January 24, 2015

"NPD Basics" by Dr. Elsa Ronningstam

I've been cleaning up my desktop and came across an informative article by Dr. Elsa Ronningstam:

NPD Basics

NPD Basics is a 14-page document, very accessible to the lay person learning about narcissism.

Dr. Ronningstam increases our understanding of people with narcissistic personalities. She corrects erroneous beliefs about narcissism. Such as:

Narcissism isn't "normal"
"Narcissism refers to feelings and attitudes towards one’s own self -- the core of normal healthy self-esteem, affects, and relationships. Normal narcissism relates to positive self-esteem and self-regard, to a sense of agency, mastery, inner autonomy, and control of thoughts, feelings, actions, and impulses. In addition, self-preservation and normal entitlement including survival and protection of one’s own self and territory are also expressions of normal narcissism."
Narcissists are grandiose---all the way to the core
"The common and underlying indications of narcissistic personality functioning include self-enhancement and self-esteem fluctuations, vulnerability, inferiority and fear of failing, limitations in interpersonal relationships, compromised empathic functioning and emotion recognition, and intense emotional reactions to threats to self-esteem, and sense of agency and control."  
Narcissists love themselves too much to contemplate suicide
"People with narcissistic personalities are particularly vulnerable to suicide. Studies have suggested that challenges to self-esteem and to a sense of internal control are contributing factors. Grandiosity and vulnerability, fluctuating self-esteem, intense emotional reactions to threats to self-experience, and limitations in interpersonal relationships are other contributing personality traits."
Narcissists are not able to empathize
"Studies have shown that people with NPD can notice and understand others’ internal states and feelings but may not be able to emotionally engage and respond to them. In other words, people with pathological narcissism or NPD have compromised and fluctuating empathy, but they do not lack empathy."
Once a narcissist, always a narcissist  
"Pathological narcissism and NPD are frequent among people in their late teens and early twenties, due to the specific developmental challenges in the transition from adolescence to adulthood. Such disturbances are usually corrected through developmental life experiences and normally do not develop into adult NPD. NPD does not necessarily remit with advanced age. Middle age is an especially critical period for the development or worsening of NPD, and narcissistic pathology and personality disorder have also been found in elderly people."

Let me know what you think about Ronningstam's article and if you're interested in talking about any of her points, feel free to comment!



  1. Thank you for this post, CZ. I've been a lurker for about six months here and thought I might share some thoughts about Elsa Rommingstam's presentation. I watched the video and am halfway through the PDF. It's pretty abstract and intellectual, so not too easy for lay people to absorb. Good information and a powerful way to think about NPD. I especially liked the discussion about the similarities and differences between NPD and BPD. Thoughts:

    1. I continue to be dubious about claim about the causes of NPD and BPD. It's fine to have theories, but I think we're still in the dark. The biggest problem is thinking we know more than we do.

    2. I doubt the usefulness of claiming that narcissism is a spectrum. "Healthy" narcissism seems to be an entirely different beast than NPD and malignant narcissism. They have only superficial characteristics in common.

    3. It would be useful if professionals and grassroots sites (like Narcissistic Continuum) had more interaction. The professionals are often boring and overly abstract - they need the concrete examples and colorful expressions of lay people. The grassroots could use a little more rigor. It's too easy for people to go way off, basing their ideas only on their personal experiences.

    4. Elsa's approach, like that of most professionals, is focused on NPD as the condition of an individual, to be treated by a professional through drugs and therapy. There are many problems with this approach. First, it is time-consuming and expensive, probably out of reach for most people. Second, as I believe Elsa reiterates, NPDs on their own are often not particularly motivated to do anything about the condition. It's usually the family, friends and co-workers who face the acute pain and are motivated to change the situation.Third, if NPD manifests itself overwhelmingly as a dysfunction in relationships, why not focus on the *relationships*? At least in some cases, it would seem to be a better approach for professionals to coach the families, etc. in how to make the situation more livable. And if it means that relationships come to an end, to help the break-up happen as gracefully as possible.

    Anyway, thanks for your work CZ. I've read many dozens of your posts and like the natural, well balanced approach you usually take.

    1. Hi Bart! Welcome to The Narcissistic Continuum where we talk about narcissism all sorts. It sounds like you've been browsing blogs and forums and have an understanding of narcissism as "personality disorder". You're not quite so sure about "normal" narcissism, the kind that's annoying but doesn't cause PTSD. NPD is a nasty beast, for the person with the disorder and for other people, too.

      1) Most professionals admit there's much to learn about the development of pathological narcissism. Benign narcissism can be picked up by osmosis in an individualistic culture, but not a personality disorder. Researchers are making good guesses and sometimes they've pin-pointed exactly what we've observed in the person we identify as a narcissist. But not always. I think credible psychologists admit we're in a learning process right now.

      2) Narcissism as a spectrum. Many people become frustrated with so much talk about "healthy narcissism" or even "benign narcissism." They'd prefer limiting discussions to NPD, the malignant form that is extremely harmful. However, what might appear to be arrogance as a youth could become pathological in midlife so it's important to identify narcissistic traits because this is where recovery work (even self-help) can be focused. Viewing narcissism on a continuum helps people know when they might want to invest in the relationship and when they might need to leave.

      Very few people have a bona fide NPD so that tells me the vast majority of damage done to society is by people who do NOT have a narcissistic personality disorders. Those traits are not benign even if they appear to be benign in comparison to NPD. Any degree of unhealthy narcissism is destructive to other people, to the narcissist, to society.

      3) I have thought about laypeople and professionals working together. This has happened in the BPD community but no-so-much with NPD. The tenuous status of NPD in the DSM-5 may have had something to do with that.

      4)Family members should learn "how" to communicate without triggering narcissist's defenses (or being triggered by the narcissist's projections, accusations, etc.). I would love to see more Family Education as the BPD community has done.

      Without specifying narcissism, some of the mental health organizations (NAMI) teach communication and coping skills that facilitate better family relationships. Without education though, families are in trouble and most of the time, they don't understand why there's constant drama or how they inadvertently contributed to the drama. 12-step groups also address many of the family problems inherent to narcissistic families by focusing on addictions.

      I have a more nuanced approach each year that I continue writing. There's nothing very nuanced about being in the middle of a crisis and realizing your best friend hates yer guts. Most people expect themselves to be way beyond what's even possible when they are actively and continuously being "discarded" like an old appliance. I had a difficult time "not being nuanced". It was hard to be angry, to write mean stuff, to let myself be unfair and judgmental. My early writings were about soul survival (mine!) and I am grateful to have come through a destructive time without causing irreparable harm to others or myself. Being able to connect with people online was integral to being where I am today.

      Thank you for reading and always check the date on my articles if you're browsing my site. The older they are, the less nuanced they'll be. I had an awful lot of anger to vent and serious losses to grieve.


    2. Thanks for the thoughtful reply, CZ. I especially liked the idea of distinguishing normal narcissism from the PDs, depending on whether the behavior causes PTSD in those around them.

      I understand completely what you mean by the arc of emotions that people follow as they heal from NPD/BPD in someone close. I have read quite a few of your posts and noticed the evolution you mention. Early on, it *is* a matter of survival, so one's behavior is not as nice as one might like. What I struggle with after many years is integrating the awareness about PD, together with the love that is still there.

      About representing narcissim on a spectrum - I think it's hard to come up with a schema that is satisfying. This is human behavior in all its complexity, after all! For myself, I use the idea of a traffic light:

      RED - Danger: get away or put up big barriers. Danger of physical or emotional damage. No awareness or ability to communicate. Frequent rages and withdrawals.

      YELLOW - Use caution. Probably safe if you're careful and don't expect too much. The people are trying, even though they probably cannot be very close. Relationships can be draining, but may be worth it. Occasional rages and withdrawals.

      GREEN - A normal person who is in a bad phase or a bad mood. It is not deeply rooted, and often the behavior can improve immediately. Responds to discussion and suggestions, and is capable of insight.

      I'm sorry to hear that therapists aren't especially good on narcissism. It reminded me of my disappointments with therapists over the years, when our family has had to deal with individuals who had BPD or NPD. I've encountered therapists who mis-diagnosed, ran away, or jumped into the drama. It's been much more helpful to talk with others who've had experiences with NPD/BDP. Online blogs and discussions are also good.

      To be fair, my experiences have occurred over the course of decades. Hopefully, current practitioners are more knowledgeable and skillful.

      Unfortunately, I think that NPD/BPD is precisely in the blindspot for therapists. Drugs and talk therapy are not too effective (or even harmful), and the people who become therapists are uniquely vulnerable to people with these disorders.

      It may be that the real answer will come from the grassroots, just as AA and Al-Anon came from the grassroots when the professionals weren't able to address the problems surrounding alcoholism.

    3. Red, Yellow and Green. Simple idea but highly effective! People have taken to the idea of Red Flag Behavior, but I haven't seen Yellow Caution Signs on any websites. I figure my ex should have come with "caution signs" and a few Hazard Cones when he veered into other people's lanes. You just can't drive on the same freeway with that man if you don't like having accidents.

      As far as therapists: I think many therapists underestimated the severity of the narcissistic disorder. They assumed, as did most of society, that pathological narcissism could be cured with a sympathetic ear and a loving family. Some of us are the product of that kind of thinking, sacrificing our own future to help someone who would "get us back" for being understanding. It's a terrible situation to be in. If you help a narcissist in trouble, s/he will feel "put down" and interpret your love as pity. Woe be the loving person accused of pitying the narcissist--for their judgment shall be swift and it shall be harsh. Therapists are part of our culture and we've all had mistaken notions about narcissistic people. I think that when psychologists (and laypeople) began discussing attachment theory and applying it to narcissists, it lessened the heavy weight born by those who actually dared to LOVE a narcissist! It's not a task for cowards, that's for sure.

      Because I had a long-term relationship with a man who suffered an abusive childhood, I was reluctant to speak up about his behavior. Not until he did something so egregious it could not be "undone", did I feel comfortable talking about our relationship and our family. To have the personality I have (very accepting and forgiving) and the intelligence I have (studious and open to information) and not be able to forge a strong relationship with him, says a great deal about the severity of the narcissistic personality. If we had only been married a short time, I probably would not feel as comfortable discussing narcissism on a continuum. But I watched the progression of NPD over the years and despite the efforts of many good-enough people in his life, he never attached to us emotionally. I suppose my story is a warning to other people like myself who are willing to understand and "work with" a difficult person because they love them.

      It sounds like you've been though more than one experience with a NPD/BPD individual. It can be excruciatingly painful if we don't know anything about personality disorders. The projection alone, is crazy-making.

      I hope to hear more from you, Bart. I don't post that often and people generally like bloggers who post frequently. But don't hesitate speaking up anytime! I love hearing from readers. We are ALL in this together...


    4. Thanks for the encouragement, CZ. I haven't gone public, but perhaps it's time to. Your balanced, human approach is appealing, and the humor makes it easy to swallow bitter truths.

      You're right that I've had a number of people with NPD/BPD in my life. One major relationship when I was young - like yours, but shorter (3 years). Also, friends and family. I have complicated feelings about them. On the one hand are the *bad behaviors* we know so well. On the other hand, many of them probably loved us in the only way they knew how. And at least for me, they are part of my history, part of my personality. To throw them away would be like throwing away a part of myself.

      After thinking more about it, you idea of a narcissistic continuum begins to make sense. People do shift in the intensity of their BPD/NPD. Some people gain awareness and do try to be fair and have good relationships. So there is hope.

    5. Bart, you have inspired me. I have some healthy skills for dealing with people who have narcissistic traits and maybe it's time to put those life-skills into words? For a long time, the only thing people wanted to know was "how to get away." No Contact became the "right" reply. While you appreciate my style and nuance, Bart, I've received my fair share of criticism for being soft.

      The thing is, people have children with narcissistic traits; bosses and neighbors and family they love with narcissistic traits. We can't high-tail it out of every relationship. If we did, we'd be living with and contending with our narcissist-within, after we'd eliminated the narcissists "out there". ha!

      I appreciated so much, your second paragraph. Yes. To throw them away would be like throwing away a part of myself. If we value family, forgiveness, compassion and understanding, we must live true to ourselves. Finding a healthier way to cope with narcissistic people is not only possible, it's meaningful. I derive a great deal of satisfaction in knowing I was able to support a family member through a potentially life-destroying period because of the hard work I've done learning about narcissism (and my reactions to narcissists!)

      If you decide to write about your relationships, be sure to let me know!


    6. Wonderful idea! A lot of the pain around NPD/BPD is probably avoidable, especially with the milder cases. Hard to "cure," but I think there are ways to make the situations more liveable. I fantasized about how it would have helped if people had Warning tags. As it is, we tend to have only a few unhappy responses: fans, codependents, PTSDed veterans. It would be nice to have more options.
      Thanks for your positive responses. Makes a difference!

  2. Hi CZ,
    Thank you for sharing this information and for furthering my understanding of narcissism. I watched the video and found the relationship between NPD and BPD insightful. It was timely in my understanding as my therapist suggested that my mother's behaviors indicate borderline.

    I appreciated her alternative approach and insight into correcting beliefs about narcissism. When I started reading about narcissism (on the web) and as I started to work on my own emotional health, I found a link in my own journey. Many of the issues I face are highlighted in her presentation. I think looking at narcissism in the different ways it can manifest unhealthily is central to healing oneself and having healthy narcissism.

    From my experience a narcissistic personality looks/sounds/is different because of the complexity of the individual - there may be a person who is more overt while another covert. I find what she mentions in the PDF, that the need to be defined comes from the outside a significant point. We need approval and at the same time, disapproval is ok too. The severity in to how far it goes to pathological is distinguishing for me. It is related to the other point on empathy, that empathy is used for a reaction, in self-service. That is still managing the self from the outside. The managing of oneself from the outside, imho, leads to the control behaviors we see in relationships. It is an impossible task to accomplish - control others and influences.

    When the control becomes destructive to someone else, it is the lack of responsibility that is there when it comes to putting one's own needs before another. The sense of responsibility is essential, if what I remember from your other posts (correct me if I'm wrong), in having a relationship.

    A point that I think Elsa Ronningstam didn't go into further in the part on intimacy in NPD was the absence of the Narcissistic Dilemma that lends itself to unlivable situations and relationships. Can I balance my needs with that of another person's? A dilemma that exists in intimate relationships, employee to company relationships, etc.

    I further reflected on the trait: narcissism from this.

    Hugs, TR

    1. Hello TR---always a pleasure to read your thoughts. Thank you.

      As Ronningstam pointed out, NPD and BPD are a "mix". In most cases, we can spot narcissism in someone with a BPD. Borderline behaviors show up when narcissists 'break down' (high stress; crisis). The advantage to understanding both disorders is regulating our behavior to avoid triggering their defenses. It's a pipe-dream to think we can "manage" a high-conflict relationship without the occasional flare-up, but we can prevent some of the problems by understanding their disorder and our reactions.

      I think you are right about "control behaviors" resulting from an external locus of control (external need for approval). Instead of managing life from the inside, narcissists manage other people. What is crazy-making is that they need people's approval yet claim to be self-reliant and self-sufficient.

      An external need for approval is why self-esteem is so important in understanding the narcissistic disorder. Narcissists are doing things to please others and earn their approval. When they are praised, their self-esteem goes up but when they "fail", their self-esteem plummets. I was glad to see Ronningstam emphasize "fragile self-esteem" because its easy to be fooled by a narcissist's self-confidence.

      Part of my life work was learning to approve of myself and not let other people's opinions defie my worth. Everyone goes through that to some degree as they mature but I think ACoNs are particularly vulnerable because they were not validated as children. If narcissistic parents did not graciously and abundantly offer parental approval, ACoNs are vulnerable to manipulation as adults.

      I think anyone raised by a narcissistic parent will be able to idenfity narcissistic traits (fleas) in themselves. The difference is that ACoNs get better and narcissists get worse. ;-P


  3. I'm thinking the good doctor has never met a malignant narcissist like my NM...it would be difficult to support a notion like they have empathy: mine had empathy only for herself.

    1. Hi Sweet Violet!

      ha...well, it sure seems like narcissists have no heart, no empathy, no soul when they don't meet a child's basic needs and they still sleep soundly at night. I have seen narcissistic mothers push their toddler away and wondered how they could do such a thing? Had they no empathy? Didn't they understand how the child felt?

      What Dr. Ronningstam is talking about I think, is "cold empathy". Narcissists are able to see and identify other people's emotions which is why they're so adept at manipulation. What they lack is "emotional empathy". To me, that means they cognitively put themselves in someone else's shoes but they don't "feel" compassion for them. Empathy to me is the trigger for emotions leading to an action that "alleviates suffering" and that is why it's so valuable in our world. If we just "empathize" with someone and do nothing to ease their pain, what good is it? I think cold empathy can be a weapon in the sadist's arsenal. They know how someone feels and it gives them satisfaction.

      So I'm thinking (and I have MUCH to learn about this) that empathy must inspire a higher set of values (doing no harm; justice and fairness; alleviating suffering) and it seems that our "emotional reaction" is central to evoking those behaviors.

      In my experience, the narcissist appeared to be empathizing with me and yes, I really do believe what I experienced was real. But there was a point to empathizing with me. I still had something they wanted (my respect, my friendship, etc.) and so they allowed themselves to participate in my experience. But once the narcissist has no need of us or perhaps we've become more trouble than we're worth, his/her empathy is turned off like a cold faucet. They can cognitively understand what we're feeling but they simply do NOT care.

      This is a complicated topic and Ronningstam's lecture inspired me to dig deeper into the topic of empathy. There are so many articles talking about the importance of empathy but having gone through a sadistic experience in which the narcissist was pleased to see me suffering, I had to wonder about the idea that narcissists "lacked" empathy.

      My interest is peaked by your comment so perhaps I'll spend some time studying the way Ronningstam is distinguishing cognitive from emotional empathy.


  4. NPD's have a clinical understanding of other people's sadness and well being. It's empathy in a clinical trained way. It's not a deep, caring for others well being empathy. I've had NPD's convince me, over numourous years, that they cared for my well being, when they didn't. It was a very clinical "so you're sad, that's sad, but what makes me sad is....." . I've also had NPD's I know not even pretend (to comfort me), but then come back for the fall out of my sadness.
    The NPD's and NPD adjacent people I know aren't grandious, they're sneaky. You wont' even notice you are demoting yourself to dedicate your life to them till it's too late.

    I also think Narcicism has a few levels,
    Red/Emotional Vampire/User, which leaves you drained, is very sneaky, can take over your life, prays on the niave, conflicting laws, exhaustihg, imprisoning, fake "connections", throw aways others, very very clearly toxic to outsiders. Possibly addictive (to their "affection") Avoid at all costs, and be vary wary.
    Yellow/Exhausting/Unfair, can leave you exhausted, can have conflicting/hypocritical rules, can push it, can talk over others often, can play the "I have more drama/pain then you" game, can break even the most patient caring person. Be wary, but worthwhile, if you use protection and make sure they don't steamroll you.
    Blue/accidental/self healing: may occassionally fall into toxic/selfish behavior under stress, but most of the time okay
    Green/sane/clean; Normal self preselving self esteem and self love.

    I think all the up to yellow the person can change, evolve and grow out of it. You can talk to them and they can think of what they're behavior affects others. Red though, it's red, if they let you out, or you escape, celebrate your win and leave, recover, sober up. People can change, but they have to choose to change.

  5. NPD's also tend to be like "why u need me, all this "needing me" stuff, cut it out" but when you don't need then they'll be like "I feel uncomfortable when we aren't about me". Damn confusing.


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