Are Narcissists Psychotic?

Natalie Frank, Ph.D.

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I’ve heard that narcissists are psychotic or at least delusional. Is this true? If so, how can you get through to them?

Given how important it is for the narcissist to maintain their defense of character to offset their low self-esteem, it stands to reason they would be at a minimum, delusional. We have seen this recently in Trump's continued insistence that he won the election despite overwhelming evidence that he did not.

However, while a narcissist's reality testing is compromised where their beliefs about themselves are concerned they are able to tell right from wrong. They have to be able to do so in order for narcissism to work for them. They need to know when they need to spin the account of their actions to present it as something laudable or they could not get others to admire and respect them. Knowing which of their actions might be objectionable to others suggests that know what is right and what is wrong.

The narcissist consciously chooses which version of a story to adopt from one moment to the next. This strategy results in an aggrandizing narrative representing a counterfactual life. They are emotionally invested in their own personal myth, so much so that over time, they come to believe this new version of the story.

However, the narcissist is in full control of their faculties, aware of their choices, and extremely goal-orientated. And the only goal that matters is replacing the curtain with a titanium wall preventing even the slightest chance that anyone, including themselves, could possibly catch a glimpse of the real person who hides behind it. The wall is built tall and wide sealing off the self they believe can never be revealed, and reinforced with the lies and delusions that shore it up and prevent access.

A narcissist never lets anyone see who they really are. That would make them too vulnerable. If they failed to gauge someone’s reaction accurately, the person might come to hold a negative belief about them. If that person knows something truthful about the narcissist, this would force the narcissist to face that truth, something they don't believe they could handle. This is why the narcissist is far more comfortable presenting themselves based on fiction rather than fact.

Narcissists are frequently amazing storytellers. They captivate you with tales of personal triumphs, heroism, self-sacrifice, romance, and intrigue. If you ever get close enough to peek behind the curtain, however, you learn they’ve rewritten history to make themselves look good. Not only are they living in a fantasy world, but they also have fooled those they surround themselves with. This can be a problem if you share friends, family members, or work associates. Any attention given to someone other than the narcissist will set that someone else up to become the target of the narcissist’s aggression.

It can be very disconcerting to find out you fell for a narcissist’s self-mythology. What’s even more disturbing is not understanding how they can get so out of control when you even subtly suggest things are not exactly the way they present them. While they may be skipping down the yellow brick road deciding they are starring in The Wizard of Oz while combining the best qualities of all the characters, you are the one left saying, “I don’t think we are in Kansas anymore.”

The wizard may be able to give the Scarecrow a brain, the Lion Courage, and send Dorothy home, he has nowhere close to enough self-esteem to fill the huge, black hole that lies at the very center of the narcissist. However, the person doesn't grasp that from where they are in their delusional Oz, they can’t even see the galaxy where reality can be found.

Narcissists are not only experts at recreating reality, they are able to hold multiple conflicting realities in their mind at the same time. They can claim one version of an event one second and immediately deny this account and claim the opposite the next minute. They expect others to go along with their alternate realities punishing anyone who won't. This is where the delusions would most likely be realized by others and why they pick their audience very carefully.

Those who they seek out are those who will go along with their delusions as well as their ability to change reality to fit their needs. Somehow, narcissists not only convince people to adopt a new reality over another more factual one, but they are also able to indirectly communicate the crucial nature of believing the altered reality. This makes those in their life willing to forget the accurate version of history. such that they willingly The most disturbing thing about this is that those who are close to the narcissist, often family members, often begin to share some of the narcissist’s delusions and ultimately come to believe these delusions are their own viewpoint.

The longer the disorder goes on the better the narcissist gets and rewriting history and convincing others that the world is flat get the more elaborate their delusional system becomes. This is not a case of a break with reality as you see with psychosis, however.

These delusions are rarely associated with a psychotic syndrome and when you see narcissistic and psychotic symptoms in the same person the symptoms are usually features of two different and distinct disorders. Delusions are false beliefs that the person is convinced are true to the extent they will strongly and in the case of narcissists aggressively, defend against anyone who says they aren’t true. Psychosis involves sensory experiences in the absence of the stimuli that cause them, for example, hearing voices when no one is speaking or seeing something that isn't there.

Some argue that what the narcissist does is no different from what the rest of us do. Most of us do have opinions and positions that we are convinced are the truth and that we will strongly, sometimes aggressively, defend against those who hold opposite opinions. If we weren’t convinced our perspective was correct we wouldn't believe it.

However, most of us can also remember times, when we had a strongly held belief that we later found out, wasn’t all that accurate. When this happens most of us will change our beliefs in light of convincing evidence to the contradictory. The difference is that the narcissist will never allow the possibility that there could ever be evidence contrary to the false reality that they have created, nor will they permit others to do so.

A narcissist’s behavior is intentional and targeted to gain a specific outcome. While their reality testing may not be 100 percent accurate, they understand that they are weaving lies in order to establish an image of superiority and to gain positive reactions from others. Most individuals with psychosis do not have such well-organized all-encompassing delusional systems.

Psychosis generally results in the opposite of what the narcissist needs. Those who are psychotic are usually shunned by those around them and they cannot create positive reactions as they are unable to detect that their perceptions do not coincide with reality. So if you look at narcissism as a coping strategy, albeit a maladaptive one, it would not serve the narcissist's needs if it resulted in social rejection. Thus, while narcissists are clearly delusional they are not psychotic.

Many people want to know how to break through these delusions and lies so that the narcissist will gain insight and stop hurting others. Yet It's important to remember that insight is the last thing the narcissist wants. They want, or rather need, to repress the truth of what they are doing and the actual nature of their self-view. They delude themselves as well as others into believing falsehoods about their own greatness and may not always do it in the most obvious way. But one thing that is obvious is their wrath when you start trying to induce insight or get them to let go of the delusions they are so invested in maintaining.

The best thing someone can do is to try to convince them to go to therapy where a neutral person who knows what to expect and is not cowed by their anger can work with them. It should be someone well experienced in working with individuals with personality disorders. Ideally, they will help the person establish other coping strategies so they can slowly face the source of the problem, their own lack of self-worth which they can't face, and work to establish positive, realistic self-perceptions.

Unfortunately, since narcissists believe every problem that occurs is someone else's fault and never their own, they cannot understand that they need help and will rarely agree to therapy. When they do it is often just another means of trying to manipulate someone’s viewpoint to gain further support for the image they want to project to further strengthen their defenses. This may occur if they fear others are starting to catch on in order to be able to say that a professional said that they were right about everything.

As a therapist, I've seen first-hand that when we change relational patterns, it often transforms even the most inflexible "trait" into something softer, gentler—not a fixed feature, but a protection that eventually yields to compassion in all the ways one would hope. Narcissism is a way of relating to others based on the fear of rejection and vulnerability that often originates in a chronic traumatic situation where they are made to doubt their self-worth.

Many narcissists are never taught to cope with negative emotions of any sort they cannot face their actual beliefs about themselves, convinces they would shatter apart. Depending on how deep this problem goes and how long it has existed, they may not be capable of moving to a more flexible form of relating to others. But some can, especially when faced with losing someone who they are convinced their self-esteem is tied to.

The key to having a relationship with someone who is narcissistic is to break the vicious cycle — to carefully block their frantic attempts to control, distance, defend, or assign blame in the relationship. Sometimes the can be accomplished by communicating that you are willing to stay in a relationship with them, but not on their terms.

This is a way of inviting them into a new version of relating, an opportunity to develop real relationships where they can be loved and admired for who they really are instead of a farfetched image of perfection they believe they have to be not to be rejected and abandoned. But this can only happen if they decide it is important enough to keep you in their life, that they are willing to trust that you will still be there when they expose their genuine self. Ultimately, there is nothing that you can do unless they are willing to allow a new experience to happen.

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