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

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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

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*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

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

In this episode, Dr. Ettensohn draws heavily on his own research concerning pathological narcissism and attachment patterns, using attachment theory as a lens to focus explanatory power onto the often confusing dynamics of NPD.

Beginning with a general overview of Bartholomew's four-prototype model of adult attachment, Dr. Ettensohn identifies the most common attachment patterns of individuals with NPD. He describes the relevant research on the development of these patterns and draws parallels with descriptions of early care deficits thought to cause pathological narcissism.

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

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LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum

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Cited References: Bartholomew, K. (1990). Avoidance of intimacy: An attachment perspective. Journal of Social and Personal Relationships, 7(2), 147-178.

Bartholomew. K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61(2), 226-244.

Bennett, C. S. (2006). Attachment theory and research applied to the conceptualization and treatment of pathological narcissism. Clinical Social Work Journal, 34(1), 45-60.

Blatt, S. J., & Levy, K. N. (2003). Attachment theory, psychoanalysis, personality development, and psychopathology. Psychoanalytic Inquiry, 23, 104-152.

Bowlby, J. (1973). Attachment and loss: Volume 2: Separation. New York: Basic Books.

Connors, M. E. (1997). The renunciation of love: Dismissive attachment and its treatment. Psychoanalytic Psychology, 14, 475-493.

Dickinson, K. A., & Pincus, A. L. (2003). Interpersonal analysis of grandiose and vulnerable narcissism. Journal of Personality Disorders, 17(3), 188-207.

Ettensohn, M.D. (2011). The relational roots of narcissism: Exploring relationships between attachment style, acceptance by parents and peers, and measures of grandiose and vulnerable narcissism. (Doctoral dissertation). Retrieved from Dissertations and Theses: Full Text. (Publicaiton No. AAT 3515488).

Gabbard, G.O. (1989). Two subtypes of narcissistic personality disorder. Bulletin of the Menninger Clinic, 53, 527-532.

Holdren, M. (2004). Causal attributions among overt and covert narcissism subtypes for hypothetical, retrospective, and prospective events. (Doctoral dissertation). Retrieved from Dissertations & Theses: Full Text. (Publication No. AAT 3146467).

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

Kobak, R. R., & Sceery, A. (1988). Attachment in late adolescence: Working models, affect regulation, and representations of self and others. Child Development, 59, 135-146.

Main, M., & Stadtman, J. (1981). Infant response to rejection of physical contact by the mother. Journal of the American Academy of child Psychiatry, 20, 292-307.

Otway, L.J., Vignoles, V.L. (2006). Narcissism and childhood recollections: A quantitative test of psychoanalytic predictions. Personality and Social Psychology Bulletin, 32(1), 104-1116.

Pistole, C. M. (1995). Adult attachment style and narcissistic vulnerability. Psychoanalytic Psychology, 12(1), 115-126.

Scroufe, L. A., Waters, E. (1977). Heart rate as a convergent measure in clinical and developmental research. Merrill Palmer Quarterly, 23, 3-25.

Smolewska, K., & Dion, K. L. (2005). Narcissism and adult attachment: A multivariate approach. Self and Identity, 4, 59-68.

In this episode, Dr. Ettensohn addresses 5 common misconceptions about pathological narcissism and NPD:

1. NPD is not a mental illness

2. NPD is not treatable

3. Even if NPD is treatable, actual healing is impossible

4. All individuals with NPD are abusers

5. People with NPD change their behavior behind closed doors, so they can't be mentally ill

Using authoritative mental health resources like the American Psychiatric Association, American Psychological Association, National Institutes of Health, and the Domestic Abuse Hotline; as well as reference to peer-reviewed literature, Dr. Ettensohn discusses each of these misconceptions and why they are mistaken.

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

VISIT THE WEBSITE: https://www.drettensohn.com/

Cited References:

Alexander. (n.d.). Abuse and mental illness: Is there a connection? National Domestic Violence Hotline. https://www.thehotline.org/resources/abuse-and-mental-illness-is-there-a-connection/

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: American Psychiatric Association.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text revision). Washington, D.C.: American Psychiatric Association.

American Psychiatric Association. (n.d.). What is mental illness? https://www.psychiatry.org/patients-families/what-is-mental-illness

American Psychological Association. (n.d.). Splitting. APA Dictionary of Psychology. https://dictionary.apa.org/splitting

Cooper, A. M., & Michels, R. (1988). [Review of Diagnostic and statistical manual of mental disorders (3rd ed., rev.)]. American Journal of Psychiatry, 145, 1300-1301.

Freud, S. (1914). On narcissism. SE, 14, 67-102. London: The Hogarth Press.

National Institutes of Health. (n.d.). Information about mental illness and the brain. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK20369/

Ronningstam, E. & Weinberg, I. (2013). Narcissistic personality disorder: Progress in recognition and treatment. Focus: The Journal of Lifelong Learning in Psychiatry, 11(2), 167-177.

In this episode, Dr. Ettensohn discusses the important topic of boundaries. He provides a definition of interpersonal boundaries, discusses the reasons why boundaries are important for mental health and healthy relationships, discusses the problems with boundaries that often occur in pathological narcissism and NPD, and provides some basic tips for assertive behavior.

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

References:

Hörz-Sagstetter, S., Caligor, E., Preti, E., Stern, B. L., De Panfilis, C., & Clarkin, J. F. (2017). Clinician-Guided Assessment of Personality Using the Structural Interview and the Structured Interview of Personality Organization (STIPO). Journal of Personality Assessment, 100(1), 30–42.

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

Mahler, M. S. (1972). Rapprochement subphase of the separation-individuation process. The Psychoanalytic Quarterly, 41(4), 487–506.