Elsa Ronningstam, a psychologist at Harvard Medical School who specializes in NPD, points out the myth is not really about self-love but the inability to love. Eleanor Payson, a therapist in Michigan and the author of The Wizard of Oz and Other Narcissists,says of people with NPD, "They have a primitive, undeveloped sense of self." To compensate, they create a grandiose image to distract from an inner state that Payson says is one of "almost malignant anxiety and emptiness."
Octomom Nadya Suleman explained in an interview that she started having her brood so she they would fill "the void, the feeling of emptiness" inside her she said was the result of an unhappy childhood. When the first six kids apparently failed to understand their Sisyphean life's work of making their mother feel loved, Suleman pushed on and had eight more. Perhaps this latest batch—once they get out of the neonatal intensive care unit—will discharge their obligations better.
People with NPD act as if they are special beings who are exceptionally intelligent, accomplished, beautiful, or sexy (or all of the above), to whom lesser people (pretty much everyone else) must bow. For example, the late real estate heiress Leona Helmsley did time in prison for her belief about herself and her husband, "We don't pay taxes. Only little people pay taxes." Narcissists like to leave posthumous landmines in their wills, and in hers Helmsley excluded two grandchildren and left $12 million to the individual she cared about the most, her Maltese, Trouble. (A judge considered the dog's needs and cut its award to $2 million.) Helmsley left a $5.2 billion fortune to a foundation whose mission was to be the care of dogs, a bequest that made her Slate's No. 1 charitable giver of 2008. But the little people may have gotten their revenge. Another judge just ruled that the foundation's trustees may ignore Helmsley's wishes.
Every personality disorder runs on a continuum from mild to severe. People with mild NPD, more than those with mild cases of other personality disorders, can be very high functioning. Their aura of excitement, the force of their personality can be powerfully seductive. The arts, medicine, politics all attract inwardly injured people with an outsize sense of themselves and a desire for the world to recognize them. As columnist Charles Krauthammer noted about the 42nd president, "Clinton craves your adulation (the source of all his troubles)." Ronningstam says part of director Ingmar Bergman's genius was that he could project his narcissistic struggles in a compelling way on-screen. A striking number of successful artistic people with NPD establish their own compounds. Bergman, architect Frank Lloyd Wright, director Stanley Kubrick, and artist Salvador Dalí all retreated to self-created worlds, populated with casts (often revolving) of adoring spouses and assistants.
NPD is a little-studied condition. According to the American Psychiatric Association, about 1 percent of the general population has it. To researchers in the field, this is a significant underestimate. (One recent study concludes it occurs in 6 percent of Americans.) Psychologists Jean Twenge and W. Keith Campbell, authors of The Narcissism Epidemic, who obviously have a stake in proving there is one, estimate around 10 percent of today's young people have clinical manifestations of NPD. They believe narcissism is a cultural virus that has spread throughout the population over the past several decades.
Those who frequently treat NPD, or its victims, point out one reason the statistics may so underestimate its incidence is that narcissists rarely show up at a therapist's office. There are no pharmaceutical fixes, and therapy is often unsuccessful. If they do seek treatment—usually under duress—a primary outcome is that they drive their therapists bonkers. A study in the American Journal of Psychiatryfound that "clinicians reported feeling anger, resentment, and dread in working with narcissistic personality disorder patients; feeling devalued and criticized by the patient; and finding themselves distracted, avoidant, and wishing to terminate the treatment."
In a paper in Comprehensive Psychiatry, researchers explored whether NPD should even be considered a disorder since the people who have it, by definition, think so highly of themselves. The authors conclude it is a pathological condition but one that uniquely causes "pain and duress" not to the sufferers but to those closest to them. Psychologist Allan N. Schore, an associate clinical professor at the David Geffen School of Medicine at UCLA says NPD can be summed up as, "Contempt of other people and their emotions." People with NPD are convinced there is nothing wrong with them; it's everyone around them who is impossible or crazy. There's some truth to their perception because often the spouse and children of the narcissist have been driven mad by their cruelty, disparagement, rages, and vindictiveness.
The leading theory about the development of NPD is that people get it the old-fashioned, Freudian way: Your parents give it to you. It starts very early when the attachment between infant and caregiver goes awry. In the first years attentive parents instinctively respond to the infant's moods. But cold, neglectful, or abusive parents don't provide the necessary comfort. Paradoxically, over-involved parents can be just as damaging because they convey anxiety and distress in the face of their child's unhappiness. As a result of neglect or smothering, these children don't learn the essential skills of being able to soothe themselves and regulate their feelings. The authors of The Narcissism Epidemic say the drift toward hovering, boosterish parents who want to gratify their child's every impulse will churn out more narcissistically disordered people.