Explore every episode of the podcast Heal NPD

In this episode, Dr. Mark Ettensohn explores the concept of annihilation anxiety and its role in narcissistic pathology and other personality disorders.

Beginning with a clinical vignette involving childhood emotional and physical abuse, the episode examines what can happen when a child’s separate thoughts, feelings, and perceptions become psychologically threatening to a caregiver. A child may depend on a parent for love, safety, and recognition while simultaneously discovering that important parts of his own subjective experience cannot safely coexist with the parent’s psychological reality. Under these conditions, psychological separateness itself can become associated with danger.

Dr. Ettensohn describes this relational configuration as a kind of zero-sum psychological system. When two minds cease to confirm one another, it can feel as though only one can remain intact. Either one person must surrender some part of their subjective experience, or the incompatible experience of the other person must be changed, discredited, controlled, or destroyed. Over time, children raised within these dynamics may internalize the expectation that maintaining a separate mind threatens attachment, identity, or psychological survival.

The episode then considers narcissistic pathology as one possible adaptation to this problem. Idealization and admiration can provide refuge from annihilation by supporting a coherent and valued sense of self. But when that self remains dependent upon confirmation from other people, criticism, disagreement, or rejection can reactivate the original threat. Familiar narcissistic defenses such as grandiosity, projection, devaluation, and rage can then function as attempts to prevent an intolerable representation of the self from existing in either person’s mind.

Dr. Ettensohn argues that this process is not exclusive to narcissism. Different forms of personality pathology may organize annihilation anxiety differently. Separateness may be surrendered through dependency, destabilize the experience of self in borderline states, become experienced as persecutory threat, or be avoided through schizoid or avoidant withdrawal. Despite their differences, these adaptations can share a common psychological problem: difficulty maintaining a stable experience of self while remaining in relationship with a genuinely separate other.

Ultimately, the episode proposes annihilation anxiety as a central conflict in personality pathology and examines how complex relational trauma can reproduce itself across generations. What gets transmitted is not simply a collection of abusive behaviors, but a way of organizing relationships in which psychological separateness becomes dangerous and one person’s subjectivity may have to disappear so that another’s can remain intact.

Works Cited:  Neuman, C. J. (2012). Impact of borderline personality disorder on parenting: Implications for child custody and visitation recommendations. Journal of Child Custody, 9(4), 233–249. https://doi.org/10.1080/15379418.2012.748350

⸻

Additional Resources

Website: https://healnpd.org   Newsletter: https://healnpd.substack.com  

Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH  

LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum   LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8  

About Heal NPD

Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, Narcissistic Personality Disorder, and related personality difficulties. We provide comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.

Learn more or inquire about services: https://healnpd.org

In this episode, Dr. Mark Ettensohn asks a simple question: What would happen if we talked about depression the way we currently talk about narcissism?

Through a thought experiment, the episode imagines an alternate reality in which depression has become the focus of the same kind of online discourse that now surrounds narcissism. Social withdrawal becomes “withholding.” Loss of motivation becomes laziness. Preoccupation with painful internal states becomes selfishness. Irritability becomes hostility. Difficulty accepting help becomes an unwillingness to take accountability. Gradually, recognizable features of a mental disorder are stripped of their psychological context and reinterpreted as evidence of a morally defective kind of person.

The thought experiment then expands. Stories from people who have been hurt by depressed partners, parents, friends, and coworkers begin supplying additional characteristics of the “depressed person.” Lying, cheating, manipulation, neglect, controlling behavior, and abuse are folded into the category, not because these behaviors have been shown to characterize depression, but because some people with depression also engage in them. 

Dr. Ettensohn argues that something similar has happened in popular discourse about narcissism. Behaviors such as lying, cheating, gaslighting, manipulation, coercion, love bombing, vindictiveness, and abuse are increasingly presented as characteristics of “the narcissist,” even though none are specific to narcissistic pathology. The result is a circular process in which harmful behavior is used to identify someone as a narcissist, while the behavior of people already identified as narcissists is then used as evidence for what narcissists supposedly do.

The episode also examines why Narcissistic Personality Disorder may be particularly vulnerable to this process, because unlike many psychiatric diagnoses, the traditional diagnostic criteria for NPD already emphasize objectionable interpersonal manifestations such as entitlement, exploitation, impaired empathy, arrogance, and grandiosity. 

Ultimately, the episode argues for putting psychology back into the cultural conversation about narcissism. When narcissistic pathology is reduced to an ever-expanding collection of frightening, hurtful, or objectionable behaviors, the psychological organization that might make those behaviors intelligible disappears. What remains may still use the language of psychology, but instead of a model of a mind, it becomes the description of a villain.

⸻ Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com

Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH

LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8

 

About Heal NPD Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, Narcissistic Personality Disorder, and related personality difficulties. We provide comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.

Learn more or inquire about services: https://healnpd.org

In this episode, Dr. Mark Ettensohn examines what self-esteem actually looks like in pathological narcissism and why common explanations such as “low self-esteem hidden beneath grandiosity” or “grandiosity masking shame” oversimplify a much more complicated psychological process. 

The episode begins by examining self-esteem as a regulatory system rather than a fixed quantity that a person either has or does not have. Healthy self-esteem is generally stable, realistic, and basically positive. Dr. Ettensohn explains how pathological narcissism can involve difficulties in all three areas, producing self-appraisals that are unstable, highly reactive to circumstances, and capable of shifting between unrealistically positive and unrealistically negative views of the self.

The discussion explores the grandiose and vulnerable self-states associated with pathological narcissism. Grandiosity can involve genuine feelings of superiority, exceptionalism, or importance, while vulnerable states may involve shame, humiliation, inadequacy, depression, envy, or anxiety. These states can alternate, overlap, and interact in complicated ways. Neither necessarily represents the person's “real” self hiding underneath the other.

Dr. Ettensohn also discusses the development of self-esteem regulation, including the interaction between temperament, heritable traits, relationships, and developmental experience. Rather than reducing pathological narcissism to a single cause, contemporary models understand personality pathology as emerging through complex interactions between the characteristics people bring into the world and the experiences through which their personalities develop.

The episode then considers behaviors frequently associated with pathological narcissism, including arrogance, entitlement, idealization, devaluation, exploitation, and impaired empathy. These features are often discussed as though they stand apart from problems of self-esteem. Dr. Ettensohn explains how they can instead function within a larger system of self-esteem regulation, particularly when grandiosity is recruited to maintain or restore a threatened sense of self.

At the same time, none of these features by itself establishes pathological narcissism. People can be arrogant, entitled, grandiose, low in empathy, or insecure without having NPD. They can also have unstable or chronically low self-esteem without being narcissistic. Pathological narcissism refers to the larger organization of these features: the vulnerability of the self-esteem system, grandiose and vulnerable self-states, and the characteristic regulatory strategies used to maintain, protect, or restore the person’s sense of self.

Ultimately, the episode challenges attempts to reduce narcissistic psychology to a single hidden truth beneath the surface. Grandiosity can sometimes defend against shame, but that particular dynamic should not be mistaken for an explanation of the disorder as a whole. ⸻ Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com

Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH

LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8

 

About Heal NPD Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, Narcissistic Personality Disorder, and related personality difficulties. We provide comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.

Learn more or inquire about services: https://healnpd.org

In this episode, Dr. Mark Ettensohn examines the circular logic that often appears in popular “narcissistic abuse” discourse and how it can create a closed system for interpreting other people’s behavior.

The episode begins with a pattern Dr. Ettensohn has repeatedly encountered online: once someone concludes that another person is a narcissist, virtually any response can become further evidence of narcissism. Disagreement becomes an inability to tolerate criticism. Anger becomes narcissistic rage. Denial becomes DARVO. Withdrawal becomes the silent treatment. An apology becomes manipulation or hoovering. Even evidence that contradicts the original conclusion can be reinterpreted as proof that the narcissist has successfully deceived others.

Dr. Ettensohn argues that this creates an essentially unfalsifiable framework. If both an accusation and its denial can be treated as evidence of guilt, there is no independent standard by which the original interpretation can be tested or revised. Rather than asking what explanation best accounts for another person’s behavior, the process begins with a conclusion and assembles evidence around it.

Drawing on his experience conducting psychological assessments, Dr. Ettensohn discusses how this reasoning can persist even when a person does not meet criteria for Narcissistic Personality Disorder or pathological narcissism. He explores how the extensive vocabulary of popular narcissistic-abuse content can encourage people to infer hidden motives and psychological states from ambiguous behavior while becoming increasingly resistant to alternative explanations.

The episode also challenges the widespread conflation of pathological narcissism with abuse. People with NPD can behave abusively, but abusive behavior does not itself establish the presence of pathological narcissism. Recent research has likewise raised questions about treating pathological narcissism as a general explanation for intimate partner abuse.

Ultimately, the discussion asks a basic epistemological question: If every possible response can be interpreted as evidence that someone is a narcissist, what evidence could ever show that the conclusion was wrong?

References: Day, N. J. S., Kealy, D., Biberdzic, M., Green, A., Denmeade, G., & Grenyer, B. F. S. (2025). Coercive control and intimate partner violence: Relationship with personality disorder severity and pathological narcissism. Personality and Mental Health, 19(4), e70038.

https://onlinelibrary.wiley.com/doi/full/10.1002/pmh.70038

⸻ Additional Resources

Website: https://healnpd.org Newsletter: https://healnpd.substack.com

Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH

LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8

   About Heal NPD Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, Narcissistic Personality Disorder, and related personality difficulties. We provide comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.

Learn more or inquire about services: https://healnpd.org

In this follow-up to a previous episode, Dr. Mark Ettensohn examines a central problem in the way narcissism is commonly discussed online: the assumption that abusive behavior is sufficient evidence of narcissism.

The episode argues that this conclusion arises, in part, from a longstanding problem in the DSM diagnostic criteria for Narcissistic Personality Disorder. Many of the interpersonal characteristics traditionally associated with NPD, including entitlement, impaired empathy, exploitation, arrogance, and refusal to take responsibility, are also common features of abusive relationships in general. As a result, virtually any abusive relationship can appear “narcissistic” without establishing that pathological narcissism is actually present.

Dr. Ettensohn explores how this lack of specificity has contributed to the widespread popularity of the concept of “narcissistic abuse,” and why it has become increasingly difficult to distinguish abusive behavior from pathological narcissism itself. He argues that contemporary research has moved toward understanding pathological narcissism as a disorder of identity and self-esteem regulation characterized by fluctuating grandiose and vulnerable states, rather than simply a collection of observable interpersonal behaviors.

The episode also examines how popular discussions of narcissism often continue to rely on the older behavioral framework while separating the term “narcissism” from its underlying clinical construct. Dr. Ettensohn argues that this creates conceptual confusion, contributes to public stigma surrounding NPD, and encourages people to mistake abuse itself for evidence of narcissistic pathology.

Ultimately, the discussion asks a simple question: When does abusive behavior actually indicate pathological narcissism, and when are we simply describing abuse?

To see the video this follows up: https://youtu.be/lcIEM7IVXxk

⸻

Additional Resources

Website: https://healnpd.org Newsletter: https://healnpd.substack.com

Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH

 

LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8

 

About Heal NPD

Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, Narcissistic Personality Disorder, and related personality difficulties. We provide comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.

Learn more or inquire about services: https://healnpd.org

 

About Heal NPD

Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, narcissistic personality disorder, and related personality difficulties. We offer comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.

Learn more or inquire about services: https://healnpd.org

Dr. Mark Ettensohn examines the common claim that personality disorders such as narcissistic personality disorder (NPD) are either caused by trauma or are primarily genetic. He argues that this framing presents a false dichotomy and does not reflect how personality development is understood in contemporary psychology.

The discussion begins by reconsidering what psychologists mean by the word trauma. Rather than treating trauma as a particular kind of event, Dr. Ettensohn explores the idea that trauma is better understood as the psychological injury resulting from life experiences. This distinction helps explain why children raised in the same family can have very different developmental outcomes despite sharing many of the same experiences.

The episode also examines the role of temperament and other heritable factors in personality development. While genetic predispositions influence how individuals experience and respond to their environments, they do not determine personality disorders in isolation. Instead, personality emerges through the ongoing interaction between biology and developmental experience.

Finally, Dr. Ettensohn addresses common arguments based on brain imaging and twin studies, explaining why these findings are often misunderstood in discussions about heritability. The episode considers the importance of construct validity, operationalization, and measurement when interpreting research on personality disorders, arguing that simplistic claims about either trauma or genetics fail to capture the complexity of human psychological development.

Additional Resources

Website: https://healnpd.org Newsletter: https://healnpd.substack.com

Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: 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

 

About Heal NPD

Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, narcissistic personality disorder, and related personality difficulties. We offer comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.

Learn more or inquire about services: https://healnpd.org

Dr. Mark Ettensohn examines the concept of “narcissistic abuse” and explains why he no longer considers it a coherent psychological construct.

Using the comment from a viewer as a starting point, the discussion explores a common misconception: that skepticism toward the concept of narcissistic abuse reflects a lack of empathy for victims. Dr. Ettensohn argues that his concern is not with the reality of abuse or the suffering of those who experience it, but with the explanatory framework that has developed around the term.

The episode examines the concept through the lens of construct validity, asking what psychological phenomenon the term actually refers to and whether it identifies a distinct form of abuse beyond categories that are already well established in psychology. The discussion considers the problems of operationalization, the distinction between observation and inference, and why labeling abuse according to the presumed diagnosis of the perpetrator differs from defining abuse by the harm it causes.

Dr. Ettensohn also revisits his own earlier use of the term, explaining how his thinking has evolved over time. He distinguishes between psychoanalytic concepts such as narcissistic injury and the contemporary online usage of “narcissistic abuse,” arguing that these represent fundamentally different theoretical models.

Finally, the episode explores how explanatory frameworks shape memory and interpretation, and why concepts that incorporate assumptions about another person’s motivations or diagnosis may become difficult to evaluate critically. Throughout, the discussion argues for greater conceptual precision in psychology while emphasizing that questioning a psychological construct is not the same as questioning the reality of abuse.

Additional Resources

Website: https://healnpd.org Newsletter: https://healnpd.substack.com

Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: 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

 

About Heal NPD

Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, narcissistic personality disorder, and related personality difficulties. We offer comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.

Learn more or inquire about services: https://healnpd.org

This episode continues the Heal NPD Seminar Series with Dr. Mark Ettensohn and associate Deanna Young, Psy.D.

In this session, the group discusses the article “A Mentalizing Approach for Narcissistic Personality Disorder: Moving From ‘Me-Mode’ to ‘We-Mode’” (Choi-Kain, Simonsen, & Euler, 2022), which explores how Mentalization-Based Treatment (MBT) can be applied to the treatment of narcissistic personality disorder.

The paper argues that many of the challenges clinicians encounter when working with narcissistic patients can be understood through the lens of attachment, mentalization, and epistemic trust. Rather than viewing narcissistic pathology primarily as a problem of entitlement, grandiosity, or lack of empathy, the authors conceptualize it as a disturbance in the capacity to understand oneself and others in psychological terms and to learn from emotionally meaningful relationships.

The discussion explores the article’s central proposal that treatment involves helping patients move from a self-focused “me-mode” toward a more collaborative “we-mode,” in which multiple perspectives can be held in mind simultaneously. Particular attention is given to the ways in which narcissistic adaptations interfere with trust, intimacy, and therapeutic engagement.

Along the way, the conversation examines several key MBT concepts, including:

* Epistemic trust and distrust * Nonmentalizing modes, including pretend mode, psychic equivalence, and teleological thinking * Marked contingent mirroring * The therapeutic alliance as a vehicle for psychological change * Why confrontation and pressure for change can sometimes reinforce narcissistic defenses rather than weaken them

The discussion also considers the broader cultural discourse surrounding narcissism and contrasts popular approaches that emphasize accountability, confrontation, and labeling with psychodynamic and attachment-based approaches that emphasize understanding, curiosity, and the gradual development of trust.

Finally, the group reflects on the practical realities of psychotherapy with narcissistic patients, including the pressures created by partners and family members seeking rapid change, the tendency for therapists to become caught in power struggles, and the challenge of maintaining a mentalizing stance in the face of difficult interpersonal dynamics.

Key themes include:

* Mentalization-Based Treatment (MBT) and narcissistic personality disorder * Attachment theory and personality pathology * Epistemic trust as a foundation for psychological growth * The relationship between vulnerability and grandiosity * Nonmentalizing modes of experience * The role of empathy, curiosity, and validation in treatment * Clinical challenges in working with narcissistic patients

This series is intended for clinicians, trainees, and viewers seeking a nuanced, clinically grounded understanding of narcissism beyond popular 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: https://amzn.to/3nG9FgH

SUBSCRIBE: https://rb.gy/kbhusf LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8

Citation:

Choi-Kain, L. W., Simonsen, S., & Euler, S. (2022). A Mentalizing Approach for Narcissistic Personality Disorder: Moving From “Me-Mode” to “We-Mode.” American Journal of Psychotherapy, 75(1), 38–43.

Full text link: https://www.psychiatryonline.org/doi/epdf/10.1176/appi.psychotherapy.20210017

This is the third part of a three-part exploration of narcissistic personality style at the neurotic level of personality organization.

In this episode, Dr. Ettensohn examines the defensive architecture of neurotic-level narcissism, including the characteristic defenses that allow individuals to manage conflict, preserve relationships, and maintain self-esteem without resorting to the identity fragmentation or reality distortion seen at more severe levels of personality organization.

Drawing on the Defense Mechanisms Rating Scale (DMRS), this episode explores obsessional defenses such as isolation of affect, intellectualization, and undoing, as well as neurotic defenses including repression, reaction formation, and displacement. Through clinical examples, personal reflections, and portrayals from film and literature, Dr. Ettensohn illustrates how these defenses shape emotional experience, interpersonal relationships, and the therapeutic process.

The episode also examines how narcissistic concerns manifest at the neurotic level, including struggles with self-worth, dependency, vulnerability, perfectionism, and grief. Particular attention is given to transference, countertransference, and the unique opportunities and challenges that emerge in psychotherapy with neurotic-level narcissistic personalities.

While neurotic-level functioning represents a profound developmental achievement, it also introduces new emotional realities. As the capacity for integration grows, so too does the capacity to experience loss, guilt, limitation, and sorrow. The movement toward greater psychological health is not the elimination of suffering, but the ability to bear it without abandoning oneself or others.

Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com

Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: 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

BECOME A MEMBER: https://www.youtube.com/channel/UCHeT5kujD1JqHRAi-x8xD-w/join

About Heal NPD Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, narcissistic personality disorder, and related personality difficulties. We offer comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.

Learn more or inquire about services: https://healnpd.org

Dr. Mark Ettensohn examines the experience of emptiness in narcissistic personality disorder and other forms of personality pathology.

Rather than approaching personality disorders as collections of traits or behaviors, the episode frames them as disturbances in identity. Dr. Ettensohn outlines how the sense of self is constructed through early relational experience and how disruptions in that process can lead to unstable, fragmented, or underdeveloped self-experience.

The discussion focuses on the role of dissociation and splitting in shaping identity, and how different self-states may become organized around incompatible relational experiences. In this context, emptiness is not simply a feeling, but reflects aspects of the self that were never fully recognized, mirrored, or integrated in development.

Dr. Ettensohn also addresses a common misunderstanding in public discourse, where narcissism is equated with observable traits such as arrogance or entitlement. He explains why these descriptions capture only one part of a broader system involving both grandiose and vulnerable states, and how focusing solely on behavior obscures the underlying psychological structure.

The episode concludes with a discussion of clinical implications, emphasizing why treatments that focus only on behavior often fall short, and why effective work with narcissistic pathology requires attention to identity, relational process, and the integration of dissociated aspects of self-experience.

Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com

Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: 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

 

About Heal NPD Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, narcissistic personality disorder, and related personality difficulties. We offer comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.

Learn more or inquire about services: https://healnpd.org

This episode continues the Heal NPD Seminar Series with Dr. Mark Ettensohn, joined by his associates Deanna Young, Psy.D., and Danté Spencer, Ph.D.

In this session, the group discusses the paper “Living with Pathological Narcissism: A Qualitative Study” (Day et al., 2020), which examines narcissistic personality pathology from the perspective of partners and family members.

Unlike most research on narcissism, this study does not rely on self-report or clinician ratings. Instead, it draws on qualitative descriptions from over 400 individuals in close relationships with someone exhibiting high levels of pathological narcissistic traits. These accounts provide a window into how narcissism is experienced interpersonally, particularly in intimate and long-term relationships.

The discussion focuses on the study’s central finding: that pathological narcissism is best understood as a system characterized by the co-occurrence of grandiosity and vulnerability. Loved ones described patterns of entitlement, arrogance, and need for admiration alongside insecurity, hypersensitivity, emotional instability, and chronic feelings of emptiness. In the majority of cases, these features were not separate “types,” but fluctuating states within the same individual.

The group explores how these findings challenge common assumptions about narcissism, including the tendency to equate it with overt grandiosity or interpersonal abusiveness. Particular attention is given to the limitations of DSM-based models, which emphasize observable traits while underrepresenting the internal dysregulation and vulnerability that define the disorder.

The conversation also examines broader relational and developmental themes, including:

• The oscillation between grandiose and vulnerable self-states
• The role of dissociation and splitting in personality organization
• The impact of early attachment trauma and “empathic failures”
• How narcissistic dynamics are expressed and amplified within close relationships
• The tendency for polarized, dehumanizing narratives to emerge in response to relational injury

Finally, the group discusses the concept of “narcissistic abuse,” noting that while experiences of harm in these relationships are real and often significant, the term itself is not a well-defined clinical construct. The discussion emphasizes the importance of distinguishing between lived experience and explanatory frameworks, and of maintaining a nuanced, non-reductive understanding of personality pathology.

Key themes include:

• Pathological narcissism as a dysregulated self-state system
• The interdependence of grandiosity and vulnerability
• Limitations of categorical and trait-based models of narcissism
• The relational expression of personality pathology
• The role of trauma, attachment, and development in narcissistic adaptation
• Clinical implications for assessment, formulation, and treatment

This series is intended for clinicians, trainees, and viewers seeking a nuanced, clinically grounded understanding of narcissism beyond popular 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: 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

Citation: Day, N. J. S., Townsend, M. L., & Grenyer, B. F. S. (2020). Living with pathological narcissism: A qualitative study. Borderline Personality Disorder and Emotion Dysregulation, 7(19). 

Full Text Link: https://pmc.ncbi.nlm.nih.gov/articles...

About Heal NPD Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, narcissistic personality disorder, and related personality difficulties. We offer comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.

Learn more or inquire about services: https://healnpd.org

This episode continues the Heal NPD Seminar Series with Dr. Mark Ettensohn, joined by his associates Deanna Young, Psy.D., and Danté Spencer, Ph.D.

In this session, the group examines the Alternative DSM-5 Model for Personality Disorders (AMPD), a dimensional framework introduced in Section III of the DSM-5 and retained in DSM-5-TR. The model was developed in response to longstanding limitations of the traditional categorical system, including diagnostic overlap, heterogeneity within disorders, and the absence of a clear framework for assessing severity.

The discussion focuses on the two core components of the model. The first, Level of Personality Functioning (Criterion A), assesses impairments in identity, self-direction, empathy, and intimacy. This portion of the model reflects a structural approach to personality and aligns with psychodynamic and developmental perspectives on personality organization.

The second component, Criterion B, introduces a trait-based system organized around five domains: negative affectivity, detachment, antagonism, disinhibition, and psychoticism. These traits are derived from dimensional personality research and represent an effort to describe maladaptive personality features in a standardized way.

The group explores the strengths of this combined model, as well as its limitations. Particular attention is given to the tension between structural and trait-based approaches, and to the question of whether personality pathology can be adequately captured through trait descriptions alone.

Using narcissistic personality disorder as a focal example, the discussion examines how the model emphasizes grandiosity and attention-seeking traits while underrepresenting vulnerability, shame, and fluctuations in self-state. The conversation highlights the importance of understanding pathological narcissism as a system of self-esteem regulation rather than a fixed set of traits.

Key themes include:

• The shift from categorical to dimensional models of personality disorder
• The distinction between personality functioning (structure) and personality traits (style)
• Limitations of trait-based approaches in capturing dynamic, state-based phenomena
• The role of self-esteem regulation, vulnerability, and oscillation in narcissistic pathology
• Clinical implications for diagnosis, formulation, and treatment

Throughout, the discussion situates the AMPD as a meaningful step forward in personality disorder classification, while also identifying areas where the model remains conceptually limited. The session emphasizes the value of structural and developmentally informed approaches in understanding personality pathology.

This series is intended for clinicians, trainees, and viewers seeking a nuanced, non-moralizing understanding of narcissism and personality disorders.

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: 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

Citation:  American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

Link to alternative model:   https://psychiatryonline.org/doi/10.1...

About Heal NPD Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, narcissistic personality disorder, and related personality difficulties. We offer comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.

Learn more or inquire about services: https://healnpd.org

Dr. Mark Ettensohn examines a growing tendency in public discourse to treat narcissism as a moral category rather than as a psychological construct.   The episode explores why this shift occurs and how misunderstandings about the nature of mental illness contribute to it. While many people intuitively apply a medical model to psychological conditions, most forms of mental illness do not operate in simple cause-and-effect ways.   Instead, psychological disorders are identified through patterns of thoughts, emotions, perceptions, and behaviors that emerge statistically across populations.   Dr. Ettensohn discusses how online discussions about narcissism often move from specific interpersonal conflicts to sweeping claims about an entire category of people. In this process, personality traits, clinical constructs, anecdotal experiences, and moral judgments frequently become conflated.   Drawing on both psychological science and his clinical experience conducting diagnostic assessments for narcissistic personality disorder, Dr. Ettensohn explains why diagnosing personality pathology requires careful evaluation and why many individuals labeled “narcissists” in everyday discourse may not have any significant narcissistic pathology at all.   The episode concludes by distinguishing several different ways narcissism is commonly understood, and why treating it as a moral category ultimately obscures more than it reveals.   Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: 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   About Heal NPD: Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, narcissistic personality disorder, and related personality difficulties. We offer comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.   Learn more or inquire about services: https://healnpd.org

Dr. Mark Ettensohn addresses a question that frequently arises in discussions of narcissism and abuse: Is it possible to maintain accountability without dehumanizing? Can someone preserve firm boundaries without abandoning empathy?

Dr. Ettensohn clarifies a distinction he often sees misunderstood. When he speaks about compassion toward pathological narcissism or narcissistic personality disorder, he is referring to a cultural and societal stance, not advising individuals to remain in unsafe or harmful relationships. He emphasizes that safety must always come first. If someone is being harmed, the primary question is not whether the other person “knew what they were doing,” but whether the situation is safe and what steps are necessary to ensure protection.

The episode explores the gray area between total innocence and calculated malice. Dr. Ettensohn discusses how dissociation and shifting self states can impair consistent self-awareness in personality disorders, while also making clear that impaired awareness is not the same as blamelessness. He examines how behavior driven by triggered trauma states may later be rationalized from a different organizing center of experience, and why this dynamic is often misinterpreted as deliberate manipulation.

Finally, the discussion turns to boundaries. Dr. Ettensohn distinguishes kindness from niceness and empathy from permissiveness, arguing that the most empathic stance can sometimes be a firm refusal of access. The episode concludes by asserting that accountability does not require demonization, and that it is possible to reject harmful behavior without reducing a person to a monster.

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: 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

 

About Heal NPD: Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, narcissistic personality disorder, and related personality difficulties. We offer comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.

Learn more or inquire about services: https://healnpd.org

This episode continues the Heal NPD Seminar Series with Dr. Mark Ettensohn, joined by his associates Deanna Young, Psy.D., and Danté Spencer, M.A.

In this session, the group examines a recent empirical study titled Coercive Control and Intimate Partner Violence: Relationship with Personality Disorder Severity and Pathological Narcissism (2025).

The discussion responds directly to common claims in online discourse that narcissism inherently causes abuse, and asks a more precise question: What does the data actually show about the relationship between narcissism, personality dysfunction, abuse, and coercive control?

The study reviewed draws on informant reports from long-term partners and family members of individuals perceived as highly narcissistic. Importantly, narcissism was rated by loved ones rather than self-reported, addressing a frequent critique of prior research.

The findings showed no significant association between overall pathological narcissism and abuse, and only weak associations with coercive control. In contrast, overall personality disorder severity showed stronger and more consistent relationships with both abuse and coercive control, but these associations were still mostly weak.

The group explores what this means clinically, emphasizing the distinction between personality style (such as narcissistic features) and personality organization or severity. The discussion clarifies why certain narcissistic subcomponents, such as exploitative behavior, entitlement-related rage, and grandiose fantasy, show limited associations with specific forms of harm, while many other narcissistic features do not. Key themes include:

• The difference between episodic abuse and chronic coercive control
• Why collapsing abuse into a single personality label is misleading
• The role of personality severity and impaired functioning across diagnoses
• The limits of trait-based and moralized explanations of harm
• Clinical implications for assessment, treatment, and stigma reduction

Throughout, the conversation situates abuse as a highly overdetermined phenomenon influenced by many overlapping factors, rather than the inevitable outcome of narcissism or any single diagnosis.

The session concludes by emphasizing the importance of dimensional, developmentally informed models of personality over reductive and stigmatizing narratives.

This series is intended for clinicians, trainees, and viewers seeking a nuanced, non-moralizing understanding of narcissism, personality disorder severity, and relational harm.

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: 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

Article Cited and Discussed: Day, N. J. S., Kealy, D., Biberdzic, M., Green, A., Denmeade, G., & Grenyer, B. F. S. (2025). Coercive control and intimate partner violence: Relationship with personality disorder severity and pathological narcissism. Personality and Mental Health, 19, e70038.

Full text link: https://onlinelibrary.wiley.com/doi/p...

In this episode, Dr. Mark Ettensohn examines a common defense of online “narcissistic abuse” content: the claim that, even if imperfect or inaccurate, it ultimately helps people leave harmful relationships.

Rather than focusing on whether such content feels validating or empowering, Dr. Ettensohn explores the ethical and psychological implications of justifying misinformation, stigma, and moralized diagnostic narratives on the basis of perceived outcomes. He argues that this form of reasoning relies on a utilitarian logic that is fundamentally incompatible with responsible mental health communication.

The discussion addresses why narc abuse frameworks often feel compelling to people in distress, how diagnostic language becomes moralized and expanded beyond its clinical meaning, and how this process reshapes viewers’ understanding of themselves, others, and psychology itself. Dr. Ettensohn distinguishes between recognizing real harm and adopting explanatory models that flatten psychological complexity, foreclose on nuance, and encourage rigid, adversarial interpretations of relational experience.

The episode also clarifies common misunderstandings about pathological narcissism, emphasizing that narcissism is not synonymous with abusive behavior and that even when narcissistic pathology is present, it does not explain behavior in a deterministic or morally absolute way. Drawing on clinical ethics, developmental theory, and real-world examples, Dr. Ettensohn outlines why anger and moral clarity can be mobilizing without requiring diagnostic distortion or dehumanization.

This video concludes with a reflection on boundaries in public mental health discourse and the importance of maintaining accuracy, restraint, and humanization when discussing stigmatized conditions.

Referenced video:    • From Validation to Isolation: The Narc-Abu...  

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: 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

In this video, Dr. Ettensohn examines the online narc-abuse ecosystem and explores how content that initially feels validating and supportive can, over time, become thought-constraining and socially isolating for some viewers.

Drawing on clinical experience and established research on high-demand systems, Dr. Ettensohn analyzes the rhetorical patterns commonly used across narc-abuse channels: the elevation of the viewer as a lone truth-seer, the narrowing of acceptable interpretations, the use of loaded psychological language, and the gradual erosion of trust in ordinary relationships. He shows how these dynamics can reshape identity, undermine critical thinking, and foster increasing dependence on content creators rather than encouraging reflection, complexity, or professional consultation.

Throughout the video, Dr. Ettensohn carefully distinguishes between genuine abuse and the expanding, imprecise use of narc-abuse language online. He emphasizes that acknowledging harm and seeking clarity are legitimate and necessary, while also warning that one-size-fits-all narratives can distort meaning, escalate conflict, and contribute to unnecessary social rupture. The focus is not on dismissing people’s pain, but on examining how certain explanatory frameworks operate psychologically and what they may unintentionally cost the people who adopt them.

This video continues Dr. Ettensohn’s clinically grounded effort to bring nuance, rigor, and psychological depth to public conversations about narcissism, offering a perspective that prioritizes complexity, reality testing, and relational context over certainty, moralization, or ideological alignment.

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

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 video continues the Heal NPD Seminar Series, featuring Dr. Mark Ettensohn with his associates, Deanna Young, Psy.D., and Danté Spencer, M.A.

In this session, the group discusses Empathy and Narcissistic Personality Disorder: From Clinical and Empirical Perspectives (2014), examining the long-standing assumption that narcissistic personality disorder is defined by a lack of empathy. Drawing on the article’s review of empirical findings and clinical case material, the conversation explores empathy as a multidimensional and context-dependent capacity rather than a fixed trait.

Key themes include the distinction between emotional and cognitive empathy, the variability of empathic functioning across grandiose and vulnerable narcissistic states, and the ways shame, threat, and affective overload can disrupt empathic engagement in intimate relationships. The discussion highlights how empathy may appear intact or even robust in some contexts, while collapsing in situations that feel most emotionally consequential.

This video continues the Heal NPD Seminar Series, featuring Dr. Mark Ettensohn with his associates, Deanna Young, Psy.D., and Danté Spencer, M.A. In this session, the group discusses Empathy and Narcissistic Personality Disorder: From Clinical and Empirical Perspectives (2014), examining the long-standing assumption that narcissistic personality disorder is defined by a lack of empathy. Drawing on the article’s review of empirical findings and clinical case material, the conversation explores empathy as a multidimensional and context-dependent capacity rather than a fixed trait. Key themes include the distinction between emotional and cognitive empathy, the variability of empathic functioning across grandiose and vulnerable narcissistic states, and the ways shame, threat, and affective overload can disrupt empathic engagement in intimate relationships. The discussion highlights how empathy may appear intact or even robust in some contexts, while collapsing in situations that feel most emotionally consequential. The seminar also addresses common misunderstandings of neuroimaging findings related to empathy, emphasizing the limits of biological reductionism and the importance of viewing brain-based data as correlates of experience rather than determinants of destiny. Throughout, the group reflects on clinical implications for treatment, including the differentiation between motivation-based and deficit-based empathic disengagement, the role of affect tolerance and reflective capacity, and the relational conditions that support the gradual restoration of empathic availability.

This series is intended for clinicians, trainees, and others interested in a nuanced, non-moralizing understanding of narcissistic personality disorder, empathy, and psychological development.

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: 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

Citation for the article discussed: Baskin-Sommers A, Krusemark E, Ronningstam E. Empathy in narcissistic personality disorder: from clinical and empirical perspectives. Personal Disord. 2014 Jul;5(3):323-33. doi: 10.1037/per0000061. Epub 2014 Feb 10. PMID: 24512457; PMCID: PMC4415495.

Full text link: https://pmc.ncbi.nlm.nih.gov/articles/PMC4415495/

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.

In this weekly insight, Dr. Ettensohn addresses the common misconception that individuals with Narcissistic Personality Disorder (NPD) never seek therapy—and the even more misleading idea that simply wondering whether you have NPD means that you don’t.

This episode explores the origins of these myths, explaining how they stem from a misunderstanding of personality disorders and the role of insight. While NPD often involves rigid, maladaptive patterns of thinking and an egosyntonic sense of grandiosity, it also frequently includes periodic self-esteem collapses, during which individuals experience deep distress, depression, and anxiety. It is in these moments that many people with NPD seek therapy—contrary to the popular belief that they never do.

Dr. Ettensohn discusses how online narratives about NPD have distorted public understanding of the disorder, reinforcing harmful stereotypes that discourage those who need help from reaching out. Drawing from clinical experience and current research, he provides a more nuanced and accurate view of why individuals with NPD do, in fact, pursue treatment.

The "Weekly Insights" series is for paid members of Dr. Ettensohn's Heal NPD Youtube channel. In the short-term, Dr. Ettensohn is posting all even-numbered episodes free of charge. If you would like access to the full series, please follow this link:  https://www.youtube.com/channel/UCHeT5kujD1JqHRAi-x8xD-w/join

In this weekly insight, Dr. Ettensohn explores how cycles of narcissistic wounding and dehumanization develop and perpetuate across relationships and even generations. He discusses the origins of pathological narcissism, the defenses formed in response to early emotional injuries, and how these patterns manifest in adult relationships as narcissistic abuse.

The discussion also highlights how those impacted by these dynamics may unknowingly adopt similar patterns of anger, projection, and polarized thinking, perpetuating the cycle. Breaking free from these patterns requires leaning into complexity, embracing nuance, and recognizing the shared humanity in all involved.

The "Weekly Insights" series is for paid members of Dr. Ettensohn's Heal NPD Youtube channel. In the short-term, Dr. Ettensohn is posting all even-numbered episodes free of charge. If you would like access to the full series, please follow this link:  https://www.youtube.com/channel/UCHeT5kujD1JqHRAi-x8xD-w/join

In this weekly insight, Dr. Ettensohn discusses the limitations of polarized or dichotomous thinking, particularly when it comes to self-experience.

Inspired by viewer responses to a previous episode on the false self, Dr. Ettensohn discusses why concepts like “true” and “false” self can be misleading when taken too literally.

Our internal experiences are complex, layered, and dynamic—identity, thought, feeling, and behavior are not static or easily divided into “good” and “bad” categories. Psychological health involves learning to tolerate and even appreciate this ambiguity rather than striving for certainty.

The "Weekly Insights" series is for paid members of Dr. Ettensohn's Heal NPD Youtube channel. In the short-term, Dr. Ettensohn is posting all even-numbered episodes free of charge. If you would like access to the full series, please follow this link:  https://www.youtube.com/channel/UCHeT5kujD1JqHRAi-x8xD-w/join

What’s the difference between healthy self-love and pathological narcissism?

In this week's episode of Weekly insights, Dr. Ettensohn discusses key differences, with recommendations for healing.

The "Weekly Insights" series is for paid members of Dr. Ettensohn's Heal NPD Youtube channel. In the short-term, Dr. Ettensohn is posting all even-numbered episodes free of charge. If you would like access to the full series, please follow this link:  https://www.youtube.com/channel/UCHeT5kujD1JqHRAi-x8xD-w/join

In this episode of the members-only "Weekly Insights" series, Dr. Ettensohn reflects on the positives and negatives of gratitude as a therapy intervention, noting the potential for unintended enactments of invalidation or 'pressure to perform' in the therapy relationship. Things like gratitude journals invite us to reflect on the things that are good in our lives. But they can also reinforce inauthenticity when someone has been raised in an emotionally invalidating environment.

In this episode, Dr. Ettensohn explores the insights of Alice Miller regarding  emotional abandonment and narcissistic use of the child, focusing on how these early dynamics shape pathological narcissism and Narcissistic Personality Disorder (NPD).

Drawing from Miller’s groundbreaking work, Dr. Ettensohn examines how a child growing up in a narcissogenic environment learns to adapt by creating a false self—a facade designed to secure love and avoid rejection in a world where their authentic self is not welcome.

The episode explores the function of grandiosity as a defense mechanism—an unconscious strategy to deny the pain of unmet emotional needs—and its counterpart, depression (narcissistic vulnerability), which turns the pain inward. Both defenses serve to protect the individual from confronting a devastating loss: the realization that the love and support they needed was not available.

The episode offers a compassionate exploration of how this tragic loss gives rise to the false self, a defense that becomes both a survival strategy and a prison. Through relatable metaphors and clinical insight, Dr. Ettensohn describes the psychological toll of living behind this mask and the challenges of reconnecting with the buried authentic self.

Though the loss cannot be undone, healing is possible. By grieving the past and clearing away the defenses, it is possible to rediscover the vibrant, authentic self that has always been there, waiting to emerge.

References:

Miller, A. (1979) Depression and Grandiosity as Related Forms of Narcissistic Disturbances. International Review of Psychoanalysis 6:61-76

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 draws on psychodynamic dimensional models of personality development to describe narcissism and NPD at the borderline level.

Characterized by identity diffusion, blurred boundaries, and disrupted internal experience, borderline personality organization represents an "in between" level where the perceptions of the self and others float in and out of clear focus.

This episode reviews the important concepts of personality style vs. organization, helping the viewer to understand what a personality disorder actually is and why all personality disorders share common features. It discusses the developmental arrests thought to underlie borderline organization and describes common defense mechanisms that characterize this level of object relations. Borderline-level NPD is then discussed using these concepts.

The episode concludes with a discussion of treatment.

 

References:

Berney, S., de Roten, Y., Beretta, V., Kramer, U., & Despland, J.-N. (2014). Identifying psychotic defenses in a clinical interview. Journal of Clinical Psychology, 70(5), 428–439.

Clarkin, J. F., Cain, N. M., & Lenzenweger, M. F. (2018). Advances in transference-focused psychotherapy derived from the study of borderline personality disorder: Clinical insights with a focus mechanism. Current Opinion in Psychology, 21, 80-85. http://dx.doi.org/10.1016/j.copsyc.2017.09.008

Di Giuseppe, M., & Perry, J. C. (2021). The hierarchy of defense mechanisms: Assessing defensive functioning with the Defense Mechanisms Rating Scales Q-Sort. Frontiers in Psychology, 12:718440 https://doi.org/10.3389/fpsyg.2021.718440

Kernberg, O. F. (1970). Factors in the psychoanalytic treatment of narcissistic personalities. Journal of the American Psychoanalytic Association, 18, 51- 85.

Kernberg, O. F. (1984). Severe personality disorders: Psychotherapeutic strategies. New Haven: Yale University Press.

Lingiardi, V., & McWilliams, N. (Eds.). (2017). Psychodynamic diagnostic manual: PDM-2 (2nd ed.). New York: Guilford Press.

McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press. 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

 

*A note about the title: The title is a partial quote from BPD specialist Marsha Linehan, describing borderline personality disorder. I am aware of her original intent to describe that specific patient population. I also use the quote in the video to describe the emotional vulnerabilities that necessitate splitting. Although she was describing BPD specifically, I feel the quote also works for borderline organization in general. The intense emotional vulnerabilities and exposure to unprocessed experience reflect the absence of moderating internal capacities - "skin" so to speak.

Dr. Mark Ettensohn answers questions and responds to viewer comments in a livestream broadcast from 7-25-24. 

In this episode, Dr. Ettensohn draws on psychodynamic dimensional models of personality development to describe narcissism and NPD at the psychotic level.

Characterized by compromised reality testing, symbiotic object relations, low integration between parts of the self, and the use of reality-distorting defense mechanisms, psychotic-level NPD represents both the least developmentally mature and most severe form of the disorder.

This episode explains the spectrum of personality development, from psychotic to healthy. It then explains the psychotic personality organization in detail, providing descriptions of specific defense mechanisms utilized at this level. Finally, psychotic-level NPD is described.

 

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

 

Cited References:

Berney, S., de Roten, Y., Beretta, V., Kramer, U., & Despland, J.-N. (2014). Identifying psychotic defenses in a clinical interview. Journal of Clinical Psychology, 70(5), 428–439.

Kernberg, O. F. (1984). Severe personality disorders: Psychotherapeutic strategies. New Haven: Yale University Press.

McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press.

Dr. Mark Ettensohn answers questions and responds to viewer comments in a livestream broadcast from 4-26-24. 

Dr. Ettensohn answers listener questions and responds to comments in a livestream broadcast from 3-14-24.