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Generalised Anxiety Disorder (GAD) Misdiagnosed as Narcissistic Personality Disorder (NPD)

Uploaded 8/20/2010, approx. 3 minute read

My name is Sam Vaknin, and I am the author of Malignant Self-Love, Narcissism Revisited.

Fatigue, irritability, difficulty concentrating, and somatic manifestations, such as an increased heart rate, sweating, or in panic attacks, even chest pains.

By definition, narcissists are anxious for social approval, for attention. They seek, compulsively, narcissistic supply.

The narcissist cannot control this need, and this creates attendant anxiety.

Here the narcissist requires external feedback in order to regulate his labile sense of self-worth, his self-confidence, his self-esteem, and this dependence makes most narcissists irritable.

They fly into rages and they have a very low threshold of frustration.

Like patients who suffer from panic attacks and social phobia, which is another anxiety disorder, narcissists are terrified of being embarrassed or criticized in public.

Consequently, most narcissists fail to function well in various settings, social, occupational, or romantic.

Many narcissists develop obsessions and compulsions. Life sufferers of generalized anxiety disorder, narcissists are perfectionists. They are preoccupied with the quality of their performance and the level of their competence.

As the Diagnostic and Statistical Manual, page 437, puts it, generalized anxiety disorder patients, especially children, are typically overzealous in seeking approval and require excessive reassurance above their performance and their worries.

This could apply equally well to narcissists. They are exactly the same.

Both classes of patients are paralyzed by the fear of being judged as imperfect or lacking or inadequate.

Narcissists, as well as patients with anxiety disorders, constantly fail to measure up to an inner harsh and sadistic critic and judge and to a grandiose inflated self-image.

The narcissistic solution is to avoid comparison and competition altogether and to demand special treatment.

The narcissist's sense of entitlement is incommensurate with the narcissist's true accomplishments, which are usually lacking or meager.

The narcissist withdraws from the rat race because it does not deem his opponents, his colleagues, or peers worthy of his efforts.

As opposed to narcissists, patients with anxiety disorders are invested in their work and in their profession.

To be exact, they are over-invested. Their preoccupation with perfection is counterproductive and ironically renders them underachievers despite all their continuous efforts.

It is easy to mistake the presenting symptoms of certain anxiety disorders with pathological narcissism.

Both types of patients are worried about social approbation and seek it actively.

All types of patients present a haute or impervious facade to the world. Both are dysfunctional and weighed down by history of personal failure on the job and in the family.

But the narcissist is egosyntonic, in other words he is proud and happy of who he is.

The anxious patient is distressed and is looking for help and for a way out of his or her predicament, hence the differential diagnosis.

Narcissists like themselves, anxious people most definitely do not.

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Narcissist's Routines

Narcissists have a series of routines that are developed through rote learning and repetitive patterns of experience. These routines are used to reduce anxiety and transform the world into a manageable and controllable one. The narcissist is a creature of habit and finds change unsettling. The narcissist's routines are often broken down when they are breached or can no longer be defended, leading to a narcissistic injury.


Negative, Fake, Low-grade Narcissistic Supply

Normal individuals seek a balanced amount of attention, while narcissists are insatiable, constantly craving affirmation to sustain their self-worth. They create a false self, projecting an idealized version of themselves to elicit reactions from others, which they refer to as narcissistic supply. Even negative attention can serve as supply for narcissists, as they prioritize any form of attention over being ignored, manipulating others to maintain their focus. Ultimately, the narcissist's existence revolves around this relentless pursuit of attention, which is intertwined with their internal struggles and feelings of worthlessness.


Narcissist's Pathological Space: His Kingdom

The pathological narcissistic space is a geographical area, group of people, or an abstract field of knowledge in which the narcissistic pathology reaches its full expression and effectiveness. It is a territorially expanded false self that is achieved via sources of narcissistic supply. The existence of the pathological narcissistic space is independent of the existence of sources of narcissistic supply. The pathological narcissistic space constantly consumes and drains narcissistic supply, and it generates negative narcissistic accumulation.


How Narcissist Experiences His Collapse (Grandiosity Bubbles and Delusional Solutions)

When a narcissist is unable to obtain narcissistic supply, they experience a phenomenon known as narcissistic collapse, leading to various internal dynamics and emotional responses. This collapse can result in a range of maladaptive solutions, including delusional narratives, antisocial behavior, and paranoid ideation, as the narcissist attempts to cope with their perceived failures and maintain a sense of self-worth. The absence of supply can trigger severe emotional dysregulation, withdrawal from reality, and even psychotic episodes, as the narcissist struggles to reconcile their grandiose self-image with the harshness of reality. Ultimately, the narcissist's reliance on external validation creates a precarious existence, where the loss of supply leads to profound feelings of emptiness and self-destruction.


Witnessing the Narcissist's Glory: Secondary Narcissistic Supply

Narcissists rely on the memories and perceptions of others to validate their existence, as they live vicariously through the reflections of their past glory. They require active reminders of their achievements and moments of admiration to sustain their self-worth, especially during times of neglect or humiliation. As their sources of narcissistic supply age and pass away, the narcissist's sense of self diminishes, leading to a gradual fading of their identity. Ultimately, the narcissist's existence is deeply intertwined with the memories held by others, making them dependent on external validation for their sense of reality.


Narcissist Re-idealizes Discarded Sources of Narcissistic Supply

Narcissists maintain discarded sources of supply in a mental reserve and may seek them out when other options are unavailable, attempting to recycle these sources for validation. To reconnect with a devalued source, they must re-idealize it without admitting past mistakes, creating a narrative that reconciles their previous devaluation with the new idealized view. Old sources of supply should remain indifferent to the narcissist's attempts to reconnect, as this indifference is intolerable to them and deprives them of the attention they crave. Ultimately, narcissists view everyone as potential sources of supply, even enemies, as any emotional response, positive or negative, serves to validate their existence.


Narcissist: No Sense of Humor

The narcissist's humor is rarely self-deprecating and is often used to seek validation and admiration from others. This inflated sense of self-importance leads to a belief in a unique mission and cosmic significance, causing the narcissist to view every aspect of life as part of a grand design. Consequently, the narcissist reacts to life's challenges with extreme emotions, oscillating between idealization and devaluation of others, and often perceives minor events as significant omens. This mindset fosters paranoia and detachment, leaving little space for genuine humor or levity.


Why Narcissist APPEARS So STUPID (Borderlines and Psychopaths, too!)

Narcissists, despite often possessing high intelligence, frequently exhibit profound stupidity in their interactions and decision-making due to cognitive distortions like grandiosity and a lack of empathy. This disconnect from reality impairs their ability to learn from past experiences, leading to repetitive mistakes and self-destructive behaviors. Their immaturity and reliance on external validation further contribute to their inability to navigate life effectively, making them susceptible to manipulation and poor judgment. Ultimately, their intellectual capabilities are overshadowed by their emotional and social dysfunctions, rendering them inadequate in real-life situations.


Narcissist’s Collapse, Narcissistic Supply The Nuances

Narcissistic collapse occurs when a narcissist fails to secure adequate narcissistic supply, which can be total or partial, depending on the type and quality of supply received. Total collapse happens when there is no supply at all, while partial collapse occurs when the narcissist receives supply that is unsatisfactory or of low quality, leading to a transition between different types of narcissism. The types of narcissistic supply include primary supply, which is attention from high-grade sources, and secondary supply, which involves regular, stable sources of validation. The dynamics of narcissistic supply are complex, as the narcissist relies on both types to maintain their self-image and avoid collapse, and any failure in securing this supply can lead to significant psychological distress.


Raging Narcissist: Merely Pissed-off?

Narcissistic rage is a phenomenon that occurs when a narcissist is frustrated in their pursuit of narcissistic supply, causing narcissistic injury. The narcissist then projects a bad object onto the source of their frustration and rages against a perceived evil entity that has injured and frustrated them. Narcissistic rage is not the same as normal anger and has two forms: explosive and pernicious or passive-aggressive. People with personality disorders are in a constant state of anger, which is effectively suppressed most of the time, and they are afraid to show that they are angry to meaningful others because they are afraid to lose them.

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