Pathological Narcissism: The Root of Other Cluster B Personality Disorders?
Sam Vaknin is probably the one who popularized the idea that NPD and APD (psychopathy) are virtually the same thing, in his book Malignanat Self Love: Narcissism Revisted. (I quote from the Project Gutenberg e-text.)
Psychopaths or sociopaths are the old names for Antisocial PD. They are no longer in use, generally. But, the line between NPD and AsPD is very thin. I, personally, believe (especially after my work in prison) that AsPD is simply a less inhibited form of NPD and that applying the two diagnoses to the same person is superfluous.
TIMEOUT: Note the glib narcissist in that quote: his "work" in prison was "time" in prison. Cunning, aren't they? ;-)
TIME-IN: Onto the topic at hand. He goes farther than the statement above. Hang in there while I backtrack a bit to show how he reasons to a general conclusion about personality disorders.
First, a rather stratling opinion about the narcissist's true self.
My personal opinion is that the False Self is a construct, not a self in the full sense.
It is the locus of the fantasies of grandiosity, the feelings of entitlements, omnipotence, magical thinking, omniscience and magical immunity of the narcissist.
It lacks so many other elements that it can hardly be called a "self".
The False Self is not a self, nor is it false. It is very real, more real to the narcissist than his True Self. ...I say that narcissists vanish and are replaced by a False Self [Kernberg]. There is NO True Self in there. It's gone.
Wow. I just tuck that one away for future reference.
Here is an example of a time when you must remember to consider the source. He is a narcissist. His true self is inaccessible to him, so he must think it's gone. I would like to hope that's it's still there, in an oubliette deep inside. Maybe that's wishful thinking, but I do think I've caught a brief glimpse of it in narcissists on special occassions. In any case, there's no sense quibbling about it, because for all practical purposes the true self IS gone.
Now, he distinguishes between the false self and the "alters" of Dissociative Identity Disorder (multiple personalities). I won't quote it all here, but you can search the book for snippets of text I have quoted to find that place and read it for yourself. I would like to note that I see no grounds of possible disagreement with him on this point. In fact, before I'd heard of NPD, when I finally faced facts that it wasn't me and that something was radically wrong with someone in my life, my first idea was that this person had multiple personalities. But that explanation just didn't quite fit, and for the very reasons Vaknin cites.
MPD (DID) is more common than believed. Those are the emotions that are segregated. The notion of "unique separate multiple whole personalities" is primitive and untrue. DID is a continuum. The inner language breaks down into polyglottal chaos. Emotions cannot communicate with each other for fear of pain (and its fatal results). So, they are being kept apart by various mechanisms (a host or birth personality, a facilitator, a moderator and so on). All PDs – except NPD – suffer from a modicum of dissociation. The narcissistic solution is to emotionally disappear. Hence, the tremendous, insatiable need of the narcissist for external approval. He exists ONLY as a reflection. Since he is forbidden to love his self – he chooses to have no self at all. It is not dissociation – it is a vanishing act.
This is why I regard pathological narcissism as THE Source of all PDs. The total, "pure" solution is NPD: self-extinguishing, self-abolishing, totally fake. Then come variations on the self-hate and perpetuated self-abuse themes: HPD (NPD with sex/body as the Source of the Narcissistic Supply), BPD (lability, movement between poles of life wish and death wish) and so on.
That makes sense to me. Pathological narcissism then is the root from which other personality disorders grow. They are just different ways of coping.
All PDs are interrelated, in my view, at least phenomenologically. True, there is no "grand unifying theory of psychopathology". No one knows whether there are – and what are – the mechanisms underlying mental disorders. At best, mental health professionals register symptoms (as reported by the patient) and signs (as observed). Then, they group them into syndromes and, more specifically, into disorders. This is descriptive, not explanatory science.
Exactly. Imagine where we'd be in medical science if we couldn't distinguish diseases by the disease-causing agent, a specific "bug." We'd be trying to deal with an illness known as "fever," trying to distinguish all the diseases that cause fever by the symptoms patients present with.
You're going to make errors that way. For, different people with the same disease will present with different symptoms, making you conclude that you are dealing with two distinct diseases. This is always a big problem when dealing with syndromes (a collection of symptoms) instead of an illness we can connect with a particular disease-causing agent.
I think that the diagnostic distinctions between the Cluster B disorders are pretty artificial. It is true that some traits are much more pronounced (or even qualitatively different) in given disorders. For example: the grandiose fantasies typical to a narcissist (their pervasiveness, their influence on the minutest behaviour, their tendency to inflate and so on) – are rather unique in both severity and character to NPD. But I think that they all the Cluster B Personality Disorders occupy a continuum.
Hence he views psychopathy as a less inhibited for of NPD. Borderlines are narcissists scared of being abandoned. And so forth.
In fact, he notes that BPDs are so like NPDs that Kerberg (a major authority on NPD) suggested doing away with the distinction between BPD and NPD altogether. The work of Hare may bring forth a similar suggestion with repsect to APD and NPD.
Not that there are no differences. It's just that what may be just an assortment of coping strategies do not seem to fit neatly into categories like the orders in Class Insecta.
Vaknin notes that distinctions between PDs are no more substantive than the distinction between, say, a doting narcissist and an ignoring narcissist. Superficially they seem opposites, but not when you dig and see that these are just two different narcissistic strategies, adapted to different circumstances, to achieve the same narcissistic end. Hence the apparent but false contradiction.
I don't know enough to be comfortable with having an opinion. But what I do know squares with what he says, and what he says makes sense to me.