We have observed three primary modes that characterize most patients with narcissistic personality disorder (in addition to the Healthy Adult mode, which the therapist tries to augment):
Not all patients with narcissistic personality disorder have all three modes, and some have other modes. However, these three modes are by far the most common ones. As we discuss the three modes, we link them to the schemas and coping styles that we theorize constitute narcissism.
In our experience, these patients are generally unable to give and receive genuine love (with the occasional exception of their own children). The core schemas of narcissism are Emotional Deprivation and Defectiveness, which are part of the Lonely Child mode. The Entitlement schema is an overcompensation for the other two schemas and is part of the Self-Aggrandizer mode. Because most patients with narcissistic personality disorder are not able to experience genuine love, they are likely to perpetuate their Emotional Deprivation and Defectiveness schemas throughout their lives. They ensure through their own behavior that they remain unable to love or be loved—unless they undergo therapy or engage in some other healing relationship.
The Lonely Child almost always has an Emotional Deprivation schema with a coping style of Overcompensation. To compensate for the schema, patients come to feel entitled. They demand much from, and give little to, the people closest to them. Because they expect to be deprived, they behave in a demanding way to ensure that their needs are met. It is their Emotional Deprivation schema that causes these patients to exaggerate how much they are neglected and misunderstood.
The Defectiveness schema is usually present in narcissism. Most patients with narcissistic personality disorder feel defective. For this reason they do not let other people get too close to them. Patients with narcissistic personality disorder are ambivalent about intimacy: They simultaneously long for it and feel uncomfortable and ward it off when they begin to receive it. (One might consider this the tension between their Emotional Deprivation and Defectiveness schemas. Their sense of deprivation motivates them to get closer to others, but their sense of defectiveness motivates them to pull away.) They believe that the exposure of any flaw is humiliating and will ultimately lead to rejection. Whenever they publicly fail to meet high standards, they collapse from grandiosity into inferiority and feel shame. Such failures often produce depression or other Axis I symptoms such as anxiety or psychosomatic disorders. In addition, failures usually precipitate renewed efforts to overcompensate.
In actual practice, we often fine-tune or alter the names of the modes to better fit each individual patient. For example, we might name the Lonely Child the “Rejected Child,” the “Ignored Child,” or the “Inadequate Child”; we might name the Self-Aggrandizer the “Competitor” or the “Critic”; we might name the Detached Self-Soother the “Excitement Junkie” or the “Speculator.” We use whatever name best captures the mode for that patient.
Emotional Deprivation, Defectiveness, and Entitlement are the most prominent schemas in patients with narcissistic personality disorder, but there are often others. We frequently observe some of the following schemas as well.
Mistrust/Abuse
Social Isolation/Alienation
Failure
Insufficient Self-Control/Self Discipline
Subjugation
Approval-Seeking/Recognition-Seeking
Unrelenting Standards/Hypercriticalness
Punitiveness
Because they use overcompensation and avoidance as coping styles, patients with narcissistic personality disorder are largely unaware of their schemas most of the time.
This mode is the version of the Vulnerable Child mode found in patients with narcissistic personality disorder. At the core, most of these patients feel like lonely children who are valued only insofar as they can aggrandize their parents. The patient, however, usually has little awareness of this core feeling. Because the most important emotional needs of the child have generally not been met, the patient usually feels empty and alone. The therapist forms the deepest bond with the patient’s Lonely Child mode.
In this mode, patients with narcissistic personality disorder often feel undeserving of love. The Lonely Child feels unloved and unlovable. Many patients with narcissistic personality disorder believe that they have somehow been able to succeed at a level far beyond their true capacity. Somehow they have tricked everybody or have been incredibly lucky. Thus they usually feel underneath that they cannot live up to the expectations that other people have set for them and that they seem on the surface to be meeting. They feel that they will not be able to keep meeting these expectations for much longer. Much of the time, these patients have the underlying sense that the areas of life in which they overcompensate to gain recognition and value are on the verge of collapse.
For these patients, the opposite of feeling “special” is feeling “average.” Average is one of the worst feelings for most patients with narcissistic personality disorder, because their self-image is split: either they are the center of attention and wonderful or they are nothing. There is no middle ground. This is a result of the conditional approval these patients received as children. To be average is to be ignored and unacceptable. If they are not special, no one will love them, no one will spend time with them. They will be alone.
The Lonely Child mode is usually triggered in patients with narcissistic personality disorder by the loss of some source of validation or special status: Their businesses fail; they are fired from their jobs; their spouses or partners leave them; they lose a competition; someone else achieves more success or acclaim; someone they respect criticizes them; or they get sick and are unable to work. Once these patients flip into the Lonely Child mode, they try to flip as quickly as possible back into one of the other modes (the Self-Aggrandizer or the Detached Self-Soother). Most patients stay in the Lonely Child mode for as short a time as possible, because experiencing the Lonely Child is intensely painful: The Lonely Child feels sad, unloved, humiliated, and (usually) inflicted with self-loathing. At some point in their lives—as a result of defeat, failure, or rejection—most patients with narcissistic personality disorder have spent some time in the Lonely Child mode. However, they usually do not remember it clearly, resist thinking about it, and will do almost anything to avoid feeling vulnerable again.
The Self-Aggrandizer mode is an overcompensation for the patient’s feelings of emotional deprivation and defectiveness. When patients are in this mode, they behave in entitled, competitive, grandiose, abusive, or status-seeking ways. Typically, this is their “default” or automatic mode, especially around other people: It is the mode patients with narcissistic personality disorder experience most of the time. They generally flip into the Detached Self-Soother mode when they are by themselves for extended periods, and only rarely do they flip into the Lonely Child mode.
Because the Lonely Child (usually) feels defective, the Self-Aggrandizer tries to demonstrate superiority. In this mode, patients often crave admiration and become critical of others. They are prone to such competitive behaviors as speaking in a condescending tone, retaliating with anger to perceived slights, one-upmanship, and always having to be right. These behaviors are compensatory: Underneath, these patients are feeling inferior and insulted. The schema also manifests in such intimacy-avoiding behaviors as expressing anger whenever they feel vulnerable and controlling the flow of conversation away from emotionally revealing material (as Carl, the case example we present later in this chapter, tries to do).
It is the Entitlement schema that leads to the patient’s self-centeredness, lack of concern for other people’s needs and rights, and sense of “specialness.” In the Self-Aggrandizer mode, patients with narcissistic personality disorder tend to behave in insensitive ways. They insist on doing and having whatever they want, regardless of the cost to others. They are almost completely self-absorbed, and show little empathy for the needs and feelings of others. They try to direct the behavior of others in accordance with their own desires. They expect to be treated as special and do not believe they should have to follow the rules that apply to everyone else.
As noted, the therapist often changes the name of the Self-Aggrandizer mode to more accurately fit the individual patient. We might call this mode the “Entitled Side” or the “Status-Seeker.” The therapist can use the most salient feature of the patient’s coping style to help name the mode.
In our experience, the most common coping styles of patients with narcissistic personality disorder when they are in the Self-Aggrandizer mode are as follows:
Aggression and Hostility
Dominance and Excessive Self-Assertion
Recognition and Status-Seeking
Manipulation and Exploitation
These coping styles represent extremes. It is important to remember that narcissism presents in many forms. Not all patients show such extreme coping styles. There is a “spectrum of narcissism” from relatively benign to malignant. At one extreme, patients are sociopathic; at the other extreme, they are self-absorbed but capable of empathy and warmth with some people. (See Kernberg’s [1984] discussion of “malignant” narcissism.) Therapy patients span the whole range. All of them, we believe, have a Vulnerable Child underneath.
When patients with narcissistic personality disorder use the coping style of Aggression and Hostility, they lash out in anger when others fail to meet their needs or challenge one of their compensations. These patients believe the saying, “The best defense is a good offense.” Feeling threatened, they attack. In the extreme, this coping style manifests itself as violence toward others. The function of the coping style is to force other people to meet their emotional needs (countering underlying feelings of emotional deprivation) or to preserve a mask of superiority (countering feelings of defectiveness).
Another coping style, Dominance and Excessive Self-Assertion, is the tendency to bully others in order to maintain control over situations. Patients who use this coping strategy can behave like tyrants. They often attempt to tower over others physically or psychologically in order to intimidate them. They attempt to be the “alpha”—and thus to get their emotional needs met or establish their superiority. They do this whenever one of their underlying schemas is triggered (usually Emotional Deprivation or Defectiveness).
Recognition- and Status-Seeking is a strong desire to obtain admiration from others, and is a dominant component of almost every patient with narcissistic personality disorder. Patients place an exaggerated importance on the outward signs of success, such as social status, high achievement, physical appearance, and wealth. They almost always do this to cope with underlying feelings of defectiveness. Because they feel “one down,” they attest that they are “better than.” In the Self-Aggrandizer mode, most patients with narcissistic personality disorder are envious of other people’s successes, including those of the people closest to them—and they frequently seek to destroy or diminish the accomplishments of others.
The coping style of Manipulation and Exploitation is the tendency to use others for one’s own gratification. At the extreme, patients who adopt this coping style are ruthless. They will do anything to get what they want, whatever the cost to others. They have little empathy and view other people as objects to use for their own satisfaction rather than as individuals in their own right. They feel entitled in order to overcompensate for their feelings of emotional deprivation. (In fact, several schemas are narcissistic overcompensations: Entitlement, Unrelenting Standards, Recognition-Seeking.)
Some patients are “closet narcissists.” They have the same three modes, but the Self-Aggrandizer mode exists in fantasy rather than reality. Like the meek title character in James Thurber’s “The Secret Life of Walter Mitty,” it is not obvious to the outside world that they see themselves as special or fantasize about another life. To the outside world, closet narcissists may appear unassuming or even people-pleasing. However, in their fantasy lives, they are superior to most people. These patients have very similar personality structures to those of more overly narcissistic individuals, but they do not openly display the Self-Aggrandizer mode around other people.
While they are with other people, patients with narcissistic personality disorder are usually in the Self-Aggrandizer mode. When they are alone, cut off from the admiration they derive from interacting with others, they usually flip into the Detached Self-Soother mode. In this mode they shut off their emotions by engaging in activities that will somehow soothe or distract them from feeling. Patients flip into the Detached Self-Soother mode when they are alone because, without other people to boost them up, they shift into the Lonely Child mode. They begin to feel empty, bored, and depressed. In the absence of external sources of validation, the Lonely Child starts to surface; the Detached Self-Soother mode is a way to avoid the pain of the Lonely Child.
The Detached Self-Soother can take many forms, all representing mechanisms of schema avoidance. Patients often engage in a variety of activities to stimulate themselves. These behaviors are usually undertaken in an addictive or compulsive way. With some patients, the mode takes the form of workaholism; with others, it takes the form of behaviors such as gambling, speculative stock investing, dangerous sports such as car racing or rock climbing, promiscuous sex, pornography or cybersex, or drugs such as cocaine. These activities provide stimulation and excitement.
Another group of patients compulsively engage in solitary interests that are more self-soothing than self-stimulating, such as playing computer games, overeating, watching television, or fantasizing. These compulsive interests focus their attention away from the pain of their Emotional Deprivation and Defectiveness schemas—away from the Lonely Child mode. The activities are all basically ways of avoiding feelings of emptiness and worthlessness.