What’s the difference between healthy confidence and pathological narcissism? Dr. Gail Saltz is joined by psychoanalyst Diana Diamond to break down how narcissism functions on a spectrum. From everyday self-esteem to more severe forms that disrupt relationships and identity.

They explore why pathological narcissism alternates between grandiosity and vulnerability, how it shows up in personal and professional life, and why it has historically been difficult to treat. Diamond also discusses a psychoanalytic treatment approach that shows promise, along with the broader cultural forces—from social media to leadership dynamics—that may be amplifying narcissistic traits today.

At its core, the conversation returns to this: lasting well-being is grounded less in status or admiration, and more in the capacity for genuine relationships.

Diana Diamond is a psychoanalytic clinician, professor, and researcher. Dr. Diamond specializes in psychoanalytic psychotherapy and supervision. In her private practice, she treats patients who are experiencing conflicts around normative life cycle transitions (e.g., puberty, marriage, parenthood) and who have difficulties with intimacy, identity formation, and goal definition. She also works with patients with severe problems in interpersonal functioning and self- and affect-regulation. She also treats couples and families. Her general therapeutic orientation is informed by contemporary psychoanalytic object relations theory, which integrates the contributions of attachment theory and cognitive neuroscience.