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On Narcissism: Psychological Theories and Therapeutic
Interventions in the Narcissistic Disorders
Understanding the Narcissistic Phenomenon
The so called narcissistic personality disorder is a complex and often misunderstood
disorder. The cardinal feature of the narcissistic personality is the grandiose sense of self
importance, but paradoxically underneath this grandiosity the narcissist suffers from a
chronically fragile low self esteem. The grandiosity of the narcissist, however, is often so
pervasive that we tend to dehumanize him or her. The narcissist conjures in us images of
the mythological character Narcissus who could only love himself, rebuffing anyone who
attempted to touch him. Nevertheless, it is the underlying sense of inferiority which is
the real problem of the narcissist, the grandiosity is just a facade used to cover the deep
feelings of inadequacy.

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The Makeup of the Narcissistic Personality
The narcissists grandiose behavior is designed to reaffirm his or her sense of
adequacy. Since the narcissist is incapable of asserting his or her own sense of adequacy,
the narcissist seeks to be admired by others. However, the narcissists extremely fragile
sense of self worth does not allow him or her to risk any criticism. Therefore,
meaningful emotional interactions with others are avoided. By simultaneously seeking
the admiration of others and keeping them at a distance the narcissist is usually able to
maintain the illusion of grandiosity no matter how people respond. Thus, when people
praise the narcissist his or her grandiosity will increase, but when criticized the
grandiosity will usually remain unaffected because the narcissist will devalue the
criticizing person.
Akhtar (1989) as cited in Carson & Butcher, 1992; P. 271 discusses six areas of
pathological functioning which characterize the narcissist. In particular, four of these
narcissistic character traits best illustrate the pattern discussed above.(1) a narcissistic
individual has a basic sense of inferiority, which underlies a preoccupation with fantasies
of outstanding achievement; (2) a narcissistic individual is unable to trust and rely on
others and thus develops numerous, shallow relationships to extract tributes from others;
(3) a narcissistic individual has a shifting morality-always ready to shift values to gain
favor; and (4) a narcissistic person is unable to remain in love, showing an impaired
capacity for a committed relationship.
The Therapeutic Essence of Treating Narcissism
The narcissist who enters therapy does not think that there is something wrong with
him or her. Typically, the narcissist seeks therapy because he or she is unable to
maintain the grandiosity which protects him or her from the feelings of despair. The
narcissist views his or her situation arising not as a result of a personal maladjustment;
rather it is some factor in the environment which is beyond the narcissists control
which has caused his or her present situation. Therefore, the narcissist expects the
therapist not to cure him or her from a problem which he or she does not perceive to
exist, rather the narcissist expects the therapist to restore the protective feeling of
grandiosity. It is therefore essential for the therapist to be alert to the narcissists attempts
to steer therapy towards healing the injured grandiose part, rather than exploring
the underlying feelings of inferiority and despair.

Differential Psychological Views of Narcissism
The use of the term narcissism in relation to psychological phenomena was first made
by Ellis in 1898. Ellis described a special state of auto-erotism as Narcissus like, in
which the sexual feelings become absorbed in self admiration (Goldberg, 1980). The
term was later incorporated into Freuds psychoanalytic theory in 1914 in his essay On
Narcissism. Freud conceptualized narcissism as a as a sexual perversion involving a
pathological sexual love to ones own body (Sandler & Person, 1991). Henceforth,
several psychological theories have attempted to explain and treat the narcissistic
phenomenon. Specifically, the most comprehensive psychological theories have been
advanced by the psychodynamic perspective and to a lesser extent the Jungian
(analytical) perspective. Essentially, both theories cite developmental problems in
childhood as leading to the development of the narcissistic disorder. The existential
school has also attempted to deal with the narcissistic problem, although the available
literature is much smaller. Existentialists postulate that society as a whole can be the
crucial factor in the development of narcissism. The final perspective to be discussed is
the humanistic approach which although lacking a specific theory on narcissism, can
nevertheless be applied to the narcissistic disorder. In many ways the humanistic
approach to narcissism echoes the sentiments of the psychodynamic approach.
The Psychodynamic Perspective of Narcissism
The psychodynamic model of narcissism is dominated by two overlapping schools of
thought, the self psychology school and the object relations school. The self psychology
school, represented by Kohut, posits that narcissism is a component of everyones
psyche. We are all born as narcissists and gradually our infantile narcissism matures into
a healthy adult narcissism. A narcissistic disorder results when this process is somehow
disrupted. By contrast the object relations school, represented by Kernberg, argues that
narcissism does not result from the arrest of the normal maturation of infantile
narcissism, rather a narcissism represents a fixation in one of the developmental periods
of childhood. Specifically, the narcissist is fixated at a developmental stage in which the
differentiation between the self and others is blurred.

Kohuts Theory of Narcissism
Kohut believes that narcissism is a normal developmental milestone, and the healthy
person learns to transform his or her infantile narcissism into adult narcissism. This
transformation takes place through the process which Kohut terms transmuting
internalizations. As the infant is transformed into an adult he or she will invariably
encounter various challenges resulting in some frustration. If this frustration exceeds the
coping abilities of the person only slightly the person experiences optimal frustration.
Optimal frustration leads the person to develop a strong internal structure (i.e., a strong
sense of the self) which is used to compensate for the lack of external structure (i.e.,
support from others). In the narcissist the process of transmuting internalizations is
arrested because the person experiences a level of frustration which exceeds optimal
frustration. The narcissist thus remains stuck at the infantile level, displaying many of
the characteristics of the omnipotent and invulnerable child (Kohut, 1977).

Kernbergs Theory of Narcissism
Kernbergs views on narcissism are based on Mahlers theory of the separation-
individuation process in infancy and early childhood. Mahlers model discusses how the
developing child gains a stable self concept by successfully mastering the two forerunner
phases (normal autism and normal symbiosis) and the four subphases (differentiation,
practicing, rapprochement, and consolidation) of separation-individuation. Kernberg
argues that the narcissist is unable to successfully master the rapprochement subphase
and is thus fixated at this level. It is essential, however, to understand the dynamics of
the practicing subphase before proceeding to tackle the narcissists fixation at the
rapprochement subphase.
The practicing subphase (age 10 to 14 months) marks the developmental stage at
which the child learns to walk. The ability to walk gives the child a whole new
perspective of the world around him. This new ability endows the child with a sense of
grandiosity and omnipotence which closely resemble the narcissists behavior. However,
reality soon catches up with the child as the child enters the rapprochement subphase
(age 14 to 24 months). At this stage the child discovers that he or she is not omnipotent,
that there are limits to what he or she can do. According to Kernberg if the child is
severely frustrated at this stage he or she can adapt by re-fusing or returning to the
practicing subphase, which affords him the security of grandiosity and omnipotence
(Kernberg, 1976).
The Preferred Psychodynamic model
The Psychodynamic literature in general tends to lean towards the object relations
school because of the emphasis it places on a comprehensive developmental explanation
(i.e. the use of Mahlers individuation-separation model). Nevertheless, the theory of
Kohut has left a deep impression on Psychodynamic thinking as is evident by the
utilization of many of his concepts in the literature (i.e. Johnson, 1987; Manfield, 1992;
and Masterson, 1981). Therefore in the remainder of the Psychodynamic section a
similar approach will be taken, by emphasizing object relations concepts with the
utilization of the occasional Kohutian idea.
The Emergence of the Narcissistic Personality
According to Kernberg and the object relations school the crisis of the
rapprochement subphase is critical to the development of the narcissistic personality.
The individual who is unable to successfully master the challenges of this stage will
sustain a narcissistic injury. In essence the narcissistic injury will occur whenever the
environment (in particular significant others) needs the individual to be something
which he or she is not. The narcissistically injured individual is thus told Dont be who
you are, be who I need you to be. Who you are disappoints me, threatens me angers me,
overstimulates me. Be what I want and I will love you (Johnson, 1987; P. 39).

The narcissistic injury devastates the individuals emerging self. Unable to be what
he or she truly is the narcissistically injured person adapts by splitting his personality into
what Kohut terms the nuclear (real) self and the false self. The real self becomes
fragmented and repressed, whereas the false self takes over the individual. The narcissist
thus learns to reject himself or herself by hiding what has been rejected by others.
Subsequently, the narcissist will attempt to compensate for his or her deficiencies by
trying to impress others through his or her grandiosity. The narcissist essentially decides
that There is something wrong with me as I am. Therefore, I must be special (Johnson,
1987; P. 53).
The Narcissists View of Others
Just as the individual becomes narcissistic because that is what the environment
needed him or her to be, so does the narcissist view others not as they are, but as what
he or she needs them to be. Others are thus perceived to exist only in relation to the
narcissists needs. The term object relations thus takes on a special meaning with the
narcissist. We are objects to him, and to the extent that we are narcissistic, others
are objects to us. He doesnt really see and hear and feel who we are and, to the extent
that we are narcissistic, we do not really see and hear and feel the true presence of others.
They, we, are objects I am not real. You are not real. You are an object to me. I am
an object to you (Johnson, 1987; P. 48). It is apparent than that the narcissist maintains
the infantile illusion of being merged to the object. At a psychological level he or she
experiences difficulties in differentiating the self from others. It is the extent of this
inability to distinguish personal boundaries which determines the severity of the
narcissistic disorder (Johnson, 1987).

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Levels of Narcissism
The most extreme form of narcissism involves the perception that no separation exists
between the self and the object. The object is viewed as an extension of the self, in the
sense that the narcissist considers others to be a merged part of him or her. Usually, the
objects which the narcissist chooses to merge with represent that aspect of the narcissists
personality about which feelings of inferiority are perceived. For instance if a narcissist
feels unattractive he or she will seek to merge with someone who is perceived by the
narcissist to be attractive. At a slightly higher level exists the narcissist who
acknowledges the separateness of the object, however, the narcissist views the object as
similar to himself or herself in the sense that they share a similar psychological makeup.
In effect the narcissist perceives the object as just like me. The most evolved
narcissistic personality perceives the object to be both separate and psychologically
different, but is unable to appreciate the object as a unique and separate person. The
object is thus perceived as useful only to the extent of its ability to aggrandize the false
self (Manfield, 1992).
Types of narcissism
Pending the perceived needs of the environment a narcissist can develop in one of two
directions. The individual whose environment supports his or her grandiosity, and
demands that he or she be more than possible will develop to be an exhibitionistic
narcissist. Such an individual is told you are superior to others, but at the same time
his or her personal feelings are ignored. Thus, to restore his or her feelings of adequacy
the growing individual will attempt to coerce the environment into supporting his or her
grandiose claims of superiority and perfection. On the other hand, if the environment
feels threatened by the individuals grandiosity it will attempt to suppress the individual
from expressing this grandiosity. Such an individual learns to keep the grandiosity
hidden from others, and will develop to be a closet narcissist. The closet narcissist will
thus only reveal his or her feelings of grandiosity when he or she is convinced that such
revelations will be safe (Manfield, 1992)
Narcissistic Defense Mechanisms
Narcissistic defenses are present to some degree in all people, but are especially
pervasive in narcissists. These defenses are used to protect the narcissist from
experiencing the feelings of the narcissistic injury. The most pervasive defense
mechanism is the grandiose defense. Its function is to restore the narcissists
inflated perception of himself or herself. Typically the defense is utilized when someone
punctures the narcissists grandiosity by saying something which interferes with the
narcissists inflated view of himself or herself. The narcissist will then experience a
narcissistic injury similar to that experienced in childhood and will respond by expanding
his or her grandiosity, thus restoring his or her wounded self concept. Devaluation is
another common defense which is used in similar situations. When injured or
disappointed the narcissist can respond by devaluing the offending person. Devaluation
thus restores the wounded ego by providing the narcissist with a feeling of superiority
over the offender. There are two other defense mechanisms which the narcissist uses.
The self-sufficiency defense is used to keep the narcissist emotionally isolated from
others. By keeping himself or herself emotionally isolated the narcissists grandiosity
can continue to exist unchallenged. Finally, the manic defense is utilized when feelings
of worthlessness begin to surface. To avoid experiencing these feelings the narcissist
will attempt to occupy himself or herself with various activities, so that he or she has no
time left to feel the feelings (Manfield, 1992).

Psychodynamic Treatment of the Narcissist
The central theme in the Psychodynamic treatment of the narcissist revolves around
the transference relationship which emerges during treatment. In order for the
transference relationship to develop the therapist must be emphatic in understanding the
patients narcissistic needs. By echoing the narcissist the therapist remains silent and
invisible to the narcissist. In essence the therapist becomes a mirror to the narcissist to
the extent that the narcissist derives narcissistic pleasure from confronting his or her
alter ego. Grunbergers views are particularly helpful in clarifying this idea. According
to him The patient should enjoy complete narcissistic freedom in the sense that he
should always be the only active party. The analyst has no real existence of his own in
relation to the analysand. He doesnt have to be either good or bad-he doesnt even have
to be Analysis is thus not a dialogue at all; at best it is a monologue for two voices,
one speaking and the other echoing, repeating, clarifying, interpreting correctly-a faithful
and untarnished mirror (Grunberger, 1979; P. 49).
The Mirror Transference
Once the therapeutic relationship is established two transference like phenomena, the
mirror transference and the idealizing transference, collectively known as selfobject
transference emerge. The mirror transference will occur when the therapist provides a
strong sense of validation to the narcissist. Recall that the narcissistically injured child
failed to receive validation for what he or she was. The child thus concluded that there is
something wrong with his or her feelings, resulting in a severe damage to the childs self-
esteem. By reflecting back to the narcissist his or her accomplishments and grandeur the
narcissists self esteem and internal cohesion are maintained (Manfield, 1992).
There are three types of the mirror transference phenomenon, each corresponding to a
different level of narcissism (as discussed previously). The merger transference will
occur in those narcissists who are unable to distinguish between the object and the self.
Such narcissists will perceive the therapist to be a virtual extension of themselves. The
narcissist will expect the therapist to be perfectly resonant to him or her, as if the
therapist is an actual part of him or her. If the therapist should even slightly vary from
the narcissists needs or opinions, the narcissist will experience a painful breach in the
cohesive selfobject function provided by the therapist. Such patients will then likely feel
betrayed by the therapist and will respond by withdrawing themselves from the therapist
(Manfield, 1992).

In the second type of mirror transference, the twinship or alter-ego transference, the
narcissist perceives the therapist to be psychologically similar to himself or herself.
Conceptually the narcissist perceives the therapist and himself or herself to be twins,
separate but alike. In the twinship transference for the selfobject cohesion to be
maintained, it is necessary for the narcissist to view the therapist as just like me
(Manfield, 1992).
The third type of mirror transference is again termed the mirror transference. In this
instance the narcissist is only interested in the therapist to the extent that the therapist can
reflect his or her grandiosity. In this transference relationship the function of the
therapist is to bolster the narcissists insecure self (Manfield, 1992).

The Idealizing Transference
The second selfobject transference, the idealizing transference, involves the
borrowing of strength from the object (the therapist) to maintain an internal sense of
cohesion. By idealizing the therapist to whom the narcissist feels connected, the
narcissist by association also uplifts himself or herself. It is helpful to conceptualize the
idealizing narcissist as an infant who draws strength from the omnipotence of the
caregiver. Thus, in the idealizing transference the therapist symbolizes omnipotence and
this in turn makes the narcissist feel secure. The idealization of the object can become so
important to the narcissist that in many cases he or she will choose to fault himself or
herself, rather than blame the therapist (Manfield, 1992).
The idealizing transference is a more mature form of transference than the mirror
transference because idealization requires a certain amount of internal structure (i.e.,
separateness from the therapist). Oftentimes, the narcissist will first develop a mirror
transference, and only when his or her internal structure is sufficiently strong will the
idealizing transference develop (Manfield, 1992).
Utilizing the Transference Relationship in Therapy
The selfobject transference relationships provide a stabilizing effect for the narcissist.
The supportive therapist thus allows the narcissist to heal his or her current low self
esteem and reinstate the damaged grandiosity. However, healing the current narcissistic
injury does not address the underlying initial injury and in particular the issue of the false
self. To address these issues the therapist must skillfully take advantage of the situations
when the narcissist becomes uncharacteristically emotional; that is when the narcissist
feels injured. It thus becomes crucial that within the context of the transference
relationship, the therapist shift the narcissists focus towards his or her inner feelings
(Manfield, 1992).
The prevailing opinion amongst Psychodynamic theorists is that the best way to
address the narcissists present experience, is to utilize a hands-off type of approach.
This can be accomplished by letting the narcissist take control of the sessions,
processing the narcissists injuries as they inevitably occur during the course of
treatment. When a mirror transference develops injuries will occur when the therapist
improperly understands and/or reflects the narcissists experiences. Similarly, when an
idealizing transference is formed injuries will take the form of some disappointment with
the therapist which then interferes with the narcissists idealization of the therapist. In
either case, the narcissist is trying to cover up the injury so that the therapist will not
notice it. It remains up to the therapist to recognize the particular defense mechanisms
that the narcissist will use to defend against the pain of the injury, and work backwards
from there to discover the cause of the injury (Manfield, 1992).
Once the cause of the injury is discovered the therapist must carefully explore the
issue with the narcissist, such that the patient does not feel threatened. The following
case provides a good example of the patience and skill that the therapist must possess in
dealing with a narcissistic patient. a female patient in her mid-thirties came into a
session feeling elated about having gotten a new job. All she could talk about is how
perfect this job was; there was no hint of introspection or of any dysphoric affect. The
therapist could find no opening and made no intervention the entire session except to
acknowledge the patients obvious excitement about her new job. Then, as the patient
was leaving, the therapist noticed that she had left her eyeglasses on the table. He said,
you forgot your glasses, to which she responded with an expression of surprise and
embarrassment saying, Oh, how clumsy of me. This response presented the therapist
with a slight seem in the grandiose armor and offered the opportunity for him to
intervene. He commented, You are so excited about the things that are happening to
you that this is all you have been able to think about; in the process you seem to have
forgotten a part of yourself. The patient smiled with a mixture of amusement
and recognition. In this example the patient is defending throughout the session and in a
moment of surprise she is embarrassed and labels herself clumsy, giving the therapist
the opportunity to interpret the defense (her focus on the excitement of the external
world) and how it takes her away from herself (Manfield, 1992; PP. 168-169).
The cure of the narcissist than does not come from the selfobject transference
relationships per se. Rather, the selfobject transference function of the therapist is
curative only to the extent that it provides an external source of support which enables
the narcissist to maintain his or her internal cohesion. For the narcissist to be cured, it is
necessary for him or her to create their own structure (the true self). The healing process
is thus lengthy, and occurs in small increments whenever the structure supplied by the
therapist is inadvertently interrupted. In this context it is useful to recall Kohuts concept
of optimal frustration. If the interruptions to the therapists selfobject function are not
so severe as to overwhelm the patients deficient internal structure, they function as
optimal frustrations, and lead to the patients development of his own internal structure
to make up for the interrupted selfobject function (Manfield, 1992; P. 167).
The Jungian (Analytical) Perspective of Narcissism
Analytical psychology views narcissism as a disorder of Self-estrangement, which
arises out of inadequate maternal care. However, prior to tackling narcissism it is useful
to grasp the essence of analytical thought.
The Ego and the Self in Analytical Psychology
It is important to understand that the Self in analytical psychology takes on a different
meaning than in psychodynamic thought (Self is thus capitalized in analytical writings to
distinguish it from the psychodynamic concept of the self). In psychodynamic theory the
self is always ego oriented, that is the self is taken to be a content of the ego. By
contrast, in analytical psychology the Self is the totality of the psyche, it is the archetype
of wholeness and the regulating center of personality. Moreover, the Self is also the
image of God in the psyche, and as such it is experienced as a transpersonal power which
transcends the ego. The Self therefore exists before the ego, and the ego subsequently
emerges from the Self (Monte, 1991).
Within the Self we perceive our collective unconscious, which is made up of
primordial images, that have been common to all members of the human race from the
beginning of life. These primordial images are termed archetypes, and play a significant
role in the shaping of the ego. Therefore, When the ego looks into the mirror of the
Self, what it sees is always unrealistic because it sees its archetypal image which can
never be fit into the ego (Schwartz-Salant, 1982; P. 19).
Narcissism as an Expression of Self-Estrangement
In the case of the narcissist, it is the shattering of the archetypal image of the mother
which leads to the narcissistic manifestation. The primordial image of the mother
symbolizes paradise, to the extent that the environment of the child is perfectly designed
to meet his or her needs. No mother, however, can realistically fulfill the childs
archetypal expectations. Nevertheless, so long as the mother reasonably fulfills the
childs needs he or she will develop normally. It is only when the mother fails to be a
good enough mother, that the narcissistic condition will occur (Asper, 1993).
When the mother-child relationship is damaged the childs ego does not develop in an
optimal way. Rather than form a secure ego-Self axis bond, the childs ego experiences
estrangement from the Self. This Self-estrangement negatively affects the childs ego,
and thus the narcissist is said to have a negativized ego. The negativized ego than
proceeds to compensate for the Self-estrangement by suppressing the personal needs
which are inherent in the Self; thus the negativized ego of the narcissistically
disturbed person is characterized by strong defense mechanisms and ego rigidity. A
person with this disturbance has distanced himself from the painful emotions of negative
experiences and has become egoistic, egocentric, and narcissistic (Asper, 1993; P. 82).

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Analytical Treatment of Narcissism
Since the narcissistic condition is a manifestation of Self-estrangement, the analytical
therapist attempts to heal the rupture in the ego-Self axis bond, which was created by the
lack of good enough mothering. To heal this rupture the therapist must convey to the
narcissist through emphatic means that others do care about him or her; that is the
therapist must repair the archetype of the good mother through a maternally caring
approach (Asper, 1993).
A maternal approach involves being attentive to the narcissists needs. Just as a
mother can intuitively sense her babys needs so must the therapist feel and observe what
is not verbally expressed by the narcissist. Such a maternal approach allows the
narcissist to experience more sympathy towards his or her true feelings and thus
gradually the need to withdraw into the narcissistic defense disappears (Asper, 1993).
The Existential Perspective of Narcissism
Existentialists perceive narcissism to be a byproduct of an alienating society. It is
difficult for the individual to truly be himself or herself because society offers many
rewards for the individual who conforms to its rules. Such an individual becomes
alienated because he or she feels that societys rituals and demands grant him or her little
significance and options in the control of his or her own destiny. To compensate such an
individual takes pleasure in his or her own uniqueness (grandiosity), he or she enjoys
what others cannot see and control. Thus, the alienated person sees himself as a puppet
cued by social circumstances which exact ritualized performances from him. His
irritation about the inevitability of this is counterbalanced by one major consolation.
This consists of his narcissistic affection for his own machinery-that is, his own processes
and parts (Johnson, 1977; P. 141).
Existential Treatment of Narcissism
The existential treatment of the narcissist is based on the existential tenant that all
existing persons have the need and possibility of going out from their centeredness to
participate in other beings (Monte, 1991; P. 492). The severely alienated narcissistic
individual, however, does not believe in the validity of experience outside of the self.
Unlike others, the narcissist does not believe that a constructive relationship with others
is possible. Existentialists therefore believe that the therapist, through emphatic
understanding, must create a strong bond with the narcissist, so that he or she can see that
others have feelings too (Johnson, 1977).
The Humanistic (Client-Centered) Perspective of Narcissism
Thus far, no specific formulations have been advanced by humanistic theorists about
the etiology of the narcissistic condition. Nevertheless, by utilizing general humanistic
principles it is possible to explain narcissism. Essentially, much like the psychodynamic
explanation, humanistic psychology would argue that narcissism results when individuals
are not allowed to truly be who they are.

According to humanistic theory, humans have an innate need for self actualization.
We want to be the best person that we could possibly be. This is accomplished by
internalizing the behaviors that fit with the individuals personal self concept (that which
the individual finds to be appealing). However the self is also subject to pressure from
significant others. Significant others place upon the individual, conditions of worth,
upon which their love and approval is dependent. These conditions may or may not be
congruent with the individuals personal self. If they contrast sharply with the personal
self, and the individual does not want to risk loosing the approval or love of significant
others, then that individual will behave in ways maladaptive to his or her self
actualization needs.
Although humanistic theory does not elaborate on the specificity of these maladaptive
behaviors, it is possible to speculate that narcissism is one possible outcome.
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On Narcissism: Psychological Theories and Therapeutic
Interventions in the Narcissistic Disorders
Understanding the Narcissistic Phenomenon
The so called narcissistic personality disorder is a complex and often misunderstood
disorder. The cardinal feature of the narcissistic personality is the grandiose sense of self
importance, but paradoxically underneath this grandiosity the narcissist suffers from a
chronically fragile low self esteem. The grandiosity
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