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 Cycles of Ups and Downs

Narcissists go through cycles of mania and depression, which are caused by external events or circumstances known as triggers. The cycles are different from manic depressive cycles in bipolar disorder, which are endogenous. The narcissist is addicted to narcissistic supply and seeks admiration, adoration, approval, attention, and so on. The narcissist goes through ups and downs, including a depressive phase, a hibernation phase, and a manic phase, which are all part of the process of obtaining and securing narcissistic supply.

Zombie Narcissist: Deficient Narcissistic Supply

Narcissists are constantly seeking praise, adoration, admiration, approval, applause, attention, and other forms of narcissistic supply. When they fail to obtain sufficient supply, they react much like a drug addict would. They become dysphoric, depressed, and may resort to alternative addictions. In extreme cases of deprivation, they may even entertain suicidal thoughts. Narcissists also have a sense of magical thinking, believing that they will always prevail and that good things will always happen to them, rendering them fearless and cloaked in divine and cosmic immunity.

Narcissism is Tiring Energy-depleting

Personality is a dynamic, ongoing process that is ever-evolving. The more primitive the personality, the less organized, the more disordered, the greater the amount of energy required to maintain it in a semblance of balance and function. Narcissists externalize most of the available energy in an effort to secure a narcissistic supply. The narcissist's constant fatigue and ennui, his short attention span, his tendency to devalue sources of supply, even his transformed aggression.

Narcissist Never Sorry

Narcissists sometimes feel bad and experience depressive episodes and dysphoric moods, but they have a diminished capacity to empathize and rarely feel sorry for what they have done or for their victims. They often project their own emotions and actions onto others and attribute to others what they hate in themselves. When confronted with major crises, the narcissist experiences real excruciating pain, but this is only a fleeting moment, and they recover their former self and embark on a new hunt for narcissistic supply. They are hunters, predators, and their victims are prey.

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.

Narcissist: Drama Queen in Pathological Narcissistic Space

Narcissists have a deep-seated need for excitement and drama to alleviate their boredom and melancholy. They create an imaginary environment called the pathological narcissistic space, where they seek admiration, adoration, approval, applause, or attention. Narcissistic supply substitutes for having a real vocation or avocation and actual achievements. The narcissist's two mechanisms of establishing a morphological narcissistic space and the urge to move continuously are completely incompatible, leading to the narcissistic condition.

Narcissist: Stable Life or Roller Coaster?

Narcissists are dependent on and addicted to fluctuating narcissistic supply, leading to volatility in their lives and moods. Classic narcissists maintain an island of stability in their lives, while the other dimensions of their existence wallow in chaos and unpredictability. Borderline narcissists react to instability in one area of their life by introducing chaos into all other dimensions of their existence. Narcissists of all kinds hate routine and avoid it as part of their emotional involvement prevention mechanisms, which prevent them from getting emotionally involved, bonding, attaching, and subsequently being hurt.

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.

Narcissist: Is He or Isn't He?

Narcissism is a spectrum of behaviors, from healthy to pathological, and the Diagnostic and Statistical Manual specifies nine diagnostic criteria for narcissistic personality disorder (NPD). A malignant narcissist is someone who has NPD and wreaks havoc on themselves and their surroundings. They feel grandiose and self-important, exaggerate accomplishments, and demand recognition as superior without commensurate achievements. They require excessive admiration, adulation, attention, and affirmation, and are interpersonally exploitative, devoid of empathy, and constantly envious of others.

Old-age Narcissist

Narcissists age without grace, unable to accept their fallibility and mortality. They suffer from mental progeria, aging prematurely and finding themselves in a time warp. The longer they live, the more average they become, and the wider the gulf between their pretensions and accomplishments. Few narcissists save for rainy days, and those who succeed in their vocation end up bitterly alone, having squandered the love of family, offspring, and mates.

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