Recognizing Narcissism and Its Effect on People With ID
By Melissa Kaplowitch, Ph.D., Mark Libon, Ph.D., Taylor Philcranz, LMHC
The origins of narcissistic personality disorder (NPD) are complex and multifaceted, often stemming from a combination of genetic predispositions, early childhood experiences, and environmental factors. Some researchers propose that individuals with NPD may have experienced significant trauma or neglect during their formative years, leading them to develop maladaptive coping mechanisms centered around self-preservation and self-enhancement. Often, these maladaptive traits impact functioning across dimensions of personality and can have a significant impact on how one interacts with people in their lives.
While it's normal for individuals to exhibit narcissistic traits occasionally, such as during moments of success or when seeking validation, those with NPD display these characteristics persistently and to a dysfunctional extent. Their obsession with maintaining a façade of perfection and superiority can manifest in various behaviors that disrupt their relationships and hinder their ability to function effectively in society.
Narcissism is a term that's frequently used in everyday conversation to describe someone who is excessively self-absorbed or vain. When used as a clinical diagnosis, NPD encompasses a pervasive pattern of grandiosity, a need for admiration and validation from others, and a lack of empathy. Individuals with narcissistic tendencies often exhibit arrogance, attention-seeking behavior, a sense of entitlement, and a propensity to exploit others for personal gain. This grandiose self-view serves as a protective shield or defense mechanism against underlying feelings of inadequacy or insecurity.
“In the worst form, a narcissist may manipulate the patient with ID into agreeing with a treatment recommendation, or strip the patient of their autonomy. There is potential for emotional and psychological abuse if the patient with ID does not have others who can advocate on their behalf.”
In the workplace, and certainly when functioning in a supervisory position, the narcissist can lack empathy for those they supervise. This means the narcissist may not demonstrate understanding or concern for their employees. The supervisees are left feeling alone and unsupported. It is common for the narcissist to take credit for the work of their subordinates, or for the narcissist to spin supervisee needs or areas of growth as a negative impact to the narcissist. As a result, subordinates are left feeling demoralized, pitted against their supervisor, and struggle with successful professional growth. When there is poor cohesion and collaboration between clinical team members, clients and patients suffer. This may be especially true when a clinical team member is working with a person diagnosed with intellectual disabilities (ID). A narcissistic practitioner can negatively impact the unique needs of these patients. They may dismiss the concerns of patients with ID or their families. They may become defensive when a subordinate professional challenges their boss. In the worst form, they may manipulate the patient with ID into agreeing with a treatment recommendation, or strip the patient of their autonomy. There is potential for emotional and psychological abuse if the patient with ID does not have others who can advocate on their behalf. Not only that, the narcissistic practitioner may struggle to address barriers to treatment for individuals with ID, instead, suggesting that the individual is not working hard enough or doesn’t “get it.” Lack of progress may frustrate a narcissistic practitioner rather than motivate them towards treatment planning conversations and revisions.
Narcissists are notoriously resistant to feedback and criticism, viewing any form of negative evaluation as a threat to their fragile self-image. Narcissists may react defensively to constructive criticism, deflecting blame onto others or refusing to acknowledge their shortcomings. They may employ manipulation techniques such as gaslighting, coercion, blaming, and guilt-tripping to manipulate decisions and advance their agendas when working with patients with ID or when addressing those they supervise. They may exhibit a lack of accountability for their actions, consistently shifting responsibility onto others to preserve their ego. These characteristics contribute to interpersonal difficulties, including the inability to maintain strong, close personal relationships. Recognizing these characteristics forms the basis for identifying narcissists and may reduce the high turnover rate when working for a boss who is narcissistic. Further, addressing these behaviors can help address inadequate care for people diagnosed with ID.
From a clinical perspective, when working with any client, one hopes to foster collaboration, cooperation, decision-making, and progress. However, the dynamics when working with clients can be complex, especially when individuals with narcissistic tendencies or other personality disorders are involved. Narcissists possess traits that can disrupt the therapeutic relationship, undermine teamwork, and hinder productivity. When this occurs, it is crucial to recognize the signs of narcissism to mitigate its potential negative impacts.
Treatment for narcissistic personality disorder can be challenging, as individuals with NPD may be resistant to acknowledging their own shortcomings or seeking help. Furthermore, because narcissists typically have fragile self-esteem that is dependent on external validation, they are highly sensitive to criticism or perceived slights, reacting with anger, defensiveness, or contempt when their sense of superiority is challenged. This hypersensitivity can make it challenging for others to engage with them authentically, as any perceived threat to their inflated self-image is met with hostility or withdrawal. However, psychotherapy, particularly approaches that focus on fostering empathy, self-awareness, and healthy interpersonal relationships, can be beneficial in addressing the underlying issues driving narcissistic behavior.
Working effectively with a narcissist requires a delicate balance of clinical skills, boundary-setting, and empathy. It's essential to understand that narcissistic individuals often have deep-seated insecurities driving their behavior. Therefore, maintaining a level-headed approach and avoiding emotional reactions is crucial. Clear communication, grounded in facts and logic, can help navigate interactions with narcissists, while setting firm boundaries can prevent manipulation, bullying, shouting and exploitation. Providing positive reinforcement for desirable behavior and seeking common ground can foster cooperation and minimize conflicts.
It's essential to recognize that narcissism exists on a spectrum, with varying degrees of severity and impact on individuals' lives. While some individuals may exhibit narcissistic traits without meeting the criteria for a full-blown personality disorder, others may experience significant distress and impairment as a result of their narcissistic tendencies.
Narcissism is more than just an exaggerated sense of self-importance; it is a complex personality disorder characterized by pervasive patterns of grandiosity, a lack of empathy, and fragile self-esteem. Understanding the underlying mechanisms of narcissism is crucial for fostering empathy and providing support to individuals grappling with this challenging condition. It is crucial to provide support to trainees or professionals who work for a narcissistic supervisor to improve job satisfaction. Lasty, healthcare systems should implement training and additional certifications to ensure that all patients but especially those with ID, receive compassionate, evidence-based, quality care.
About the Authors
Melissa Kaplowitch, Ph.D., LMHC is an Assistant Professor in the Department of Psychology and the Program Coordinator of the M.S. in Counseling Program at Salem State University where she has trained students to become licensed mental health counselors for the past 22 years. She was named the 2017 Distinguished Teacher at Salem State University. Trained in Counseling Psychology, at Northeastern University, where she earned her Ph.D., Columbia University where she earned her M.A. and M.Ed. and Clark University where she earned her B.A., Dr. Kaplowitch has worked with children and adults in both inpatient and outpatient settings. Her clinical work has had an emphasis on effective treatment for people who suffer from chronic mental illness.
Mark Libon, Ph.D. is a full-time Assistant Professor at Salem State University and Clinical Training Director of the M.S. in Counseling Psychology program. He has been an adjunct faculty member at Salem State for the past 22 years. Prior to joining Salem State, he worked at The Dimock Center in Roxbury where he served as the Vice President of Behavioral Health Services. Prior to working at Dimock, Mark was the Chief Clinical Officer at Gosnold on Cape Cod. He also worked for 25 years as the Vice President of Ambulatory Services for Lahey Health Behavioral Services. Mark maintains a private practice in Salem where he works with individuals, couples, and families. Dr. Libon holds a Doctorate in clinical psychology from the California School of Professional Psychology in Berkeley.
Taylor Philcrantz, LMHC has a Bachelor of Arts in Psychology and a Masters of Science in Counseling and Psychological Services. She also is a Licensed Mental Health Counselor (LMHC) and Licensed Marriage and Family Therapist (LMFT) in Massachusetts. Taylor has worked in multiple therapeutic settings, with a variety of ages and populations. She has been teaching for 12 years at local colleges teaching both undergraduate and graduate psychology. She enjoys working with students to not only learn the information in the courses she teaches but find ways to apply the given material to their lives and careers.
