Narcissism Case Study Girl

‘They unconsciously deny an unstated and intolerably poor self-image through inflation. They turn themselves into glittering figures of immense grandeur surrounded by psychologically impenetrable walls. The goal of this self-deception is to be impervious to greatly feared external criticism and to their own rolling sea of doubts.” This is how Elan Golomb describes narcissistic personality disorder in her seminal book Trapped in the Mirror. She goes on to describe the central symptom of the disorder – the narcissist’s failure to achieve intimacy with anyone – as the result of them seeing other people like items in a vending machine, using them to service their own needs, never being able to acknowledge that others might have needs of their own, still less guess what they might be. “Full-bodied narcissistic personality disorder remains a fairly unusual diagnosis,” Pat MacDonald, author of the paper Narcissism in the Modern World, tells me. “Traditionally, it is very difficult to reverse narcissistic personality disorder. It would take a long time and a lot of work.”

What we talk about when we describe an explosion of modern narcissism is not the disorder but the rise in narcissistic traits. Examples are everywhere. Donald Trump epitomises the lack of empathy, the self-regard and, critically, the radical overestimation of his own talents and likability. Katie Hopkins personifies the perverse pride the narcissist takes in not caring for others. (“No,” she wrote in the Sun about the refugee crisis. “I don’t care. Show me pictures of coffins, show me bodies floating in water, play violins and show me skinny people looking sad. I still don’t care.”) Those are the loudest examples, blaring like sirens; there is a general hubbub of narcissism beneath, which is conveniently – for observation purposes, at least – broadcast on social media. Terrible tragedies, such as the attacks on Paris, are appropriated by people thousands of miles away and used as a backdrop to showcase their sensitivity. The death of David Bowie is mediated through its “relevance” to voluble strangers.

It has become routine for celebrities to broadcast banal information and fill Instagram with the “moments” that constitute their day, the tacit principle being that, once you are important enough, nothing is mundane. This delusion then spills out to the non-celebrity; recording mundane events becomes proof of your importance. The dramatic rise in cosmetic surgery is part of the same effect; the celebrity fixates on his or her appearance to meet the demands of fame. Then the vanity, being the only truly replicable trait, becomes the thing to emulate. Ordinary people start having treatments that only intense scrutiny would warrant – 2015 saw a 13% rise in procedures in the UK, with the rise in cosmetic dentistry particularly marked, because people don’t like their teeth in selfies. The solution – stop taking selfies – is apparently so 2014.

The compelling epidemiological evidence comes from The Narcissism Epidemic, in which the American academics Jean Twenge and Keith Campbell found that narcissistic personality traits rose just as fast as obesity from the 1980s to the present, with the shift in women particularly marked. Scores have risen faster since the turn of this century.

Campbell is also the author of a meta-analysis of three cohort studies that found increases over the generations in the Rosenberg self-esteem scale among US middle school, high school and college students in the two decades to 2008. By 2008, a score of 40 (perfect self-esteem) was the modal response of college students, chosen by 18% of participants; 51% scored 35 or over. At this point, the test has to change or the measurement has to stop: the self-esteem of nearly one in five college students could not get any higher.

One study, sponsored by the US National Institutes of Health, looks at lifetime prevalence: you’d expect any trait to become more pronounced over time, since people who have lived longer have more time to develop it. In fact, narcissistic traits afflict almost 10% of people in their 20s, compared with 3% of people in their 60s. Older people have more formed personalities and are less influenced by socio-cultural pressures; when they were young, these pressures simply didn’t exist.

‘The best-case scenario is disillusionment’

Most of the traits have at their core the belief that one is extraordinary. The problem is obvious immediately: most people are not extraordinary.

Sharing the (self) love: the rise of the selfie and digital narcissism

The problem with narcissistic traits is that they’re unrealistic; the belief in one’s own extraordinariness will sooner or later abut the world, and the result will be disillusionment in the best-case scenario or ever-greater fake grandeur in the worst. “Especially when you’re talking about traits and not the disorder, it’s correlated in youth with less depression, less anxiety,” says Twenge. “It wasn’t until middle age that narcissists became depressed, because of their failed relationships.”

Your immediate worry, obviously, is that you have narcissistic traits yourself. Experiencing this anxiety means you don’t, since true narcissists know it – and freely admit it. Another major figure in the narcissism field, Brad Bushman, has shown that agreeing with the statement, “I am a narcissist” correlates highly with narcissistic traits. They are proud of it: they would say it helps them succeed. They also relate proudly, in surveys, that they’re low on empathy and caring isn’t their thing. There’s not much guilt in narcissism.

If you’re still anxious, or just curious, you should take the narcissistic personality inventory (NPI). “I made my husband take it on our fourth date,” says Twenge. “I’m not joking.” And he passed with flying colours? She laughs. “Yes. You don’t have to score zero. A little above or a little below the average, you’re fine. It’s when people start scoring a 20 or above [out of 40] that there’s some potential to worry.” It has seven strands: authority, self-sufficiency – a belief that you’ve achieved everything on your own – superiority, exhibitionism, exploitativeness, vanity and entitlement. I scored 11, mostly on exhibitionism. Now I’m worried that it’s narcissistic even to tell you that. God, it’s a swamp.

The damage narcissism brings can be quite amorphous and ill-defined. “Much of our distress,” MacDonald notes, “comes from a sense of disconnection. We have a narcissistic society where self-promotion and individuality seem to be essential, yet in our hearts that’s not what we want. We want to be part of a community, we want to be supported when we’re struggling, we want a sense of belonging. Being extraordinary is not a necessary component to being loved.”

The full-blown disorder is associated with harsh, critical parenting, but a mass rise in narcissistic traits is partly ascribed by MacDonald to lax and indulgent parenting: “[With] parents seeing their children as extensions of themselves – they want to be mates, the boundaries aren’t set – the child gets very confused: ‘You’re great, you’re terrific.’ Maybe we’re not, maybe we need to know we’re just ordinary.”

This has been evinced – again by Bushman, alongside Eddie Brummelman – in a longitudinal study that found overpraised children showed narcissistic traits six months to a year later. It’s not so much a new kindness in parenting as a kind of lackadaisical positive assertion, where self-esteem can be conjured out of thin air simply by the people around you saying it’s so. To a degree, MacDonald traces the new style of parenting back to new media: “You see mums relating to the non-human other, the smartphone, not the baby. The child is not getting a sense of self.” But the impact of social media is more pronounced – currently, at least – in the adult with narcissistic traits. “There’s a good accumulation of evidence that narcissists have more friends on Facebook,” Twenge says. “We can’t make the case definitively that social media causes narcissism, although it does certainly call for a certain type of attention-seeking. If you look at Twitter, and the quest for followers, that has a narcissistic ring to it.”

‘Our collective narcissism is destroying the planet’

There is a context even broader than Twitter: a competitive culture in which asserting one’s difference, one’s specialness, is the bare minimum for being market-ready. Twenge is cautious: “The market stuff hasn’t been as closely examined. Certainly, individualism tends to be correlated with materialism, and so is narcissism. Economic prosperity does seem to be linked to individualism.” Yet, it is hard to conceive of this mantra – you’re special, you’re worth it, you’re different – arriving unrelated to the call of competitiveness; the idea – popularised by monetarist politicians since the late-70s – that self-interest is beneficial, and that all of us acting in our own self-interest will create better outcomes for all.

In a way, this is easier to see played out in group narcissism. “Take, for example, members of parliament,” MacDonald says. “It’s not individual greed, is it? It’s a culture of: ‘Let’s grab it when we can.’ You walk into that culture when you become an MP, when you become a banker. Group narcissism is huge. And the worst thing our collective narcissism is doing is the destruction of the planet. Together, we’re wiping out species after species after species, fuelled by consumerism, fuelled by our self-importance. Our narcissism may destroy us in the end.”

One long-term study of narcissists and those with prominent narcissistic traits found that they do the most significant damage to those around them, over time. Among those with the full-blown disorder, this would relate to their failure to consider another person on an intimate level, seeing them only relationally: what can they do for me, or, in the case of their children, how do they reflect on me, or how have they disappointed me in what they’ve failed to reflect? Don’t forget that, in the original myth, Narcissus is punished with a terminal fascination for his own reflection in revenge for his treatment of Echo, whom he despises for loving him. It is properly understood not as self-love but emotionally monogamous self-love. Those with narcissistic traits may be more capable of considering others as discrete people, and it is this tendency to overreact to criticism that causes the damage over time.

So, let’s say you have taken the NPI, haven’t lied (because narcissists don’t – at least, not about their own narcissism) and have scored relatively highly, and that this correlates with your observation that your high expectations of yourself are often not met, your relationships fail and people who like you initially like you less four months later. All is not lost. MacDonald picks out five principles of self-improvement: gratitude, modesty, compassion (for self and others), mindfulness and community. Some of these are obvious – modesty as an antidote to self-love – and some have a practical application.

“If, for example, you write down at the end of the day three things you’re grateful for, that can go a long way to reverse your narcissism,” he says. (This is huge in psycho-self-help at the moment: stimulating grateful thoughts also allays guilt. Hebb’s law – neurones that fire together, wire together – suggests that your brain will always choose the more familiar pathway.) As for compassion, “if we can remain more humble, we become kinder, too”, he says, but this is a two-way street. “We need to have compassion for ourselves, as well; compassion for others will follow.”

The interesting thing, as their prevalence increases, will be seeing whether society rebels against or accommodates narcissistic traits. “There’s a natural human tendency to think that things are getting worse, or at least they’re not getting better, and you have to fight that tendency,” says Twenge. “But you also have to fight the tendency to stick your head in the sand and say: ‘The kids are great and there’s nothing wrong.’”

What are the traits of a narcissist? Read therapy session notes from man diagnosed with Narcissistic Personality Disorder (NPD).

Notes of first therapy session with Sam V., male, 43, diagnosed with Narcissistic Personality Disorder (NPD)

Sam presents with anhedonia (failure to enjoy or find pleasure in anything) and dysphoria bordering on depression. He complains of inability to tolerate people's stupidity and selfishness in a variety of settings. He admits that as a result of his "intellectual superiority" he is not well placed to interact with others or even to understand them and what they are going through. He is a recluse and fears that he is being mocked and ridiculed behind his back as a misfit and a freak. Throughout the first session, he frequently compares himself to a machine, a computer, or a member of an alien and advanced race, and talks about himself in the third person singular.

Life, bemoans Sam, has dealt him a bad hand. He is consistently and repeatedly victimized by his clients, for instance. They take credit for his ideas and leverage them to promote themselves, but then fail to re-hire him as a consultant. He seems to attract hostility and animosity incommensurate with his good and generous deeds. He even describes being stalked by two or three vicious women whom he had spurned, he claims, not without pride in his own implied irresistibility. Yes, he is abrasive and contemptuous of others at times but only in the interests of "tough love." He is never obnoxious or gratuitously offensive.

Sam is convinced that people envy him and are "out to get him" (persecutory delusions). He feels that his work (he is also a writer) is not appreciated because of its elitist nature (high-brow vocabulary and such). He refuses to "dumb down". Instead, he is on a mission to educate his readers and clients and "bring them up to his level." When he describes his day, it becomes clear that he is desultory, indolent, and lacks self-discipline and regular working habits. He is fiercely independent (to the point of being counter-dependent - click on this link: The Inverted Narcissist ) and highly values his self-imputed "brutal honesty" and "original, non-herd, outside the box" thinking.

He is married but sexually inactive. Sex bores him and he regards it as a "low-level" activity practiced by "empty-headed" folk. He has better uses for his limited time. He is aware of his own mortality and conscious of his intellectual legacy. Hence his sense of entitlement. He never goes through established channels. Instead, he uses his connections to secure anything from medical care to car repair. He expects to be treated by the best but is reluctant to buy their services, holding himself to be their equal in his own field of activity. He gives little or no thought to the needs, wishes, fears, hopes, priorities, and choices of his nearest and dearest. He is startled and hurt when they become assertive and exercise their personal autonomy (for instance, by setting boundaries).


Sam is disarmingly self-aware and readily lists his weaknesses and faults - but only in order to preempt real scrutiny or to fish for compliments. He constantly brags about his achievements but feels deprived ("I deserve more, much more than that"). When any of his assertions or assumptions is challenged he condescendingly tries to prove his case. If he fails to convert his interlocutor, he sulks and even rages. He tends to idealize everyone or devalue them: people are either clever and good or stupid and malicious. But, everyone is a potential foe.

Sam is very hypervigilant and anxious. He expects the worst and feels vindicated and superior when he is punished ("martyred and victimized"). Sam rarely assumes total responsibility for his actions or accepts their consequences. He has an external locus of control and his defenses are alloplastic. In other words: he blames the world for his failures, defeats, and "bad luck". This "cosmic conspiracy" against him is why his grandiose projects keep flopping and why he is so frustrated.

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next: The Sadistic Patient ~ back to: Case Studies: Table of Contents

Last Updated: 06 July 2016
Reviewed by Harry Croft, MD

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