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Q&A with Dr. Lisa Firestone: Are we becoming more narcissistic in the age of selfies?

lisa-firestoneIn the age of selfies, snaps and tweets, the cultural norm in our society is to document nearly every aspect of our lives on social media. Although not everyone who posts selfies on Facebook, Twitter or Instagram is self-absorbed, arrogant or narcissistic, experts do say that social media used for self-promotion can be a means for people to express and reinforce their pre-existing narcissistic tendencies and traits.

People who are narcissistic or who have narcissistic tendencies aren’t necessarily diagnosed as having a mental health condition. Rather, narcissism is used to describe individuals who have an exaggerated sense of entitlement, self-worth and superiority over others. Narcissists seek to gain power, superiority, wealth and fame over other people, just for the sake of fulfilling their needs for attention, admiration and praise.

According to the American Psychiatric Association, the clinical term for narcissism is called narcissistic personality disorder, or NPD, a condition characterized by a need for admiration, a lack of or little empathy for others, and a grandiose and inflated view of self. Significant others, coworkers, employees, family and friends may find it difficult to be around people who are diagnosed with NPD because of their aggression, and despondency when they do not receive the attention they feel they deserve.

Lisa Firestone, Ph.D., is a clinical psychologist, director of research and education at The Glendon Association, and senior editor at PsychAlive.org. Dr. Firestone was a panelist for the March 20th radio broadcast “In Your Right Mind”; on the edition titled “Narcissistic Personality Disorder: The Age of the Selfie,” she discussed the cognitive factors involved in narcissism and the entitled mindset that has developed in our society. We spoke to Dr. Firestone about narcissism, and at what point it becomes pathological.

Q: Can you tell me some of the ways that narcissism influences a person’s behavior?

A narcissist is generally dissatisfied with life and often not very happy; if they aren’t getting their needs for validation met in their environment, they feel pretty bad and look for places where their needs for validation are met. If their friends and family aren’t meeting those needs, they may turn to others for validation, for example their work environments. Narcissists need almost constant validation and are intolerant of almost any type of criticism or feedback. They don’t feel very good about themselves when challenged, and have a need to really substantiate that inflated self-image. If anything counters it, they can become incredibly negative toward anyone who is critical, and often lash out or lash back in ways that you just wouldn’t do if you were acting in your own self-interest, and it doesn’t always work out well for them.

Narcissists need outside validation of that inflated self-image; they seek it for whatever quality their grandiosity focuses on – their intelligence, self-image, looks, business skills, or whatever else that might be. Their need for that kind of feedback indicates that they don’t really have a strong sense of self-esteem. Most experts believe that there are two types of narcissism – one type is more grandiose, while the other one is more vulnerable; there are distinctions between those two subtypes.

Q: How does NPD impact a person’s relationships?

I think that it’s really difficult—it makes them hard to live with and people who are involved with narcissists can feel very lonely at times because their focus is very much on themselves. That can be difficult. I have a colleague who writes about “closet narcissism,” which is when people are drawn to narcissists and bask in their glow. You know, “I’m so great because I’m with this person.”

Narcissists are often the life of the party, the most exciting person in the room, and can be a lot of fun, very intense and interesting. When they focus their attention on you, it’s like you have a light shone on you, and that can be very warming to people. The flip side to that is when they become dissatisfied with you, or if you have any dissatisfaction with them, their attitude can really switch.

Another thing that people who are with narcissists face is that, while they get the glow with their partner at a party because their partner attracts attention, it can become difficult to live with day in and day out. Part of the reason that people get into relationships with narcissists is because they seem so amazing, but later find out that living with them is impossible.

One of my patients was involved with a very narcissistic, incredibly successful man. The entire time he was dating with her, bringing her to family functions and spending holidays with her, he was engaged to marry someone else. You can imagine how difficult that was! When she found out, he expected the relationship to continue, but she was not up for that. This is what happens—you have a person that is your world and you are getting a lot out of that relationship albeit that narcissistic attention, or as part of that narcissistic couple, but then you lose everything.

Q: Can you explain how culture, technology and social media have contributed to narcissism?

I think that [social media] provided another outlet for narcissism. I think it created a place where people can it is easy to get those needs met; it’s immediately reinforcing if 100 or 1,000 people liked your picture or comment. If you think about the types of things that people post on the internet, it’s generally for the purpose of making themselves look good. We put up the prettiest picture of us, not the ones where we don’t look so well. We put up the glorious pictures of our children or our partners or whatever that gives the impression that we live this wonderful, perfect life. On social media, that’s easily controlled; people usually only see what you put up; they don’t see the whole picture.

We had narcissism long before social media, and still do. Interactive media can also easily make  people feel bad about themselves, because, for example, they don’t have as much as other people do, or didn’t go on that holiday, or do whatever somebody else did. Social media provides a means of comparing yourself with many people to whom you otherwise might not be exposed.

Q: Do you think that narcissistic personality traits help people succeed in the workplace? Why or why not?

I think partly it does “wow” people initially, because narcissists are willing to toot their own horn and tell you how great they are in an interview or in a sales deal. That confidence, or grandiosity, can impress people at first. In the long-term, however, it can be kind of grating. And narcissism can produce a lot of bad behavior towards others; narcissists can get really aggressive when people are critical of them, either by lashing out at them or, in the case of males, asserting their self-esteem by becoming violent.

Q: Is NPD associated with other mental disorders? If yes, how can a person learn to manage both of these mental health conditions together?

There’s a cluster of personality disorders that NPD is part of. This includes borderline personality disorder  and antisocial personality disorder. So, sometimes people who have NPD also have features of other disorders – it can border into being antisocial and manifest as aggression, or it can border into being more borderline, as when they have an unstable sense of self. It’s difficult to diagnose, and some people are misdiagnosed with bipolar disorder instead of narcissism.

Q: What are some of the structural differences in the brains of people with NPD?

Recent studies show some structural differences in the brains of persons with NPD when compared with individuals diagnosed with borderline [personality disorder] and or no personality disorder at all. This indicates that NPD may develop early in a person’s life, and that is affected by the neural architecture of the brain. All human beings are born with the neural architecture to develop empathy for example, but it’s experience-dependent. Those experiences, especially early in our lives, really shape the entire way our brains are wired, and can manifest as NPD. Another study actually compared the brains of people with borderline personality disorder with the brains of people who had NPD and observed differences in the brains of each group.

Q: What kind of treatment is best for people with NPD?

It’s definitely a clinical challenge to treat people who are narcissists. We now know our brains are neuroplastic, so we can effect change, especially if we intervene early on. It’s interesting that we also see these changes in other disorders such as schizophrenia, where we definitely see brain differences, and bipolar disorder.

There is new research that indicates that if you can catch people early, right as they are starting to manifest the disorder, and do an intervention that takes stress off of them, and teaches them skills for managing their emotions, they may not necessarily ever develop the disorder, which changes their whole lifetime course. This is because once you’ve had an episode of one of those major mental health disorders, you’re likely to have more, especially bipolar disorder, depression and schizophrenia.

Q: What are the challenges in treating people with NPD?

A: It is pretty difficult to treat people with NPD for a number of reasons. One reason is that it’s hard for them to develop trust in the therapist. If they’re going to trust you, they’re going to feel superior to you and will fire you if you dare to criticize them. So building a therapeutic alliance is very difficult. It’s really important to focus on the therapeutic alliance if you’re working with someone who’s narcissistic. They aren’t going to be very open to feedback, even if the feedback isn’t meant to be critical. They will be reactive to it, and that makes it very difficult to give them feedback in therapy.

Providing feedback and challenging people to change their behavior are important parts of therapy, no matter what kind of intervention you’re doing. The same problems with empathy and being able to connect are going to be problems in all the narcissist’s interpersonal relationships – in the workplace and in personal relationships. While narcissism may help you to get that great job, it makes it harder to keep that great job.  Or you can attract a very attractive person as a partner, but it’s not going to help you to keep that person as your partner.

Narcissists often resist treatment, and it is often very hard to keep them in therapy. There really aren’t any treatments with empirical validation; most approaches have been psychodynamic or psychoanalytic. Treatment is typically long-term. They might feel as if you are bringing down their self-esteem a notch or two, and, in a sense, you do want to bring down that grandiosity.

I like how a man named Baumeister described it: “It’s really different to feel good about yourself than to desperately want to feel good about yourself.”  I think with narcissism there’s a piece of that desperately wanting to feel good about oneself. These individuals have to keep the image up, but underneath they don’t really feel like they are much.

One of the difficulties in treating someone with narcissism is that therapists tend to get provoked and annoyed by these patients. In general, to be a good therapist for a patient with a personality disorder, you have to really know yourself and be able to regulate your own emotions; that is even truer when treating someone who is narcissistic. From the narcissist’s standpoint, anyone who is not doing their bidding is a problem. Those are the kinds of things that lead to disruptions in the patient-therapist relationship, but again, these are people who bring a lot to the table but also expect a lot in return.

Q: What are the goals of treatment for NPD?

Some of the goals are to improve their ability to have empathy for themselves and for others, to have compassion for themselves and others, and to be able to regulate their emotions. Our ability to regulate our emotions, or our window of tolerance for our emotions, is something that we, to some degree, are born with. Some kids have very little tolerance for almost anything, and some have a nice big, wide window. You want to stretch that window – this comes from Dan Siegel’s work in interpersonal neurobiology, but he also talks about this in general terms.

Somebody who has narcissism has a small window of tolerance, so they aren’t very good at regulating emotions, but they can’t tolerate them either. That is why they act out and act condescending or act critical. Control is a big part of it too. They try to control those around them. They may feel a need to be in control of their partners. Narcissists are people who didn’t get a sense of security and a feeling of being loved when they were little, so what they are feeling is sort of that the way you get love is to make people love you, make sure that people love you, and remind people that they love you, regularly. They just need a lot of attention, and so in therapy we try to teach them about how to regulate their emotions and actually improve their self-esteem. We work with the emotions that go with those thoughts as well; there can be a lot of anger or rage that go along with those critical voices as well.

More about Dr. Firestone

Lisa Firestone, Ph.D. is the director of research and education at The Glendon Association and senior editor at PsychAlive.org. She is the author of several books including Conquer Your Critical Inner Voice, Creating a Life of Meaning and Compassion and, most recently, The Self under Siege. Dr. Firestone has been involved in clinical trainings and applied research in the areas of suicide and violence. In collaboration with Dr. Robert Firestone, their studies resulted in the publication of several assessments including Firestone Assessment of Self-Destructive Thoughts (FAST) and the Firestone Assessment of Violent Thoughts (FAVT). Dr. Firestone is a national and international presenter on the topics of suicide and violence as well as couple relationships and parenting. She is a clinical psychologist in private practice in Santa Barbara and a consultant on the management of high risk clients. Dr. Firestone is also a very popular blogger on Psychology Today and the Huffington Post, you can visit the websites www.glendon.org and www.psychalive.org to learn more about her work.