What are the signs of narcissism personality disorder?

The key features of someone with NPD are a pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration and lack of empathy.

Q. My cousin has been married for 12 years. Her husband abuses her emotionally and mentally.

He never says words of endearment to her. He does not touch her and also does not let her hold his hands nor touch him outside of sex. He does not spend time with her or yearn for her. He is a workaholic and very much a loner. When he is not working, he does not want her company and likes to do things alone.  He does not allow discussions about their relationship. He does not talk about his feelings nor does he confide in her.

However, he would show concern whenever she is unwell and would nudge her to see a doctor. He is a good provider and is generous in buying her gifts.

We did a search on Google to find out more about his behaviour and the signs and symptoms point to narcissism personality disorder (NPD).

He has two older sisters. When he was young, his father favoured the first-born. He is the youngest, so it is not the middle-child syndrome. He showed no empathy even when my cousin shed tears and told him how she could not feel his love. He refused to evaluate or talk about the problems they are facing.

He said she is free to leave the marriage if she is so unhappy. He does not see the need to change in any way to save the marriage. This is his second marriage. His first marriage ended in the same way and my cousin found out only after she had married him.

My cousin finds it futile to stay on in such a lopsided relationship. She loves him deeply, but feels only superficial concern from him. She feels the invisible layers of barricades put up by him. It is as though he is protecting himself from emotional harm.  She feels like a child with parents who do not spend time with her and who make up for their neglect with gifts and money. She feels the emptiness and is very lonely.

Is there help for men with this disorder? According to websites on this subject, it is better for women in such relationships to leave as men with NPD do not have the capacity for love. It is like having emotional autism.

A. The key features of someone with NPD are a pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration and lack of empathy.

While the lack of empathy is evident from the information you provided, it is not so clear that he has a grandiose sense of self-importance (although there are some hints suggestive of that) or that he has a need for excessive admiration.

A person with NPD may also be preoccupied with fantasies of success, power, beauty or ideal love, has a sense of entitlement or special favourable treatment, and is often envious of others' successes or possessions. The person is also arrogant and disdainful towards others.

So, based on the information available, there are suggestions of possible pathological narcissism, but it is difficult to ascertain if your cousin's husband indeed has NPD.

That said, his childhood experiences do seem to have a major impact on his personality and behaviour.

He obviously has issues dealing with his emotions and has been using unconscious defence mechanisms, such as emotional insulation, to avoid being disappointed and hurt.

In NPD, the "inflated self" is idealised, while the unacceptable part is repressed and projected onto external parties. And the external party (your cousin, in this case) is often devalued.

The grandiose self protects the individual from an underlying sense of vulnerability and imperfection.

These are unconscious processes and not easily accessible at a conscious level to the person with the problem.

Given the adverse impact on his relationship in his current and previous marriages, counselling or psychotherapy to help him to process and understand the origin of his emotions, thinking and behaviour would be helpful.

The problem is that most people with NPD or other personality disorders do not necessarily see themselves as having any particularly serious problems and, even if they do, they would not be motivated to seek treatment.

Those who decide to seek help will need fairly long-term psychotherapy to make gradual improvement.

Your cousin may want to get help for herself to cope with her issues and the marriage situation instead.

DR JOSHUA KUA
Consultant psychiatrist at the Raffles Counselling Centre


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