“I have the boss from hell,” Kara told her psychotherapist at the beginning of treatment. Kara had been experiencing poor self-esteem, sleeplessness, and constant worry since she started her new job as an assistant to Mr. E, a junior vice president. On her first day, he greeted her with “My old assistant was completely incompetent. She couldn’t take the heat. I hope you’ll do better. I’m the star of this company and I’m so good I can make anyone shine. Most of the assistants I’ve trained moved on to top positions-
Apple, Google, Amazon, you name it.”

Kara became demoralized and bewildered working with Mr. E. Not only was she not shining, it seemed she couldn’t do anything right. Mr. E constantly criticized her, saying, “My 2 year old could do a better job!” Once, he became enraged at a typo and ripped up her presentation, screaming, “Are you deliberately trying to make me look bad- how dare you give me this crap!” When he wasn’t yelling, he would stare at her chest rather than look her in the eye and make her do tasks that weren’t in her job description, like cleaning his bathroom. When she tried to protest, he’d say, “You’re not one of those snowflake millennials, are you? Don’t bother to complain to HR. You’ll be the one who gets fired. I’m much too valuable to this company.”

This is a fictional composite of a supervisor with narcissistic personality disorder, an unhealthy coping strategy with the theme, “Be better than the peasants.” People with narcissistic personality disorder make others feel small so they can seem tall. True narcissists never developed a healthy ego in early childhood to give them an internal sense that they are okay. Deep in their subconscious, they feel damaged, inferior, empty. To avoid this feeling, they frantically try to prove that they are superior beings to whom ordinary rules don’t apply.

The definition of narcissism is self-love. Narcissus was a character from Greek mythology who was so entranced with his reflection in a pool of water that he pined away in despair because it could never be his lover. His lasting contribution was the yellow narcissus flower that sprang up where his body withered and died. Narcissistic personality disorder is similarly self-destructive.

Some narcissism is healthy and normal. Having a feeling of self-worth helps us to survive and thrive. Humans are born narcissistic. Babies are aware only of themselves. They perceive that their environment exists solely to fulfill their needs. When they are hungry they cry and get fed. When they are wet, their diapers are changed. Other humans are not real; they are mechanisms to feed and comfort them.

As children age, they become increasingly aware that others exist independently, with their own needs. Their narcissism decreases, but is still present and adaptive. Children at the pool who yell to their parents, “Look at me! Watch me do a handstand!” are unknowingly using narcissism in a healthy way. If adults didn’t notice them, they could drown, or in ancient times, be dragged away by a wolf.

Teenagers tend to grow less narcissistic and more altruistic. Significant brain changes normally occur during puberty to allow the concept of helping others because it is the right thing to do rather than for personal gain or to obey the law. However, healthy narcissism still plays a role. Teenagers tend to feel that they are special people with a special destiny. Confidence in their abilities motivates them to strive to make the world a better place, sparking the drive to become writers, scientists, innovators, healers.

Narcissism becomes a disorder when it is an adult’s go-to coping strategy, harming relationships with coworkers, family, and friends. Malignant narcissism, the most severe form, includes antisocial behavior such as treating people like suckers to be swindled, and conversely, fearing that others will swindle them. Malignant narcissists may obtain business success because they cut corners, break rules, and take advantages that more ethical people would not. It can be very difficult to work with narcissists since they deprecate and exploit underlings and become enraged with perceived criticism. They take credit for other’s accomplishments, and blame others for their own failures.

Malignant narcissists lack the ability to care what others feel. People are tools to exploit. They view their children not as real people but as narcissistic extensions of themselves, and try to force them into roles meant to bring glory to the family. They become harsh, critical, and rejecting if their children fail to do so.

Beyond immediate family, they feel good only in relation to making other people seem inferior. They thrive on praise, admiration, and applause. If not readily attained, they may tell outrageous exaggerations or outright lies to appear superior. It doesn’t matter if it isn’t true, as long as it makes them seem better than others. For example, if narcissists learn where their colleagues went to college, they may say that they were accepted to that same college with a full scholarship, but turned it down because their own college begged them to attend to be captain of the tennis team. If they learn that someone else’s child scored an A on a math test, they will claim that their child does college level calculus. They also find ways to denigrate others’ accomplishments: “So what if he got a Purple Heart – it doesn’t mean he was brave, just that he got injured.”

A malignant narcissist is an emotional vampire, sucking up all the good will in the room. Being exposed to a narcissist, even if only listening in on the conversation, may leave one feeling emotionally exhausted, vulnerable and frustrated. Narcissists may have spent the conversation bragging about themselves and making emotional digs at others. If they sense vulnerability, they will attack further. For example, if a colleague says, “I must be getting old; I’m so winded walking up the stairs,” they might reply, “Really? It was so easy for me; I could do it ten more times and still be bursting with energy.”

What happens if their sense of superiority is threatened? The same thing that happens when a balloon bursts- it flies randomly across the room, creating noise and chaos. Malignant narcissists will become enraged and try to do as much damage as possible to prop up their sinking egos. If fired from a job, they may try to sabotage the work environment for their successor to prove that they were the better employee.

If unable to salve their ego, they become deflated balloons. They experience inverse narcissism- they are a special person with special problems no one else could possibly comprehend, a misunderstood genius, with the world against them; if only they worked in a better environment where their accomplishments could have been truly appreciated. They withdraw and become depressed and anxious.

Ironically, in this state, they can most be helped. It is normally very difficult to motivate narcissists to change their behaviors. They perceive that the rest of the world, not them, has the problem. However, they may seek treatment to help with the painful feelings of depression, anxiety, and isolation that resulted from their narcissism. They cannot be directly confronted- they will become enraged and storm out of treatment. A skilled psychotherapist can ideally teach them to feel good about themselves without making others feel badly. Optimally, they can be convinced of the advantages of following social norms and treating others with respect. If not helped, narcissists will eventually repeat the same maladaptive patterns and find a new venue and audience, like a seductive vampire seeking fresh blood.