by Kristina Madjoska
If asked the question: what is the similarity between Adolf Hitler and the modern selfie taker, would you be able to respond? Certainly, only one of them is responsible for an aggressive regime that claimed the lives of millions. While they may seem worlds apart, these two personalities do share something in common—an obsession with themselves. The term ‘narcissist’ has been loosely used and overused in pop-culture to describe those who only care about themselves, who are overly and overtly concerned about their own appearance, wealth and social status. Especially in the western individualistic culture, being a narcissist is frequently considered a lifestyle choice, one adorned with vibrant images of assertiveness, self-confidence and success. Perhaps this social tendency has, in the eyes of many people, framed narcissism more as a cultural phenomenon than a pathology. Still, the psychiatric society of today recognizes the existence of a narcissistic personality disorder, a psycho-pathological state that manifests itself in many ways beyond the obvious display of grandiose self-love. In response, researchers are becoming increasingly interested in mapping the neurobiological and genetic sources of this disorder. Although the existent empirical evidence on narcissistic personality disorder is rather scarce, there have been some significant findings that are beginning to help us grasp the science behind this curious illness.
FROM MYTH TO MEDICAL FACT
The history of diagnosis of narcissistic personality disorder (NPD) goes far back to ancient Greece. The ancient Greeks used the term hubris to describe excessive haughtiness, arrogance and pride. Interestingly, the concept of hubris was vital to many narratives of Greek mythology, usually to capture the misfortune that ensues the vain hero. Many centuries later, the famous psychoanalyst Freud described narcissism as a magnified and extreme display of otherwise normal feelings of “self-love” and “libidinal self-nourishment”.1 Subsequent psychoanalysts built from Freud’s ideas on narcissism and the ego and recognized the degree of abnormality and the nature of the symptoms that characterize pathological narcissists. In 1980, the third edition of the acclaimed Diagnostic and Statistical Manual of Psychiatry established narcissism as a distinct type of personality disorder and outlined criteria for its diagnosis. Nowadays, these criteria have been revised as part of the newly published DSM-V.2 Accordingly, the personality disorder is placed in the Cluster B category, a group of personality disorders that is generally identified by problems with emotional regulation, lack of impulse control and decreased ability for social bonding. In fact, all four personality disorders that belong to this group—borderline, histrionic, antisocial and narcissistic—are moderately to highly comorbid;3 that is, they tend to occur and be diagnosed simultaneously.
BECOMING A NARCISSIST
There are certain symptoms of NPD that distinguish it from the other Cluster B subtypes. Thus, a diagnosed narcissist would pervasively feel grandiose, unique and chosen. Time and again, he would fantasize about unlimited success, power, beauty and influence. In the pursuit of those goals, a narcissist would exploit and manipulate others without fretting about their personal well-being. Yet, a narcissist is far from dismissive of others when it comes to appraisal of his own self-worth—it is absolutely essential to him that others enthusiastically affirm his highly idealized self-image.
In those displeasing moments when a narcissist does not get the needed affirmation from others, he is bound to experience a severe drop in his self-esteem. Even though there is a certain variance between the character and intensity of symptoms among diagnosed patients, there is a general consensus as to what qualities the personality disorder entails.
In discussing the possible biological bases for the occurrence of these symptoms, it is important to note that the disorder is not due to the presence of a foreign substance in the body. Rather, the biological basis of its symptoms is found in the imbalance of neurochemistry and brain anatomy that manifests into the generation of extreme thoughts and behaviors which are otherwise normal among the general population. Because there is no clear cut line that distinguishes NPD and non-NPD, psychologists and psychiatrists have recently tried to portray it as a spectrum or a range, rather than strictly delineated categories. Recently, researchers have been able to produce evidence for the neurobiological foundations of the disorder, particularly in the realm of social interaction. There is now significant insight into the diminished brain structures responsible for some of the symptoms that NPD patients experience.
SOME MEN DO FEEL LIKE ISLANDS
In a normal human brain, there are special neural circuits that are responsible for empathy, the ability to understand and share the feelings of another.4 There are two parallel brain systems responsible for the feeling of two different kinds of empathy. The first type of empathy involves feeling others’ feelings as if they were one’s own. It is felt due to the simulation system, located in the insular cortex of the brain.5 According to research,5 the brains of people that have a normally functioning insular cortex fire the same neural circuits both when they themselves feel pain and when someone close to them feels it. The healthy insular cortical region makes people able to effectively respond to other people’s emotional experiences. The second type of empathy is often referred to as cognitive empathy, or the ‘theory of mind’ —the abstract understanding that other people have their own feelings and thoughts and experience the world differently.5 Several other cortical regions of the brain are responsible for this type of empathy.
In one study conducted by the German research university Humboldt in Berlin,6 patients diagnosed with NPD were studied through self-reported and experimental methods for their ability to experience empathy. The study’s findings supported the theory that narcissists exhibit little to no responsiveness to other people’s feelings, which is to say that they have a dysfunctional emotional simulation system. However, they do show a great capacity to cognitively recognize other people’s emotions, which may be the reason why narcissists are very successful at exploiting and manipulating others around them for their own personal gains. In another study conducted by the same researchers,6 the same patients were subjected to brain imaging scans. The results showed that, in comparison to non-NPD patients, those who were diagnosed with the disorder had a statistically significant decrease in grey-matter volume in the left anterior insula, the part of the brain related to the simulation system. Moreover, additional results from the same study showed a reduction in the gray matter volume of two other significant parts of the brain: the cingulate insular cortex system and parts of the prefrontal cortex. The former part of the brain is related to decision making in a social context (that is, thought about how one’s decisions affect others) as well as the pain simulation system. The latter part is related to the ability for self-reflection in terms of emotional experience, which has a positive correlation with the ability to empathize with others and understand their own emotional experience. In lacking of empathy, a vital capacity for social bonding, a narcissist tends to form shallow and unfulfilling relationships. Ultimately, a narcissist who cannot bond with others around forms an instrumental relationship with them—they themselves are necessary tools for a path to glory, and their compliments and praise are necessary for the continuity of a grandiose self-image.
BEHIND THE MASK OF CONFIDENCE
Although on the surface a narcissist seems to be an invincibly confident person, feelings of deep shame and low self-esteem in response to social disapproval are at the core of NPD. One study tested the relative shame-proneness of NPD patients compared to healthy participants through a standardized testing procedure measuring strength of reaction to shame-provoking stimuli.7 The study showed that, in comparison to the control healthy participants, the NPD patients were significantly more shame-prone and had stronger reactions to the shame-provoking stimuli. In such a setting where shame is invoked, narcissists tend turn intensely angry. Undoubtedly, this occurs because they are fundamentally unable to reconcile the highly idealized sense of self they are trying to maintain and the diminished sense of self that occurs when they receive negative social feedback. Narcissistic anger has been correlated to diminished levels of the neurotransmitter serotonin.8 A neurotransmitter is a molecule that transmits messages between neuronal cells. In particular, serotonin has been linked to the ability for emotional regulation, which high-NPD patients lack. Because they lack this ability, narcissists tend to react more intensely and impulsively when they perceive a person or an event as a threat.8 Thus, instead of trying to induce sympathy, an ashamed narcissist would even further alienate others through seemingly self-preserving aggression.
THE CONFUSING GAME GENES AND ENVIRONMENT PLAY
In light of all these experimental findings, what seems to befuddle psychiatrists is the relationship between genetics and environment that is decisive in the development of a narcissistic personality. A research institute in Norway has recently generated three important findings that help stretch our understanding of genes and their relation to personality disorders.9 For these purposes, the research studies the difference in expression of symptoms between monozygotic and dizygotic twins. In one of these studies, it was found that narcissistic personality disorder has an index of 24% heritability, a somewhat moderate genetic correlation. A more detailed study looked at specific personality traits that are characteristic for different categories of personality disorders; this study showed that affective lability (or emotional dysregulation) had an overall heritability of 45%, whereas narcissism has a 53% heritability index. An analysis of these numbers suggests that these personality traits are, in fact, highly heritable. Perhaps most importantly, the third study has brought to light the complexity of gene-environment interaction through incorporation of epigenetics—the study of the modification of gene expression rather than change in the genetic sequence itself. What epigenetics has highlighted in the study of personality disorders is that inheritance is non-linear; that is, it is not solely a specific gene or the environment that determine a personality, but rather that the environment can fundamentally change how a gene is expressed. To illustrate, the novelty-seeking characteristic linked to narcissistic personality disorder is correlated to the expression of a specific gene only if the child carrying that gene was also raised in a hostile environment where the parents were either emotionally involved with the child or punished the child for expressing emotions. This developmental condition can leave a child ill-equipped to regulate his or her own emotional experiences, respond to those of others, and to pursue a stable sense of self. Although the field of epigenetics is still quite new, it may be able to precisely capture the intricate connection between genes and the environment in the development of a narcissistic personality.
HOW AND WHY DO WE THINK ABOUT NPD?
Now that we have glanced at the biology and genetics of a narcissist, it is important to think about the social consequences of the disorder. In reality, people tend to have little empathy for a narcissist, precisely because narcissists themselves display arrogant and emotionally indifferent behavior. However, this isolation renders them even less capable of dealing with their pervasive and intense emotion in a social environment, which can possibly lead to destructive and antisocial behavior. And although it may seem as if the greatest threat posed by a narcissist to our society may be a figure like Kanye West, there is in fact a growing body of evidence suggesting that today’s extremist religious leaders and individual terrorist attackers could also be sufferers of the maladapted sense of grandiosity and of the lack of empathy characteristic of a narcissistic personality. By all means, understanding this illness can help us better respond to the needs of both sufferers and those close to them, as well as tackle the threats it may pose to a wider social scene.
Kristina Madjoska ‘19 is a freshman in Hollis Hall.
- Freud, S. On Narcissism: An Introduction. Read Books Ltd. 2013.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. APA, 2013.
- “Comorbidity.” TheFreeDictionary. com. Web. 19 Oct. 2015.
- “Empathy.” TheFreeDictionary.com.
- Blaney, Paul H., Robert F. Krueger, and Theodore Millon. Oxford Textbook of Psychopathology. Third Edition. Oxford UP: UK, 2014. 791-805.
- Ritter et al. The Narcissistic Personality Disorder: Empirical Studies. Humboldt U: Berlin, 2013.
- Ritter et al. Shame in Patients with Narcissistic Personality Disorder. Psychiatry Research 215.2, 2014, 429–437.
- Adshead et al. Personality Disorders as Disorders of Attachment and Affect Regulation. Advances in Psychiatric Treatment. 12 (2006): 297-305.
- Nurnberger Jr., J.I. et al. The Genetics of Personality Disorders. Principles of Psychiatric Genetics. Cambridge UP: UK, 2012, 316-323.