(English) Narcissist Predators: Their Prey and Habitat (Acibadem Sistina Hospital)

Only intro in Macedonian. The entire lecture is in English.

PHENOMENOLOGY of Narcissistic Personality Disorder (NPD)

Shame and grief: vulnerability and fragility

9 clinical features and trait domains of narcissism:

The above enumerated impairments should be "stable across time and consistent across situations ... not better understood as normative for the individual’s developmental stage or socio-cultural environment ... are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma)."

Lack of affective/emotional empathy

Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimation of own effects on others.

Fear of intimacy (insecure, usually dismissive-avoidant attachment style)

Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others’ experiences and predominance of a need for personal gain.

Disturbed or diffuse identity

Excessive reference to others for self-definition and self-esteem regulation (narcissistic supply); exaggerated self-appraisal inflated or deflated, or vacillating between extremes (grandiosity, a cognitive distortion); emotional regulation mirrors fluctuations in self-esteem.

Attention seeking behaviors (narcissistic supply or self-supply)

Excessive attempts to attract and be the centre of attention of others; admiration seeking.

Goal-setting based on gaining approval from others; personal standards unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.

Grandiosity (cognitive distortion) and Entitlement

Feelings of entitlement, either overt or covert; self-centredness; firmly holding to the belief that one is better than others; condescension towards others.

Anankastia

Negative affectivity, including fragility (bad object)

Dissociality (antisocial behaviors)

Antagonism

Only the last 2 traits mellow with age, not owing to learning from experience (the narcissist is incapable of that), but probably for biological reasons. The same mellowing is observed in psychopaths and borderlines.

AETIOLOGY of Narcissistic Personality Disorder (NPD)

Disruption in formation, constellation, integration of Self owing to ACEs, trauma, and abuse (DEFINE ABUSE)

Empty schizoid core

Black hole in autistic children first suggest by Frances Tustin in 1972.

We are all born with empty schizoid core, compensate by introjecting Mommy (symbiosis and primary narcissism).

Narcissism is compensatory and infantile: object inconstancy, ceaseless introjection and incorporation of internal object MASK the emptiness, compensate for it (introjective personality).

Dissociation, confabulation

Introjection of external objects (Othering failure)

Failure of separation-individuation

Fantasy defense, especially in interpersonal relationships (shared fantasy):

Idealization-devaluation-discard-replacement-hoovering

Hall of mirrors

Dual mothership

Covert vs. Overt narcissism: injury, collapse, decompensation-mortification

Primitive-infantile Defenses:

Splitting

Projection

Projective Identification

Rationalization

Narcissistic Rage (Frustration-aggression hypothesis)

I. Explosive – The narcissist flares up, attacks everyone in his immediate vicinity, causes damage to objects or people, and is verbally and psychologically abusive.

II. Pernicious or Passive-Aggressive (P/A) – The narcissist sulks, gives the silent treatment, and is plotting how to punish the transgressor and put her in her proper place. These narcissists are vindictive and often become stalkers. They harass and haunt the objects of their frustration. They sabotage and damage the work and possessions of people whom they regard to be the sources of their mounting wrath.

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