011).

Psychoanalytic studies noted that the subjective experiences of fluctuating or loss of self-agency are especially consequential for people whose sense of self-worth is fragile and whose ability for interpersonal relatedness is compromised (Knox, 2011). Disturbance in self-agency is an essential part of psychopathology (Spengler, von Cramon, & Brass, 2009; Fonagy et al., 2010). For example, schizotypal traits correlate with deficits in prediction which lead to weaker sense of self-agency (Asai & Tanno, 2008; Asai, Sugimori, & Tanno, 2008). Discrepancies between predicted and actual action–effect connection contributed to decreased sense of agency (Sato & Yasuda, 2005; Spengler, von Cramon, & Brass, 2009), and perceived reduced control of events was associated with decreased experience of authorship/instigation (Aarts, Wegner, & Dijksterjuis, 2006).

A young man, Bob 21 years old, dropped out of college and was hospitalized with a range of problems: At the initial evaluation the clinician noticed general anxiety, obsessive–compulsive preoccupation, racing thoughts, social anxiety, avoidance, and suicidality. Family members and friends portrayed Bob to the case-manager as inconsiderate, demanding, and demeaning, with threatening and verbally aggressive behavior, and involved in poly substance abuse. Bob described himself as struggling with internal agony caused by his inconsistent cognitive intellectual functioning, and feeling overwhelmed by insecurity and internal self-criticism. He often felt frustrated with other people; he found them stupid, unpredictable, and difficult to understand. In addition, he had been isolating and engaged in Internet sex-dating where he felt safer and more in control compared with if he tried to meet somebody at bars and parties.

Bob also described the week before being hospitalized; on Friday he met with his professor and began outlining a project for a paper. He thought the meeting went well as he perceived that his ideas were well understood and appreciated by his professor, and he left feeling motivated and competent. On Sunday he spoke in front of 10,000 people at a big sports event at his college. Apparently he did a good job, both according to his own assessment and based on the others’ enthusiastic feedback. With a smile he admitted that he felt he could become a future president of the United States. On Tuesday he found himself unable to speak in front of his class of 8 peer students. It was his turn to present the outline of his project, and just before the class began he experienced sudden anxiety with difficulties holding on to logical thinking and reasoning. When he was about to begin he experienced a total cognitive blockage and had to leave the room. A day later he saw no future for himself and struggled with excruciating self-reproach and intense suicidal ideations and impulses. He admitted that he anticipated critical and “stupid” comments from his peers and feared the anticipation of exposing himself to something he could not control. Most of all, he felt unable to rely upon his own competence and dreaded a sudden loss of his ability to think and speak.

Bob was highly intelligent, with an IQ in the range between 140 and 150. Some even considered him to be a genius, although he himself did not believe that, but he appreciated the admiration and acknowledgment. He was a competitive swimmer and leader of his swim team, and had encountered no problems with either swimming or team leadership. He had overall done well in college, especially on exams, and received high grades despite some inconsistencies. His professional aspirations and plan was to become a lawyer like his grand-father. He met 8 of the 9 Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM–IV) and fifth edition (DSM-5) criteria for NPD (not #6, interpersonal exploitive) according to the Diagnostic Interview for DSM–IV Personality Disorders, DIPD-IV (Zanarini, Frankenburg, Sickel, & Young, 1996).

After having presented this rather diverse set of experiences Bob said to the therapist: “I cannot trust my faculties, I do not know from one day to another whether I can rely on my thinking and reasoning, access my knowledge, communicate, and perform. I struggle inside myself with dreadful self-scolding, constantly comparing and criticizing myself. I am a perfectionist, and I know that I can be very good, even exceptional. I have been considered a genius, but it does not hold up. I can’t tolerate closer contact with people. I get so angry and frustrated at them. I can see that I may be unfair, at times . . . , but I just can’t stand it. It works much better when I am in charge or if there is a distance to other people, like if I have a large audience. I feel extremely afraid of the future and ashamed of having to be in treatment. Some days I really doubt that anything can change or that I can get help, other days I can feel more optimistic”.

Bob presented with areas and moments of real potentials, consistent competence, and proactive interpersonal functioning, that is, as a swimmer and team leader, and in individual academic performance and interactions with his supervisors. On the exceptional side was his ability to speak in front of large audiences. He had both unrealistic grandiose fantasies as well as real age-appropriate professional aspirations. He came across as confident and self-promoting, alternating between bragging and a disdainful attitude. However, internally he struggled with extreme self-criticism, self-doubt (the reverse side of perfectionism), and interpersonal insecurity when facing close and intimate or collaborative interactions with peers, as if they tend to become critical enemies. However, this most consequential vulnerability was not triggered in his physical sport activities, only in his intellectual academic activities. In terms of self-agency, Bob was unable to integrate and regulate perceptions of challenges, failures, and interpersonal limitations with his actual competence and real abilities. From a self-regulatory perspective he used perfectionism and avoidance as well as substances to enhance self-esteem, and sense of control and to modulate self-criticism, fear, and anxiety. Apparently he had reached a point where he faced a rapid and extreme downhill spiral. High ambitions, perfectionism, and intermittent experiences of competence and even exceptional abilities under certain circumstances, turned into escalating interpersonal intolerance and fear, insecurity, distancing and avoidance, self-criticism and self-scolding, with substance usage and suicidality.

Although grandiosity is a diagnostic hallmark for NPD, and an indication of the pathological grandiose self (Kernberg, 1975), its complexity and changeability suggest that the diagnosis of NPD should not depend heavily on overt indications of grandiosity (Ronningstam, Gunderson, & Lyons, 1995). State-dependent signs or temporary reactive increase of grandiosity can alter or coexist with more persistent overt or covert grandiose self-experience, as well as with more proactive or authentic functioning. Given narcissistic patients’ identity diffusion and difficulties knowing who they are, identifying and differentiating their real competence, assets, and accomplishments from exaggerated or non-existing achievement and wished for talents are important. Equally important is the differentiation of their age appropriate ambitions and proactive aspiration from high-flying or unrealistic fantasies. It is not uncommon that patients with NPD struggle with uncertainty, shame, excessive self-criticism, and insecurity related to their actual talents, value and competence, parallel with an enhanced self-presentation, especially if they are young. Like in the case of Bob, it is also important to acknowledge areas of actual individual uniqueness and special talents or potentials as part of the overall self-regulatory functioning. In addition, encouraging patients’ own narrative, especially describing moments when they experience incompetence, inferiority, and fragility, is also a most essential part of the diagnostic process. The shifts in self-esteem from grandeur to inferior or vice versa with accompanying self-regulatory change in self-enhancement and self-devaluation are most informative. The subjective experiences of those interpersonal or situational conditions that cause such shifts are diagnostic hallmark for pathological narcissism and NPD (Ronningstam, 2012a, 2013).

Diagnostic evaluation and treatment tend to mobilize self-protection and control in people with narcissistic personality functioning. Some can be extremely and effectively defensive, focusing on details or seemingly relevant issues while avoiding more urgent or deeper and challenging problems. Others can mobilize plasticity and adjustment, agreeing and following along, and still others can get argumentative, aggressive, and critical. Although on the surface intelligent and articulated, even with moments of perspective-taking and reflection, these people also present with a significant resistance or inability to deeply connect, attach, and change. Doubts, shame and insecurity, confused self-identity, and self-criticism, combined with a range of self-enhancing strategies, contribute to their sometimes drastic self-regulatory interpersonal stands.

A conditional and limited alliance is unfolding, that can seem collaborative and interactive with common language, and even with processing of challenging inquiries and complex interpretations. However, the patients’ motive for seeking help and experience of facing treatment may be totally separated from acknowledging their problems and work toward changes or modifications of problematic areas functioning. Their reputation of being difficult to treat, or even untreatable, stems from a particularly complex and constricting mental functioning. Clinical observation and empirical findings indicate compromised functioning and impaired abilities behind the NPD diagnostic traits that indeed underpin pathological narcissism and contribute to the specific internal and interpersonal regulatory patterns. Awareness and integration of these factors in the diagnostic process is crucial for gaining a meaningful identification of the narcissistic patient.

The first set of such factors concerns the ability to access, process, and identify emotions. Studies have shown that both defensive and compromised emotional functioning influence self-regulation in people with pathological narcissism or NPD (Model, 1975; Krystal, 1998). Avoidance of emotions, especially fear of failure and humiliation, is considered a motivating, self-regulatory strategy (Bélanger et al., 2012). Vigilance, sensitivity, and reactivity to negative events and anticipation of humiliation (Besser & Zeigler-Hill, 2010) can coexist with emotion intolerance and difficulties processing feelings, in particular fear and shame. Fear, recognized in both psychoanalytic and empirical studies as essential in pathological narcissism, is also underlying several management and avoidance strategies typical for narcissistic personality functioning, such as competitiveness, perfectionism, risk-taking, and procrastination (Ronningstam & Baskin-Sommers, 2013). Shame also plays a significant role, especially in narcissistic interpersonal relating, and can motivate avoidance as well as defensive, retaliatory anger to regain agency and control (Tangney, 1995; Trumbull, 2003).

Compromised emotion recognition, that is, impaired accuracy in recognizing facial emotional expressions in others, especially fear and disgust (Marissen, Deen, & Franken, 2012), weaken the narcissistic patient’s ability for interpersonal guidance and information processing. Similarly, alexithymia, that is, the inability to feel and identify own feelings, either because of unawareness or incapacity to distinguish physical and affect states or because of lacking words for emotions (Krystal, 1998) can also impede on the ability to recognize emotions in others (Fan et al., 2011).

Studies of empathic deficits, another outstanding feature of NPD, have raised the question whether motivation/self-regulation or actual deficits, or both, contribute to compromised empathic ability. Impairment in emotional empathic ability was found in patients diagnosed with NPD (Ritter et al., 2011). Although their cognitive emphatic ability was intact and influenced by motivation, their emotional empathic functioning was affected by compromised ability for mirroring and responsiveness to the emotional states of others. On the other hand, NPD patients’ failure to accurately recognize emotions in others combined with overestimation of their own empathic ability indicates a more general empathic deficit (Marissen, Deen, & Franken, 2012). Emotion intolerance may also play a role in empathic ability as the person may be able to notice feelings in others, as mentioned above, but the perception of others’ feeling states can evoke overwhelming powerlessness, disgust, shame or loss of internal control, and hence trigger strong aggressive reactions or emotional or physical withdrawal (Ronningstam, 2009). In addition, noticeable fluctuations in narcissistic patients’ empathic ability may be influenced by self-regulation, with increased ability to empathize when feeling confident and in control, and decreased ability when feeling exposed, inferior or threatened.

The specific attachment pattern associated with pathological narcissism and NPD, as mentioned above, contributes to a second set of factors involving significant difficulties relating and connecting, especially in ways that can promote change (Kernberg, 2007). NPD patients often do not know who they are on a deeper level, and their identity is influenced by more profound and persistent self-enhancing efforts. Difficulties with dependency and mutuality and strong tendencies for avoidance and control are also, like in the case of Bob’s choice of intimacy via Internet, typical indicators of compromised interpersonal functioning (Kernberg, 1998). Perfectionism is such an effort because it involves both exceptionally high or inflexible (although inconsistent) ideals and standards of self or others, with strong reactions, including aggression, harsh self-criticism, shame, fear, or deceitfulness when self or others fail to measure up (Hewitt et al., 2008; Ronningstam, 2010). In interpersonal and social situations perfectionism can be self-promoting to enhance certain qualities, but it can also be self-protective and serve to hide something non-perfect. On the other hand, self-prescribed perfectionism can contribute to extremely unyielding self-criticism, like in the case of Bob, with hypervigilance and automatic cognitive appraisal of interpersonal situations as overly provocative or threatening. Especially, it contributes to reluctance to acknowledge and being seen as imperfect, and hence, to seek help for own distress and to integrate and benefit from treatment interventions.

Impaired ability for self-disclosure, self-silencing, selective or noncommunicativeness, and inability to share feelings and thoughts (Model, 1980; Besser, Flett, & Davis, 2003) are all aspects of narcissistic pathology that contribute to diagnostic challenges. Similarly, reversible perspective taking (Etchegoyen, 1999), the tendency to smoothly adopt the therapist’s comments and interpretations and seemingly internalize those given perspective without changing one’s own, and without incorporating the therapeutic process to generate change in own personality functioning, is yet another complicating defensive feature.

A third set of factors relates to the specific psychological aspects of trauma that can reinforce pathological narcissistic functioning. A narcissistic trauma is caused by a subjective experience of loss of supportive or sustaining external life conditions, such as changes in marriage/family, work and career, or financial situation, or loss of connection to a good, supportive idealized other person, leading to a loss or distortion of internal ideals and meaning. Sudden loss of a sense of control and competence, like in the case of Bob, can also be traumatizing for people whose self-esteem is strongly connected with performance and achievement. Such losses cause an acute internal state that threatens the continuity, coherence, stability, and wellbeing of the self (Maldonado, 2006). Narcissistic self-protection aimed at organizing and understanding the traumatic experience fail, and the sense of loss, rejection, and abandonment, along with feelings of shame, fear, and worthlessness become overwhelming (Gerzi, 2005). A narcissistic trauma is more subjective and self-esteem related, and involving exposure and humiliation. Sometimes such trauma can even be entirely emotional and internal, accompanied by compromised hope, sense of value, control, meaning, and affiliation. This contrasts to more external obvious traumatic experiences, such as physical attacks, abuse, accidents, and so forth. Narcissistic trauma, like in Trauma Associated Narcissistic Symptoms, TANS (Simon, 2002) can be intrinsic to the characterological vulnerability to disruption of self-regulation, and loss of agency and self-esteem in NPD. On the other hand, narcissistic traumas, experienced in young age, can also be deeply internalized and subjectively organized in a narcissistic patient’s mind, contributing to an armor-like, seemingly impenetrable narcissistic character functioning, with denial, omnipotence, and organizing and protecting narcissistic fantasies, covering split off shame and fear. These types of traumatic experiences may easily be either misdiagnosed or bypassed in a diagnostic evaluation as they often differ from standard psychiatric definitions of trauma involving abuse, neglect, catastrophes, and so forth (Ronningstam, 2012b; Simon, 2002; Krystal, 1998) and can remain effectively shielded. Facing the impact of external life events might actually help some patients to begin to access and process such subjectively internalized experiences.

This study has focused on identifying underpinnings and self-regulatory patterns behind the diagnostic traits for NPD. A flexible, exploratory, and collaborative diagnostic process is recommended that attends to the patients’ internal experiences and motivations as well as to their external and interpersonal functioning. The patients’ limitations and compromised abilities, as well as their interpersonally provocative, although sometimes quite elaborative self-regulatory and enhancing strategies should be attended to in ways that are informative and meaningful for both the patient and clinician. Identifying and differentiating healthy or protective aspects of narcissistic patterns from those that are pathological and perpetuating is important. Clarifying the threatening, injuring, or traumatic experiences and situations that escalate narcissistic reactivity is equally essential. Clinicians’ observations of the narcissistic patients’ functioning often do not concur with the patients’ own experiences of themselves or formulations of their problems. More detailed exploration of a recent event that caused fluctuations in the patient’s self-esteem and agency can be a useful start. Such exploration can provide the opportunity to clarify the patient’s internal subjective perspective, needs, and motives for self-enhancement, experiences of vulnerability and deflation, and the organizing and protective role of narcissistic functioning, both internally in relation to self and in relationship to others. A focus on these areas of functioning is in line with the Workgroups proposal for personality functioning in DSM-5 Section III, which includes identity (regulation of self and emotions), self-direction (self-agency), empathy and intimacy (interpersonal relatedness). With regard to the diagnosis of NPD, these changes represent significant improvement compared with the entirely trait-based diagnosis. Encouraging self-assessment and the patients’ own narratives of their performance, anticipations, aspirations, and shifts in states, self-esteem, and emotions can begin to bridge the different perspectives of the patient and the clinician, and help reaching a diagnostic agreement and understanding of the patient’s functioning.

Aarts, H., Wegner, D. M., & Dijksterhuis, A. (2006). On the feeling of doing: Dysphoria and the implicit modulation of authorship ascription. Behaviour Research and Therapy, 44, 1621–1627. doi:10.1016/j.brat.2005.12.004

Asai, T., Sugimori, E., & Tanno, Y. (2008). Schizotypal personality traits and prediction of one’s own movements in motor control: What causes an abnormal sense of agency?Consciousness and Cognition: An International Journal, 17, 1131–1142. doi:10.1016/j.concog.2008.04.004

Asai, T., & Tanno, Y. (2008). Highly schizotypal students have a weaker sense of self-agency. Psychiatry and Clinical Neurosciences, 62, 115–119. doi:10.1111/j.1440-1819.2007.01768.x

Bélanger, J. J., Lafreniere, M.-A. K., Vallerand, R. J., & Kruglanski, A. W. (2013). Driven by fear: The effect of success and failure information on passionate individuals performance. Journal of Personality and Social Psychology, 104, 180–195. doi:10.1037/a0029585

Besser, A., Flett, G. L., & Davis, A. (2003). Self-criticism, dependency, silencing the self, and loneliness: A test of a mediational model. Personality and Individual Differences, 35, 1735–1752. doi:10.1016/S0191-8869(02)00403-8

Besser, A., & Zeigler-Hill, V. (2010). The influence of pathological narcissism on emotional and motivational responses to negative events: The roles of visibility and concern about humiliation. Journal of Research in Personality, 44, 520–534. doi:10.1016/j.jrp.2010.06.006

Cooper, A. M. (1998). Further developments of the diagnosis of narcissistic personality disorder. In E.Ronningstam (Ed.), Disorders of narcissism: Diagnostic, clinical, and empirical implications (pp. 53–74). Washington, DC: American Psychiatric Press.

Dickinson, K. A., & Pincus, A. L. (2003). Interpersonal analysis of grandiose and vulnerable narcissism. Journal of Personality Disorders, 17, 188–207. doi:10.1521/pedi.

Etchegoyen, H. R. (1999). Fundamentals of psychoanalytic technique. London, UK: Karnac Books.

Fan, Y., Wonneberger, C., Enzi, B., de Greek, M., Ulrich, C., Tempelmann, C., . . .Northoff, G. (2011). The narcissistic self and its psychological and neural correlates: An exploratory fMRI study. Psychological Medicine, 41, 1641–1650.

Fonagy, P. (2001). Attachment theory and psychoanalysis. New York, NY: Other Press.

Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect regulation, mentalization and the development of the self. New York, NY: Other Press.

Fonagy, P., Luyten, P., Bateman, A., Gergely, G., Strathearn, L., Target, M., & Allison, D. E. (2010). Attachment and personality pathology. In J. F.Clarkin, P.Fonagy, & G. O.Gabbard (Eds.), Psychodynamic psychotherapy for personality disorders: A clinical handbook (pp. 37–87). Arlington, VA: American Psychiatric Publishing, Inc.

Foster, J. D., & Brennan, J. C. (2011). Narcissism, the agency model, and approach-avoidance motivation. In W. K.Campbell and J. D.Miller (Eds.), The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments (pp. 89–100). Hoboken, NJ: Wiley.

Gallagher, S.Self-agency and mental causality. Paper presented at Philosophical issues in psychiatry: Natural kinds, mental taxonomy and the nature of reality. University of Copenhagen, Denmark, May 25–26, 2006.

Gerzi, S. (2005). Trauma, narcissism and the two attractors in trauma. The International Journal of Psychoanalysis, 86, 1033–1050. doi:10.1516/2TTK-G0TL-9DWL-UHWY

Hewitt, P. L., Habke, A. M., Lee-Baggley, D. L., Sherry, S. B., & Flett, G. L. (2008). The impact of perfectionist self-presentation on the cognitive, affective and physiological experience of a clinical interview. Psychiatry: Interpersonal and Biological Processes, 71, 93–122.

Kernberg, O. F. (1975). Borderline conditions and pathological narcissism. New York, NY: Jason Aronson, Inc.

Kernberg, O. F. (1998). Pathological narcissism and narcissistic personality disorder: Theoretical background and diagnostic classification. In E.Ronningstam (Ed.), Disorders of narcissism - Diagnostic, clinical, and empirical implications (pp. 29–51). Washington, DC: American Psychiatric Press.

Kernberg, O. F. (2007). The almost untreatable narcissistic patient. Journal of the American Psychoanalytic Association, 55, 503–539. doi:10.1177/00030651070550020701

Knox, J. (2011). Self-agency in psychotherapy. New York, NY: Norton.

Krystal, H. (1998). Affect regulation and narcissism: Trauma, alexithymia and psychosomatic illness in narcissistic patients. In E.Ronningstam (Ed.), Disorders of narcissism - Diagnostic, clinical and empirical implications (pp. 299–325). Washington, DC: American Psychiatric Press.

Maldonado, J. L. (2006). Vicissitudes in adult life resulting from traumatic experiences in adolescence. The International Journal of Psychoanalysis, 87, 1239–1257. doi:10.1516/4VUN-32CV-BPW9-8QBF

Marissen, M. A. E., Deen, M. L., & Franken, A. (2012). Disturbed emotion recognition in patients with narcissistic personality disorder. Psychiatry Research, 198, 269–273. doi:10.1016/j.psychres.2011.12.042

Modell, A. H. (1975). A narcissistic defence against affects and the illusion of self-sufficiency. The International Journal of Psychoanalysis, 56, 275–282.

Modell, A. H. (1980). Affects and their non-communication. The International Journal of Psychoanalysis, 61, 259–267.

Pincus, A. L., & Lukowitsky, M. R. (2010). Pathological narcissism and narcissistic personality disorder. Annual Review of Clinical Psychology, 6, 421–446. doi:10.1146/annurev.clinpsy.121208.131215

Ritter, K., Dziobek, I., Preiβler, S., Rüter, A., Vaer, A., Fydrich, T., . . .Roepke, S. (2011). Lack of empathy in patients with narcissistic personality disorder. Psychiatry Research, 187, 241–247. doi:10.1016/j.psychres.2010.09.013

Ronningstam, E. (2009). Narcissistic Personality Disorder: Facing DSM-V. Psychiatric Annals, 39: 111–121. doi:10.3928/00485713-20090301-09

Ronningstam, E. (2010). Narcissistic Personality Disorder – A current review. Current Psychiatry Report, 12, 68–75. doi:10.1007/s11920-009-0084-z

Ronningstam, E. (2012a). Alliance building and the diagnosis of Narcissistic Personality Disorder. Journal of Clinical Psychology, 68, 943–953. doi:10.1002/jclp.21898

Ronningstam, E. (2012b). Narcissistic trauma and sudden suicide. Paper presented at American Psychoanalytic Association Winter Meeting. New York, January 2012.

Ronningstam, E. (2013). Narcissistic Personality Disorder - The diagnostic process. In T.Widiger (Ed.), Handbook of personality disorders (pp. 527–548). Oxford, UK: Oxford University Press.

Ronningstam, E., & Baskin-Sommers, A. (2013). Fear and decision-making in narcissistic personality disorder - a link between psychoanalysis and neuroscience. Dialogues in Clinical Neuroscience, 15, 191–201.

Ronningstam, E., Gunderson, J., & Lyons, M. (1995). Changes in pathological narcissism. The American Journal of Psychiatry, 152, 253–257.

Russ, E., Shedler, J., Bradley, R., & Westen, D. (2008). Refining the construct of narcissistic personality disorder: Diagnostic criteria and subtypes. The American Journal of Psychiatry, 165, 1473–1481. doi:10.1176/appi.ajp.2008.07030376

Sato, A., & Yasuda, A. (2005). Illusion of sense of self-agency: Discrepancy between the predicted and actual sensory consequences of actions modulates the sense of self-agency, but not the sense of self-ownership. Cognition, 94, 241–255. doi:10.1016/j.cognition.2004.04.003

Simon, R. I. (2002). Distinguishing trauma-associated narcissistic symptoms from posttraumatic stress disorder: A diagnostic challenge. Harvard Review of Psychiatry, 10, 28–36. doi:10.1080/10673220216206

Spengler, S., von Cramon, D. Y., & Brass, M. (2009). Was it me or was it you? How the sense of agency originates from ideomotor learning revealed by fMRI. NeuroImage, 46, 290–298. doi:10.1016/j.neuroimage.2009.01.047

Tangney, J. P. (1995). Shame and guilt in interpersonal relations. In J. P.Tangney & K. W.Fischer (Eds.), Self-conscious emotions: The psychology of shame, guilt, embarrassment and pride (pp. 114–139). New York, NY: Guilford Press.

Trumbull, D. (2003). Shame: An acute stress response to interpersonal traumatization. Psychiatry: Interpersonal and Biological Processes, 66, 53–64.

Zanarini, M. C., Frankenburg, F. R., Sickel, A. E., & Yong, L. (1996). Diagnostic Interview for DSM–IV Personality Disorders (DIP-IV). Boston, MA: Laboratory for the Study of Adult Development, McLean Hospital and the Department of Psychiatry, Harvard Medical School.

Zeigler-Hill, V., Myers, E. M., & Clark, B. (2010). Narcissism and self-esteem reactivity: The role of negative achievement events. Journal of Research in Personality, 44, 285–292. doi:10.1016/j.jrp.2010.02.005

This publication is protected by US and international copyright laws and its content may not be copied without the copyright holders express written permission except for the print or download capabilities of the retrieval software used for access. This content is intended solely for the use of the individual user.

Source: Personality Disorders: Theory, Research, and Treatment. Vol. 5. (4), Oct, 2014 pp. 434-438)
Accession Number: 2014-42878-005
Digital Object Identifier: 10.1037/per0000034

Russ, E., Shedler, J., Bradley, R., & Westen, D. (2008). Refining the Construct of Narcissistic Personality Disorder: Diagnostic Criteria and Subtypes. American Journal of Psychiatry AJP, 165(11), 1473-1481.

Skodol, A. E., Bender, D. S., & Morey, L. C. (2014). Narcissistic personality disorder in DSM-5. Personality Disorders: Theory, Research, And Treatment, 5(4), 422-427. doi:10.1037/per0000023