Heal NPD

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