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Simone Hoermann, Ph.D.Simone Hoermann, Ph.D.
A blog about the personality disorders (borderline, narcissistic, etc.) with a focus on research and therapy

Narcissism And What's Underneath

Simone Hoermann, Ph.D. Updated: Mar 15th 2010

photograph of a handmirror on grey backgroundA week ago, Henry I. Miller wrote a commentary in, responding to Al Gore’s op-ed article on global warming in the New York Times.  Miller’s main point is that he diagnoses, if not to say accuses, Al Gore with having Narcissistic Personality Disorder (NPD).  The label NPD seems to have become more and more of a household term. It appears to be “en vogue” to identify NPD in others, particularly those we dislike or who we disagree with, as a way of discrediting them.  This pejorative attitude makes sense, given that the destructive effects of Narcissistic Personality Disorder on the people surrounding the narcissist can be tremendous, and examples are plenty.  I have touched upon this in a previous blog.


            Miller’s article, though, reminds me of conversation I had recently with the renowned psychiatrist Dr. Frank Yeomans, a leading expert on Narcissistic Personality Disorder.  Frank Yeomans pointed out that we commonly think narcissists are egotistical and stuck up, basically that they are nasty people. And it is true that narcissists can be entitled, arrogant, condescending, and devaluing, and often exploitive and sadistic.

But Dr. Yeomans is quick to explain that this is all a show to cover up a profound sense of emptiness and inadequacy. “It’s mostly a defensive position against not feeling good enough.” says Dr. Yeomans, “A lot of narcissists can do really nicely for themselves financially, and can be successful in their careers, but underneath it all, they hate themselves. They constantly put themselves down, because they never feel good enough.”

According to Frank Yeomans, the problem with narcissism is mainly an issue with self-esteem regulation.  Narcissists tend to have extremely high expectations of themselves and what they should achieve.  Those expectations can become exaggerated, even tyrannical, so that narcissists end up believing that they need to be special, outstanding and superior, lest they be completely worthless.  This typically causes successful narcissists to be high-achieving perfectionists. Unsuccessful narcissists may shut down completely because they can never live at the level of their demands on themselves.

Most of us have high expectations of ourselves and we want to succeed. However, as we go through life, people with healthy personalities recognize their limitations, learn to accept them and deal with them, and develop a balanced sense of their own self-worth that includes both their strengths and weaknesses.   Not so those with NPD who feel that they are completely unworthy if they are not special.  As they go through life, they end up trying to live in a way that supports their belief that they are meant to be special and superior.  This belief that they are meant to be superior continues to be held up against all kinds of data, but it gets harder to maintain for people if they have not met their goals, if they have not become a famous actor because they have not been discovered yet, if they have not made billions yet because nobody recognized their talent, and so on.  This typically causes tremendous anxiety in the narcissist, and causes them to try whatever they can to maintain that air of superiority, leading to more and more interpersonal problems and social isolation.

So, according to Dr. Yeomans there’s more to narcissism than just being plain nasty.  There is a profound underlying problem that causes severe difficulties.  How do you know you’re a narcissist?  “If you feel empty and like you’re never good enough, and your social relationships turn sour periodically, and you can’t develop true intimacy.” answers Dr. Yeomans.  Sounds like a good time to seek treatment and deal with what’s underneath.


Simone Hoermann, Ph.D.Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.

Reader Comments
Discuss this issue below or in our forums.

Worked4one - Ken - Jun 15th 2012

While working for one, which I did not realize or understand then, but certainly suffered under, I must say, it is the strength of what they try to do and pull off that is so astounding and challenging.

They use you and keep coming up with ways and variations to do so.

I felt strong abuse I did not know was possible and in the end my health started to deteriorate even more, so I one day I just got up and left.

My best friend said I was depressed all the time I was working for this man, imagine that  - the hidden stress much deeper than I recognized as I fought to survive all his idiocy.

He drove many people away and questioned why he was not successful, thinking it should somehow come to him. He did not want to work at it enough.

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