Narcissism is a term that has roots in Greek mythology, and as the story goes, a nymph named Echo fell in love with a handsome young man named Narcissus, who loved nobody but himself. Echo had previously been cursed by a vengeful goddess who took from her the ability to form her own words. Thus, she was only able to repeat the words of others. One day Narcissus came across his reflection in a pool of water and self-proclaimed, “I love you.” Echo, only able to repeat his words, uttered the same but could not capture his attention. She watched as Narcissus stared endlessly at his reflection until he wasted away and died.

When someone reads this story, it’s difficult to imagine how narcissism could be helpful to anyone, but this provides the opportunity to distinguish between healthy narcissism and pathologic narcissism.

Narcissism itself is not a disorder, disease, or inherently pathologic. We see it in parents, teachers, doctors, and even children. If you look hard enough, you will find that narcissism is everywhere. Therefore, narcissism only becomes relevant when a person with this character structure interacts with others.

Healthy narcissism (more appropriately referred to as self-esteem) stems from how anxiety is dealt with in childhood. When child has anxiety, and parents reinforce/strengthen the child’s identity and personality, the child’s sense of security is solidified. This is a process through which there is a constant acknowledgment of the core idea that the child is loved, valued, strong, and worthwhile. This allows the child to develop just enough healthy narcissism to serve as their first primary defense. Because of this intrinsic level of parental involvement, healthy narcissism includes the opportunity for healthy object-relations and, thus, healthy relationships.

This is in stark contrast to pathologic narcissism, where a child’s upbringing is inadvertently arranged in such a way that they develop behaviors that can be quite harmful to themselves and the people around them. In this type of narcissism, the opportunity for healthy object-relations, and thus healthy relationships, is precluded. Why? Because acknowledging a desire for a relationship implies a need which is unacceptable to a pathologic narcissist. The act of needing means they are imperfect on their own, which is not suitable for them. Pathologic narcissists maintain that the world is perfect because they have no needs, which leads to an illusion of omnipotence.

When people, particularly adults, behave in a narcissistic fashion, observers often make the assumption that they are choosing to behave as such. We often forget that the development of a personality structure is a process that requires input from others in order to come to light. As such, one can argue that the childhood of a pathologic narcissist was arranged so that they could only turn out one way. This would imply that the traits we see in them were done to them as a child.

The question then becomes. What went wrong?

There are many wrong turns in which child development can find itself; pathologic narcissism is but one. Pathologic narcissism is simply a model for parenting failures without prescribing fault to the parents because we know that they, too, have their own childhood experiences that affect the way they parent.

In healthy narcissism, childhood anxiety is managed in a way that encourages the child to be seen and heard. In pathologic narcissism, there is an opposite reaction. This manifests as a retreat from anything that could possibly endanger them, basically a retreat from life. Specifically, the biggest thing that might endanger a person, a relationship. This leads to an embrace of omnipotence, where an individual denies their ability to need.

The narrative becomes: I don’t need anything.  I certainly don’t need anybody. I have everything. I can do everything. I am completely self-sufficient.

There is a deflection of object-relations, and if the child keeps using it as they get older, they keep returning to it.  The goal is to never be dependent or lacking in any way because to depend on means to be vulnerable.  Everyone is their enemy; they trust no one, with the single exception being when they are confronted with adulation, which is often short-lived and unsustainable.

The pathological narcissist then finds that this defense works to a limited degree, and not very well. There is a deep sense of lack of fulfillment as they do not experience a sustained feeling of love or support, which means they are constantly hungry for these and never satisfied. This is akin to trying to survive off designer chocolates. They are beautiful and delicious but won’t keep you alive. Once you finish one, you want another one, but there are never enough, and you constantly need more.

Externally and superficially, pathologic narcissists look perfect. They are often invested in finding a “trophy” partner that serves as a testament to their own perfection and is thus a reflection of themselves. This doesn’t bode well for relationships because they are not much interested in the other person’s needs. There is a difference between a union where you are emotionally invested and a union where the other person functions as an appendage as opposed to an equal.

This dynamic becomes even more complicated when children are involved.

Pathologic narcissism is a highly dysfunctional defense that interferes in the narcissist’s life and, of course, others’ lives in which they are involved. They are toxic to people around them and thus have significant difficulty with interpersonal relationships, particularly romantic ones, and because of that, they never seem to be very happy. They are constantly losing relationships, which supports this narrative that they can trust no one, depend on no one, and at the end of the day, are able to only rely on themselves.

When we see these people, interact with them, and find that they are difficult, we develop assumptions and attitudes about them, usually negative. What I think allows us to be more compassionate is when we realize that they are a product of their childhood and, in essence, are responding to their upbringing. When someone not raised within this framework asks of them, “what’s wrong with you?” The short answer will be, “my parents made me this way.”

Anjani Amladi is a psychiatrist and can be reached at her self-titled site, Anjani Amladi, MD.

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