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Understanding Narcissism 

by Donna Kovacs 

All the headlines focusing on the Amber Heard and Johnny Depp domestic abuse story have led me to consider the challenges that our clients may face when in a relationship with a person with a mental disorder such as Narcissism. 

My research has led me to the following synopsis. Healthy narcissism is a mature and realistic state of mind (Kohut 1977) that we all need in order to have a healthy level of self-esteem. When a person has healthy narcissism, they understand their worth in the world and are able to create healthy boundaries in relationships and in life in general. 

The extreme opposite end of “Healthy Narcissism” is “Pathological Narcissism” or as a diagnosis “Narcissistic Personality Disorder” or NPD. 

NPD is a dysfunctional state of mind; a person diagnosed with NPD is immature, unrealistic and completely self-absorbed. 

Self-absorption occurs when there is a continual need to focus on one’s self in almost every situation (Brown 1998, 2001, 2006). 

According to the American Psychiatric Association, individuals with narcissistic personality disorder often suffer from low self-esteem and feelings of inferiority, while also projecting displays of arrogance and vanity. 

What Causes NPD? 

NPD has been detected in children as young as 

10 years of age, but is more commonly diagnosed 

during adolescence. 

Although the cause of narcissistic personality 

disorder isn’t fully known, researchers believe 

that NPD is likely to occur in children with a 

more vulnerable temperament and is created 

through either codependent overly protective 

parenting and or neglectful and abusive style 


Recent evidence by Dr Stefan Röpke, a professor in the department of psychiatry at the Charité – Universitätsmedizin Berlin in Germany found evidence of a bio-neurological component with research carried out in 2013. With the use of functional MRI the study compared the brains of 17 individuals diagnosed with narcissistic personality disorder with 34 control subjects and found, the fronto-paralimbic area particularly the left anterior insula of the brain showed a reduction of gray matter. 

The fronto-paralimbic area of the brain is associated with empathy, self-control, and emotional processing. The researchers found that the degree to which a person was able to exhibit empathy was directly tied to the volume of gray matter in the left anterior insula of the brain in both the control group and those with NPD – meaning that less gray matter in that area correlated with an inability to show empathy and vice versa. (The detailed results of the study were published online June 17 in the Journal of Psychiatric Research.) 

Covert and Overt Narcissism 

Within the diagnosis of NPD two subcategories also exist: overt narcissism and covert narcissism. Psychologists have observed that although the overall attitudes and characteristics remain consistent within both categories, their typical behaviours differ. 

Overt behaviours are those that can be easily observed by others and more closely associated with the extraverted personality type. Covert behaviours are subtle and yet devious, and are more often linked to introverted personality types. 

Below is a description of the listed behaviours, attitudes and characteristics of someone with a typical narcissistic personality disorder (NPD) diagnosis as per the DSM-5. 

Grandiosity – An exaggerated or grandiose sense of self-importance that isn’t supported by reality. The person will see themselves as super human, with unreasonable expectations and preoccupations with fantasies of extraordinary success, wealth, power, beauty and love. 

Entitlement Attitude – This attitude assumes that everyone is an extension of them and therefore others exist only to meet their needs. They believe they deserve special treatment because they are special and unique; and that they can only be understood by other special people. 

Attention seeking – Having an intense need for admiration. The person with overt NPD tends to speak loudly and speak a lot. They dress to attract attention and will enter and leave social gatherings in a big way in order to draw as much attention to themselves as possible. The person with covert NPD is more inclined to seek continuous reassurance by being critical of themselves in order to receive a compliment. i.e.: “Everyone here looks so much better than me” ensures an attentive partner will fulfill their need for attention.

If they are on social media, they will be constantly checking to see how many likes they have, they are expecting to have a huge number of followers very quickly. The person with covert NPD may become more risqué to draw attention whereas the covert NPD approach may be to spread false rumors and create gossip to reduce the following of their competition. 

Lack empathy – Since the individual with NPD lacks real empathy, they are easily able to exploit others without feeling guilt or remorse. 

They are basically indifferent to others’ emotions and so the impact of their critical, demeaning and devaluing comments and remarks towards others are easily expressed. On the flip side they are overly sensitive to others comments and expect everyone to be empathic to their needs, wants and desires. 

Envious – They are envious of others’ successes, accomplishments, possessions or opportunities because they feel as if they are more deserving than others. With this grandiose attitude they also assume others are envious of them, which only adds to the delusion of superiority. 

Arrogance – The arrogant attitude and sense of entitlement makes people with NPD speak down to others and behave in patronizing ways. Boasting about their successes at every opportunity helps to prove to themselves and others how deserving they are. 

Lack Interpersonal Skills – Since NPD relationships are purely one sided, they find it difficult to form and maintain any real or long-term connections. Since their need for connection is based purely on self validation, the other party can soon feel invisible if they spend too much time in their presence. 

A Typical Narcissistic Personality Disorder (NPD) 


A person with overt NPD can at first appear to be 

extremely confident, generally outgoing and full of 

bravado. The overt NPD type’s gregarious 

personality loves the spotlight and enjoys 

accolades whenever possible. 

They love to make a statement wherever they go, so you will see them often dressed in the most outlandish of outfits at social gatherings, because drawing the most attention (positive or negative) reminds them how attractive and admired they are by others. To that same extent they are often extremely loud. You will hear their flamboyant laughter across the room, letting everyone know they are the life of the party. 

The person with covert NPD certainly craves importance and has the same thirst for admiration but because of their introverted nature can be found at social gatherings in a smaller circle of admirers, gossiping about the appearance of those they perceive as competition. 

They might purposefully minimize their own accomplishments or talents so that people will offer them reassurance of how talented they are. 

Comments such as “I’m so ugly” as they smooth their already perfectly styled shining hair or “I’m getting so fat” after they have already scanned to ensure they are the thinnest person within the vicinity of this statement, are covertly asking for the validating compliments that they feel that they deserve.

AACHP Inc A0036986V 

Healthy Narcissism vs NPD 

Everyone will be able to identify with certain traits listed in the DSM-5, but this does not mean everyone that can recognize these traits will have narcissistic tendencies. 

For example, we have all experienced feelings of entitlement for things that we have earned fairly, but a continuous expectation of receiving something for nothing is a narcissistic response. 

Lacking empathy for another person’s situation or viewpoint until we have listened and understood them is a normal response, but to ignore a person’s emotions and exploit the situation to control or manipulate them is a typical narcissistic response. 

What happens to the victims of NPD? 

The manipulative and controlling behaviours of the person with NPD can be extremely debilitating to those in a relationship with them. 

Below is a list of common signs of psychological abuse that can be linked to the behaviours of a person with NPD: 

verbal insults, frequent criticisms, or put-downs 

being screamed or yelled at often 

threats of physical harm or to remove something held dear 

controlling behaviour, such as deciding when another person can eat, sleep, or see family and friends forcing physical or emotional isolation 

invasions of privacy, such as checking phones or reading private text messages 

Treatment for NPD 

I found no specific treatment recommended for narcissistic personality disorder other than talk therapy (psychotherapy). Medications were prescribed if comorbidities exist along with the NPD diagnosis. 


Narcissistic personality disorder is a mental disorder characterized by a life-long pattern of exaggerated feelings of self-importance, an excessive craving for admiration, and a diminished ability to empathize with others’ feelings. 

As we can see, these self-centered behaviours not only have a detrimental effect on the person with the disorder, but also on those around them. 

No matter what your point of view on the Amber Heard and Johnny Depp case, it has certainly brought the important topic of mental illness and its impacts, to the forefront of our minds. 

Donna Kovacs 

Dip Clinical Hypnotherapy, Dip Couns, DipMenHth