自恋型人格障碍

Narcissistic Personality Disorder 
 

 

编辑整理: 枫丹白露

弗洛伊德曾给出“自恋”定义是自己对于自我投注里比多兴奋（libido，泛指一切身体器官的快感。即弗洛伊德认为的“性”，这里的性不是指生殖意义上的性）的状态。有这一表情况的个体称之为自恋人格障碍患者。从里比多的方式来说，也就是他将本来应该投注于自我的对象客体的里比多，反向投注到自己身上，这样病人就无法和别人建立有效和融入的亲密人际关系，并且经常沉浸在自己不切实际的幻想中。自恋一词还有一种另外的说法: 自控。 

 

但科胡特修正了之前弗洛伊德这个“自恋”的定义，而提出自恋其实就是里比多的本质，或者更直接说自恋其实就是人类的一般本质，每个人本质上都是自恋的。自恋是一种藉着胜任的经验而产生的真正的自我价值感，是一种认为自己值得珍惜、保护的真实感觉。也就是说一般个体的自恋并不是不健康的，而且我们整个社会也是允许适度自恋的，而只有个体过度自恋并超出了社会对与自恋允可的范围那才是不健康的。 

 

科胡特的合作者兼学生的巴史克提出了一个模型来解释自恋，他认为自恋的达成其实是可以使用当代认知心理学等合理阐述的。自恋是对于自我胜任感的体验，而这一获得的回路开始于大脑的期待型态，然后进行下一步的实施决定，再后付诸行动的实践——当个体在实际世界中实践后，会得到反馈，这一反馈则再次输入大脑，然后大脑将此信息与之前的期待型态配对。如果输入信息与之前的期待型态配对成功，则个体就可能立即获得自体胜任感的喜悦。 

 

如果不能配对成功，大脑就会再次决定、计划行动、实践，然后又反馈大脑以求得配对的成功。如果反复没有办法获得成功，大脑则根据实际情况采取或修正期待型态、或修正决定、或修正行动方式等方式来使自己，当然也有可能这一修正仍然是无效的或者是失败的，则个体就可能会放弃这一回路构成，而以别的方式替代，也有可能彻底放弃。这时候，不合适的回路调整就可能直接引起自恋的失败——无法获得自体胜感或自我价值感，因此就会产生自恋失败时的暴怒及焦虑，当焦虑过于强大或者失败时，则个体会体验到消极的防御——抑郁。 

 

《DSM-IV》（《精神疾病诊断与统计手册》（ The Diagnostic and Statistical Manual of Mental Disorders，简称DSM）由美国精神医学学会出版，是一本在美国与其他国家中最常使用来诊断精神疾病的指导手册。自从出版以来，DSM历经五次改版（II， III， III-R， IV， IV-TR）。　　

 

自恋型人格障碍也被称为自恋狂，手册中定义“自恋型人格障碍”为以下项目：夸大（幻想或行为）、需要他人赞扬、并缺乏同感；起自早期成年时，前后过程多种多样，表现为下列5项以上： 

 

1．对批评的反应是愤怒、羞愧或感到耻辱(尽管不一定当即表露出来)。
2．喜欢指使他人，要他人为自己服务。
3．过分自高自大，对自己的才能夸大其辞，希望受人特别关注，不诚实。
4．坚信他关注的问题是世上独有的，不能被某些特殊的人物了解。
5．对成功、权力、荣誉、美丽或理想爱情有非份的幻想。
6．渴望持久的关注与赞美。
7．缺乏共情同感之心，不能设身处地地认识或认同他人的感情和需求。
8．有很强的嫉妒心和控制欲。
9．显示骄傲、傲慢的行为或态度。

 

以上所显示自恋性障碍特征应该和暂时发生的自恋分清不同，例如某个人因为获得某种程度的成功而变得自大起来一段时间，我们则不能简单得视为自恋性人格障碍，尽管这两者似乎有类似。但自恋性人格障碍应该是从童年起到目前一贯的表现，而非暂时、短期的行为。 

 

自恋性人格障碍的形成:

关于自恋性人格障碍的成因，经典精神分析理论的解释是这样的：患者无法把自己本能的心理力量投注到外界的某一客体上，该力量滞留在内部，便形成了自恋。现代客体关系理论认为，自恋性人格障碍者的特点是“以自我为客体”，通俗地说，就是“你我不分、他我不分”。造成这种现象的原因是，患者在早年的经历中体验过人际关系上的创伤，如与父母长期分离、或者父母对其态度过于粗暴或过于溺爱等等。有这样一些经历，使得患者觉得自己爱自己才是安全的、理所应当的。

 

在科胡特看来，可以追溯到童年的婴儿时期，按照客体关系理论家马勒等的研究，这一障碍大约形成于一岁半到三岁之间。科胡特认为，每一个个体在其婴儿期都是有自体自大、夸大倾向的，例如婴儿稍稍不得到满足就会大哭等等，在婴儿的心理世界中，他或她是全能的上帝。当这一上帝由于被养育者（自体客体）所满足时，则获得快乐。如果不满足，则因为自己的全能感遭受挫折无法实现而暴怒。这一不被满足的情况其实是在婴儿养育中经常偶然发生的，但如果养育婴儿者是长期的如此对待婴儿的，也就是说婴儿是长期无法得到夸大的自体自恋满足的。不能与内部期待配对成功，则婴儿将失望于外在，大脑则据实际情况放弃这一正常的养育被养育的循环回路构成，而以自体幻想性循环回路来替代补偿这一自恋之需要。这样的幻想往往是阻碍了自体了解正常自恋的现实性，而超出常人所能接受的范围而形成自己独有和过分的自恋，于是就会有以上自恋性人格障碍的类似夸大性格的表现。 

 

自恋的形成，一类是，由于早期与父母长期分离，缺少来自父母的直接关爱，受抛弃的创伤，使得婴儿觉得自己必须爱自己才是安全的、理所应当的。另一类是早期条件优越。自恋型的人，常常是些从小家境宽裕，受到过份的溺爱和羡慕的孩子，具有超乎常人的天赋、智商或者漂亮的外貌。在他们的早期经验中，没有与别人的愿望和意志产生健康的摩擦，也不需要通过成就来赢得那种价值感，这导致他们出现了一种不切实际的权力感和自大感，为戏剧性的荣耀着迷，并且毫不怀疑自己应维持自童年起就接受的那种优越感。他们期待持久的好运，指望靠命运和别人来满足自己的愿望。他们的自信让他们具有较好的社会适应性，但与此同时他们的自私和罔顾他人感受，必然导致亲密关系的困难。

 

自恋狂的表现:

 

在自卑、自怜基础上发展出来的病态自我依赖。拉。洛克福库德说过：“自恋狂是比世界上最善于欺骗的人更加善于欺骗。”他又说：“自恋狂是最伟大的谄媚者。”《韦伯斯特辞典》把自恋界定为第六种贪得无厌的情感。具有自恋心态的人唯我独尊，唯我独存，爱惜自己达到病态的程度。只愿索取，不愿付出；只要求权利，不愿尽义务；只追求权力，不愿负责任；只相信自己，不相信他人；不诚实，只爱自己，不爱他人……凡此种种，都是自恋心态的表现。具有自恋心态的人不能与他人发展出任何有意义的人际关系，容易陷入孤独之中。自恋和孤独，经常如影随形地伴随在一起。而且，与自恋结伴而行的是自卑和忧郁。 

 

自恋又叫自以为是的自我陶醉人格。其主要表现是：强烈的自我表现欲和从他人那里获得注意与羡慕的愿望；一贯自我评价过高，自以为才华出众、能力超群，常常不现实地夸大自己的成就，倾向于极端的自我专注；好做海阔天空的幻想，内容多是自我陶醉性的，如幻想自己成就辉煌，荣誉和享受接踵而来；权欲倾向明显，期待他人给自己以特殊的偏爱和关心，不愿相互承担责任，很少意识到其剥夺性行为是自私的和专横的；缺乏责任心，常用自负傲慢、妄自尊大、花颜巧语和推诿转嫁等态度来为自己的不负责任辩解，漠视正确的自重和自尊；在人际交往方面，与他人缺乏感情交流；在面临批评和挫折时，要么表现出不屑一顾，要么表现出剧烈的愤怒、羞辱或空虚；容易给人造成一种毫不在乎的假象，事实上却很在意别人的注意和称赞。

自恋型个体夸张地认为自己是特别的、优越的。他们表现的并不是强有力的自信，而是对自我过分地热衷。患者明显的信念是自己具有优越感的补偿心理：“我是一个珍贵的而且特别的人”，或者“我比其他人优秀”。如果其他人没有认可患者的特殊地位，患者即认为遭受了忍无可忍的的虐待，变得气愤不已，充满戒备，情绪低落。如果未能成为优胜者或未被当做特殊人物，就会感到自己低人一等、微不足道、弱小，从而寻求自我保护、自我防御的补救措施。

自恋型个体在与人交流时显得爱批评、固执己见、态度强硬，因为他们认为优秀的人应该有优秀的判断。他们的认知以绝对化的、非黑即白的推论、显而易见的偏见及武断的推理、概括为特征。不管别人是什么意见，很容易就推翻别人的判断或观点。

自恋个体临床表现为自尊受损，在自尊受到威胁时，常常反应强烈。自恋者仍然固守着无瑕疵或强大的形象的重要性，有如水仙爱慕自己的倒影而在水边生根一样。一旦无瑕的形象不存在，不如别人的核心信念就会被激活。一旦遭到反对，或被证明是错的，他们的自信和自我价值感就逐渐地被摧垮。一旦面临自恋受侮辱的状态，就会变得气愤、自我保护，甚至会极端蔑视他人。与自恋者亲近的人会感觉到：“他老说爱我，可是好像没有一个行为真正爱我，他在伤害我。我只觉得他爱的只是自己。”离自恋者近的人会妨碍患者的自恋，自恋狂患者一旦觉得亲近的人妨碍了他的自恋，他就会把这个亲近的人赶走。

自恋狂患者时刻都很在意自己的面子。在受到批评或遇到挑战时，自恋狂患者均可能出现虐待自己或他们的行为，甚至暴力性的行为。与他的意见不一，没有对他表示恰当的“尊重”或欣赏，或者挑战他的信念，这些都可能威胁他的自尊。其他人很容易发现即使是以最机智、细心的方式向患者提出建设性的意见，自恋狂患者总是充满戒备、不愿接纳或反应迟钝。面对缺陷或批评，自恋型患者易于变得不愉快，戒备心增高。由于他们的自大行为，其他人可能认为他们苛求、不可靠（尤其是期望从自恋狂者那儿获得情感支持时）、不容易受影响、易激惹。

自恋狂者以自我中心，对别人的情感漠不关心，可以由友好突然转成愤怒，流露出对自我的关注。他们虚伪的热情举止可能因自我吹嘘、无情的抨击别人或反应迟钝的行为而大打折扣。缺乏对别人的需要和情感的关注，既不以简单的形式表示自己的情感叨唠承认别人对他们的帮助，也不尊重更复杂更深层次的情感。嫉妒别人成功，怀疑被竞争对手伤害。自恋狂者也会傲慢地认为造成敌对关系的责任和错误是在于别人（如“我怎么可能有错？有错都是别人的错”）。

 

 

自恋狂患者的补偿策略包括对别人的缺点过分警觉。自恋的个体易于通过夸大别人的需要和弱点、美化自己的长处来创造个人的机遇（“他们需要我”，“我为他们服务”），以此来使他们自我满足或利用他人的行为合理化，自恋者将自己看成是豁达、高贵的恩人或老师以缩小或否认对其他人可能有的危险或伤害。尽管他们可以确实做过一些努力，但夸大了别人获得的利益，误认为他们的行为对别人有相当大的帮助。即使是以偏狭之心或权利在惩罚别人，自恋者也将此认为是“他们需要接受教训，这对他们有好处”。

自尊是自恋患者寻求反馈背后的原动力。夸大自我形象的个体易于产生和保持虚构的正偏倚，他们渴求积极反馈，避免自我观念的改变，对别人要求苛刻，以敌意和攻击应对矛盾（“如果遇到挑战，我必须保护自己”，“不能让任何人批评我”），行为不协调，与低度自尊完全不同。　　

 

自恋型人格最主要的特征是：认定自身的优越，有种特权者的感觉，坚信自己值得别人无条件的爱和帮助，以获得一切为理所当然。缺乏共情能力，无欲望去认识或认同他人的情感和需要。 

 

出于一种对自身力量和重要性的不现实的意识，自恋者过分关注自己的需要，而且总是认为自己的需要是正当的，所以有权率性而为。他们期望得到别人无条件的爱，而不管自己平日是多么的漠视别人的需要。别人的处境和感受从来不在他们的考虑范围之内，他们看着别人，实际上眼里还是那个需要被满足的自己。寻求优越感是他们生活中不可幻灭的梦想，只有这梦想才能给生活赋予一种闪闪发光的意义。 

 

自恋狂在爱情关系里的表现:

自恋者具有迷人自信的表象魅力特质。在个人感情关系层面，自恋狂者在恋爱的初期，用海誓山盟，超乎寻常的炽热激情和娴熟的讨好谄媚技巧让对方陷入爱河而不能自拔。他会让另一方感到，他如一个纯洁的天使降落到她的世界，她遇到了她生命中的王子。他使她在如痴如醉，如梦如幻的爱海里下沉，下沉。。。。。。

但是这种无与能比的幸福感只是自恋狂赐给对方的剧毒品。一旦对方染上毒瘾，深陷其掌控中，自恋狂的真面目就爆露出来。对还痴心爱着他的另一方，爱海就成为无边的苦海。他开始无情地在感情上剥削(或玩弄)爱他的人。他的情感戏剧化、难以捉摸、忽冷忽热、极强的控制欲、狂燥、无端的愤怒和指责、莫名的嫉妒、空洞的许诺，以及发展到后期的令人发指的谎言、欺骗和被叛，把爱他的另一方打入痛苦的深渊，从中自恋狂得到超人般的陶醉和满足。这种与自恋患者相爱的共有感情模式，不可避免的使爱上他的人身心倍受伤害。爱上自恋狂患者比染上吸毒还危害百倍。自救的唯一出路，认清对方自恋狂的特性，逃离自恋狂，越远越好。

 

自恋狂患者在生活中寻找刺激和世俗荣耀，追求社会性成功的标志物和陈腐不堪的浪漫情调。然而，在这条通往无上优越的路途上，人的灵魂势必要受到一次次的考验，每一次挫败实际上都会造成自我鄙视和自我折磨，而人为了保全自己，不可避免要放弃那个真实的自我。 

 

自恋是用过度美化和拔高生活细节来粉饰平庸，同时向他人塑造理想中的自己。自恋是心理上的化妆品，抹上它不只是为了给人看，也是为了哄自己高兴。久而久之，自己都看不见自己的真面目，不知自己青面獠牙。自恋者其实时刻需要一面镜子来观赏自己。 


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Perfect Match - The Narcissist Marries a Borderline Personality

By Linda Martinez-Lewi, Ph. D.

When a narcissist chooses a marital partner, he/she makes sure that this person will adoringly follow his lead in every aspect of their lives. The narcissist expects to be mirrored perfectly---to receive from his partner: absolute loyalty, adulation, compliance, selfless service. There is an unspoken understanding that the narcissist will never admit mistakes, nor should his faults and failings ever be pointed out, even in the vaguest of terms. Narcissists often choose marital partners who suffer from borderline personality disorder. These individuals are emotionally dependent and have a fragile sense of themselves as valuable individuals. The narcissist is the master; the borderline, the servant. That is the arrangement. The partner will be constantly lied to and betrayed. The narcissist holds the threat over the head of his borderline spouse that he or she can be disposed of precipitously

The individual suffering from borderline personality disorder lives in perpetual fear of abandonment and psychological annihilation. Borderlines fuse psychologically with others, often to the point where they are emotionally unable to distinguish between their identity and that of their partner. This grave psychological impediment is described as a boundary issue. Psychological boundaries are necessary for each person to have a firm sense of who he is and to distinguish and respect the individuality of the other. The borderline has not reached this stage of development, often due childhood trauma. His growth was arrested. Inside, he feels like a very young child, desperately hanging on, begging a parent to pay attention to him, to promise not to hurt or abandon him again. The borderline suffers from a fragile sense of self and feelings of worthlessness. They are emotionally dependent on others and have poor impulse control. Some of these individuals go through periods of delusional thought and paranoia, have psychotic breaks and end up in psychiatric hospitals. Higher level borderlines function quite well in the world despite their psychological dependencies and unconscious feelings of worthlessness and instability. Unlike the narcissist, the borderline is capable of feeling deeply for others and can be highly empathic.

This is a marriage made in Hades. The borderline acquiesces to the demanding, perfectionistic, self-entitled narcissist. Beneath the yoke of his psychological burden, the borderline despises his spouse the way he unconsciously hated his parents when he was a child. He repeats this pattern in adulthood, hoping to get the love and respect that he deserved so long ago. The borderline has come to the wrong place. He will not be accepted and loved for himself here. He will be exploited. Many borderline spouses stay with their abusive narcissistic mates because they are in so much psychological pain, suffer from low self esteem and are accustomed to being treated abusively. The cruelty of this marital arrangement mimics the familiar painful psychological patterns of childhood. The cycle continues until the narcissist decides to discard his current spouse for an updated, more attractive, compliant model. The used up spouse is ejected to fend for himself. The narcissist moves on to his next great excitement without memories or regret. For him, it's a relief: a one handed flick of a fly off the face.

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“The Narcissist Didn’t Love Me!” Coming To Terms With This Agony

By  Melanie Tonia Evans

When we discover essential truths about narcissists, and realise that the narcissist is not capable of genuine love, it’s gut-wrenching. The intense salt in the wounds is the understanding that he or she doesn’t love us now, and never did so.

We may experience this in many different forms. Maybe this person who once vowed and declared we are their soul mate, that they truly love us, and they can’t live without us has moved on to another relationship without even a second glance. And maybe this person is attempting to discredit and destroy us, and is trying to rip us apart in property and custody battles.

These behaviours are clearly the very opposite of what love should be.

Of course this feels personal, and the narcissist’s tactics bring on every insecurity and fear that we may have had about ourselves, namely I am not lovable and not worthy of being loved.

Virtually every individual who has sustained a relationship with a narcissist loved this person, and kept loving until it hurt – horrifically. We can agonise about the injustice of handing over so much of our love and support for months, years or decades to come to the horrific realisation that all of this loving and giving amounted to nothing, and was never genuinely reciprocated by the very person who was meant to love us.

In all of the people that I work with, and within my own narcissistic abuse experience, this situation proves to be one of the hardest to get past, and to come to terms with. We feel emotionally annihilated by this insane betrayal of what we thought our love with this person was.

As human beings with a conscience, compassion and love to give, it feels unthinkable that another person is incapable of loving, or that they can profess love one minute, and do the exact opposite the next.

This insane version of love greatly disturbs our logic and destroys our emotions, because ‘love’ is the very essence of why we want to be in a relationship, connect and share our lives with another person. Loving and the being able to share love is as natural a desire for us as it is to breathe air.

When we look at our version of love we have no ability to fathom, let alone accept, why the narcissist did not reciprocate love genuinely. 

Understanding Why the Narcissist is Incapable of Love

In order to come to terms with The Narcissist Never Loved You, you must understand why he or she acts the way narcissists do.

• The narcissist does not operate as what we know is a ‘normal’ human being.

• The narcissist has no desire to allow love, teamwork and co-operation into his or her life.

• The narcissist believes he or she has to remain ‘separate’ in order to survive.

• The narcissist needs to dump his or her internal torment onto an intimate partner and make the other person at fault in order to try to relieve his or her tormented inner self.

• The narcissist needs to steal energy (‘narcissistic supply’) in order to attempt to fill their own pain of inner emptiness.

• The narcissist, due to internal emptiness needs to take energy, and doesn’t have the resources to give energy once having secured much needed supply.

• The narcissist through damaging a person close to them, experiences the omnipotent high of feeling significant enough to affect another person in this manner.

• The narcissist cannot genuinely feel love, but knows how to feign it in order to secure attention and significance.

• Narcissists know that intimate people in their life, who are hooked, are the best targets to harvest as well as release internal anger, and that these people will hang around whilst it takes place.

From our own moral compass, these things seem horrific and unspeakable. The following information may be confrontation, but the reason I am expressing what I am about to say is because it will help you understand what narcissism is…

If we are all honest with ourselves – we know that the times when we feel empty, worthless, scared and insecure that we may have acted in manipulative ways, and even hurt other people in order to try and feel better within ourselves.

Whether or not we were children or adults, we know our capacity to be immature and nasty. If we live our life through a lens of fear and victimised feelings, we feel separate, unworthy and unlovable, and may act narcissistically when seeing other people as the enemy.

Hopefully these times are momentary, and because we have a conscience we often regret what we have done – and apologise and take responsibility. If we apply self-realisation, we realise that these tactics of fear, separation and egoic defence mechanisms do not procure healthy results, and accordingly we decide to grow up.

Can you imagine what it would be like if you were stuck in this programming with no way out? This is exactly the reality for the narcissist who has such an over-developed, fearful and aggressive ego and such a damaged, stunted and numb sense of connection, union and trust, that the narcissist simply cannot operate in any other way. If he or she momentarily does, as soon as self-loathing and fear re-surfaces (which are the narcissist’s powerful inner drivers) the old compulsions kick straight back into gear and constantly reassert.

Quite simply the narcissist can’t and doesn’t grow up.

You would have experienced this many times. Just when you think the narcissist gets it, takes responsibility for the poor behaviour and professes to change, My Hyde appears again, and you’re going back through the same abusive, non-sensical and mind-bending patterns. You continually feel like you are battling with an irrational 5 year old.

If you are really honest with yourself – you know that this is not what ‘love’ is meant to be.

The truth of the matter is: the narcissist is incapable of love, because the narcissist is incapable of loving and accepting his or her self. The enemy within becomes the enemy without – and everyone is the enemy because of this self-loathing – and as the intimate partner, this most definitely means you are the closest target on this list.

The first step in gaining relief from the torment of realising He or she never loved me, is the acceptance of the truth that a narcissist does what a narcissist does, because they are a narcissist.

The Truth will always set you free…