My name is Sam Vaknin, and I am the author of Mental Illness that is very difficult to encapsulate and to capture in a few words.

I have been studying it for 16 years now. Still, I decided to give it a go, to try.

Autological narcissism pervades every facet of the personality, every behavior, every cognition, and every emotion, and this makes narcissistic personality disorder very difficult to treat.

At today’s, the narcissist’s unthinking and deeply ingrained resistance to authority figures such as therapists and healing or even mere behavior modification are rendered almost unattainable.

Autological narcissism is often comorbid with mood disorders such as depression or bipolar, compulsive rituals, substance abuse, paraphelia, sexual paraphelia, sexual deviance, and reckless behavior patterns. Many narcissists are also anti-social. They lack empathy, and they are convinced of their own magnificence and grandiosity. They feel that they are above social conventions and the law. Some of these concomitant problems are amenable to a combination of medication and talk therapy, but not so the core defense mechanisms of the narcissist.

These are untouchable. They are hard. They are rigid. The narcissist is both victimizing, but he is also a victim.

The essence of the narcissistic disorder is a breakdown of internal communication. The narcissist invents and nurtures a false self. This false self is intended to elicit attention, positive or negative, from other people. And this attention is needed to fulfill the innermost void that is at the crux of the narcissist, that is the core of the narcissist.

The narcissist inside is empty. The narcissist is a shell. The narcissist is so engrossed in securing narcissistic supply from these sources by putting on an energy-sapping show that he fails to materialize and realize his own potential. He fails to have mature, adult relationships, a feel, and in general to enjoy life.

To the narcissist, other people are never more than potential sources of narcissistic supply with a useful shelf life. The narcissist invariably ends up cruelly devaluing and discarding these people, like dysfunctional objects or broken toys.

Little wonder that the narcissist, hoarding, abrasive, exploitative, manipulative, untruthful, is universally held in contempt, derided, hated, persecuted, and cast out.

But we should never forget that the narcissist pays a dear price for something which essentially is beyond his full control. In other words, for his mental illness.

There are no authoritative studies to back a genetic predisposition to pathological narcissism.

The often heard claim that it is the outcome of abuse is also not fully substantial.

But anecdotal evidence, case studies, the investigation of populations in patient out-clinics and so on, all these reveal a correlation between abuse in early childhood and infancy and the emergence of claustrophobic hypnosticism with a defense mechanism in the adult.

Abuse, there are many forms of abuse. The most well-known and frequently discussed forms of abuse are incest. Molestation, beatings, constant berating, terrorizing, abandonment, arbitrary punishment, capricious and unstable parental behavior in environment, authoritarian, emotionless, rigid and hierarchical home regimes and so on and so forth.

But these are only the classical forms of abuse. More pernicious are the subtle and socially acceptable forms of abuse, such as doting, smothering, treating the child as an extension of a parent, forcing the child to realize the parent’s unfulfilled dreams and unrealized wishes, putting the child on a constant pedestal on display, maintaining unrealistic expectations of the child and so on and so forth.

These are all forms of abuse because they treat the child not as an individual with boundaries, but as some sort of instrument, some sort of tool.

These modes of abuse permeate the tenuous self-boundaries formed by the child and teach the child that he is loved because of what he accomplishes, not because of who he is.

So back to treating narcissism.

Every aspect of the personality is pervaded by pathological narcissism.

As I said, it covers the narcissist’s behavior, his cognition, his thoughts, his emotional landscape.

And this ubiquity renders pathological narcissism virtually untreatable.

Additionally, as I mentioned, the narcissist develops deep self-resistance to authority figures such as therapists.

His attitude to treatment is conflictual, competitive and hostile.

When the narcissist fails to co-opt the therapist into upholding his grandiose self-image, he then devalues and discards both the treatment and the mental health practitioner administering it.

More disorders, compulsive rituals, substance abuse, sexual paraphelias, reckless or antisocial behavior patterns often accompany pathological narcissism. They are comorbid, as I mentioned before.

While some of these coexistence problems can be ameliorated through a combination of medication and top therapy, not so the core defense mechanisms of the narcissist.

We are back where we started.

Narcissism is a vicious circle in the full sense of the word.