“Narcissism,” “narcissistic,” and “narcissist” are terms that are frequently used in today’s culture. Some people use these terms as labels for one of their parents or an acquaintance, or for our society, our generation, or even our general time in history. Some have said that the narcissistic personality is the “‘personality of our time’ in the same way that the hysterical personality is associated with the Victorian period and the obsessive-compulsive personality psychologically characterizes the stage of competitive capitalism.” (Philipson, 1985). Although there may be truth to many of these claims, the abundant use of these terms has caused us to treat narcissism flippantly. When someone is perceived to be self-serving or as having a big ego, he or she is quickly labeled a narcissist. If it is perceived that a certain individual lacks empathy towards another person, clearly he or she must be a narcissist. However, even though people are often familiar with the concept of narcissism, and even may be able to accurately label someone who has Narcissistic Personality Disorder a narcissist, there is still much that is commonly unknown. This is especially true as narcissism relates to gender.
Based on how our culture so often speaks of how we have narcissistic and entitlement issues as a society, one might assume that Narcissistic Personality Disorder (NPD) would affect a relatively high percentage of the population in America. However, according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., American Psychiatric Association, 2000), estimates of the prevalence of NPD “range from 2% to 16% in the clinical population and less than 1% in the general population.” The DSM-IV-TR also states “of those diagnosed with NPD, 50%-75% are male.” Two things stand out about these figures: 1) what is clinically diagnosed as NPD is clearly narrower than what is commonly understood and 2) that fact that up to 75% of individuals diagnosed with NPD are male should be seen as significant, especially when considering gender issues in counseling.
The study of narcissism really took root in the late 1960s when Otto Kernberg and Heinz Kohut both studied and developed theories about narcissistic disorders (as well as other disorders including Borderline Personality Disorder). Although their theories differ from one another in some significant ways, Kohut departing from traditional understandings of Freud and Kernberg remaining faithful to Freudian theory, their contribution to the understanding of NPD still continues through to this day, although certain aspects of their respective theories have been seriously challenged. The term “Narcissistic Personality Disorder” was first proposed by Kohut in 1968 (Kohut, 1968).
As much as Kernberg and Kohut did for psychology’s understanding of narcissism, there were a number of areas that were left to explore. Although their theoretical frameworks differed significantly in a number of places, there was at least one area in which they, as well as many who followed them, simply assumed: that their theory was gender neutral. Their discoveries and observations were treated as being true for males and females alike, although in their examples the proportion of males was significantly higher than that of females. In Kernberg’s Borderline Conditions and Pathological Narcissism (1975), and Kohut’s Analysis of the Self (1971) and Restoration of the Self (1977) a total of 29 cases are presented as examples of various manifestations of NPD, but only five depict women (Philipson, 1985). Ilene Philipson (1985) also points out a number of other times in which presentations on narcissism have a significantly higher percentage of males represented as opposed to women. She also points out that “these ratios of men to women must be seen in light of the fact that two-thirds of all psychiatric patients in the population are women” (Philipson, 1985).
Critiquing the Gender Neutral Approach to Understanding Narcissism
I have already made significant reference to Ilene Philipson’s article “Gender and Narcissism” (1985), but in my research of a number of articles and books, Philipson’s critique of the traditional gender neutral approach in understanding and diagnosing NPD stands out. Although Philipson relies heavily upon Kohut’s theory of the formation of NPD, she brings strong challenges to the efficacy of the research and theory when applied to both men and women. It seems that she has no problem with Kohut’s theory applying to men because she believes that the research only analyzes data about narcissism from the male perspective. In her words she suggests “that it is possible to understand men’s disproportionate appearance in the case material on narcissism as a reflection of the fact that narcissism—as a personality type and pathological disorder—denotes a way of being in the world that is primarily, if not exclusively, experienced by men” (Philipson). She believes the problem lies “in the social construction of the asymmetrical development of women and men in the period of early childhood, when the foundation of pathological narcissism takes form.” (Philipson).
In summary of her article, Philipson believes that narcissism’s formation in an individual occurs as a result of “improper identity development during the time when a child is separating and individuating itself from its mother, assuming the mother is the primary caretaker of the child” (Philipson, 1985). This does not disagree with much of the research on narcissism. Traditionally it is explained that in children who grow up possessing narcissistic personality characteristics there are serious failures in maternal empathy and in the mother’s acceptance of a child’s separation from her. The faulty empathy of the mother is the result her ambivalence towards her child’s pull towards individuation and her child’s need for autonomy, control, and mastery. Philipson’s critique is that we should not assume that boys and girls react the same to their mother during this individuating time, and that we also should not assume that mother’s react the same to their daughters as they do to their sons. It is generally assumed that both boys and girls are affected in the same way by a mother’s faulty empathy, but Philipson asserts that that is not true. She asserts that what is commonly understood as the generic “child” in psychoanalytic literature discussing narcissism is truly the male experience and not the female experience (Philipson). She states that “because of an assumed gender neutrality, the psychoanalytic explanation of narcissism obfuscates the gendered relationship between mother and son and mother and daughter, which colors all aspects of psychological growth, whether that growth is ‘narcissistic’ or not” (Philipson). She explains that faulty empathy within a mother leads to the inability to tend to a child on the basis of her or his own needs, and such inability is frequently the result of unconsciously viewing the child “as another person, as an extension of oneself, or as embodying salient characteristics of a significant other” (Philipson). The key to Philipson’s understanding is that when mothers view their children in such a manner, they seem to do so in a gender specific way. Sons are most likely to be seen as husbands, fathers, and brothers, and daughters are seen as the mother’s mother or as extensions of themselves. This leads to significant differences between the relationship of a mother and her son, and the mother and her daughter. The difference in the level of how “other” the son feels when contrasted to the daughter has significant impact upon the formation of what is commonly understood to be NPD.
For the adult woman who has experienced her mother see her as an extension of herself, she goes on to find an “omnipotent” person who can fulfill her desires of love and complete her sense of identity, as she had previously had with her mother. For the adult male who has experienced his mother see him as her father, husband, or brother, he goes on to seek admiration and love from those around him as a person of his own, building his grandiose self – this being the commonly understood description of someone with NPD (Philipson). Philipson’s assertions about the differences between the kind of attachment a son has with his mother and the attachment a daughter has with her mother helps explain why there is a disparity in the number of male narcissists and female narcissists as we define narcissism today. She says that it is because we are defining narcissism from a completely male perspective.
The Relationship Between Gender and Narcissism and the Evangelical Worldview
Gender relations is often a touchy subject within Evangelical circles today. And discussions about psychology and its place within Christianity are usually inflammatory in most evangelical churches. So what happens when we mix these two subjects into one and bring it up as a discussion within the typical Evangelical church? It is probably not going to be very productive. This presents a challenge when approaching topics like narcissism, and even more specifically, what the relationship is between narcissism and gender. Nevertheless, I believe that the Bible does speak generally to this topic.
I believe that gender relations were dramatically affected at the fall. Sin has distorted so much of developmental processes and our how we relate to one another as human beings. I believe that the power of sin also affects the incredibly formative beginning years of our lives, as we grow and develop a personality. Sin has dramatically tainted the process of our identity formation. The image of God we all have been made in, as described in Genesis 1:26-27, has remained in contact, but affected by sin in deep-rooted ways. After the fall, when God declares his condemnations upon the serpent, the woman, and the man, he specifically tells the woman in Gen 3:16 that her desire will be for her husband, and he will rule over her. This pronouncement is due to the fall; due to sin. When the breakdown of the mother-daughter relationship happens so that the mother sees the daughter as an extension of herself, this causes an increased desire for someone to unhealthily contribute to her identity and give her love that she is incredibly needful of to function. For many such women, that is often her husband. I believe that the assertions that Ilene Philipson makes are not in conflict with Scriptural teaching. Yet, as within the psychology world, such observations often go dreadfully unnoticed. But theology and psychology can clearly inform one another, and work hand in hand with each other.
If the church wants to be effective as possible in helping people grow holistically we need to, in submission to the Holy Spirit and under the authority of the Bible, understand and study what psychology has to contribute to our theology and think about how our theology can enrich psychological findings. But there remain many Evangelical and especially Fundamental Christians who would have nothing to do with the world of psychology or anything it promotes.
Some psychologists have proposed that American Evangelicalism and Fundamentalism are narcissistic themselves as movements, in that we separate ourselves out from “the world” and then make ourselves feel better by contrasting our lives to those of “the world” we separated ourselves from (Dyer, 2012). At the same time, in doing this Dyer suggests that there has been “a turn of focus away from God, yet a movement toward the self in seeking a sense of comfortableness, intimacy, and the meeting of felt-need in a space of worship for the adherent.” Ultimately, narcissism’s reach into the Evangelical circles is seen as “a product of Protestant individualism” (Dyer).
However, as I have already somewhat alluded to, I believe that the discussion of narcissism in this way is counterproductive. Narcissism Personality Disorder is a serious disorder. A counseling professor of mine has said that he would much rather have a client with Borderline Personality Disorder over a client with Narcissistic Personality Disorder. He said this because he believes that it is nearly impossible to effectively work with a narcissist. This shows the seriousness of the disorder. But if we use the language of narcissism so flippantly, I believe it detracts from the serious attention and work that needs to occur within our understanding of what narcissism truly is.
Assessing Narcissistic Personality Disorder
The DSM-IV-TR has nine diagnostic criteria specifically listed, a total of at least five of the nine need to be present in order to diagnose someone with NPD. What the DSM-IV-TR says is consistent of NPD is “a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts…” The Mayo Clinic staff (2011) on their website add, “Those with narcissistic personality disorder believe that they’re superior to others and have little regard for other people’s feelings. But behind this mask of ultra-confidence lies a fragile self-esteem, vulnerable to the slightest criticism.”
There have been a number of various types of inventories, but perhaps the most widely used inventory is the Narcissistic Personality Inventory (NPI, Raskin and Hall, 1979). It was developed to measure “individual differences in the extent to which a grandiose sense of self and a grandiose fantasy life combine with hypersensitivity, exhibitionism, feelings of entitlement, interpersonal exploitiveness, and a lack of empathy for others to form dominant themes of an individual’s personality” (Tschanz, Morf, Turner, 1998). Tschanz et al. strongly question whether the type of narcissism that is purportedly assessed by the NPI can be validly generalized to both the male and female experience. However, the NPI particularly focuses on behavior manifestations of explosiveness and entitlement rather than the internal underlying psychological issues (Tschanz et al.). Philipson shows that the underlying psychological elements are what is key to understanding the differences between men and women more so than focusing on the behavioral aspects.
The mayo clinic website offers some great information on the treatment of NPD as it is commonly understood and diagnosed. But it also shows the lack of differentiation between men and women who experience and live out narcissism in different ways. It treats it in a gender neutral way, not acknowledging or mentioning any differences between genders.
They explain “NPD treatment is centered around psychotherapy. There are no medications specifically used to treat narcissistic personality disorder” (Mayo Clinic Staff). They go on to explain that Cognitive-Behavior therapy, Family therapy, or Group therapy might help them in various ways. Perhaps what is best (and most disheartening) is the honesty in which they approach how difficult NPD is to overcome.
The Mayo Clinic Staff state to the person with NPD:
because personality traits can be difficult to change, therapy may take several years. The short-term goal of psychotherapy for narcissistic personality disorder is to address such issues as substance abuse, depression, low self-esteem or shame. The long-term goal is to reshape your personality, at least to some degree, so that you can change patterns of thinking that distort your self-image and create a realistic self-image.”
Clearly there is a lack of discussion about how male and female narcissism differs, or even if it is a possibility. This is definitely a lacking element in the assessment, diagnosis, and treatment of NPD.
Some Aspects to Be Further Considered and Explored
After doing some research about NPD I believe there are many avenues for further exploration. If Philipson is correct in her assertions that how we understand NPD is from a completely male lens, distorting the realities of what narcissism looks like for women there is a lot of work that needs to be done to reevaluate how gender differences play into the development of NPD. This affects the definition of what narcissism is, this changes the diagnosis requirements, and this changes our understanding of the prevalence of narcissism in America. If Philipson is correct in her assertions, then there are a lot of women who have NPD realized in a different way that we acknowledge it now, that is going unrecognized and therefore undiagnosed. The numbers may not be drastically skewed towards men as thought.
I believe theologically speaking there is much that can be explored. Many questions can be asked. If women are seeking to find their love from a “omnipotent” source that matched what their mother once was for them, what does it look like to have that attachment be placed and founded in the true Omnipotent one? How can God be put into the equation more effectively when dealing with NPD? Is a man who has patterns of grandiosity in fantasy or behavior resistant to a relationship with God? If the male with NPD is already a Christian, does he want to naturally withdraw from intimacy with God? How does the narcissist’s theology inform his identity? How does his narcissism inform his theology?
Clearly there are plenty of theological paths to be further explored, and this is where I feel Christian theology is strongly lacking because of a resistance within the conservative Christian community to interact with psychological studies and research. As a Church, we need to better interact with Psychology and think about how practical theology can be informed by and inform psychological research.
Also, the relationship between gender and narcissism clearly needs to be more thoughtfully explored. There are a number of articles that have been written with gender in mind when discussing various aspects narcissism and narcissistic personality disorder. Hopefully more substantial work will be done concerning how gender plays a significant role in psychological issues and disorders. And hopefully the future DSMs will reflect those realizations.
References
Dyer, Jennifer E., (2012) Loving thyself: A Kohutian interpretation of “limited” mature narcissism in evangelical megachurches. J Relig Health, 51, 241-255.
Heiserman, Arthur, Cook, Harold, (1998). Narcissism, affect, and gender: an empirical examination of Kernberg’s and Kohut’s Theories of Narcissism. Psychoanalytic Psychology, 15(1), 74-92.
Kohut, Heinz, (1968). The Analysis of the self: A systematic approach to the psychoanalytic treatment of narcissistic personality disorders. Chicago: University of Chicago Press.
Mayo Clinic Staff, (2011). Retrieved from http://www.mayoclinic.com/health/narcissistic-personality-disorder/
Philipson, Ilene, (1985). Gender and narcissism. Psychology of Women Quarterly. 9, 213-228.
Raskin, R.N., Hall, C.S. (1979). A narcissistic personality inventory. Psychological Reports, 45, 590.
Tschanz, Brian T., Morf, Carolyn C., Turner, Charles W., (1998). Gender differences in the Structure of Narcissism: A Multi-Sample Analysis of the Narcissistic Personality Inventory. Sex Roles, 38(9/10), 863-870.
