Living with Pathological Narcissism: What Loved Ones Reveal

This episode continues the Heal NPD Seminar Series with Dr. Mark Ettensohn, joined by his associates Deanna Young, Psy.D., and Danté Spencer, Ph.D.

In this session, the group discusses the paper “Living with Pathological Narcissism: A Qualitative Study” (Day et al., 2020), which examines narcissistic personality pathology from the perspective of partners and family members.

Unlike most research on narcissism, this study does not rely on self-report or clinician ratings. Instead, it draws on qualitative descriptions from over 400 individuals in close relationships with someone exhibiting high levels of pathological narcissistic traits. These accounts provide a window into how narcissism is experienced interpersonally, particularly in intimate and long-term relationships.

The discussion focuses on the study’s central finding: that pathological narcissism is best understood as a system characterized by the co-occurrence of grandiosity and vulnerability. Loved ones described patterns of entitlement, arrogance, and need for admiration alongside insecurity, hypersensitivity, emotional instability, and chronic feelings of emptiness. In the majority of cases, these features were not separate “types,” but fluctuating states within the same individual.

The group explores how these findings challenge common assumptions about narcissism, including the tendency to equate it with overt grandiosity or interpersonal abusiveness. Particular attention is given to the limitations of DSM-based models, which emphasize observable traits while underrepresenting the internal dysregulation and vulnerability that define the disorder.

The conversation also examines broader relational and developmental themes, including:

• The oscillation between grandiose and vulnerable self-states
• The role of dissociation and splitting in personality organization
• The impact of early attachment trauma and “empathic failures”
• How narcissistic dynamics are expressed and amplified within close relationships
• The tendency for polarized, dehumanizing narratives to emerge in response to relational injury

Finally, the group discusses the concept of “narcissistic abuse,” noting that while experiences of harm in these relationships are real and often significant, the term itself is not a well-defined clinical construct. The discussion emphasizes the importance of distinguishing between lived experience and explanatory frameworks, and of maintaining a nuanced, non-reductive understanding of personality pathology.

Key themes include:

• Pathological narcissism as a dysregulated self-state system
• The interdependence of grandiosity and vulnerability
• Limitations of categorical and trait-based models of narcissism
• The relational expression of personality pathology
• The role of trauma, attachment, and development in narcissistic adaptation
• Clinical implications for assessment, formulation, and treatment

This series is intended for clinicians, trainees, and viewers seeking a nuanced, clinically grounded understanding of narcissism beyond popular discourse.

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Citation: Day, N. J. S., Townsend, M. L., & Grenyer, B. F. S. (2020). Living with pathological narcissism: A qualitative study. Borderline Personality Disorder and Emotion Dysregulation, 7(19).

Full Text Link: https://pmc.ncbi.nlm.nih.gov/articles...

About Heal NPD Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, narcissistic personality disorder, and related personality difficulties. We offer comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.

Learn more or inquire about services: https://healnpd.org