Heal NPD

This episode continues the Heal NPD Seminar Series, featuring Dr. Mark Ettensohn and his associates, Deanna Young, Psy.D., and Danté Spencer, M.A. I n this session, the group discusses a recent meta-analytic review examining suicide-related outcomes in narcissistic personality functioning. The conversation explores why studies using DSM-based diagnoses of Narcissistic Personality Disorder consistently fail to predict suicidal ideation, attempts, or self-injury, while dimensional measures that include vulnerable narcissism show strong and reliable associations with elevated risk. Themes include the distinction between grandiose and vulnerable self-states, the limitations of trait-based and purely behavioral diagnostic models, and the deeper affective and regulatory structures that define pathological narcissism. The team examines how shame, identity instability, emotional dysregulation, and collapse of self-esteem stability contribute to suicidality—and how grandiose presentations can mask underlying fragility in ways that obscure clinical risk. Throughout the seminar, the group reflects on the developmental and relational origins of vulnerable narcissism, emphasizing the role of early emotionally invalidating early environments, contingent self-esteem, and dissociated self-states in shaping defensive functioning. The discussion also highlights clinical challenges in assessing suicide risk in narcissistic patients, including the role of masking, externalization, and shame-driven withdrawal. This seminar is designed for clinicians, students, and anyone seeking a nuanced, clinically grounded understanding of narcissistic personality functioning, suicide risk, and the hidden dimensions of vulnerability that are often overlooked in public discourse. To learn more about our work, visit www.HealNPD.org Additional Resources: Newsletter: https://healnpd.substack.com Assessment and therapy inquiries: https://healnpd.org/contact Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH   SUBSCRIBE: https://rb.gy/kbhusf LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8    Citation for the article discussed: Sprio, V., Mirra, L., Madeddu, F., Lopez-Castroman, J., Blasco-Fontecilla, H., Di Pierro, R., & Calati, R. (2024). Can clinical and subclinical forms of narcissism be considered risk factors for suicide-related outcomes? A systematic review. Journal of Psychiatric Research, 172, 307–333. https://doi.org/10.1016/j.jpsychires.2024.02.017 Full text link: https://www.sciencedirect.com/science/article/pii/S0022395624000803

In this episode, Dr. Mark Ettensohn responds to a common question: How can someone with a perfectly normal and mostly happy childhood develop narcissistic personality disorder? The discussion challenges the widespread misconception that narcissism is simply a personality type, a collection of traits, or the result of genetics alone. Dr. Ettensohn explains that pathological narcissism is a disorder of self-esteem regulation and identity formation, not just a pattern of behavior. Drawing on clinical research and developmental theory, he explores how early experiences that appear loving and stable can still leave important parts of the self unseen, unrecognized, or conditionally valued. These subtle, chronic relational injuries, repeated over years rather than occurring as a single traumatic event, can distort the developing self’s capacity to maintain a stable and realistic sense of worth. The episode distinguishes between “popular narcissism,” which focuses on abusive behavior, and clinical narcissism, which reflects an internal system of dysregulated self-esteem. Through metaphor and clinical reflection, Dr. Ettensohn illustrates how a child can grow up in an environment that looks healthy on the surface yet still learn to equate love with performance, value with achievement, and safety with control. Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com Assessment and therapy inquiries: https://healnpd.org/contact Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH SUBSCRIBE HERE: https://rb.gy/kbhusf LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 BECOME A MEMBER: https://www.youtube.com/channel/UCHeT5kujD1JqHRAi-x8xD-w/join Article Citations: Vater, A., Ritter, K., Schröder-Abé, M., Schütz, A., Lammers, C.-H., & Roepke, S. (2013). When grandiosity and vulnerability collide: Implicit and explicit self-esteem in narcissistic personality disorder. Journal of Behavior Therapy and Experimental Psychiatry, 44(1), 37–47. https://doi.org/10.1016/j.jbtep.2012.07.004 Weinberg I, Ronningstam E. Narcissistic Personality Disorder: Progress in Understanding and Treatment. Focus (Am Psychiatr Publ). 2022 Oct;20(4):368-377. doi: 10.1176/appi.focus.20220052. Epub 2022 Oct 25. PMID: 37200887; PMCID: PMC10187400.

This episode continues the Heal NPD Seminar Series, featuring Dr. Mark Ettensohn and his associates, Deanna Young, Psy.D., and Danté Spencer, M.A. In this session, the group discusses Narcissistic Personality Disorder: Progress in Understanding and Treatment by Igor Weinberg, Ph.D., and Elsa Ronningstam, Ph.D. The conversation examines recent advances in how clinicians conceptualize and treat narcissistic personality disorder, moving beyond fixed trait models toward a dynamic, relational understanding of the self and its development. Themes include the interplay between grandiose and vulnerable self-states, the interdependence of self-esteem regulation, affect, cognition, empathy, and interpersonal functioning, and the recognition that narcissistic pathology evolves through cumulative disruptions in early attunement and relational safety. The discussion also explores how developmental misattunements - whether through neglect, overindulgence, or inconsistency - shape defensive adaptations and contribute to the oscillation between self-inflation and shame. Throughout the seminar, the team reflects on the therapeutic process of working with narcissistic patients, emphasizing empathy, reflective capacity, and the slow, relational work of rupture and repair that makes genuine transformation possible. This series is designed for clinicians, students, and anyone interested in a nuanced, compassionate understanding of narcissism, personality, and psychological change. To learn more about our work, visit www.HealNPD.org Additional Resources: Newsletter: https://healnpd.substack.com Assessment and therapy inquiries: https://healnpd.org/contact Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH SUBSCRIBE HERE: https://rb.gy/kbhusf LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 BECOME A MEMBER: https://www.youtube.com/channel/UCHeT5kujD1JqHRAi-x8xD-w/join Citation for the article discussed: Weinberg I, Ronningstam E. Narcissistic Personality Disorder: Progress in Understanding and Treatment. Focus (Am Psychiatr Publ). 2022 Oct;20(4):368-377. doi: 10.1176/appi.focus.20220052. Epub 2022 Oct 25. PMID: 37200887; PMCID: PMC10187400. Full text of the article: https://pmc.ncbi.nlm.nih.gov/articles/PMC10187400/

This episode continues the Heal NPD Seminar Series, featuring Dr. Mark Ettensohn and his associates, Deanna Young, Psy.D., and Danté Spencer, M.A. In this session, the group discusses Principles of Psychodynamic Treatment for Patients with Narcissistic Personality Disorder by Holly Crisp, M.D., and Glen Gabbard, M.D. The conversation explores how psychodynamic clinicians conceptualize and treat narcissistic personality disorder, emphasizing the disorder’s pleomorphic nature - its capacity to take many forms depending on context, stress, and level of personality organization. Themes include the oscillation between grandiose and vulnerable self-states, the role of shame as a central organizing affect, and the therapist’s challenge of moving flexibly along a supportive–interpretive continuum. The group also examines common transference and countertransference dynamics, the integration of Kohut’s and Kernberg’s models, and the transformative role of rupture and repair in the therapeutic process. Through candid discussion, clinical reflection, and moments of humor, the seminar illustrates how empathic attunement, flexibility, and authentic connection form the heart of effective treatment for pathological narcissism. This series is designed for clinicians, students, and anyone interested in a deeper and more nuanced understanding of narcissism, personality, and the process of psychological healing. To learn more about our work, visit www.HealNPD.org. Citation for the article discussed: Crisp H, Gabbard GO. Principles of psychodynamic treatment for patients with narcissistic personality disorder. Journal of Personality Disorders. 2020 Mar;34(Suppl):143-158. doi: 10.1521/pedi.2020.34.supp.143. PMID: 32186987.

In this episode, Dr. Mark Ettensohn challenges one of the most persistent distortions in contemporary discourse on narcissism: the myth of “the narcissist.” He explains how this cultural archetype, an image of coldness, cruelty, and manipulation, has eclipsed legitimate clinical understanding of Narcissistic Personality Disorder. Drawing on both the peer-reviewed literature and his clinical experience, Dr. Ettensohn describes how terms like narcissistic abuse, covert narcissism, and narcissistic supply have come to dominate popular psychology despite lacking grounding in peer-reviewed research. The episode explores how this narrative misleads clinicians, alienates patients, and perpetuates stigma, while offering a more accurate view of pathological narcissism as a defensive structure rooted in shame, vulnerability, and loss. Dr. Ettensohn argues that it is time to discard the myth of “the narcissist” and replace it with a more compassionate, evidence-based understanding of NPD...one that recognizes both the pain it causes and the suffering it defends against. Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com Assessment and therapy inquiries: https://healnpd.org/contact   Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH   Related Links: In-depth exploration of the DSM NPD construct: https://youtu.be/I2fD65wy48I   SUBSCRIBE HERE: https://rb.gy/kbhusf LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8

This episode marks the beginning of a new educational series from Heal NPD, featuring Dr. Mark Ettensohn and his associates: Deanna Young, Psy.D. and Danté Spencer, MA. This series offers a rare window into clinical reasoning and supervision, bringing viewers inside real discussions about theory, diagnosis, and treatment of personality pathology. In this first seminar, the group examines an influential paper by Pincus & Lukowitsky (2010) and explores one of the central challenges in the field: how to define pathological narcissism. The conversation addresses the criterion problem surrounding narcissism. That is, the lack of a unified construct definition. It traces how this has led to conflicting models and measures of narcissism. Topics include the distinction between pathological narcissism and NPD, the interplay of grandiosity and vulnerability, the overlap with depression and trauma, and emerging dimensional approaches to understanding personality. This series is designed for clinicians, students, and anyone interested in a deeper and more integrative understanding of narcissism, personality, and self-regulation. To learn more about our work, visit www.HealNPD.org Citation for the article discussed: Pincus, A. L., & Lukowitsky, M. R. (2010). Pathological narcissism and narcissistic personality disorder. Annual Review of Clinical Psychology, 6, 421–446. https://doi.org/10.1146/annurev.clinpsy.121208.131215

Dr. Ettensohn reflects on the recent loss of his father. Drawing on both clinical theory and personal experience, he explores how children internalize idealized images of caregivers as a source of safety and reassurance during times of vulnerability. This episode examines how these idealizations can provide stability but also carry developmental costs if they are never gradually tempered by ordinary disappointments and the recognition of parental imperfection. Dr. Ettensohn situates this dynamic within the broader context of self-psychology, showing how therapy can become a place where idealized projections are worked through and reclaimed in more realistic form. With psychological nuance and openness, he shares how this process unfolded in his own relationship with his father, moving from idealization toward a fuller recognition of imperfection, accountability, and authentic connection. The goal, as he frames it, is not to reject or diminish the idealized parent, but to integrate those images into a more grounded sense of self and relationship. Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 VISIT THE WEBSITE: https://www.healnpd.org

Dr. Ettensohn expands on his recent episode exploring splitting as a dissociative process. Drawing from clinical experience and developmental theory, he addresses a common question: What’s the difference between splitting, identity diffusion, and Dissociative Identity Disorder (DID)? Rather than viewing these as separate diagnostic constructs, Dr. Ettensohn presents them as points along a continuum of dissociation. They represent defensive adaptations to overwhelming early experience. He explains why the traditional boundaries between “personality disorders” and “dissociative disorders” may be more fluid than we think. This episode continues Dr. Ettensohn’s unique, trauma-informed reframing of narcissistic personality dynamics, offering psychological depth without jargon and compassion without minimization. Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 VISIT THE WEBSITE: https://www.healnpd.org

In this episode, Dr. Ettensohn offers a groundbreaking perspective on one of the most misunderstood features of pathological narcissism: splitting. Drawing from the work of Philip Bromberg and his own clinical practice, Dr. Ettensohn reframes splitting not as black-and-white thinking, but as a dissociative process rooted in early relational trauma. Rather than treating splitting as a rigid symptom, this episode explores how dissociated self-states form when conflicting emotional truths, such as shame, longing, idealization, and rage, cannot safely coexist. What looks like instability or contradiction is actually a protective adaptation. Dr. Ettensohn shows how these self-states develop as compartmentalized responses to unmanageable experience, and how they survive into adulthood, shaping identity, memory, and relationships. Through clear explanation and compassionate framing, he illustrates how healing involves standing in the spaces between self-states, without collapsing into any one of them. Whether you live with these experiences yourself or work with people who do, this video offers a radically humanizing and clinically grounded way to understand dissociation, narcissism, and the divided self.   References: Bromberg, P. M. (1996). Standing in the spaces: The multiplicity of self and the psychoanalytic relationship. Contemporary Psychoanalysis, 32(4), 509–535.   Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8   VISIT THE WEBSITE: https://www.healnpd.org

In this Weekly Insight, Dr. Ettensohn explores subtle signs of false self experiencing. Drawing from clinical work and developmental theory, he reflects on how early relational demands can lead individuals to organize their identity around performance, compliance, or emotional suppression. The episode examines how precocious self-monitoring, idealized emotional states, and internalized expectations often become automatic, forming a false self that feels necessary for connection but ultimately leaves authentic self experience obscured. Dr. Ettensohn situates the false self as a broad survival strategy shaped by narcissogenic environments. With compassion and psychological nuance, he offers signs that may indicate someone is operating from a false self, and encourages viewers to reflect gently on moments of disconnection, exhaustion, or rigid self-presentation. The goal, as he frames it, is not to attack or dismantle these protective structures, but to begin noticing them and allowing more space for what is real. LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 VISIT THE WEBSITE: https://www.healnpd.org

In this Weekly Insight, Dr. Ettensohn addresses widespread misconceptions about narcissism by clarifying what the term does not mean. Drawing on clinical examples and years of engagement with public discourse, he explores how the label “narcissist” has become a cultural catch-all for behaviors that are often common, non-pathological, and only proximally related to Narcissistic Personality Disorder (NPD). This episode examines how actions such as setting a boundary, avoiding emotional intimacy, or disagreeing with someone’s interpretation of events are frequently misread as narcissistic - especially when filtered through shame, hurt, or interpersonal conflict. Dr. Ettensohn distinguishes these behaviors from the psychological structure of narcissism, which involves instability in self-esteem regulation and associated interpersonal strategies. He also addresses the growing tendency to conflate narcissism with abuse, control, gaslighting, or moral failure, arguing that these associations undermine both clinical clarity and compassion. Misusing the term “narcissism” can lead to stigmatization, inhibit treatment-seeking, and reinforce rigid victim-abuser narratives that obscure the mutual complexity of relational harm. This Weekly Insight is a call for greater nuance, clinical integrity, and psychological humility. By understanding what narcissism isn’t, we create more space to see what it is, and how it might be worked with more constructively in both cultural discourse and clinical care.  Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 VISIT THE WEBSITE: https://www.healnpd.org

Join Dr. Mark Ettensohn from Heal NPD for a live broadcast answering questions and responding to viewer comments.

What does it mean to say that narcissists lack empathy? In this Weekly Insight, Dr. Ettensohn challenges the common assumption that low empathy is a fixed trait in narcissistic personality disorder (NPD). Drawing from psychoanalytic theory and clinical observation, he explores how empathy in NPD often collapses in response to internal threat, and how this collapse is due to defenses rather than intrinsic empathy deficits. The episode identifies three core processes that disrupt empathic functioning in NPD: paranoid anxiety, dissociated self-states, and shame-driven defenses against dependency. These processes help explain the inconsistency, withdrawal, and emotional detachment often seen in narcissistic dynamics. Whether you identify with narcissistic traits or have been affected by them in others, this video invites a more psychologically informed and humanistic understanding of how empathy functions under distress. Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH   LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 VISIT THE WEBSITE: https://www.healnpd.org   Works Cited: Miller, A. (2008). The drama of the gifted child: The search for the true self (Rev. ed., R. Mannheim, Trans.). Basic Books. (Original work published 1979)    

In this Weekly Insight, Dr. Ettensohn examines the rise of moral panic within contemporary discourse about narcissism, particularly how popular online narratives have transformed psychological terms into tools of moral judgment. In this Weekly Insight, Dr. Ettensohn examines the rise of moral panic within contemporary discourse about narcissism, particularly how popular online narratives have transformed psychological terms into tools of moral judgment. Using a recent online interaction as a jumping-off point, the video traces how disagreement is increasingly reframed as harm, and how nuanced discussions of narcissistic personality structure are met with accusations of abuse, gaslighting, or complicity. Drawing on Stanley Cohen’s original criteria for moral panic, and placing current trends alongside historical examples such as witch hunts, McCarthyism, and the Satanic Panic, Dr. Ettensohn contextualizes the intense emotional reactions that now dominate conversations about NPD. The video explores how stigma, stereotypes, and moral binaries are amplified online, creating a culture in which appeals to complexity and humanity have become taboo. It also considers the communal function of scapegoating within current narratives about narcissism. This video offers a clinically grounded, sociologically informed framework for understanding what happens when trauma discourse is overtaken by lurid sensationalism and moral panic, and why the path toward healing lies in reclaiming psychological depth, complexity, and humanization.  

Link to episode 1 in this series, on psychotic-level NPD: https://youtu.be/IoxUCbNUJUE Link to episode 2 in this series, on borderline-level NPD: https://youtu.be/Oz-C503q_9Y Link to part 1 of episode 3 in this series: https://youtu.be/vUsnambadIE This is the third episode of a four-episode series describing the narcissistic personality style across different levels of severity. Due to the length of the material, this episode has been divided into three parts. This is part two. In this part, Dr. Ettensohn explores the emotional consequences of the developmental shift from borderline to neurotic-level personality organization. While borderline-level defenses aim to ward off annihilation through splitting, projection, and omnipotence, neurotic-level functioning introduces new emotional burdens: grief, guilt, and the realization that some losses cannot be undone. Drawing on psychoanalytic theories of the paranoid-schizoid and depressive positions, this episode examines how individuals begin to internalize the reality of separate minds, enduring subjects, and the permanence of emotional injury. These capacities open the door to deeper love, mutuality, and ethical concern—but also to sorrow, remorse, and longing. Dr. Ettensohn also outlines the core developmental conditions that support this shift, including “good enough” relational experiences that enable ambivalence to be tolerated and meaning to be preserved across time. Finally, the episode offers concrete strategies for strengthening neurotic-level integration and functioning, both in therapy and in everyday life. References: Bollas, C. (1987). The shadow of the object: Psychoanalysis of the unthought known. Columbia University Press. Gabbard, G. O., & Wilkinson, S. M. (1994). Management of countertransference with borderline patients. American Psychiatric Publishing. Johnson, S. M. (1987). Characterological change: The hard work miracle. W. W. Norton. Klein, M. (1946). Notes on some schizoid mechanisms. International Journal of Psychoanalysis, 27, 99–110. Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press. Winnicott, D. W. (1949). Hate in the counter-transference. The International Journal of Psychoanalysis, 30, 69–74. Winnicott, D. W. (1965). The maturational processes and the facilitating environment: Studies in the theory of emotional development. International Universities Press.

Link to episode 1 in this series, on psychotic-level NPD: https://youtu.be/IoxUCbNUJUE Link to episode 2 in this series, on borderline-level NPD: https://youtu.be/Oz-C503q_9Y This is the third episode of a four-episode series describing the narcissistic personality style across different levels of severity. Due to the length of the material, this episode has been divided into three parts. This is part one. In this part, Dr. Ettensohn explores the developmental shift from borderline to neurotic-level personality organization, and how this shift transforms the inner life of individuals with narcissistic traits. Part one serves as a conceptual bridge—reviewing core ideas from earlier episodes while highlighting the emergence of psychological capacities that make neurotic-level functioning possible. These include the ability to maintain a continuous sense of self, to recognize others as enduring subjects, and to experience ambivalence, guilt, and loss without fragmentation. Through the lens of psychoanalytic developmental theory, Dr. Ettensohn illustrates how this shift brings with it new emotional burdens: the capacity to grieve, to feel remorse, and to live with an awareness of history. This part introduces the foundational concepts of subjectivity and historicity, which will be explored in greater depth in parts two and three. References: Kernberg, O. F. (1984). Severe personality disorders: Psychotherapeutic strategies. Yale University Press. Ogden, T. H. (1986). The matrix of the mind: Object relations and the psychoanalytic dialogue. International Universities Press. Ogden, T. H. (1989). The primitive edge of experience. Jason Aronson. Winnicott, D. W. (1965). The maturational processes and the facilitating environment: Studies in the theory of emotional development. International Universities Press.

In this video, Dr. Ettensohn examines the growing claim that Narcissistic Personality Disorder (NPD) is almost entirely genetic, offering a critical, clinically grounded reflection on what the current science actually supports—and where it falls short. He discusses how genetic contributions to personality traits are often misunderstood, and why claims of “hardwired narcissism” oversimplify a profoundly complex developmental process. Drawing from empirical research, neurodevelopmental theory, and clinical observation, Dr. Ettensohn explores how narcissistic pathology emerges not simply from temperament, but from early relational experiences—especially chronic emotional neglect, inconsistent attunement, and conditional regard. He addresses how brain plasticity, diagnostic controversies, and the misunderstood vulnerable core of NPD further complicate the genetic narrative. This video offers a nuanced perspective for anyone seeking to understand NPD beyond reductive models, emphasizing the importance of relational context, developmental history, and psychological depth. References: Brummelman, E., Thomaes, S., Nelemans, S. A., Orobio de Castro, B., Overbeek, G., & Bushman, B. J. (2015). Origins of narcissism in children. Proceedings of the National Academy of Sciences, 112(12), 3659–3662. https://doi.org/10.1073/pnas.1420870112 Chen, Y., Jiang, X., Sun, Y., & Wang, Y. (2023). Neuroanatomical markers of social cognition in neglected adolescents. NeuroImage: Clinical, 38, 103501. https://doi.org/10.1016/j.nicl.2023.103501 Gatz, M., Reynolds, C. A., Fratiglioni, L., Johansson, B., Mortimer, J. A., Berg, S., & Pedersen, N. L. (2006). Role of genes and environments for explaining Alzheimer disease. Archives of General Psychiatry, 63(2), 168–174. https://doi.org/10.1001/archpsyc.63.2.168 Horton, R. S., Bleau, G., & Drwecki, B. (2006). Parenting Narcissus: What are the links between parenting and narcissism? Journal of Personality, 74(2), 345–376. https://doi.org/10.1111/j.1467-6494.2005.00380.x Luo, Y. L. L., Cai, H., & Song, H. (2014). A behavioral genetic study of intrapersonal and interpersonal dimensions of narcissism. PLOS ONE, 9(4), e93403. https://doi.org/10.1371/journal.pone.0093403 Nenadić, I., Lorenz, C., & Gaser, C. (2021). Narcissistic personality traits and prefrontal brain structure. Scientific Reports, 11, 15707. https://doi.org/10.1038/s41598-021-94920-z Otway, L. J., & Vignoles, V. L. (2006). Narcissism and childhood recollections: A quantitative test of psychoanalytic predictions. Personality and Social Psychology Bulletin, 32(1), 104–116. https://doi.org/10.1177/0146167205279907 Schulze, L., Dziobek, I., Vater, A., Heekeren, H. R., Bajbouj, M., Renneberg, B., & Roepke, S. (2013). Gray matter abnormalities in patients with narcissistic personality disorder. Journal of Psychiatric Research, 47(10), 1363–1369. https://doi.org/10.1016/j.jpsychires.2013.05.017 Skodol, A. E. (2012). The revision of personality disorder diagnosis in DSM-5: What’s new? Current Psychiatry Reports, 14(1), 39–43. https://doi.org/10.1007/s11920-011-0243-2

In this Weekly Insight, Dr. Ettensohn shares an adapted preview from his upcoming video on narcissism at the neurotic level of personality organization. He reflects on what it means to move toward psychological integration, emotional complexity, and the capacity for self-reflection - especially for those doing this work without a therapist. Drawing from clinical understanding and developmental theory, Dr. Ettensohn discusses how self-acceptance, mindfulness, and the capacity to tolerate imperfection are crucial aspects of healing. He emphasizes the importance of allowing history to be real, recognizing and managing splitting, and loosening rigid self-perceptions that often emerge from narcissistic defenses. Using metaphor, lived experience, and grounded strategies, he shows how healing becomes possible even outside the therapeutic relationship when we begin to relate to ourselves differently.

In this Weekly Insight, Dr. Ettensohn explores the nature of grandiosity in pathological narcissism and Narcissistic Personality Disorder (NPD), emphasizing that grandiose self-states are distortions that mask underlying vulnerability. He examines how these states emerge, why they are so compelling, and how they become self-reinforcing through positive feedback loops. Dr. Ettensohn also discusses the hidden instability beneath grandiosity, the interpersonal consequences of maintaining a distorted self-image, and the trauma-based origins of grandiose narcissistic armor. Drawing on the work of Ernst Wolf and real-world examples, he offers a compassionate yet clear-eyed look at how grandiosity functions as both protection and prison—and how growth is possible even after years of wearing the armor.

In this Weekly Insight, Dr. Ettensohn explores the deep existential conflict at the heart of pathological narcissism and NPD: the fear of being ordinary. Drawing from a recent presentation by psychiatrist and psychoanalyst Dr. Salman Akhtar, he examines how the pressure to be extraordinary—instilled early in life—becomes a defining and isolating feature of the narcissistic identity. Dr. Ettensohn discusses the paradox of extraordinariness: how the very thing that promises acceptance and recognition instead fosters loneliness and disconnection. He explores why admiration and envy are poor substitutes for love and how healing involves letting go of an identity built on standing apart—so that real connection can finally become possible.