Are Narcissists Psychotic? (4th World Congress on Neuropsychiatry, Sleep Disorders and Medicine)

4th World Congress on Neuropsychiatry, Sleep Disorders and Medicine, Rome, November 2019

Psychosis is chaotic thinking that is the result of a severely impaired reality test ( the patient cannot tell inner fantasy from outside reality). Some psychotic states are short-lived and transient (microepisodes). These last from a few hours to a few days and are sometimes reactions to stress. Psychotic microepisodes are common in certain personality disorders, most notably the Borderline and Schizotypal. Persistent psychoses are a fixture of the patient's mental life and manifest for months or years.

Psychotics are fully aware of events and people "out there". They cannot, however separate data and experiences originating in the outside world from information generated by internal mental processes. They confuse the external universe with their inner emotions, cognitions, preconceptions, fears, expectations, and representations.

Similarly, patients suffering from Narcissistic Personality Disorder and, to a lesser extent, Antisocial and Histrionic Personality Disorders fail to grasp others as full-fledged entities. They regard even their nearest and dearest as cardboard cut-outs, two-dimensional representations (introjects), or symbols. They treat them as instruments of gratification, functional automata, or extensions of themselves.

Consequently, both psychotics and the personality disordered have a distorted view of reality and are not rational. No amount of objective evidence can cause them to doubt or reject their hypotheses and convictions. Full-fledged psychosis involves complex and ever more bizarre delusions and the unwillingness to confront and consider contrary data and information (preoccupation with the subjective rather than the objective). Thought becomes utterly disorganized and fantastic.