The Clinical Picture and Developmental Roots - Opening Remarks

Terminology

Co-dependents

People who depend on other people for their emotional gratification and the performance of Ego or daily functions. They are needy, demanding, submissive. They fear abandonment, cling and display immature behaviors in their effort to maintain the "relationship" with their companion or mate upon whom they depend. No matter what abuse is inflicted upon them - they remain in the relationship.

See also the definition of the "Dependent Personality Disorder" in the DSM IV.

Inverted Narcissist

Previously called "covert narcissist", this is a co-dependent who depends exclusively on narcissists (narcissist-co-dependent). If you live with a narcissist, have a relationship with one, are married to one, work with a narcissist, etc. - it does NOT mean that you are an inverted narcissist.

To "qualify" as an inverted narcissist - you must WANT to be in a relationship with a narcissist, regardless of any abuse inflicted on you by him/her. You must ACTIVELY seek relationships with narcissists - and ONLY with narcissists - no matter what your (bitter and traumatic) past experience has been. You must feel EMPTY and UNHAPPY in relationships with ANY OTHER kind of person. Only THEN - AND if you satisfy the other diagnostic criteria of a Dependent Personality Disorder - can you be safely labeled an "Inverted Narcissist".

Introduction

The DSM IV uses 9 criteria to define the NPD. It is sufficient to possess 5 of them to "qualify" as a narcissist. Thus, theoretically, it is possible to be NPD WITHOUT being grandiose. Many researchers (Alexander Lowen, Jeffrey Satinover, Theodore Millon and others) suggested a "taxonomy" of pathological narcissism. They divided narcissists to sub-groups (very much as I did with my somatic versus cerebral narcissist dichotomy - SV). Lowen, for instance, talks about the "phallic" narcissist versus others. Satinover makes a very important distinction between narcissists who were raised by abusive parents - and those who were raised by doting and smothering or domineering mothers. See an expansion of the Satinover classification in The Narcissist's Mother.

In "Psychodynamic Psychiatry in Clinical Practice / The DSM-IV Edition's comments on Cluster B Personality Disorders - Narcissistic" we find this:

"...what definitive criteria can be used to differentiate healthy from pathological narcissism? The time honored criteria of psychological health - to love and to work - are only partly useful in answering this question."

"An individual's work history may provide little help in making the distinction. Highly disturbed narcissistic individuals may find extraordinary success in certain professions, such as big business, the arts, politics, the entertainment industry, athletics and televangelism field. In some cases, however, narcissistic pathology may be reflected in a superficial quality to one's professional interests, as though achievement in and acclaim are more important than mastery of the field itself.

Pathological forms of narcissism are more easily identified by the quality of the individual's relationships.

One tragedy affecting these people is their inability to love. Healthy interpersonal relationships can be recognized by qualities such as empathy and concern for the feelings of others, a genuine interest in the ideas of others, the ability to tolerate ambivalence in long-term relationships without giving up, and a capacity to acknowledge one's own contribution to interpersonal conflicts. People who are characterized by these qualities may at times use others to gratify their own needs, but the tendency occurs in the broader context of sensitive interpersonal relatedness rather than as a pervasive style of dealing with other people. One the other hand, the person with a narcissistic personality disorder approaches people as objects to be used up and discarded according to his or her needs, without regard for their feelings.

People are not viewed as having a separate existence or as having needs of their own. The individual with a narcissistic personality disorder frequently ends a relationship after a short time, usually when the other person begins to make demands stemming from for his or her own needs. Most importantly, such relationships clearly do not 'work' in terms of the narcissist's ability to maintain his or her own sense of self-esteem."

"...These criteria (the DSM IV's - SV) identify a certain kind of narcissistic patient - specifically, the arrogant, boastful, 'noisy' individual who demands to be in the spotlight. However, they fail to characterize the shy, quietly grandiose, narcissistic individual whose extreme sensitivity to slights leads to an assiduous avoidance of the spotlight."

The DSM-III-R alluded to at least TWO TYPES of narcissists, but the DSM-IV committee chose to delete this:

"...included criterion, 'reacts to criticism with feelings of rage, shame, or humiliation (even not if expressed)' due to lack of 'specificity'."

Other theoreticians, clinicians and researchers similarly suggested a division between "The Oblivious Narcissist" (a.k.a. overt) and "The Hypervigilant Narcissist"(a.k.a. covert).

The Compensatory versus the Classic Narcissist

Another interesting distinction, suggested by Dave Kelly in his excellent PTYPES web site is between the "Compensatory" type NPD and the "Classic" NPD (DSM IV type):

Here are the Compensatory NPD Criteria according to Dave Kelly:

"Ptypes Personality Types proposes Compensatory Narcissistic Personality Disorder as a pervasive pattern of unstable, covert narcissistic behaviors that derive from an underlying sense of insecurity and weakness rather than from genuine feelings of self-confidence and high self-esteem, beginning by early adulthood and present in a variety of contexts, as indicated by six (or more) of the following:
The basic trait of the Compensatory Narcissistic Personality Type is a pattern of 'overtly' narcissistic behaviors [that] derive from an underlying sense of insecurity and weakness, rather than from genuine feelings of self-confidence and high self-esteem."
(Millon).