And you would just have to do that, everything that you wanted.

That’s just how it’s supposed to be.

So in a way, we’re going to go through the last chapter, the initial two and the final two, and then we’ll go through the next chapter.

So, Professor, I am in the process of writing a book myself. I’m also been a psychotherapist for around 10 years, but I’m no academic like you.

And clearly there has been so much begun to be written about this condition and the broader form of dark triad and narcissism, etc.

My personal view is that you are the most deeply researched and poignant in this space. And there’s a lot of cranks on TikTok and various other places that I’m sure are trying to be helpful, but I certainly haven’t found them that helpful in my own study.

So I wanted to come to you as a real source, as I’m beginning to write, to make sure that I get it right, because I’m concerned that in some ways proliferating what’s wrong is not a great thing.

I’ve got about 13, 14 questions, if that’s okay.

How much of your discourse?

I wanted to start really with the broadest question, which is there appears to be a huge rise in either the number of people that are being diagnosed or suspected of narcissism, but certainly it’s being written about.

I know you’ve talked about between 5 and 7% of the population.

I’m just wondering in your view, is there an increase in people that are adopting or having these issues or is it more our understanding is increasing or a mixture of the two?

Well, first of all, the figures are a bit different.

It’s 1% in the general population, people diagnosed with narcissistic personality disorder. It’s 1% in the general population, 5 to 7% in the clinical population.

When you say clinical, Sam, what do you mean?

People who are in inpatient clinics, outpatient clinics, in therapy on a regular basis, having been diagnosed with other mental health issues and so on and so forth.

Bear in mind that narcissistic personality disorder is very often comorbid with other mental health issues.

We find narcissism with borderline personality disorder, with mood disorders, with bipolar disorder, etc.

The people with pure, pure-bred narcissists, narcissists who have only this diagnosis, narcissistic personality disorder, are almost nowhere to be found because at the very minimum they would be abusing substances, for example, or they would be suffering from depression, or they would have episodes of emotional dysregulation and so on and so forth.

This, of course, reflects very badly on the diagnostic and statistical manual because such levels of comorbidity imply that the clinical entities, the diagnoses within this book are somehow erroneous. They are delimited wrongly.

The differential diagnoses are not clear enough. They’re fuzzy.

Now, we have a new approach.

When I say we are in the profession, I’m not a therapist. I’m teaching clinical psychology.

So now we have a new approach.

That new approach says there’s a single personality disorder with various manifestations throughout the lifespan and in reaction to stressors and life circumstances and changing environments.

So you would have a personality disorder.

Under certain circumstances, you would become emotionally dysregulated because you have been narcissistically injured or mortified, and then you would qualify to be diagnosed as a borderline. And then you would be anticipating abandonment and rejection and betrayal, and you would act in a very cruel, ruthless and callous manner. You would be reckless and defiant and contumacious, hateful of authority. That would make you a psychopath.

So everyone goes through every conceivable personality disorder once they have been diagnosed with a personality disordered personality organization.

In the vast majority of people, luckily for us, this construct, which is a bit of an artificial construct, the personality, seems to have a core and seems to be stable across the lifespan and seems to be predictable.

And to some extent rigid in a good way, with boundaries.

That’s in the vast majority of healthy people.

But in people with personality disorder, none of this applies. Everything is chaotic and disorganized.

And so they’re trying to compensate for this by imposing external rigidity. Everything inside is mayhem and tumult and the deluge.

So they’re compensating for this by acting very rigidly and very robotically and very algorithmically.

That’s their way of somehow maintaining control over the void and the insanity raging inside and seething inside themselves.

Yes.

But I understand.

What’s interesting for me is that whenever there’s a diagnosis of borderline that I observe, there’s a lot of sympathy and empathy towards that individual knowing what a difficult life they are leading.

I noticed the opposite of those that get diagnosed with narcissistic personality disorder, that there’s often an immediate dislike towards that individual as if they have a choice versus the borderline.

Would you say that’s true and why that might be?

First, I think I already answered your first question.

And the answer is that we bandy about, we mislabel people as narcissists. We simply call them narcissists when they are essentially jerks or a-holes.

Just a bit selfish. We had a fight with them or we divorced them or something. They instantly become narcissists.

There hasn’t been a rise in the corresponding rise in the diagnosis of narcissistic personality disorder in clinical settings with one exception.

And this exception are people under age 25. People under age 25, the diagnosis of narcissistic personality disorder and similar disorders did increase. I would even say increased dramatically.

And this has been attributed by scholars like Twenge and Campbell and others. This has been attributed to the exposure to social media and more generally, more broadly to screens.

The divorce from reality inhabiting a fantasy world. That is the essence of pathological narcissism.

Pathological narcissism is not about being nasty to people or being mean to people. Pathological narcissism is a withdrawal into a defense fantasy when reality becomes burdensome or even intolerable.

And this is the true self, full self, idealized self at play large, right?

Yes.

Well, the true self has been sacrificed usually in the narcissistic pathology has been sacrificed very early on between the ages of three and or maybe even two between the ages of two and six.

Yeah.

And in its place, what took its place was a divinity, a deity.

So this is a form of primitive religion. It’s the way a child would conceive, would conceive God.

So a child, a child creates a false self, which is essentially a Godhead. And then the child sacrifices his true self to this Godhead, which is human sacrifice. And then the child continues to worship this deity throughout his life, having become an adult.

So narcissism is a much more onerous condition than borderline. Much more difficult.

Yeah.

In my view, narcissists, and here I beg to differ with Otto Kernberg. In my view, narcissists are much closer to psychosis than borderlines.

In borderline, psychosis is limited in time and it’s usually in the form of reactive micro episodes.

Yeah.

The psychosis in borderline involves dissociation, amnesia, depersonalization, derealization. These are difficult things. Of course they are.

But throughout the borderline’s life, psychosis is rare. It’s pretty rare.

While the narcissist is in a constant psychotic state, the narcissist cannot tell the difference between reality and fantasy at all.

And the narcissist converts every meaningful external object, every meaningful person into an internal object with which the narcissist continues to interact.

Narcissists are no longer with us.

No.

So narcissism is much, much worse condition than borderline. Much more difficult to endure.

Yes.

Much more painful and so on and so forth.

Yeah.

Good to understand.

Okay.

My next question again is blunt and you’ll give me a yes or no, I suspect.

I’m curious around the connection within diagnosis or even suspicion around covert narcissism and the avoidant personality type.

Is there a correlation between the two?

I’ve observed that maybe there is in my limited clinical experience and I’ve just wondered what you think about that.

I think there’s a question of cart and horse.

I think being avoidant might lead to the development of covert narcissism as a compensatory mechanism.

Yes.

Similar, for example, to autism spectrum disorder.

I was going to ask you about that too.

Yeah.

There’s similarities of lack of empathy and things that can present in all of them.

Yeah.

But the autistic child is usually rejected by parental figures, by peers, by siblings.

This rejection is very difficult to endure.

And so the autistic child is very likely to develop pronounced narcissistic defenses and in extreme cases become a narcissist.

I think similarly people with anxiety disorders or depressive disorders might become narcissists.

I think people with avoidant personality disorder or social phobia or social anxiety might become narcissists.

To cut a long story short, narcissism is a way to compensate for shortcomings, dysfunctions and similar mental health problems.

Therefore narcissism is much more universal than we think.

Yes.

Although we must distinguish between pathological narcissism and what Len Sperry calls narcissistic style.

Yes.

Many, many people who have narcissistic style.

We estimate 10 to 15% of a population have narcissistic style.

Narcissistic style simply means diminished empathy, tendency to exploit other people, lack of awareness and sensitivity, lack of ability to put yourself in other people’s shoes.

That’s not exactly empathy. It’s a lack of ability to imagine other people or to other, to regard them as other, etc.

This is narcissistic style and we all from time to time degenerate or deteriorate or devolve into a narcissistic style.

That is not the narcissistic pathology because someone with a narcissistic style is able to tell the difference between fantasy and reality and does interact with external objects.

Yes.

And it feels that those that work or deal with narcissists, whenever they challenge that fantasy in any form, that is when often they really feel the annihilation or the attempt of annihilation from that individual.

It feels that anyone tampering with something they truly believe or has to be true for them. That often feels the time when they most feel the heat of that.

Would that be fair?

The most recent development in the field is the realization that the only true narcissist is someone who’s very fragile and has a disrupted, disintegrated self.

Therefore has no ego, actually.

Narcissist ironically, I’ll selfless.

So this kind of person is teetering on the brink of self extinction.

Everything is precariously balanced.

This kind of person cannot afford any challenge, any undermining of the elaborate construction that he had labored for decades to create.

Any challenge to this would be perceived as an act of hostility and enmity.

And so you become the enemy. You become something called the secretary object. You become the enemy.

And you know, it’s a war.

Yeah, I saw your post on that just the other day.

Narcissist lashes out.

Narcissist, first of all, devalues.

By devaluing you, he renders your input insignificant.

And then he attempts to eliminate you, to eliminate the source of frustration.

This has been first discovered in 1939 by Dole.

Dole described what he called the frustration-aggression hypothesis.

He says that frustration creates inevitably, inexorably creates aggression.

And so you frustrate the narcissist by even hinting that his perception of others, of the world and of himself is somehow either incomplete or fundamentally flawed.

Yes, understood.

The conversations around psychopathy and I always forget, sociopathy, is that the right word?

It feels, is that a spectrum?

Do people tip from one to the other? Do they work up and down those?

Because often again, you feel sometimes it’s on the sadistic behaviors and it starts to edged into different levels of behavior.

Again, what’s your view on that?

Do people, can people work up and down them? Do they promote themselves up and down? Do they get worse with age? What’s your view? Are they very distinct conditions?

Well, this may come as a shock to you and to the viewers.

There is no such thing as psychopathy or sociopathy. These are not recognized diagnosis or clinical entities.

The Diagnostic and Statistical Manual Committee has rejected four separate times over 30 years.

The possible diagnosis of psychopathy, having weighed all the evidence for a total, a grand total of 25 years.

So these are not, online and a bit offline, we have many terms that appear to be clinical, but actually are not and are not supported by any evidence or studies.

On these terms, we have empaths, a nonsensical self-aggrandizing label. We have emotional flashbacks, total nonsense.

A flashback is reviviveness. Flashback is when you have an experience that is indistinguishable in your mind from reality.

And so on. There’s a whole vocabulary of non-sensical clinical labels, pseudo clinical labels, which are not accepted in academia or in the literature.

Sociopathy has infiltrated the literature to some extent and so did psychopathy because I think they do describe real phenomena.

However, the DSM committee has been right to reject them as clinical entities because psychopaths and sociopaths are not mentally ill.

Psychopathy and sociopathy are lifestyles. They are choices to resist society, its edicts, social mores, conventions, norms, rules. They’re a choice to act by defiance, to adopt defiance as a main mode of communication.

In short, they represent a personality type rather than a mental health pathology.

To understand that difference given the DCM and the IC10, etc., I understand.

So, okay, that’s really helpful to know. And interesting, as you say, that there’s a choice rather than it’s a mental illness that has some lack of control to some degree.

To some extent, even overt, grandiose narcissism is a choice.

Yes.

This is why today the cutting edge or the bleeding edge of the profession, we suggest that overt grandiose narcissists are actually psychopaths.

And the only true type of narcissist is what used to be called the covert narcissist or the compensatory narcissist in Theodore Millon’s work.

This is the only real narcissist with a fragile inner environment, vulnerable, very, very hyper-vigilant, and so on and so forth.

And this kind of narcissist compensates with overt grandiose statements and so on and so forth.

The overt narcissist, the narcissist who feels good with himself, the narcissist who feels comfortable with his own self-imputed superiority, and so on.

This kind of narcissist may well be a psychopath.

And I can prove easily that these are choices because when the narcissist ends up in prison, all his narcissistic behaviors vanish.

If there’s no audience, it’s very impressive.

Not only a question of audience, being if you were to act narcissistically in prison, this would have an impact on your longevity and life expectancy.

It’s a dangerous environment.

The victims are not so malleable and not so submissive.

So if you were to try to exercise your superiority and haughtiness and exploitativeness and lack of empathy in prison, you wouldn’t survive for long.

And so when narcissists enter prison, most of their behaviors vanish.

I would say, they become indistinguishable from healthy people, normal people.

So it’s clearly a behavioral choice, or at least a behavioral choice is involved.

This is not the case with covert narcissists.

Covert narcissists, regardless of the environment, are always seething with resentment and envy. They’re always passive-aggressive and so on and so forth.

Understood.

And so the belief for you is that for a covert narcissist, for example, they have an early life experience.

You don’t believe there’s any genetic and no one’s born with this?

Well, we have no proof that there is a genetic component, nor do we have any serious study that connects pathological narcissism to any type of brain abnormality.

However, it definitely stands to reason that there is a predisposing genetic element in narcissism.

And the reason is simple. Ten children are exposed to the same parenting style with the same parents.

Only one of them becomes a narcissist.

Why?

If narcissism were an ineluctable response to parental abuse and trauma, we would have expected all of them to become narcissists, and yet only one does.

And so that’s not the true statistic. The true statistic is that only one of 100 does.

Yeah.

OK.

So there’s good reason to believe that there is a genetic predisposition.

Yes, understood.