We have found four factors that often characterize the childhood environments of patients with narcissistic personality disorder:
Loneliness and isolation
Insufficient limits
History of being used or manipulated
Conditional approval
Most patients with narcissistic personality disorder were lonely as children. They were unloved in some significant way. Most endured significant emotional deprivation. The mother (or other main caretaking figure) may have paid a lot of attention to them but was not often physically affectionate or demonstrative. There was a lack of empathy and attunement on the part of the mother, as well as an absence of genuine love and emotional attachment. In addition, many patients felt rejected by or different from peers. Patients with narcissistic personality disorder have childhood histories that include such schemas as Emotional Deprivation, Defectiveness, and Social Isolation. Typically patients are unaware (or only vaguely aware) of these schemas.
Most patients with narcissistic personality disorder were not given sufficient limits as children and were usually indulged. However, they were not indulged emotionally; rather, they were indulged in material ways or permitted to behave as they wanted without regard to the feelings of others. Perhaps they were allowed to mistreat others or were given their way whenever they had “temper tantrums.” They may have been largely unsupervised—except in regard to sources of narcissistic gratification for their parents—in activities such as household chores or curfews. A feeling of “specialness” served as a substitute for love: It was the best the child got. These patients have childhood histories that include such schemas as Entitlement and Insufficient Self-Control/Self-Discipline.
Most patients were used or manipulated in some way as children, usually by one of their parents. For example, a parent might have used them sexually, manipulated them to fill the role of a substitute spouse, or pushed them to vicariously fill the parent’s need for achievement, success, status, or recognition. As children many of these patients were used to overcompensate for a parent’s schemas—to fill the parent’s unmet needs for sexual gratification, emotional support (the Emotional Deprivation schema), or feelings of inadequacy (the Defectiveness schema).
Typically this happened largely out of the child’s awareness. Patients often begin treatment saying, “I had a great childhood; both of my parents were wonderful.” They do not consciously realize that something was wrong. However, when the therapist looks more closely at the childhoods of such patients, the therapist finds parents who did not understand the needs of their children but were gratifying their own needs through their children. Often, the therapist finds parents with a narcissistic personality disorder.
As children, most of these patients experienced a confusing situation. They received attention, praise, and admiration; and all of these felt good, so they believe they were loved. But typically they lacked basic nurturing: They were not touched, they were not kissed, they were not hugged. They were not mirrored nor understood—they were not “seen” and they were not “heard.” Thus they got approval but did not experience genuine love: They were used, in the sense that they were given attention only when they performed up to certain standards. Their childhood histories often include such schemas as Mistrust/Abuse and Subjugation. In these cases, someone, usually a parent, used or dominated them, as though they were objects meant only for the parent’s gratification.
Most patients were given conditional approval as children, rather than genuine, unselfish love. (It is hard to say whether the parent “loved” the child—whether the parent’s feelings actually constituted love. As one patient put it, “Yes, my father loved me, like the wolf loves the lamb.”) As children, they felt special when they met some high standard imposed by the parent; otherwise, they were ignored or devalued by that parent. The parent emphasized “appearances” at the expense of true happiness and intimacy. The child tried to be perfect in order to be worthy of the parent’s approval and to ward off the parent’s criticisms and demands. The child was unable to develop a stable sense of self-esteem; rather, the child’s self-esteem became dependent on the approval of others. When others approved, the child felt momentarily worthwhile; when others disapproved, the child felt worthless. Patients with narcissistic personality disorder have childhood histories that include such schemas as Defectiveness, Unrelenting Standards, and Approval-Seeking.
We describe some typical childhood histories of patients narcissistic personality disorder. These are common patterns but not universal ones in narcissism. A large number of patients had one doting parent in childhood who treated them preferentially, as if they were “special,” and set few limits. Usually this parent was the mother, but sometimes it was the father. The mother spoiled and indulged them, but her behavior was based on her own needs, not their needs. The mother sought to meet her own needs for status and recognition through them. She idealized them and set very high expectations for them to meet. In order to keep them in line with her desires, she could be manipulative and controlling. She lacked empathy for their needs and feelings and did not give them physical affection (except perhaps in front of others, for show, or when she wanted it). The other parent also played an important role. For most of these patients, the other parent was at the opposite extreme. They had fathers who were absent, passive, distant, rejecting, critical, or abusive. Thus, as children, these patients often received two distinctly opposite messages from their parents: One parent inflated their value, whereas the other parent ignored or devalued them.
Many patients with narcissistic personality disorder were gifted in some way as children: They were brilliant, beautiful, athletic, or artistic. Typically, one or both parents pushed them hard to gain accolades through this talent. When they excelled in their achievements or appearance in a way that reflected positively on the parent, they were showered with adoration and attention; otherwise, they were given little or nothing—they were ignored or devalued. They labored to keep displaying their gift for the sake of the parent’s approval, because they were afraid that, if they stopped, the parent would abruptly withdraw attention or criticize them. There was a discrepancy between their specialness in one situation—when they were displaying their gift—and their worthlessness in another situation—when they were ordinary children.
Similarly, some patients with narcissistic personality disorder grew up in families that others viewed as special. Perhaps the family was wealthier than other families, one parent was famous or highly successful, or the family was in some other way higher in status. As children, these patients learned, “I’m special because my family is special.” However, inside the family it was different—inside the family they were ignored or rejected. Inside the family, they learned that the children who got praise and attention were the ones who excelled. Children who were average were invisible. Again, there was a tension between their high value in one situation—outside the family—and their low value in another situation—inside the family
Another common childhood origin of narcissism is social rejection or alienation. Some patients were loved and valued within the home, but outside the family they were rejected by peers or felt different in some significant way. Perhaps they were unattractive to the opposite sex, unathletic, or not as rich as the children around them. As adolescents, they were not popular or part of the “in crowd.”