Given that personality disorders are rooted in abnormal experience and development. There has been much discussion about the aetiology of Narcissistic Personality Disorder. Having a concept of the causes of such an illness is helpful in establishing the answer to my question. The common belief was that beneath the arrogance of a narcissist, is an incredibly low self-esteem, hence the need to protect the fragile ego.

Those with narcissistic personality disorder believe that they're superior to others and have little regard for other people's feelings. But behind this mask of ultra-confidence lies a fragile self-esteem, vulnerable to the slightest criticism.

Mayo Clinic

I can see that there is some discussion refuting this, and postulating the opposite.

It was once thought that narcissists have high self-esteem on the surface, but deep down they are insecure. However, the latest evidence indicates that narcissists are actually secure or grandiose at both levels.

Psychology Today

I have wondered, how do we really know how the narcissist self-esteem is?
Is there an inverse relationship between narcissism and self-esteem or is the converse true?

Please provide a well researched answer.

  • 1
    $\begingroup$ I would like to see the evidence that indicates narcissists are secure. I have the 'feeling' if I saw such evidence, I could find flaws in the reasoning. Can you edit your question to include an example of a narcissistic person and show how it was determined they are secure? $\endgroup$
    – Randy
    Aug 14, 2013 at 1:08
  • 1
    $\begingroup$ @Randy In my conclusion some of them can be secure (its essentially a mixed bag), but narcissim ended up being a much more complex topic than "narcissists are secure or not secure." Also, the big study I included was only patients that went to a doctor for apparently something. In essence it wasn't testing the normal population. There very well may be narcissists out there that get along fine - perhaps they realize they are a narcissist and consciously choose not to act like one. I think that term is thrown around too loosely anyway...it's based on a greek story of a guy staring at himself $\endgroup$
    – user3433
    Aug 26, 2013 at 2:52
  • 1
    $\begingroup$ for very long periods of time to the point where he'd rather fall in love with himself than anyone else. And in fact, as one of my citations points out doctors were still trying to figure out how to categorize it as a DSM in 2008. $\endgroup$
    – user3433
    Aug 26, 2013 at 2:53

1 Answer 1


First off, your second link there hasn't been reviewed since 2010. I got a case study from 2013, an attempt to change the DSM for narcissism due to it's actual granularity and subtypes from 2008, and a letter to the journal of Indian Pscy med from 2012.

  1. Seishin Shinkeigaku Zasshi. 2013;115(4):363-71.

[A case of major depressive disorder barely distinguishable from narcissistic personality disorder].

[Article in Japanese]

Saito S, Kobayashi T, Kato S.

Department of Psychiatry, Jichi Medical University.

The recent increase in cases of depression with a narcissistic tendency, especially among young individuals, has been pointed out. When the narcissistic tendency is conspicuous, patients may be treated for a personality disorder or pervasive developmental disorder, and not for a mood disorder. A case is described of a man in his late twenties who developed depression due to his failure in research work and job hunting, and, after a time, due to the break off of his engagement with his fiancée, manifested with narcissistic symptoms including an exaggerated opinion of himself, a sense of entitlement, interpersonal exploitation, lack of empathy, strong feelings of envy, and an extrapunitive tendency. He was regarded at the start of treatment as having narcissistic personality disorder. However, persevering treatment, mainly with supportive psychotherapy and pharmacotherapy including antidepressants (high dose of maprotiline combined with low dose of mirtazapine), sodium valprote and aripiprazole, finally improved not only his depressive symptoms, but also the symptoms regarded as a deriving from a personality disorder. He presented fierce anger and aggression regarded as a mixed state, and showed the rapid improvement in his depressive state after hospitalization, which we considered to show potential bipolarity. We diagnosed the patient with narcissistic depression, emphasizing the aspect which suggested a mood disorder, such as the episodic presence of narcissistic symptoms as long as a depressive state resided, his circular, recursive discourse, and his potential bipolarity. To accurately evaluate the aspect of mood disorders which patients appearing to show personality disorders have, it is considered useful to grasp a patient's condition from the viewpoint of a personality structure and viable dynamics. From a therapeutic standpoint, we suggest the importance of simple but persevering psychotherapy and a sufficient quantity of antidepressant medication for patients with depression, even if they are thought to have a personality disorder.

PMID: 23789317 [PubMed - indexed for MEDLINE]

Hmm well they seem to note initially that the converse is true in the first sentence. We'll investigate why this is true soon too and the reasons for it.

Before even reading this, I hypothesized someone with bipolar disorder could have this type of problem...and sure enough...they mention the patient as potentially having it.

This one is back from 2008. It seems like they were having some trouble with the DSM labeling of the disorder back then. Apparently there are several different subtypes of narcissistic disorder, which could definatly seem viable. So, so far your answer is 'sometimes'.

  1. Am J Psychiatry. 2008 Nov;165(11):1473-81. doi: 10.1176/appi.ajp.2008.07030376. Epub 2008 Aug 15.

Refining the construct of narcissistic personality disorder: diagnostic criteria and subtypes.

Russ E, Shedler J, Bradley R, Westen D.

Department of Psychology, Emory University, Atlanta, GA, USA. [email protected]

Comment in Am J Psychiatry. 2008 Nov;165(11):1379-82.

OBJECTIVE: Narcissistic personality disorder has received relatively little empirical attention. This study was designed to provide an empirically valid and clinically rich portrait of narcissistic personality disorder and to identify subtypes of the disorder.
METHOD: A random national sample of psychiatrists and clinical psychologists (N=1,201) described a randomly selected current patient with personality pathology. Clinicians provided detailed psychological descriptions of the patients using the Shedler-Westen Assessment Procedure-II (SWAP-II), completed a checklist of axis II diagnostic criteria, and provided construct ratings for each axis II personality disorder. Descriptions of narcissistic patients based on both raw and standardized SWAP-II item scores were aggregated to identify, respectively, the most characteristic and the most distinctive features of narcissistic personality disorder.
RESULTS: A total of 255 patients met DSM-IV criteria for narcissistic personality disorder based on the checklist and 122 based on the construct ratings; 101 patients met criteria by both methods. Q-factor analysis identified three subtypes of narcissistic personality disorder, which the authors labeled grandiose/malignant, fragile, and high-functioning/exhibitionistic. *Core features of the disorder included interpersonal vulnerability and underlying emotional distress, along with anger, difficulty in regulating affect, and interpersonal competitiveness, features that are absent from the DSM-IV description of narcissistic personality disorder.*
CONCLUSIONS: These findings suggest that DSM-IV criteria for narcissistic personality disorder are too narrow, underemphasizing aspects of personality and inner experience that are empirically central to the disorder. The richer and more differentiated view of narcissistic personality disorder suggested by this study may have treatment implications and may help bridge the gap between empirically and clinically derived concepts of the disorder.

PMID: 18708489 [PubMed - indexed for MEDLINE]

And the story gets more complicated...to the point where there seem like many different types of treatment and just problems with therapists dealing with narcissists.

Q-Type Analysis:

  • grandiose/malignant
  • fragile
  • high-functioning/exhibitionistic

Core features of the disorder

  • included interpersonal vulnerability and underlying emotional
  • distress, along with anger
  • difficulty in regulating affect
  • interpersonal competitiveness

Looks like your question's answer is getting split up in many different ways.

I found this interesting letter that was sent to the Indian Journal of Psych Med. It looks like there are specific type of strategies for dealing with specific types of issues....like for relationship issues there's one way, for other types...there's another.

I'll bold the interesting parts.

Indian J Psychol Med. 2012 Oct-Dec; 34(4): 403–404.
doi: 10.4103/0253-7176.108236
PMCID: PMC3662146
Demystifying Paradoxical Characteristics of Narcissistic Personality Disorder
Matthew Gildersleeve Queensland University of Technology, Brisbane, Queensland, Australia Address for correspondence: Dr. Matthew Gildersleeve, Queensland University of Technology, Brisbane, Queensland, Australia.


This letter is aimed for psychotherapy clinicians and researchers who should acknowledge the relationship linking Kohut's self-psychology and Glasser's Choice theory that can demystify relationship difficulties and mental health problems in narcissistic personality disorder (NPD). NPD is commonly experienced interpersonally by others as insufferable, pompous, and un-empathic.[1] NPD persons have been identified to possess giant self-centeredness, a certainty that they own supreme personality, and their humiliation of others makes them intolerable for interpersonal relations.[1] Importantly, Heinz Kohut's legacy to psychology is known as self-psychology and was centered principally on narcissistic personality development and treatment.[2] Suboptimal psychological development is thought to arise when maternal compassion is discriminately substandard.[3] As a result, the narcissistic self constructs a defense against the helplessness of a hurtful world.[3] Kohut[2] cited in Banai et al.[3] called the compassion required from maternal figures as “self-object needs” because these needs develop the self-image and are provided by external objects. (Oh wow, it seems like they're talking about entitled rich kid's attitudes, that's kinda funny, interesting).

By not receiving necessary self-object transferences through decisive epochs in development, the young individual cannot build the competence to control self-respect or construct a positive self-image.[3] *Consequently, the child, now an adult, depends on other humans to construct their self-image. The self-object transferences received as an adult provide a feeling of significance, which was not established during child development.[3] However, NPD persons are apprehensive of meeting self-object absence as an adult.[4] In order to feel the control of their fate, NPD persons present a mindset of dominance in the interpersonal sphere. As a result of this authoritarian manner, persons with NPD typically have a record of numerous unsuccessful relationships.[4]*

Go to: PARADOXICAL CHARACTERISTICS IN NARCISSISTIC PERSONALITY DISORDER Thus far, this letter has acknowledged that NPD persons rely heavily on self-object transferences to develop a positive self-image. The behavioral characteristics of NPD persons reflect this need and are well documented.[5] However, what is paradoxical about these behavioral characteristics is that instead of behaving in a way to increase the chance of receiving self-object transferences in relationships, NPD individuals act in a way to reduce that possibility by destroying interpersonal relations.
(So not only have we seen narcissists become depressed...they also have the propentencity to do things in relationships that sabotage them....which may then lead to this depression.)

Glasser[6] has specified relationship building and destroying behavior in a grand detail in his Choice theory. “Seven Caring Habits” and “Seven Deadly Habits” offer superb rules for how psychotherapists should interact with clients to enhance the likelihood that these individuals use caring interpersonal habits to attain optimal mental health. It is evident from the literature that NPD behavioral characteristics reflect the “Seven Deadly Habits.”[1] Glasser's Seven Caring Habits are Supporting, Encouraging, Listening, Accepting, Trusting, Respecting, Negotiating differences and the Deadly Habits are Criticizing, Blaming, Complaining, Nagging, Threatening, Punishing, Bribing, or Rewarding to Control.

Go to: CHOICE THEORY The writing of Kohut and advocates of self-psychology argue that the feeling of love, belonging, closeness, and connectedness with other humans are essential for individuals with NPD who requires self-object transferences.[7] Unfortunately, the pushing, demanding actions (Seven Deadly Habits or External Control Psychology) being used by NPD persons destroy relationships and therefore prevents self-object needs being met. When external control is used by NPD persons, it will destruct the capacity of one or both individuals to locate contentment, eventually resulting in severed relationships.[8] This interpersonal disengagement is argued to be the foundation for the majority of human mental illness.[6] Choice Theory and the Seven Caring Habits are offered to replace external control psychology and the Seven Deadly Habits[6] to preserve relationships and optimal mental health.

External Control Psychology is an attempt to control others to act in a way they do not want to.[6] This ideology of a person who uses external control does not permit individuals outside the self to formulate preference about individual freedom, and advocates that other individuals should be punished to modify their behavior to attain the controllers' needs.[6] The “Deadly Habits” demolishes individual freedom of the oppressed individual and therefore acts to disconnect relationships, as freedom has been identified as one of the basic human needs.[6]

Consequently, a central thesis of Choice theory is that the only individual one can be in command of is themselves.[6] If the individual believes they can command other humans, then they will encounter anger and irritation leading to mental illness.[6] Anger, irritation, and mental illness will also arise if the individual believes that other humans can command them and then externalizes blame to the perceived controller for undesirable events.[6] For that reason, it is vital for the NPD individual to focus on internal control of their own choices and to value the rights of other people who have their own needs.[6]

In conclusion, it is important that the caring habits be taught to the NPD client, once a therapist has identified an individual with strong self-object needs and who meets the criteria for NPD. Using Choice theory, the psychotherapist directs an individual toward fulfilling interpersonal relationships and educates the person to relate in more helpful modes using internal control psychology.[6] The better NPD persons are proficient at bonding and comprehending other individual needs, the better prospect they possess to receive positive self-object transferences and happiness.

Go to: ACKNOWLEDGMENTS Thank you to Amy-lee Weisse for constructive discussion and invaluable guidance.


1. Millon T, Millon CM, Meagher S. Hoboken, New Jersey: John Wiley & Sons; 2012. The Narcissistic Personality. Personality Disorders in Modern Life; p. 330.

2. Kohut H. Chicago: University of Chicago Press; 2011. Introductory Considerations. The Analysis of the Self: A Systematic Approach to the Psychoanalytic Treatment of Narcissistic Personality Disorders; p. 1.

3. Banai E, Mikulincer M, Shaver PR. “Selfobject” needs in kohut's self psychology: Links with attachment, self-cohesion, affect regulation, and adjustment. Psychoanal Psychol. 2005;22:224–60.

4. McLean J. Psychotherapy with a Narcissistic Patient Using Kohut's Self Psychology Model. Psychiatry. 2007;4:40–47. [PMC free article] [PubMed]

5. Silverstein ML. Washington, DC: American Psychological Association; 2007. Narcissitic Personality Disorder, Disorders of the Self: A Personality-Guided Approach; p. 27.

6. Glasser Bloomington: IUniverse; 2011. Replacing External Control With The New Choice Theory Psychology. Take Charge of Your Life: How to Get What You Need with Choice-Theory Psychology; p. 8.

7. Strack Hoboken, New Jersey: John Wiley & Sons; 2005. Self Psychological Foundations of Personality Disorders. Handbook of Personology and Psychopathology; p. 181.

8. Glasser , Glasser New York: Harper Collins; 2007. External Control Can Kill a Marriage. Eight Lessons for a Happier Marriage; p. 11. Linkback here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662146/

So, it looks like there's alot of stuff going on with Narcissists. Or what they call "NPD."

As for my conclusions:

NPD or (Perceived NPD) or actually scientists are still trying to figure it out I'm going to put into three categories that even have subcategories.

1) Being the center of attention and always getting what you wanted while growing up...only to realize when it times come to get a job that doesn't exist anymore - which can admittedly be a difficult shift for someone to have to make. This could also stem from derivatives of this. Obviously would say psychopathology here and environmental influencers are important players.** The affects of this seem to appear as relationship issues mostly - as they have developed a certain "expectation for this or that" which puts stress on their mate....whom then eventually leaves them....which then causes them to be a depressed narcissist. This cycle also seems to repeat itself although methods are suggested to help treat a patient with this disorder in the last piece of literature.

2) Genuinely having some subtype of NPD that is more than just psychopathologically based. This goes back to that 2nd study where they were trying to identify the subtypes for the DSM definition. These adjectives don't seem to describe someone who would necessarily fit into category #1, although they partially seem to discribe someone who would fit into my 3rd category - someone who is simply bipolar and has a "narcissistic mania." And yes, I just made that medical diagnosis up.

Q-Type Analysis (the authors labeled these as the three subtypes):

  1. grandiose/malignant
  2. fragile
  3. high-functioning/exhibitionistic

Core features of the disorder (NPD)

  • included interpersonal vulnerability and underlying emotional
  • distress, along with anger
  • difficulty in regulating affect
  • interpersonal competitiveness

So I actually don't really believe many #1's would fit into this #2 category I have set up due to the lack of focus on problems in certain types of relationships (they mention interpersonal failures...but not as directly).

I'd say these are most likely people with a true "NPD" pathology - with a couple bipolar's mixed in depending upon if their methodologies were very affective at weeding them out and since it's a Q-type analysis...I'd feel somewhat unconfident about that.

3) Someone who is bipolar and when they have their manic episode, they become narcissistic. Obviously they'd go up and down and have all sorts of fun problems.

Answer to your question:

They can be both, either/or, have it depend upon things like interpersonal issues because they feel like the world owes them something. Apparently the pathology of narcissism is a very complex thing to figure out or put any sort of hard and fast label on. It could be caused by one's psychology from how they were raised or a genuine mental disorder of a physiological kind. There's also problems with distinguishing it from bipolar disorder (although I'd say if someone had bipolar disorder then they'd probably know it).

  • 1
    $\begingroup$ Lol, everyone likes your question but not my response. It seems like people just want short answers even to questions that are hard to fully respond to. Sigh. $\endgroup$
    – user3433
    Sep 3, 2013 at 6:59
  • 1
    $\begingroup$ @user3433 I love your answer. Having been married to what I have finally figured out is a narcissist for 20 years, there was a lot of clicking going on in my brain when I read it. $\endgroup$
    – user13594
    Sep 2, 2016 at 14:12

Your Answer

By clicking “Post Your Answer”, you agree to our terms of service and acknowledge you have read our privacy policy.