自戀型人格障礙

Narcissistic Personality Disorder 
 

 

編輯整理: 楓丹白露

弗洛伊德曾給出“自戀”定義是自己對於自我投注裏比多興奮（libido，泛指一切身體器官的快感。即弗洛伊德認為的“性”，這裏的性不是指生殖意義上的性）的狀態。有這一表情況的個體稱之為自戀人格障礙患者。從裏比多的方式來說，也就是他將本來應該投注於自我的對象客體的裏比多，反向投注到自己身上，這樣病人就無法和別人建立有效和融入的親密人際關係，並且經常沉浸在自己不切實際的幻想中。自戀一詞還有一種另外的說法: 自控。 

 

但科胡特修正了之前弗洛伊德這個“自戀”的定義，而提出自戀其實就是裏比多的本質，或者更直接說自戀其實就是人類的一般本質，每個人本質上都是自戀的。自戀是一種藉著勝任的經驗而產生的真正的自我價值感，是一種認為自己值得珍惜、保護的真實感覺。也就是說一般個體的自戀並不是不健康的，而且我們整個社會也是允許適度自戀的，而隻有個體過度自戀並超出了社會對與自戀允可的範圍那才是不健康的。 

 

科胡特的合作者兼學生的巴史克提出了一個模型來解釋自戀，他認為自戀的達成其實是可以使用當代認知心理學等合理闡述的。自戀是對於自我勝任感的體驗，而這一獲得的回路開始於大腦的期待型態，然後進行下一步的實施決定，再後付諸行動的實踐——當個體在實際世界中實踐後，會得到反饋，這一反饋則再次輸入大腦，然後大腦將此信息與之前的期待型態配對。如果輸入信息與之前的期待型態配對成功，則個體就可能立即獲得自體勝任感的喜悅。 

 

如果不能配對成功，大腦就會再次決定、計劃行動、實踐，然後又反饋大腦以求得配對的成功。如果反複沒有辦法獲得成功，大腦則根據實際情況采取或修正期待型態、或修正決定、或修正行動方式等方式來使自己，當然也有可能這一修正仍然是無效的或者是失敗的，則個體就可能會放棄這一回路構成，而以別的方式替代，也有可能徹底放棄。這時候，不合適的回路調整就可能直接引起自戀的失敗——無法獲得自體勝感或自我價值感，因此就會產生自戀失敗時的暴怒及焦慮，當焦慮過於強大或者失敗時，則個體會體驗到消極的防禦——抑鬱。 

 

《DSM-IV》（《精神疾病診斷與統計手冊》（ The Diagnostic and Statistical Manual of Mental Disorders，簡稱DSM）由美國精神醫學學會出版，是一本在美國與其他國家中最常使用來診斷精神疾病的指導手冊。自從出版以來，DSM曆經五次改版（II， III， III-R， IV， IV-TR）。　　

 

自戀型人格障礙也被稱為自戀狂，手冊中定義“自戀型人格障礙”為以下項目：誇大（幻想或行為）、需要他人讚揚、並缺乏同感；起自早期成年時，前後過程多種多樣，表現為下列5項以上： 

 

1．對批評的反應是憤怒、羞愧或感到恥辱(盡管不一定當即表露出來)。
2．喜歡指使他人，要他人為自己服務。
3．過分自高自大，對自己的才能誇大其辭，希望受人特別關注，不誠實。
4．堅信他關注的問題是世上獨有的，不能被某些特殊的人物了解。
5．對成功、權力、榮譽、美麗或理想愛情有非份的幻想。
6．渴望持久的關注與讚美。
7．缺乏共情同感之心，不能設身處地地認識或認同他人的感情和需求。
8．有很強的嫉妒心和控製欲。
9．顯示驕傲、傲慢的行為或態度。

 

以上所顯示自戀性障礙特征應該和暫時發生的自戀分清不同，例如某個人因為獲得某種程度的成功而變得自大起來一段時間，我們則不能簡單得視為自戀性人格障礙，盡管這兩者似乎有類似。但自戀性人格障礙應該是從童年起到目前一貫的表現，而非暫時、短期的行為。 

 

自戀性人格障礙的形成:

關於自戀性人格障礙的成因，經典精神分析理論的解釋是這樣的：患者無法把自己本能的心理力量投注到外界的某一客體上，該力量滯留在內部，便形成了自戀。現代客體關係理論認為，自戀性人格障礙者的特點是“以自我為客體”，通俗地說，就是“你我不分、他我不分”。造成這種現象的原因是，患者在早年的經曆中體驗過人際關係上的創傷，如與父母長期分離、或者父母對其態度過於粗暴或過於溺愛等等。有這樣一些經曆，使得患者覺得自己愛自己才是安全的、理所應當的。

 

在科胡特看來，可以追溯到童年的嬰兒時期，按照客體關係理論家馬勒等的研究，這一障礙大約形成於一歲半到三歲之間。科胡特認為，每一個個體在其嬰兒期都是有自體自大、誇大傾向的，例如嬰兒稍稍不得到滿足就會大哭等等，在嬰兒的心理世界中，他或她是全能的上帝。當這一上帝由於被養育者（自體客體）所滿足時，則獲得快樂。如果不滿足，則因為自己的全能感遭受挫折無法實現而暴怒。這一不被滿足的情況其實是在嬰兒養育中經常偶然發生的，但如果養育嬰兒者是長期的如此對待嬰兒的，也就是說嬰兒是長期無法得到誇大的自體自戀滿足的。不能與內部期待配對成功，則嬰兒將失望於外在，大腦則據實際情況放棄這一正常的養育被養育的循環回路構成，而以自體幻想性循環回路來替代補償這一自戀之需要。這樣的幻想往往是阻礙了自體了解正常自戀的現實性，而超出常人所能接受的範圍而形成自己獨有和過分的自戀，於是就會有以上自戀性人格障礙的類似誇大性格的表現。 

 

自戀的形成，一類是，由於早期與父母長期分離，缺少來自父母的直接關愛，受拋棄的創傷，使得嬰兒覺得自己必須愛自己才是安全的、理所應當的。另一類是早期條件優越。自戀型的人，常常是些從小家境寬裕，受到過份的溺愛和羨慕的孩子，具有超乎常人的天賦、智商或者漂亮的外貌。在他們的早期經驗中，沒有與別人的願望和意誌產生健康的摩擦，也不需要通過成就來贏得那種價值感，這導致他們出現了一種不切實際的權力感和自大感，為戲劇性的榮耀著迷，並且毫不懷疑自己應維持自童年起就接受的那種優越感。他們期待持久的好運，指望靠命運和別人來滿足自己的願望。他們的自信讓他們具有較好的社會適應性，但與此同時他們的自私和罔顧他人感受，必然導致親密關係的困難。

 

自戀狂的表現:

 

在自卑、自憐基礎上發展出來的病態自我依賴。拉。洛克福庫德說過：“自戀狂是比世界上最善於欺騙的人更加善於欺騙。”他又說：“自戀狂是最偉大的諂媚者。”《韋伯斯特辭典》把自戀界定為第六種貪得無厭的情感。具有自戀心態的人唯我獨尊，唯我獨存，愛惜自己達到病態的程度。隻願索取，不願付出；隻要求權利，不願盡義務；隻追求權力，不願負責任；隻相信自己，不相信他人；不誠實，隻愛自己，不愛他人……凡此種種，都是自戀心態的表現。具有自戀心態的人不能與他人發展出任何有意義的人際關係，容易陷入孤獨之中。自戀和孤獨，經常如影隨形地伴隨在一起。而且，與自戀結伴而行的是自卑和憂鬱。 

 

自戀又叫自以為是的自我陶醉人格。其主要表現是：強烈的自我表現欲和從他人那裏獲得注意與羨慕的願望；一貫自我評價過高，自以為才華出眾、能力超群，常常不現實地誇大自己的成就，傾向於極端的自我專注；好做海闊天空的幻想，內容多是自我陶醉性的，如幻想自己成就輝煌，榮譽和享受接踵而來；權欲傾向明顯，期待他人給自己以特殊的偏愛和關心，不願相互承擔責任，很少意識到其剝奪性行為是自私的和專橫的；缺乏責任心，常用自負傲慢、妄自尊大、花顏巧語和推諉轉嫁等態度來為自己的不負責任辯解，漠視正確的自重和自尊；在人際交往方麵，與他人缺乏感情交流；在麵臨批評和挫折時，要麽表現出不屑一顧，要麽表現出劇烈的憤怒、羞辱或空虛；容易給人造成一種毫不在乎的假象，事實上卻很在意別人的注意和稱讚。

自戀型個體誇張地認為自己是特別的、優越的。他們表現的並不是強有力的自信，而是對自我過分地熱衷。患者明顯的信念是自己具有優越感的補償心理：“我是一個珍貴的而且特別的人”，或者“我比其他人優秀”。如果其他人沒有認可患者的特殊地位，患者即認為遭受了忍無可忍的的虐待，變得氣憤不已，充滿戒備，情緒低落。如果未能成為優勝者或未被當做特殊人物，就會感到自己低人一等、微不足道、弱小，從而尋求自我保護、自我防禦的補救措施。

自戀型個體在與人交流時顯得愛批評、固執己見、態度強硬，因為他們認為優秀的人應該有優秀的判斷。他們的認知以絕對化的、非黑即白的推論、顯而易見的偏見及武斷的推理、概括為特征。不管別人是什麽意見，很容易就推翻別人的判斷或觀點。

自戀個體臨床表現為自尊受損，在自尊受到威脅時，常常反應強烈。自戀者仍然固守著無瑕疵或強大的形象的重要性，有如水仙愛慕自己的倒影而在水邊生根一樣。一旦無瑕的形象不存在，不如別人的核心信念就會被激活。一旦遭到反對，或被證明是錯的，他們的自信和自我價值感就逐漸地被摧垮。一旦麵臨自戀受侮辱的狀態，就會變得氣憤、自我保護，甚至會極端蔑視他人。與自戀者親近的人會感覺到：“他老說愛我，可是好像沒有一個行為真正愛我，他在傷害我。我隻覺得他愛的隻是自己。”離自戀者近的人會妨礙患者的自戀，自戀狂患者一旦覺得親近的人妨礙了他的自戀，他就會把這個親近的人趕走。

自戀狂患者時刻都很在意自己的麵子。在受到批評或遇到挑戰時，自戀狂患者均可能出現虐待自己或他們的行為，甚至暴力性的行為。與他的意見不一，沒有對他表示恰當的“尊重”或欣賞，或者挑戰他的信念，這些都可能威脅他的自尊。其他人很容易發現即使是以最機智、細心的方式向患者提出建設性的意見，自戀狂患者總是充滿戒備、不願接納或反應遲鈍。麵對缺陷或批評，自戀型患者易於變得不愉快，戒備心增高。由於他們的自大行為，其他人可能認為他們苛求、不可靠（尤其是期望從自戀狂者那兒獲得情感支持時）、不容易受影響、易激惹。

自戀狂者以自我中心，對別人的情感漠不關心，可以由友好突然轉成憤怒，流露出對自我的關注。他們虛偽的熱情舉止可能因自我吹噓、無情的抨擊別人或反應遲鈍的行為而大打折扣。缺乏對別人的需要和情感的關注，既不以簡單的形式表示自己的情感叨嘮承認別人對他們的幫助，也不尊重更複雜更深層次的情感。嫉妒別人成功，懷疑被競爭對手傷害。自戀狂者也會傲慢地認為造成敵對關係的責任和錯誤是在於別人（如“我怎麽可能有錯？有錯都是別人的錯”）。

 

 

自戀狂患者的補償策略包括對別人的缺點過分警覺。自戀的個體易於通過誇大別人的需要和弱點、美化自己的長處來創造個人的機遇（“他們需要我”，“我為他們服務”），以此來使他們自我滿足或利用他人的行為合理化，自戀者將自己看成是豁達、高貴的恩人或老師以縮小或否認對其他人可能有的危險或傷害。盡管他們可以確實做過一些努力，但誇大了別人獲得的利益，誤認為他們的行為對別人有相當大的幫助。即使是以偏狹之心或權利在懲罰別人，自戀者也將此認為是“他們需要接受教訓，這對他們有好處”。

自尊是自戀患者尋求反饋背後的原動力。誇大自我形象的個體易於產生和保持虛構的正偏倚，他們渴求積極反饋，避免自我觀念的改變，對別人要求苛刻，以敵意和攻擊應對矛盾（“如果遇到挑戰，我必須保護自己”，“不能讓任何人批評我”），行為不協調，與低度自尊完全不同。　　

 

自戀型人格最主要的特征是：認定自身的優越，有種特權者的感覺，堅信自己值得別人無條件的愛和幫助，以獲得一切為理所當然。缺乏共情能力，無欲望去認識或認同他人的情感和需要。 

 

出於一種對自身力量和重要性的不現實的意識，自戀者過分關注自己的需要，而且總是認為自己的需要是正當的，所以有權率性而為。他們期望得到別人無條件的愛，而不管自己平日是多麽的漠視別人的需要。別人的處境和感受從來不在他們的考慮範圍之內，他們看著別人，實際上眼裏還是那個需要被滿足的自己。尋求優越感是他們生活中不可幻滅的夢想，隻有這夢想才能給生活賦予一種閃閃發光的意義。 

 

自戀狂在愛情關係裏的表現:

自戀者具有迷人自信的表象魅力特質。在個人感情關係層麵，自戀狂者在戀愛的初期，用海誓山盟，超乎尋常的熾熱激情和嫻熟的討好諂媚技巧讓對方陷入愛河而不能自拔。他會讓另一方感到，他如一個純潔的天使降落到她的世界，她遇到了她生命中的王子。他使她在如癡如醉，如夢如幻的愛海裏下沉，下沉。。。。。。

但是這種無與能比的幸福感隻是自戀狂賜給對方的劇毒品。一旦對方染上毒癮，深陷其掌控中，自戀狂的真麵目就爆露出來。對還癡心愛著他的另一方，愛海就成為無邊的苦海。他開始無情地在感情上剝削(或玩弄)愛他的人。他的情感戲劇化、難以捉摸、忽冷忽熱、極強的控製欲、狂燥、無端的憤怒和指責、莫名的嫉妒、空洞的許諾，以及發展到後期的令人發指的謊言、欺騙和被叛，把愛他的另一方打入痛苦的深淵，從中自戀狂得到超人般的陶醉和滿足。這種與自戀患者相愛的共有感情模式，不可避免的使愛上他的人身心倍受傷害。愛上自戀狂患者比染上吸毒還危害百倍。自救的唯一出路，認清對方自戀狂的特性，逃離自戀狂，越遠越好。

 

自戀狂患者在生活中尋找刺激和世俗榮耀，追求社會性成功的標誌物和陳腐不堪的浪漫情調。然而，在這條通往無上優越的路途上，人的靈魂勢必要受到一次次的考驗，每一次挫敗實際上都會造成自我鄙視和自我折磨，而人為了保全自己，不可避免要放棄那個真實的自我。 

 

自戀是用過度美化和拔高生活細節來粉飾平庸，同時向他人塑造理想中的自己。自戀是心理上的化妝品，抹上它不隻是為了給人看，也是為了哄自己高興。久而久之，自己都看不見自己的真麵目，不知自己青麵獠牙。自戀者其實時刻需要一麵鏡子來觀賞自己。 


=========================================================

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.

====================================================================

“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…