Heal NPD

Narcissism and Suicide Risk: The Hidden Side of NPD

This episode continues the Heal NPD Seminar Series, featuring Dr. Mark Ettensohn and his associates, Deanna Young, Psy.D., and Danté Spencer, M.A. I
n this session, the group discusses a recent meta-analytic review examining suicide-related outcomes in narcissistic personality functioning. The conversation explores why studies using DSM-based diagnoses of Narcissistic Personality Disorder consistently fail to predict suicidal ideation, attempts, or self-injury, while dimensional measures that include vulnerable narcissism show strong and reliable associations with elevated risk.
Themes include the distinction between grandiose and vulnerable self-states, the limitations of trait-based and purely behavioral diagnostic models, and the deeper affective and regulatory structures that define pathological narcissism.
The team examines how shame, identity instability, emotional dysregulation, and collapse of self-esteem stability contribute to suicidality—and how grandiose presentations can mask underlying fragility in ways that obscure clinical risk.
Throughout the seminar, the group reflects on the developmental and relational origins of vulnerable narcissism, emphasizing the role of early emotionally invalidating early environments, contingent self-esteem, and dissociated self-states in shaping defensive functioning.
The discussion also highlights clinical challenges in assessing suicide risk in narcissistic patients, including the role of masking, externalization, and shame-driven withdrawal.
This seminar is designed for clinicians, students, and anyone seeking a nuanced, clinically grounded understanding of narcissistic personality functioning, suicide risk, and the hidden dimensions of vulnerability that are often overlooked in public discourse.
To learn more about our work, visit www.HealNPD.org
Additional Resources: Newsletter: https://healnpd.substack.com Assessment and therapy inquiries: https://healnpd.org/contact
Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH
 
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Citation for the article discussed: Sprio, V., Mirra, L., Madeddu, F., Lopez-Castroman, J., Blasco-Fontecilla, H., Di Pierro, R., & Calati, R. (2024). Can clinical and subclinical forms of narcissism be considered risk factors for suicide-related outcomes? A systematic review. Journal of Psychiatric Research, 172, 307–333. https://doi.org/10.1016/j.jpsychires.2024.02.017 Full text link: https://www.sciencedirect.com/science/article/pii/S0022395624000803

What About Narcissists Who Had a Happy Childhood?

In this episode, Dr. Mark Ettensohn responds to a common question: How can someone with a perfectly normal and mostly happy childhood develop narcissistic personality disorder? The discussion challenges the widespread misconception that narcissism is simply a personality type, a collection of traits, or the result of genetics alone. Dr. Ettensohn explains that pathological narcissism is a disorder of self-esteem regulation and identity formation, not just a pattern of behavior. Drawing on clinical research and developmental theory, he explores how early experiences that appear loving and stable can still leave important parts of the self unseen, unrecognized, or conditionally valued. These subtle, chronic relational injuries, repeated over years rather than occurring as a single traumatic event, can distort the developing self’s capacity to maintain a stable and realistic sense of worth. The episode distinguishes between “popular narcissism,” which focuses on abusive behavior, and clinical narcissism, which reflects an internal system of dysregulated self-esteem. Through metaphor and clinical reflection, Dr. Ettensohn illustrates how a child can grow up in an environment that looks healthy on the surface yet still learn to equate love with performance, value with achievement, and safety with control.
Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com Assessment and therapy inquiries: https://healnpd.org/contact Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH SUBSCRIBE HERE: https://rb.gy/kbhusf LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 BECOME A MEMBER: https://www.youtube.com/channel/UCHeT5kujD1JqHRAi-x8xD-w/join Article Citations: Vater, A., Ritter, K., Schröder-Abé, M., Schütz, A., Lammers, C.-H., & Roepke, S. (2013). When grandiosity and vulnerability collide: Implicit and explicit self-esteem in narcissistic personality disorder. Journal of Behavior Therapy and Experimental Psychiatry, 44(1), 37–47. https://doi.org/10.1016/j.jbtep.2012.07.004 Weinberg I, Ronningstam E. Narcissistic Personality Disorder: Progress in Understanding and Treatment. Focus (Am Psychiatr Publ). 2022 Oct;20(4):368-377. doi: 10.1176/appi.focus.20220052. Epub 2022 Oct 25. PMID: 37200887; PMCID: PMC10187400.

Seminar Series 3: Beyond Traits - The Relational roots of NPD

This episode continues the Heal NPD Seminar Series, featuring Dr. Mark Ettensohn and his associates, Deanna Young, Psy.D., and Danté Spencer, M.A. In this session, the group discusses Narcissistic Personality Disorder: Progress in Understanding and Treatment by Igor Weinberg, Ph.D., and Elsa Ronningstam, Ph.D. The conversation examines recent advances in how clinicians conceptualize and treat narcissistic personality disorder, moving beyond fixed trait models toward a dynamic, relational understanding of the self and its development. Themes include the interplay between grandiose and vulnerable self-states, the interdependence of self-esteem regulation, affect, cognition, empathy, and interpersonal functioning, and the recognition that narcissistic pathology evolves through cumulative disruptions in early attunement and relational safety. The discussion also explores how developmental misattunements - whether through neglect, overindulgence, or inconsistency - shape defensive adaptations and contribute to the oscillation between self-inflation and shame. Throughout the seminar, the team reflects on the therapeutic process of working with narcissistic patients, emphasizing empathy, reflective capacity, and the slow, relational work of rupture and repair that makes genuine transformation possible. This series is designed for clinicians, students, and anyone interested in a nuanced, compassionate understanding of narcissism, personality, and psychological change. To learn more about our work, visit www.HealNPD.org Additional Resources: Newsletter: https://healnpd.substack.com Assessment and therapy inquiries: https://healnpd.org/contact Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH SUBSCRIBE HERE: https://rb.gy/kbhusf LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 BECOME A MEMBER: https://www.youtube.com/channel/UCHeT5kujD1JqHRAi-x8xD-w/join Citation for the article discussed: Weinberg I, Ronningstam E. Narcissistic Personality Disorder: Progress in Understanding and Treatment. Focus (Am Psychiatr Publ). 2022 Oct;20(4):368-377. doi: 10.1176/appi.focus.20220052. Epub 2022 Oct 25. PMID: 37200887; PMCID: PMC10187400. Full text of the article: https://pmc.ncbi.nlm.nih.gov/articles/PMC10187400/

Seminar Series 2: Rupture and Repair - Principles of Treatment for NPD

This episode continues the Heal NPD Seminar Series, featuring Dr. Mark Ettensohn and his associates, Deanna Young, Psy.D., and Danté Spencer, M.A. In this session, the group discusses Principles of Psychodynamic Treatment for Patients with Narcissistic Personality Disorder by Holly Crisp, M.D., and Glen Gabbard, M.D. The conversation explores how psychodynamic clinicians conceptualize and treat narcissistic personality disorder, emphasizing the disorder’s pleomorphic nature - its capacity to take many forms depending on context, stress, and level of personality organization. Themes include the oscillation between grandiose and vulnerable self-states, the role of shame as a central organizing affect, and the therapist’s challenge of moving flexibly along a supportive–interpretive continuum. The group also examines common transference and countertransference dynamics, the integration of Kohut’s and Kernberg’s models, and the transformative role of rupture and repair in the therapeutic process. Through candid discussion, clinical reflection, and moments of humor, the seminar illustrates how empathic attunement, flexibility, and authentic connection form the heart of effective treatment for pathological narcissism. This series is designed for clinicians, students, and anyone interested in a deeper and more nuanced understanding of narcissism, personality, and the process of psychological healing. To learn more about our work, visit www.HealNPD.org. Citation for the article discussed: Crisp H, Gabbard GO. Principles of psychodynamic treatment for patients with narcissistic personality disorder. Journal of Personality Disorders. 2020 Mar;34(Suppl):143-158. doi: 10.1521/pedi.2020.34.supp.143. PMID: 32186987.

It's Time We Discarded The Myth of "The Narcissist"

In this episode, Dr. Mark Ettensohn challenges one of the most persistent distortions in contemporary discourse on narcissism: the myth of “the narcissist.”
He explains how this cultural archetype, an image of coldness, cruelty, and manipulation, has eclipsed legitimate clinical understanding of Narcissistic Personality Disorder.
Drawing on both the peer-reviewed literature and his clinical experience, Dr. Ettensohn describes how terms like narcissistic abuse, covert narcissism, and narcissistic supply have come to dominate popular psychology despite lacking grounding in peer-reviewed research.
The episode explores how this narrative misleads clinicians, alienates patients, and perpetuates stigma, while offering a more accurate view of pathological narcissism as a defensive structure rooted in shame, vulnerability, and loss.
Dr. Ettensohn argues that it is time to discard the myth of “the narcissist” and replace it with a more compassionate, evidence-based understanding of NPD...one that recognizes both the pain it causes and the suffering it defends against.
Additional Resources
Website: https://healnpd.org
Newsletter: https://healnpd.substack.com
Assessment and therapy inquiries: https://healnpd.org/contact
 
Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH
 
Related Links:
In-depth exploration of the DSM NPD construct: https://youtu.be/I2fD65wy48I
 
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Seminar Series 1: Defining Pathological Narcissism - The Criterion Problem

This episode marks the beginning of a new educational series from Heal NPD, featuring Dr. Mark Ettensohn and his associates: Deanna Young, Psy.D. and Danté Spencer, MA.
This series offers a rare window into clinical reasoning and supervision, bringing viewers inside real discussions about theory, diagnosis, and treatment of personality pathology. In this first seminar, the group examines an influential paper by Pincus & Lukowitsky (2010) and explores one of the central challenges in the field: how to define pathological narcissism.
The conversation addresses the criterion problem surrounding narcissism. That is, the lack of a unified construct definition. It traces how this has led to conflicting models and measures of narcissism.
Topics include the distinction between pathological narcissism and NPD, the interplay of grandiosity and vulnerability, the overlap with depression and trauma, and emerging dimensional approaches to understanding personality.
This series is designed for clinicians, students, and anyone interested in a deeper and more integrative understanding of narcissism, personality, and self-regulation.
To learn more about our work, visit www.HealNPD.org
Citation for the article discussed: Pincus, A. L., & Lukowitsky, M. R. (2010). Pathological narcissism and narcissistic personality disorder. Annual Review of Clinical Psychology, 6, 421–446. https://doi.org/10.1146/annurev.clinpsy.121208.131215

From Ideal to Real: Lessons From My Father

Dr. Ettensohn reflects on the recent loss of his father.
Drawing on both clinical theory and personal experience, he explores how children internalize idealized images of caregivers as a source of safety and reassurance during times of vulnerability.
This episode examines how these idealizations can provide stability but also carry developmental costs if they are never gradually tempered by ordinary disappointments and the recognition of parental imperfection.
Dr. Ettensohn situates this dynamic within the broader context of self-psychology, showing how therapy can become a place where idealized projections are worked through and reclaimed in more realistic form.
With psychological nuance and openness, he shares how this process unfolded in his own relationship with his father, moving from idealization toward a fuller recognition of imperfection, accountability, and authentic connection.
The goal, as he frames it, is not to reject or diminish the idealized parent, but to integrate those images into a more grounded sense of self and relationship.
Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH
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Dissociation is Key: Linking Splitting, DID, BPD, and NPD

Dr. Ettensohn expands on his recent episode exploring splitting as a dissociative process.
Drawing from clinical experience and developmental theory, he addresses a common question: What’s the difference between splitting, identity diffusion, and Dissociative Identity Disorder (DID)?
Rather than viewing these as separate diagnostic constructs, Dr. Ettensohn presents them as points along a continuum of dissociation. They represent defensive adaptations to overwhelming early experience.
He explains why the traditional boundaries between “personality disorders” and “dissociative disorders” may be more fluid than we think.
This episode continues Dr. Ettensohn’s unique, trauma-informed reframing of narcissistic personality dynamics, offering psychological depth without jargon and compassion without minimization.
Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH
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What If Splitting Is Dissociation? A New Way to Understand Narcissism

In this episode, Dr. Ettensohn offers a groundbreaking perspective on one of the most misunderstood features of pathological narcissism: splitting.
Drawing from the work of Philip Bromberg and his own clinical practice, Dr. Ettensohn reframes splitting not as black-and-white thinking, but as a dissociative process rooted in early relational trauma.
Rather than treating splitting as a rigid symptom, this episode explores how dissociated self-states form when conflicting emotional truths, such as shame, longing, idealization, and rage, cannot safely coexist. What looks like instability or contradiction is actually a protective adaptation.
Dr. Ettensohn shows how these self-states develop as compartmentalized responses to unmanageable experience, and how they survive into adulthood, shaping identity, memory, and relationships.
Through clear explanation and compassionate framing, he illustrates how healing involves standing in the spaces between self-states, without collapsing into any one of them.
Whether you live with these experiences yourself or work with people who do, this video offers a radically humanizing and clinically grounded way to understand dissociation, narcissism, and the divided self.
 
References: Bromberg, P. M. (1996). Standing in the spaces: The multiplicity of self and the psychoanalytic relationship. Contemporary Psychoanalysis, 32(4), 509–535.
 
Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH
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Signs You're Trapped in a False Self

In this Weekly Insight, Dr. Ettensohn explores subtle signs of false self experiencing. Drawing from clinical work and developmental theory, he reflects on how early relational demands can lead individuals to organize their identity around performance, compliance, or emotional suppression.
The episode examines how precocious self-monitoring, idealized emotional states, and internalized expectations often become automatic, forming a false self that feels necessary for connection but ultimately leaves authentic self experience obscured.
Dr. Ettensohn situates the false self as a broad survival strategy shaped by narcissogenic environments. With compassion and psychological nuance, he offers signs that may indicate someone is operating from a false self, and encourages viewers to reflect gently on moments of disconnection, exhaustion, or rigid self-presentation. The goal, as he frames it, is not to attack or dismantle these protective structures, but to begin noticing them and allowing more space for what is real.
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