In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) delve into the complexities of pathological narcissism, exploring its various expressions, including covert, overt, grandiose, and vulnerable narcissism. We discuss how these themes of overt and covert narcissism appear in all narcissistic individuals, as do grandiose and vulnerable themes. We articulate how covert narcissism is under the surface in thoughts and fantasies, whereas overt narcissism is behavioral. We also highlight the shiny, extroverted themes of grandiose narcissism, while discussing the underlying emotional issues associated with vulnerable narcissism, including shame, anger, and moodiness. We overall emphasize the overlap between grandiose and vulnerable narcissism, detailing that both can coexist within a single individual, leading to a range of ways pathological narcissism can present.

Chapters 00:00 Introduction to Pathological Narcissism 03:26 Distinguishing Between Covert and Overt Narcissism 09:39 Exploring Grandiose and Vulnerable Narcissistic Themes 12:37 The Psyche of Grandiose Narcissism 19:54 The Psyche of Vulnerable Narcissism 30:10 Similarities Between Grandiose and Vulnerable Narcissism 33:19 Summary and Closing

References

• Akhtar, S. (2000). The shy narcissist. In J. Sandler, R. Michels, & P. Fonagy (Eds.), Changing ideas in a changing world: The revolution in psychoanalysis: Essays in honour of Arnold Cooper, (pp. 111-119).
• Blaney, P. H., Krueger, R. F., Millon, T. (Eds.). (2014). Oxford textbook of psychopathology (3rd ed.). Oxford University Press.
• Kernberg, O. F. (2009). Narcissistic personality disorders: Part 1[Editorial]. Psychiatric Annals, 39(3), 105–107, 110, 164–166.
• Horowitz, M. (2009). Clinical phenomenology of narcissistic pathology. Psychiatric Annals, 39(3), 124–128.
• Pincus, A. L., & Roche, M. J. (2011). Narcissistic grandiosity and narcissistic vulnerability. In W. K. Campbell & J. D. Miller (Eds.), The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments (pp. 31–40). John Wiley & Sons.
• Wink, P. (1991). Two faces of narcissism. Journal of Personality and Social Psychology, 61(4), 590–597 Personality Couch Links Website https://www.personalitycouch.com/ Blog https://www.personalitycouch.com/blog/ Instagram https://www.instagram.com/personalitycouch/ Facebook https://www.facebook.com/personalitycouch #mentalhealthpodcast #mentalhealthprofessionals #mentalhealth #narcissisticpersonality #narcissism #narcissist #narcissitic #personalitydisorder #personality #personalitypsychology #narcissisticabuse #narcissismawareness #bpd #borderline #borderlinepersonalitydisorder #borderlinepersonality #toxicrelationships #vulnerablenarcissism #grandiose #covertnarcissist #overtnarcissist

In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) delve into the complexities of narcissism and narcissistic personality disorder (NPD). We explore the historical origins of narcissism, the DSM criteria for diagnosing NPD, and the key characteristics of individuals with this disorder, including a lack of empathy and pervasive envy. Our conversation highlights the roots, characteristics, and the dual nature of narcissism, as well as the challenges in researching NPD. We highlight characteristics such as grandiose self-importance, the need for excessive admiration, and the interpersonal exploitation that can occur in relationships. We also give a preview on the vulnerable aspects of narcissism, highlighting how it can manifest as low self-esteem and social withdrawal, a topic that will be discussed in an upcoming episode!

Chapters 00:00 Intro to Narcissistic Personality Disorder 01:07 Historical Context of Narcissism 06:02 Defining Narcissistic Personality Disorder 09:32 First Symptom: Lack of Empathy 10:52 NPD vs Autism 14:24 Second Symptom: Envy 15:46 Third Symptom: Fantasies of Success, Power, Beauty 16:33 Fourth Symptom: Grandiosity 17:55 Fifth Symptom: The Need for Specialness 20:54 Sixth Symptom: Excessive Admiration 22:22 Seventh Symptom: Entitlement 24:17 Eighth Symptom: Exploitation in Relationships 26:25 Ninth Symptom: Arrogance and Haughty Attitudes 27:37 Vulnerable Narcissism

References:

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th edition, text revision.). https://doi.org/10.1176/appi.books.9780890425787 Blaney, P. H., Krueger, R. F., Millon, T. (Eds.). (2014). Oxford textbook of psychopathology (3rd ed.). Oxford University Press.
• Blashfield, R. K., & Intoccia, V. (2000). Growth of literature on the topic of personality disorders. American Journal of Psychiatry, 157(3), 472-473.
• Millon, T. (2011). Disorders of personality: Introducing a DSM / ICD spectrum from normal to abnormal (3rd edition). John Wiley & Sons, Inc.
• South, S. C., Eaton, N. R., & Krueger, R. F. (2011). Narcissism in official psychiatric classification systems: Toward DSM-5. In Campbell, W. K. & Miller, J. D. (Eds.), The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments (pp. 22-30). John Wiley & Sons, Inc.. https://doi.org/10.1002/9781118093108.ch3

In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) unpack the 5 major signs of pathological narcissism, as well as 3 bonus invisible signs of narcissism. We explore warning signs of pride, superiority, vanity, and inauthenticity (among others!), providing insights into how these traits manifest in behavior and relationships. We also explore how anger and lack of empathy manifest. We end the episode by discussing vulnerable narcissistic themes that are less observable, like emptiness, helplessness, and low self-esteem. Our discussion highlights everyday narcissism, as well as darker aspects of it, including antisocial and murderous examples of such.

Chapters

00:00 Introduction to Pathological Narcissism 01:28 Defining Pathological Narcissism 04:55 Sign 1 of Pathological Narcissism: Pride & Self-Righteousness 07:06 Defining Defensive Self-Sufficiency 08:45 Vigilante Narcissism 10:45 Sign 2 of Pathological Narcissism: Superiority & Inferiority 13:20 Specialness & Entitlement 16:50 Sign 3 of Pathological Narcissism: Vanity & Inauthenticity 19:23 Sign 4 of Pathological Narcissism: Anger & Contempt 22:45 Sign 5 of Pathological Narcissism: Decreased Empathy & Callousness 26:12 Invisible Signs of Pathological Narcissism (Vulnerable Narcissism) 32:44 Summary and Closing

References:

• Blaney, P. H., Krueger, R. F., Millon, T. (Eds.). (2014). Oxford textbook of psychopathology (3rd ed.). Oxford University Press.
• McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press.

In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) delve into the complexities of narcissism, exploring its cultural labeling, the distinction between pathological and trait narcissism, and its development from infancy. We discuss the importance of understanding narcissism in contemporary society, the confusion surrounding its definition, and how it manifests in all personality pathology and personality disorders. The conversation emphasizes the need for clarity in labeling narcissistic behaviors, the balance between healthy and pathological narcissism, and the impact of parenting styles on narcissistic traits. Our discussion highlights the importance of understanding narcissism as a spectrum and the need for realistic self-reflection.

Chapters

00:00 Introduction to Narcissism and Misuse of the Term 03:31 What is Narcissism? 10:38 Narcissism in Childhood Development 16:13 Pathological Narcissism 24:12 The Role of Parenting in Narcissistic Development 25:22 The Complexity and Variability of Narcissism

Personality Couch Links

Website https://www.personalitycouch.com/

In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) explore the cultural and clinical trends of 2024, focusing on global unrest, political polarization, re-examining power dynamics, and the ongoing mental health crisis. We discuss the impact of trauma awareness and the complexities of the victim mentality, as well as state-specific mental health trends revealed through recent research. In this episode, we further explore the state of mental health in America, discussing various mental health trends across states, the impact of misinformation on mental health, and the public's outrage towards healthcare practices, as evidenced in the assassination of United Healthcare’s CEO. We delve into the role of venture capital in telehealth and the ethical implications of profit-driven healthcare. The conversation emphasizes the need for advocacy and ethical change in the mental health landscape, urging listeners to engage in positive dialogue and action.

Chapters

00:00 Cultural and Clinical Trends of 2024 03:54 Global Unrest and Political Polarization 6:55 Re-examining Power Dynamics, Trauma, and Victim Mentality 12:22 Cosmetic Facial Scar Study 13:32 Attitudes Towards Trauma Study 15:25 The Mental Health Crisis and Its Impacts 16:30 State-Specific Mental Health Trends 2024 23:08 Health Insurance and Public Outrage 27:36 The Impact of Venture Capital on Telehealth 31:03 Advocacy and Ethical Change in Mental Health

Personality Couch Episodes Referenced:

• Personalities that Kill (Ep. 07): https://youtu.be/Ob7WLEX7ZvQ
• What's Trending in Our Culture and How it Affects Mental Health (Ep. 09): https://youtu.be/uJKTb9Qj8RA

References:

Global Election Results:

• https://apnews.com/article/global-elections-2024-incumbents-defeated-c80fbd4e667de86fe08aac025b333f95
• https://abcnews.go.com/538/democrats-incumbent-parties-lost-elections-world/story?id=115972068
• https://www.ft.com/content/e8ac09ea-c300-4249-af7d-109003afb893
• https://time.com/6550920/world-elections-2024/

Trauma and Our Perceptions:

• Jones and McNally Facial Scar Study (2022): https://psycnet.apa.org/record/1981-28014-001
• Kleck and Strenta Study on Expectancy and Trauma (1980): https://psycnet.apa.org/record/1981-28014-001

Mental Health Trends By State:

• https://mhanational.org/issues/state-mental-health-america
• https://www.aol.com/mental-illness-plagues-va-n-184111928.html

Mental Health Venture Capital Companies’ Impact:

• https://www.amha-or.com/the-toxic-impact-of-venture-capital-on-psychotherapy
• https://www.reddit.com/r/therapists/comments/143v1yg/venture_capitol_funded_mental_health_companies/?rdt=44172
• https://www.chesshealthsolutions.com/2023/08/17/the-dark-side-of-venture-capital-investments-in-healthcare/

In this episode of the Personality Couch Podcast, we continue to explore the complexities of Borderline Personality Disorder (BPD), particularly focusing on the lesser-known subtype: Quiet BPD. We delve into the historical origins of the term 'borderline,' discuss the various subtypes of BPD, and highlight the differences between Quiet and Noisy BPD. The conversation also touches on the lack of recent empirical research on Quiet BPD and the cultural emergence of the term. We further emphasize the importance of understanding the internal versus external presentations of BPD symptoms and the implications for treatment. The discussion emphasizes the importance of recognizing the different types of BPD and the need for nuanced understanding in both clinical practice and societal perceptions.

Chapters

00:00 BPD Name and Subtypes in History 04:32 As-If Patients and Quiet BPD Connection 11:09 Quiet BPD and Millon’s Discouraged Type 14:44 Current Research on BPD Subtypes 15:52 Internalizing BPD 20:24 Externalizing BPD 25:42 Mixed-Ambivalent BPD 31:30 Quiet BPD Today and Subtype Importance 34:10 Summary and Closing

References

• Cohen, C. P., & Sherwood, V. R. (1991). Becoming a constant object in psychotherapy with the borderline patient. Jason Aronson.
• Deutsch, H. (1942). Some forms of emotional disturbance and their relationship to schizophrenia. The Psychoanalytic Quarterly, 11(3), 301-321. https://doi.org/10.1002/j.2167-4086.2007.tb00257.x
• Gunderson, M. D. (2010). Revising the borderline diagnosis for DSM-V: An alternative proposal. Journal of Personality Disorders, 24, 694–708.
• Johnston, J. (2010). Being disturbed: Integration and disintegration in the patient and professional relationship. Psychoanalytic Psychotherapy, 24(3), 231-251. https://doi.org/10.1080/02668734.2010.502306
• Millon, T. (2011). Disorders of personality: Introducing a DSM / ICD spectrum from normal to abnormal (3rd edition). John Wiley & Sons, Inc.
• Rosse, I. C. (1890). Clinical evidences of borderland insanity. The Journal of Nervous and Mental Disease, 15(10), 669-683.
• Sherwood, V. R., & Cohen, C. P. (1994). Psychotherapy of the quiet borderline patient: The as-if personality revisited. Jason Aronson.
• Stern, A. (1938). Borderline group of neuroses. The Psychoanalytic Quarterly, 7, 467–489.
• Wolf, K., Scharoba, J., Noack, R., Keller, A., & Weidner, K. (2023). Subtypes of borderline personality disorder in a day-clinic setting—Clinical and therapeutic differences. Personality Disorders: Theory, Research, and Treatment, 14(5), 555–566. https://doi.org/10.1037/per0000624

In this episode of the Personality Couch Podcast, we dive into the complexities of Borderline Personality Disorder (BPD) treatment, in particular, the healing power of the invisible dynamics in therapy. We discuss the importance of motivation and insight in recovery for BPD, and the significance of the therapeutic relationship. The conversation emphasizes that while BPD is treatable, the journey is often non-linear and requires active participation from the patient. We also highlight the necessity of setting boundaries within therapy to create a safe and effective environment for healing. In this conversation, we discuss the importance of evaluating effort in therapy, the significance of attachment, and the challenges posed by boundary violations. Our conversation also explores the concepts of transference and counter-transference, the process of repairing ruptures in the therapeutic relationship, and the methods of facilitating insight and connections in therapy. Overall, this discussion emphasizes the individualized nature of treatment and the invisible dynamics that play a crucial role in the therapeutic process.

Chapters

00:00 Understanding Treatability and Recovery in Borderline Personality Disorder (BPD) 05:50 The Role of Motivation in Treatment 11:28 Which Treatment is Best for BPD? 14:08 Our Approach to BPD Therapy: Invisible Concepts 14:58 Boundaries in Therapy 21:15 The Therapy Relationship 22:51 Bad Therapy 26:51 Transference and Counter-Transference 33:35 Facilitating Insight and Connections 36:35 Summary and Conclusion

In this episode of the Personality Couch Podcast, we delve into the complexities of Borderline Personality Disorder (BPD), focusing on the themes of suicidal ideation and self-harm. We explore the DSM criteria for BPD, the motivations behind self-harming behaviors, and the stigma associated with these actions. The conversation emphasizes the importance of understanding the emotional pain experienced by individuals with BPD and the impact on their relationships. We provide insights into navigating these dynamics, the need for professional help, and the significance of setting boundaries.

Chapters

00:00 Introduction to Borderline Personality Disorder (BPD) Series 01:46 DSM Criteria for Suicidal Ideation and Self-Harm in BPD 03:31 Triggers for Self-Harm and Parasuicidal Behaviors 07:36 Reasons for Self-Harm and Parasuicidal Behaviors 10:11 Defining the Parasuicidal and Self-Harm Spectrum 13:59 Additional Reasons for Self-Harm and Parasuicidal Behaviors 17:24 Self-Harm and Parasuicidal Behaviors Outside of BPD 18:51 Hidden Self-Harm 20:36 Stigma and Motives of Behavior 29:39 Navigating Relationships and BPD 38:29 Conclusion and Key Takeaways

CRISIS RESOURCES

• Text Line: Text HOME to 741-741; a trained crisis counselor receives the text and responds quickly.
• National Hopeline Network: https://www.thehopeline.com/
• National Suicide Prevention Lifeline @ 988 or https://988lifeline.org/
• American Foundation for Suicide Prevention @ https://afsp.org/ -https://www.mentalhealthishealth.us/better-together-summit/

Psychoeducation

• https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
• https://www.nami.org/learn-more/mental-health-conditions/borderline-personality-disorder
• https://www.borderlinepersonalitydisorder.org/