“Narcissistic Personality Disorder.”

What does narcissism mean in this context?

We have to be really clear about defining what we mean by the term “narcissism.” When I use the term Narcissist or refer to narcissism, it is a shorthand way of saying the person is displaying the pattern of thinking, behavior, coping skills, and deficits that are called by mental health professionals “Narcissistic Personality Disorder.”
Among other things, people who qualify for a diagnosis of NPD:

  • Lack whole object relations and object constancy.
  • They also lack emotional empathy.
  • They are hierarchical in their thinking and are acutely conscious of anything that signals high status or low status.
  • They have unstable self esteem.
  • They need other people to validate them to feel successful.
  • They are hypersensitive to trivial slights.
  • They feel entitled to special treatment.
  • They devalue other people.

Why can’t Narcissism be a byproduct of addiction?

NPD cannot be a response to addiction because it begins to form in early childhood, as do all personality disorders. I don’t know any preschool addicts.

Why are there so many Narcissists with an addiction problem?

It is unclear what percentage of people with NPD have an addiction problem. I do not work with anyone with an active alcohol or substance abuse problem. Very few of my narcissistic clients have had addictions or alcohol issues. Most of the people with NPD that I have met do not have any substance abuse problems.

Why do Narcissists get addicted?

I did once ask a highly narcissistic and very intelligent friend of mine named Steve why he became a heroin addict. This is an abbreviated version of what he said:

I am in psychological pain 24/7. Heroin kills the pain. It also structures my day and provides for almost all my needs. I wake up and know I need to hustle some money together to get a fix.

Then I go uptown and meet a stranger on the corner. I give him my money and he says he will bring me back heroin. He could just be ripping me off. This creates a bit of excitement.

Then I go home and shoot up. I don’t know if I will get high or die. He could have sold me poison. That adds more excitement.

When I come down, I start hustling for my next fix. And that is my life.

Unlike Steve, the other people I know who had NPD chose cocaine as their drug of choice. They said that good cocaine made them feel smart and invincible. It stroked their ego. They did not appear to notice that it also diminished further their ability to empathize with or connect to other people.

Some people with NPD choose alcohol as their drug of choice. It is legal and they can safely buy it. My client Jane told me that:

A few drinks makes me more comfortable. My social inhibitions disappear and so does the part of my brain that is always judging me. I sometimes make really poor decisions when I am drunk because I love male attention. I have woken up in more strange beds than I can count. I don’t do it for the sex. It gives me a sense of power when a man shows he finds me irresistible.

Punchline: In this case of which came first, the narcissism or the addiction, the answer is clear: in all cases of true Narcissistic Personality Disorder, the addiction is a later addition.

Elinor Greenberg, PhD, CGP

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