After reading this excellent article in Psychiatric Times, which comments on the new definition of Narcissistic Personality Disorder in the DSM-5, we had a long conversation about NPD. We’ve both interviewed several people who’ve had relationships with people who had NPD and I’ve worked with clients with this challenging disorder.
We all like and dislike people, often for reasons we’re not proud of. But people with NPD can be very charming and easy to like—until you spend time trying to get to know them. They are often hard to get to know because they have no idea who they, themselves, are.
Perhaps the new DSM definition will enrich our understanding of this complex disorder. We were reminded of *Helen, whose therapist we interviewed several years ago.
Helen was extremely talented; she was a **musician, an artist and a poet. But although she had a tremendous amount of technical skill, her performances and art never was quite able to break through to the next level. She never received much positive critical feedback. She couldn’t understand why. Of course, she took this all very personally. And in fact, it was personal.
Nothing Helen did seemed to make an impact. This wasn’t for lack of trying. She had divorced three times, receiving large settlements in two of the divorces. She also lived very nicely off an inheritance and spent much of her money on promoting herself and her work. She gave large donations to public radio and television in the hopes they would positively review her work. She bought tickets to society events, charitable or not, in order to meet people she felt would be able to help her.
She paid for and made quality audio and video recordings of her performances and self-published beautifully bound books of her poetry and illustrations, as well as made limited prints of her other visual artwork.
There might have been a few technical reasons that she couldn’t “make her mark” as she put it, but they all boiled down to one thing: she had been diagnosed with narcissistic personality disorder and this was reflected in all her work (as well as her self-promotion tactics). Her NPD came through loud and clear, and alienated most people.
Her musical performances, while technically very good, were devoid of emotion, according to critics. Her visual art had a few touches that were off putting in some ways. Animals were drawn beautifully, in great detail, especially reptiles, amphibians, and insects, as were make-believe monster-like creatures. People, however, were faceless.
When asked to draw a woman in therapy, Helen drew a woman dressed completely covered from head to toe, including gloves on the hands, covered up except for the face. The face was an oval, with another, smaller oval inside. A tunnel to what must have felt like a black hole.
It is fascinating how much this woman-figure revealed about Helen. This was a character that appeared frequently in her work and yet it is extraordinary that Helen was unable to see how this represented herself. When her therapist asked her who the figure was, even when the probable connection was pointed out to her she just didn’t get it!
The fact that the woman was dressed in hijab or like a nun was also unusual; many if not most people, when asked to draw someone of the same gender as themselves, draw them clothed like themselves or similarly to how most people of that gender dress in that culture.
At some point Helen’s therapist recommended art therapy to her. At first, Helen drew what she thought the art therapist would want to see. After a few weeks she told the therapist that she had read a book on art therapy and therefore “knew all about it.”
Personality disorders are just that: disorders of the personality, or self. People with NPD usually have great difficulty in experiencing a connection to their emotions. It’s like a wall goes up, and they protect themselves from feeling emotions which might trigger feelings of unworthiness or fear (or any other untenable, unbearable feeling.)
The arts are many things, but perhaps we can all agree that they are forms of self-expression. If the primary sense of self is external (looks, clothing, social rank, and so on) but the emotional/spiritual self is perceived as embodying emptiness, can art therapy help the person get in touch with their emotions? Can it help them define self?
We think that art therapy can be an important supportive therapy for those with personality disorders. (We’d love feedback from art therapists who’ve worked with people who have NPD or other PDs.)
Perhaps once the new, more nuanced, definition of NPD is taken into consideration, therapy in general will be more effective.
Meanwhile, we’ve followed up with the therapist who says that it seems that Helen no longer attends any therapy at all.
*Helen is not her real name. She was a woman whose therapist we interviewed for our book “Therapy Revolution.” The therapist we interviewed has changed some of the identifying details.
**It is said those with NPD are insensitive to beauty, including those of the arts. However, experience shows that some people with NPD are attracted to the arts and have been blessed with talent. Perhaps their experience of the beauty of the arts is different than the experience of those who are better able to experience the full range of emotions.