Key Points

Narcissistic personality disorder develops as a multifactorial process.
The methodology for psychiatric diagnosis is somewhat different than what we find in regular medical settings.

Neurodevelopmental issues, as well as genetics, parenting, and trauma can contribute to the emergence of NPD.

Ultimately, the emergence of NPD—and its associated traits—is somewhat of a mystery that can be better understood in good psychotherapy.

You can’t go a day without hearing the word “narcissism.” “Narcissism.” “Narcissism.” It’s become a label. A way of differentiating, of protecting oneself, of attacking. Ages ago, we would call someone a “communist,” “fascist,” or “atheist,” all of which negate the labels of a different era. Now it’s narcissism, these self-centered, manipulative, self-serving people.

So, welcome to complexity. Calling someone a psychopath when you’re not a professional is not okay. It’s even worse when you’re a professional but that person isn’t your patient. The label of a jerk is enough for most people who are selfish, charming, manipulative, and vindictive. So, with that out of the way, let’s delve into the origins of difficult people who meet the criteria for narcissism (or narcissistic traits) within the confines of a professional office.

To be clear, there are undoubtedly people in the general population who suffer from these traits: self-importance, lack of empathy, using others as pawns, grandiosity, and an emotional response to attacking them viciously when criticized, all under the influence of an inflated ego that masks the volatility (and weakness) of fragile self-esteem.

This is a conversation worth having.

TheIndicativeValue of Labels

Many people have bits of narcissism in them. This is not a mental illness; it is a human illness. However, if a person lives this way consistently, year after year, it may be a mental disorder that the DSM-5 defines as narcissistic personality disorder (NPD).

Where do these traits and this disorder come from? How do people become narcissists? The truth is, no one knows.

Let’s start with the evidential value of labels. In medicine, we use the term “diagnosis” to describe physical ailments. For example, a broken humerus is something we can all agree on through examination, tests (like X-rays), and history.

Psychological diagnosis is more subjective. There are no X-rays for narcissistic personality disorder—and our tests, even when they are comprehensive, are often subjective. There is no narcissistic spot in the brain (at least not yet) and no hard evidence other than psychological testing (which is helpful) and a history that reveals a series of painful and lost relationships driven by entitlement that blames everyone but oneself for what’s happening.

In other words, the diagnosis is there. It’s just more varied and shaky than is typically found in the medical world.

Origins of Narcissism

Now let’s look at the big picture. The susceptibility to narcissistic personality disorder (or traits) is probably multifactorial; genetic, developmental, and sometimes trauma-related.

For example, recent research suggests that some children are genetically programmed to be more grandiose and entitled than others. However, a tendency toward grandiosity and entitlement does not necessarily lead to narcissistic personality disorder. Some people are naturally grandiose and entitled but instead become strong leaders, parents, clergy, doctors, politicians, and so on. From an evolutionary perspective, one could argue that these traits, when used in a prosocial way, actually serve society. As such, they carry an adaptive value that persists in the gene pool. Certainly food for thought.

Good parents can teach these children (and all children) how to care for others; and how to understand right and wrong. But when these traits are left unattended by bad parents, it’s not hard to imagine that some genetic traits that could have been mobilized for good instead find expression in the despair we might find in narcissists. Parenting matters.

Now let’s discuss a difficult-to-document element of the developing child. There are 80 billion neurons in the human brain. This explains the radically different ways we process information, feelings, sights, sounds, and relational moments. Some of us perceive the world more accurately—and some less accurately. Some of us relate easily and trustfully, and some of us, for various reasons, distrust or have difficulty perceiving (the idea of ​​reason) the good intentions or intentions of others, including our parents.

Our inability to internalize a sense of security, whether because we are naturally anxious, read the world poorly, were raised chaotically, or were controlled by a parent, can bruise our self-esteem and distort our empathy for others.

Imagine a chaotic home. Every man (or child) is self-interested.

Imagine a controlling home. Every man (or child) is self-interested.

Imagine a traumatic home (or early experience). It is not difficult to imagine the self-preoccupied sense of self-protection as a psychological outcome.

The sense of having to win at all costs, of being on your own (with little empathy for others), is a core feature of narcissism that arises, yes, from a unique multifactorial mix that includes the neurodevelopmental component we have just discussed, now added to by upbringing, genetics, and trauma. Again, a broken humerus is a much easier problem to understand.

To be clear, not all children who grow up in chaotic, controlling, or traumatic environments are likely to develop NPD. There are many other ways to cope with these experiences, including growing up to be like most people on the planet who do not have NPD. The mystery of pathological narcissism as a developmental phenomenon lies in a combination of neurodevelopment, genetics, parenting, and psychological challenges that can be revealed in psychotherapy after the fact, but are difficult to predict in advance for any individual.

Finally, there is the issue of social reinforcement in narcissism.

Success and Failure

Narcissists often succeed early in life.

They often have charisma, natural talents, good looks, verbal prowess, parental favor, or unusually good interpersonal, academic, or athletic skills.

The ability to outshine people because of looks, charisma, or talent can heighten a child’s growing sense of entitlement (and grandiosity). As a result, these children may lose the value of normal frustration; the healthy, growth-enhancing value of moderate disappointment. If anything, all this success can make the developing narcissist vulnerable to emotional fragility when things don’t go their way.

Conclusion

We can only really predict how any given person with Narcissistic Personality Disorder (or traits) will develop. This can’t be predicted in advance, but it can often be reasonably well captured in treatment. The methodology of this work has been refined over the years by important thinkers such as Heinz Kohut, Otto Kernberg, Glenn Gabbard, and others. The message for the general public? Some qualified therapists can help.

However, most experts in the field agree that developmental factors play a large role, as well as success in narcissistic strategies such as manipulating people, directing anger toward those who upset you, and managing fragile self-esteem through grandiose aspirations and entitlement.

Some narcissistic men and women rise to high places in society, often with colleagues, partners, group members, political constituents, and family hurt along the way. Every sentient being has been burned by such characters. We know it in our bones.

However, many fail in their attempt to win at any cost, hurting the wrong person, and finding themselves trapped in some scheme, or alone, with the earth scorched around them.

To return to the narcissistic playbook, failure usually leads to anger and bitterness toward the world. But there is a positive point in all this pain; the failed narcissist can be open to the possibility of change if he is willing to engage in long-term—but helpful—psychotherapy.