ScienceSocial SciencesEducation

Heal NPD

Mark Ettensohn, Psy.D.

Dr. Ettensohn is a clinical psychologist who specializes in treating narcissism and related disorders. This podcast discusses pathological narcissism from a compassionate and non-stigmatizing perspective. It is for individuals who struggle with narcissism, their loved ones, and the general public.

Play

Open in

29 episodes
Avg 28 min
English

Episodes 29

Newest Oldest Longest

All20 Unplayed20 In progress0 Played0

Counted on this page — what you have heard stays on this device, so it is not something the list can be paged by.

#71
Yesterday · 17 min
Annihilation Anxiety: The Hidden Conflict in Personality Disorders
In this episode, Dr. Mark Ettensohn explores the concept of annihilation anxiety and its role in narcissistic pathology and other personality disorders. Beginning with a clinical vignette involving childhood emotional and physical abuse, the episode examines what can happen when a child’s separate thoughts, feelings, and perceptions become psychologically threatening to a caregiver. A child may depend on a parent for love, safety, and recognition while simultaneously discovering that important parts of his own subjective experience cannot safely coexist with the parent’s psychological reality. Under these conditions, psychological separateness itself can become associated with danger. Dr. Ettensohn describes this relational configuration as a kind of zero-sum psychological system. When two minds cease to confirm one another, it can feel as though only one can remain intact. Either one person must surrender some part of their subjective experience, or the incompatible experience of the other person must be changed, discredited, controlled, or destroyed. Over time, children raised within these dynamics may internalize the expectation that maintaining a separate mind threatens attachment, identity, or psychological survival. The episode then considers narcissistic pathology as one possible adaptation to this problem. Idealization and admiration can provide refuge from annihilation by supporting a coherent and valued sense of self. But when that self remains dependent upon confirmation from other people, criticism, disagreement, or rejection can reactivate the original threat. Familiar narcissistic defenses such as grandiosity, projection, devaluation, and rage can then function as attempts to prevent an intolerable representation of the self from existing in either person’s mind. Dr. Ettensohn argues that this process is not exclusive to narcissism. Different forms of personality pathology may organize annihilation anxiety differently. Separateness may be surrendered through dependency, destabilize the experience of self in borderline states, become experienced as persecutory threat, or be avoided through schizoid or avoidant withdrawal. Despite their differences, these adaptations can share a common psychological problem: difficulty maintaining a stable experience of self while remaining in relationship with a genuinely separate other. Ultimately, the episode proposes annihilation anxiety as a central conflict in personality pathology and examines how complex relational trauma can reproduce itself across generations. What gets transmitted is not simply a collection of abusive behaviors, but a way of organizing relationships in which psychological separateness becomes dangerous and one person’s subjectivity may have to disappear so that another’s can remain intact. Works Cited: Neuman, C. J. (2012). Impact of borderline personality disorder on parenting: Implications for child custody and visitation recommendations. Journal of Child Custody, 9(4), 233–249. https://doi.org/10.1080/15379418.2012.748350 ⸻ Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 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 provide comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members. Learn more or inquire about services: https://healnpd.org
#70
Yesterday · 15 min
If We Talked About Depression the Way We Talk About NPD
In this episode, Dr. Mark Ettensohn asks a simple question: What would happen if we talked about depression the way we currently talk about narcissism? Through a thought experiment, the episode imagines an alternate reality in which depression has become the focus of the same kind of online discourse that now surrounds narcissism. Social withdrawal becomes “withholding.” Loss of motivation becomes laziness. Preoccupation with painful internal states becomes selfishness. Irritability becomes hostility. Difficulty accepting help becomes an unwillingness to take accountability. Gradually, recognizable features of a mental disorder are stripped of their psychological context and reinterpreted as evidence of a morally defective kind of person. The thought experiment then expands. Stories from people who have been hurt by depressed partners, parents, friends, and coworkers begin supplying additional characteristics of the “depressed person.” Lying, cheating, manipulation, neglect, controlling behavior, and abuse are folded into the category, not because these behaviors have been shown to characterize depression, but because some people with depression also engage in them. Dr. Ettensohn argues that something similar has happened in popular discourse about narcissism. Behaviors such as lying, cheating, gaslighting, manipulation, coercion, love bombing, vindictiveness, and abuse are increasingly presented as characteristics of “the narcissist,” even though none are specific to narcissistic pathology. The result is a circular process in which harmful behavior is used to identify someone as a narcissist, while the behavior of people already identified as narcissists is then used as evidence for what narcissists supposedly do. The episode also examines why Narcissistic Personality Disorder may be particularly vulnerable to this process, because unlike many psychiatric diagnoses, the traditional diagnostic criteria for NPD already emphasize objectionable interpersonal manifestations such as entitlement, exploitation, impaired empathy, arrogance, and grandiosity. Ultimately, the episode argues for putting psychology back into the cultural conversation about narcissism. When narcissistic pathology is reduced to an ever-expanding collection of frightening, hurtful, or objectionable behaviors, the psychological organization that might make those behaviors intelligible disappears. What remains may still use the language of psychology, but instead of a model of a mind, it becomes the description of a villain. ⸻ Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 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 provide comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members. Learn more or inquire about services: https://healnpd.org
#69
Tuesday · 16 min
What Narcissistic Self-Esteem REALLY Looks Like
In this episode, Dr. Mark Ettensohn examines what self-esteem actually looks like in pathological narcissism and why common explanations such as “low self-esteem hidden beneath grandiosity” or “grandiosity masking shame” oversimplify a much more complicated psychological process. The episode begins by examining self-esteem as a regulatory system rather than a fixed quantity that a person either has or does not have. Healthy self-esteem is generally stable, realistic, and basically positive. Dr. Ettensohn explains how pathological narcissism can involve difficulties in all three areas, producing self-appraisals that are unstable, highly reactive to circumstances, and capable of shifting between unrealistically positive and unrealistically negative views of the self. The discussion explores the grandiose and vulnerable self-states associated with pathological narcissism. Grandiosity can involve genuine feelings of superiority, exceptionalism, or importance, while vulnerable states may involve shame, humiliation, inadequacy, depression, envy, or anxiety. These states can alternate, overlap, and interact in complicated ways. Neither necessarily represents the person's “real” self hiding underneath the other. Dr. Ettensohn also discusses the development of self-esteem regulation, including the interaction between temperament, heritable traits, relationships, and developmental experience. Rather than reducing pathological narcissism to a single cause, contemporary models understand personality pathology as emerging through complex interactions between the characteristics people bring into the world and the experiences through which their personalities develop. The episode then considers behaviors frequently associated with pathological narcissism, including arrogance, entitlement, idealization, devaluation, exploitation, and impaired empathy. These features are often discussed as though they stand apart from problems of self-esteem. Dr. Ettensohn explains how they can instead function within a larger system of self-esteem regulation, particularly when grandiosity is recruited to maintain or restore a threatened sense of self. At the same time, none of these features by itself establishes pathological narcissism. People can be arrogant, entitled, grandiose, low in empathy, or insecure without having NPD. They can also have unstable or chronically low self-esteem without being narcissistic. Pathological narcissism refers to the larger organization of these features: the vulnerability of the self-esteem system, grandiose and vulnerable self-states, and the characteristic regulatory strategies used to maintain, protect, or restore the person’s sense of self. Ultimately, the episode challenges attempts to reduce narcissistic psychology to a single hidden truth beneath the surface. Grandiosity can sometimes defend against shame, but that particular dynamic should not be mistaken for an explanation of the disorder as a whole. ⸻ Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 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 provide comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members. Learn more or inquire about services: https://healnpd.org
#68
Tuesday · 14 min
The Circular Logic of Narc Abuse Content
In this episode, Dr. Mark Ettensohn examines the circular logic that often appears in popular “narcissistic abuse” discourse and how it can create a closed system for interpreting other people’s behavior. The episode begins with a pattern Dr. Ettensohn has repeatedly encountered online: once someone concludes that another person is a narcissist, virtually any response can become further evidence of narcissism. Disagreement becomes an inability to tolerate criticism. Anger becomes narcissistic rage. Denial becomes DARVO. Withdrawal becomes the silent treatment. An apology becomes manipulation or hoovering. Even evidence that contradicts the original conclusion can be reinterpreted as proof that the narcissist has successfully deceived others. Dr. Ettensohn argues that this creates an essentially unfalsifiable framework. If both an accusation and its denial can be treated as evidence of guilt, there is no independent standard by which the original interpretation can be tested or revised. Rather than asking what explanation best accounts for another person’s behavior, the process begins with a conclusion and assembles evidence around it. Drawing on his experience conducting psychological assessments, Dr. Ettensohn discusses how this reasoning can persist even when a person does not meet criteria for Narcissistic Personality Disorder or pathological narcissism. He explores how the extensive vocabulary of popular narcissistic-abuse content can encourage people to infer hidden motives and psychological states from ambiguous behavior while becoming increasingly resistant to alternative explanations. The episode also challenges the widespread conflation of pathological narcissism with abuse. People with NPD can behave abusively, but abusive behavior does not itself establish the presence of pathological narcissism. Recent research has likewise raised questions about treating pathological narcissism as a general explanation for intimate partner abuse. Ultimately, the discussion asks a basic epistemological question: If every possible response can be interpreted as evidence that someone is a narcissist, what evidence could ever show that the conclusion was wrong? References: Day, N. J. S., Kealy, D., Biberdzic, M., Green, A., Denmeade, G., & Grenyer, B. F. S. (2025). Coercive control and intimate partner violence: Relationship with personality disorder severity and pathological narcissism. Personality and Mental Health, 19(4), e70038. https://onlinelibrary.wiley.com/doi/full/10.1002/pmh.70038 ⸻ Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 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 provide comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members. Learn more or inquire about services: https://healnpd.org
#67
Tuesday · 14 min
Why Every Abuser Looks Like A 'Narcissist'
In this follow-up to a previous episode, Dr. Mark Ettensohn examines a central problem in the way narcissism is commonly discussed online: the assumption that abusive behavior is sufficient evidence of narcissism. The episode argues that this conclusion arises, in part, from a longstanding problem in the DSM diagnostic criteria for Narcissistic Personality Disorder. Many of the interpersonal characteristics traditionally associated with NPD, including entitlement, impaired empathy, exploitation, arrogance, and refusal to take responsibility, are also common features of abusive relationships in general. As a result, virtually any abusive relationship can appear “narcissistic” without establishing that pathological narcissism is actually present. Dr. Ettensohn explores how this lack of specificity has contributed to the widespread popularity of the concept of “narcissistic abuse,” and why it has become increasingly difficult to distinguish abusive behavior from pathological narcissism itself. He argues that contemporary research has moved toward understanding pathological narcissism as a disorder of identity and self-esteem regulation characterized by fluctuating grandiose and vulnerable states, rather than simply a collection of observable interpersonal behaviors. The episode also examines how popular discussions of narcissism often continue to rely on the older behavioral framework while separating the term “narcissism” from its underlying clinical construct. Dr. Ettensohn argues that this creates conceptual confusion, contributes to public stigma surrounding NPD, and encourages people to mistake abuse itself for evidence of narcissistic pathology. Ultimately, the discussion asks a simple question: When does abusive behavior actually indicate pathological narcissism, and when are we simply describing abuse? To see the video this follows up: https://youtu.be/lcIEM7IVXxk ⸻ Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 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 provide comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members. Learn more or inquire about services: https://healnpd.org
#66
Tuesday · 13 min
Dr. Ramani Says 'Narcissism' Isn't A Diagnosis. I Agree
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
#65
Tuesday · 7 min
The Truth About Narcissism and Trauma
Dr. Mark Ettensohn examines the common claim that personality disorders such as narcissistic personality disorder (NPD) are either caused by trauma or are primarily genetic. He argues that this framing presents a false dichotomy and does not reflect how personality development is understood in contemporary psychology. The discussion begins by reconsidering what psychologists mean by the word trauma. Rather than treating trauma as a particular kind of event, Dr. Ettensohn explores the idea that trauma is better understood as the psychological injury resulting from life experiences. This distinction helps explain why children raised in the same family can have very different developmental outcomes despite sharing many of the same experiences. The episode also examines the role of temperament and other heritable factors in personality development. While genetic predispositions influence how individuals experience and respond to their environments, they do not determine personality disorders in isolation. Instead, personality emerges through the ongoing interaction between biology and developmental experience. Finally, Dr. Ettensohn addresses common arguments based on brain imaging and twin studies, explaining why these findings are often misunderstood in discussions about heritability. The episode considers the importance of construct validity, operationalization, and measurement when interpreting research on personality disorders, arguing that simplistic claims about either trauma or genetics fail to capture the complexity of human psychological development. Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 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
#64
Tuesday · 14 min
My Problem with 'Narcissistic Abuse'
Dr. Mark Ettensohn examines the concept of “narcissistic abuse” and explains why he no longer considers it a coherent psychological construct. Using the comment from a viewer as a starting point, the discussion explores a common misconception: that skepticism toward the concept of narcissistic abuse reflects a lack of empathy for victims. Dr. Ettensohn argues that his concern is not with the reality of abuse or the suffering of those who experience it, but with the explanatory framework that has developed around the term. The episode examines the concept through the lens of construct validity, asking what psychological phenomenon the term actually refers to and whether it identifies a distinct form of abuse beyond categories that are already well established in psychology. The discussion considers the problems of operationalization, the distinction between observation and inference, and why labeling abuse according to the presumed diagnosis of the perpetrator differs from defining abuse by the harm it causes. Dr. Ettensohn also revisits his own earlier use of the term, explaining how his thinking has evolved over time. He distinguishes between psychoanalytic concepts such as narcissistic injury and the contemporary online usage of “narcissistic abuse,” arguing that these represent fundamentally different theoretical models. Finally, the episode explores how explanatory frameworks shape memory and interpretation, and why concepts that incorporate assumptions about another person’s motivations or diagnosis may become difficult to evaluate critically. Throughout, the discussion argues for greater conceptual precision in psychology while emphasizing that questioning a psychological construct is not the same as questioning the reality of abuse. Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 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
#63
Tuesday · 52 min
Moving From Me to We: Mentalization-Based Treatment of NPD
This episode continues the Heal NPD Seminar Series with Dr. Mark Ettensohn and associate Deanna Young, Psy.D. In this session, the group discusses the article “A Mentalizing Approach for Narcissistic Personality Disorder: Moving From ‘Me-Mode’ to ‘We-Mode’” (Choi-Kain, Simonsen, & Euler, 2022), which explores how Mentalization-Based Treatment (MBT) can be applied to the treatment of narcissistic personality disorder. The paper argues that many of the challenges clinicians encounter when working with narcissistic patients can be understood through the lens of attachment, mentalization, and epistemic trust. Rather than viewing narcissistic pathology primarily as a problem of entitlement, grandiosity, or lack of empathy, the authors conceptualize it as a disturbance in the capacity to understand oneself and others in psychological terms and to learn from emotionally meaningful relationships. The discussion explores the article’s central proposal that treatment involves helping patients move from a self-focused “me-mode” toward a more collaborative “we-mode,” in which multiple perspectives can be held in mind simultaneously. Particular attention is given to the ways in which narcissistic adaptations interfere with trust, intimacy, and therapeutic engagement. Along the way, the conversation examines several key MBT concepts, including: * Epistemic trust and distrust * Nonmentalizing modes, including pretend mode, psychic equivalence, and teleological thinking * Marked contingent mirroring * The therapeutic alliance as a vehicle for psychological change * Why confrontation and pressure for change can sometimes reinforce narcissistic defenses rather than weaken them The discussion also considers the broader cultural discourse surrounding narcissism and contrasts popular approaches that emphasize accountability, confrontation, and labeling with psychodynamic and attachment-based approaches that emphasize understanding, curiosity, and the gradual development of trust. Finally, the group reflects on the practical realities of psychotherapy with narcissistic patients, including the pressures created by partners and family members seeking rapid change, the tendency for therapists to become caught in power struggles, and the challenge of maintaining a mentalizing stance in the face of difficult interpersonal dynamics. Key themes include: * Mentalization-Based Treatment (MBT) and narcissistic personality disorder * Attachment theory and personality pathology * Epistemic trust as a foundation for psychological growth * The relationship between vulnerability and grandiosity * Nonmentalizing modes of experience * The role of empathy, curiosity, and validation in treatment * Clinical challenges in working with narcissistic patients This series is intended for clinicians, trainees, and viewers seeking a nuanced, clinically grounded understanding of narcissism beyond popular 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: https://amzn.to/3nG9FgH SUBSCRIBE: https://rb.gy/kbhusf LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 Citation: Choi-Kain, L. W., Simonsen, S., & Euler, S. (2022). A Mentalizing Approach for Narcissistic Personality Disorder: Moving From “Me-Mode” to “We-Mode.” American Journal of Psychotherapy, 75(1), 38–43. Full text link: https://www.psychiatryonline.org/doi/epdf/10.1176/appi.psychotherapy.20210017
#62
June 3 · 43 min
The Birth of Sorrow | Part 3: Conflict and Defense In Neurotic-Level Narcissism
This is the third part of a three-part exploration of narcissistic personality style at the neurotic level of personality organization. In this episode, Dr. Ettensohn examines the defensive architecture of neurotic-level narcissism, including the characteristic defenses that allow individuals to manage conflict, preserve relationships, and maintain self-esteem without resorting to the identity fragmentation or reality distortion seen at more severe levels of personality organization. Drawing on the Defense Mechanisms Rating Scale (DMRS), this episode explores obsessional defenses such as isolation of affect, intellectualization, and undoing, as well as neurotic defenses including repression, reaction formation, and displacement. Through clinical examples, personal reflections, and portrayals from film and literature, Dr. Ettensohn illustrates how these defenses shape emotional experience, interpersonal relationships, and the therapeutic process. The episode also examines how narcissistic concerns manifest at the neurotic level, including struggles with self-worth, dependency, vulnerability, perfectionism, and grief. Particular attention is given to transference, countertransference, and the unique opportunities and challenges that emerge in psychotherapy with neurotic-level narcissistic personalities. While neurotic-level functioning represents a profound developmental achievement, it also introduces new emotional realities. As the capacity for integration grows, so too does the capacity to experience loss, guilt, limitation, and sorrow. The movement toward greater psychological health is not the elimination of suffering, but the ability to bear it without abandoning oneself or others. Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH 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 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
#61
May 26 · 15 min
Internal Absence: Emptiness in NPD
Dr. Mark Ettensohn examines the experience of emptiness in narcissistic personality disorder and other forms of personality pathology. Rather than approaching personality disorders as collections of traits or behaviors, the episode frames them as disturbances in identity. Dr. Ettensohn outlines how the sense of self is constructed through early relational experience and how disruptions in that process can lead to unstable, fragmented, or underdeveloped self-experience. The discussion focuses on the role of dissociation and splitting in shaping identity, and how different self-states may become organized around incompatible relational experiences. In this context, emptiness is not simply a feeling, but reflects aspects of the self that were never fully recognized, mirrored, or integrated in development. Dr. Ettensohn also addresses a common misunderstanding in public discourse, where narcissism is equated with observable traits such as arrogance or entitlement. He explains why these descriptions capture only one part of a broader system involving both grandiose and vulnerable states, and how focusing solely on behavior obscures the underlying psychological structure. The episode concludes with a discussion of clinical implications, emphasizing why treatments that focus only on behavior often fall short, and why effective work with narcissistic pathology requires attention to identity, relational process, and the integration of dissociated aspects of self-experience. Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 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
#60
May 26 · 58 min
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. 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: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 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
#59
May 26 · 58 min
The DSM's New Model of Personality Disorders: The Good, The Bad, and What's Missing
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 examines the Alternative DSM-5 Model for Personality Disorders (AMPD), a dimensional framework introduced in Section III of the DSM-5 and retained in DSM-5-TR. The model was developed in response to longstanding limitations of the traditional categorical system, including diagnostic overlap, heterogeneity within disorders, and the absence of a clear framework for assessing severity. The discussion focuses on the two core components of the model. The first, Level of Personality Functioning (Criterion A), assesses impairments in identity, self-direction, empathy, and intimacy. This portion of the model reflects a structural approach to personality and aligns with psychodynamic and developmental perspectives on personality organization. The second component, Criterion B, introduces a trait-based system organized around five domains: negative affectivity, detachment, antagonism, disinhibition, and psychoticism. These traits are derived from dimensional personality research and represent an effort to describe maladaptive personality features in a standardized way. The group explores the strengths of this combined model, as well as its limitations. Particular attention is given to the tension between structural and trait-based approaches, and to the question of whether personality pathology can be adequately captured through trait descriptions alone. Using narcissistic personality disorder as a focal example, the discussion examines how the model emphasizes grandiosity and attention-seeking traits while underrepresenting vulnerability, shame, and fluctuations in self-state. The conversation highlights the importance of understanding pathological narcissism as a system of self-esteem regulation rather than a fixed set of traits. Key themes include: The shift from categorical to dimensional models of personality disorder The distinction between personality functioning (structure) and personality traits (style) Limitations of trait-based approaches in capturing dynamic, state-based phenomena The role of self-esteem regulation, vulnerability, and oscillation in narcissistic pathology Clinical implications for diagnosis, formulation, and treatment Throughout, the discussion situates the AMPD as a meaningful step forward in personality disorder classification, while also identifying areas where the model remains conceptually limited. The session emphasizes the value of structural and developmentally informed approaches in understanding personality pathology. This series is intended for clinicians, trainees, and viewers seeking a nuanced, non-moralizing understanding of narcissism and personality disorders. 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: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 Citation: American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Link to alternative model: https://psychiatryonline.org/doi/10.1... 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
#58
May 26 · 13 min
Narcissism Is Not a Moral Category
Dr. Mark Ettensohn examines a growing tendency in public discourse to treat narcissism as a moral category rather than as a psychological construct. The episode explores why this shift occurs and how misunderstandings about the nature of mental illness contribute to it. While many people intuitively apply a medical model to psychological conditions, most forms of mental illness do not operate in simple cause-and-effect ways. Instead, psychological disorders are identified through patterns of thoughts, emotions, perceptions, and behaviors that emerge statistically across populations. Dr. Ettensohn discusses how online discussions about narcissism often move from specific interpersonal conflicts to sweeping claims about an entire category of people. In this process, personality traits, clinical constructs, anecdotal experiences, and moral judgments frequently become conflated. Drawing on both psychological science and his clinical experience conducting diagnostic assessments for narcissistic personality disorder, Dr. Ettensohn explains why diagnosing personality pathology requires careful evaluation and why many individuals labeled “narcissists” in everyday discourse may not have any significant narcissistic pathology at all. The episode concludes by distinguishing several different ways narcissism is commonly understood, and why treating it as a moral category ultimately obscures more than it reveals. Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 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
#57
May 26 · 15 min
Accountability Without Dehumanization
Dr. Mark Ettensohn addresses a question that frequently arises in discussions of narcissism and abuse: Is it possible to maintain accountability without dehumanizing? Can someone preserve firm boundaries without abandoning empathy? Dr. Ettensohn clarifies a distinction he often sees misunderstood. When he speaks about compassion toward pathological narcissism or narcissistic personality disorder, he is referring to a cultural and societal stance, not advising individuals to remain in unsafe or harmful relationships. He emphasizes that safety must always come first. If someone is being harmed, the primary question is not whether the other person “knew what they were doing,” but whether the situation is safe and what steps are necessary to ensure protection. The episode explores the gray area between total innocence and calculated malice. Dr. Ettensohn discusses how dissociation and shifting self states can impair consistent self-awareness in personality disorders, while also making clear that impaired awareness is not the same as blamelessness. He examines how behavior driven by triggered trauma states may later be rationalized from a different organizing center of experience, and why this dynamic is often misinterpreted as deliberate manipulation. Finally, the discussion turns to boundaries. Dr. Ettensohn distinguishes kindness from niceness and empathy from permissiveness, arguing that the most empathic stance can sometimes be a firm refusal of access. The episode concludes by asserting that accountability does not require demonization, and that it is possible to reject harmful behavior without reducing a person to a monster. 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: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 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
#56
May 26 · 53 min
2025 Study: Narcissism Does Not Predict Abuse
This episode continues the Heal NPD Seminar Series with Dr. Mark Ettensohn, joined by his associates Deanna Young, Psy.D., and Danté Spencer, M.A. In this session, the group examines a recent empirical study titled Coercive Control and Intimate Partner Violence: Relationship with Personality Disorder Severity and Pathological Narcissism (2025). The discussion responds directly to common claims in online discourse that narcissism inherently causes abuse, and asks a more precise question: What does the data actually show about the relationship between narcissism, personality dysfunction, abuse, and coercive control? The study reviewed draws on informant reports from long-term partners and family members of individuals perceived as highly narcissistic. Importantly, narcissism was rated by loved ones rather than self-reported, addressing a frequent critique of prior research. The findings showed no significant association between overall pathological narcissism and abuse, and only weak associations with coercive control. In contrast, overall personality disorder severity showed stronger and more consistent relationships with both abuse and coercive control, but these associations were still mostly weak. The group explores what this means clinically, emphasizing the distinction between personality style (such as narcissistic features) and personality organization or severity. The discussion clarifies why certain narcissistic subcomponents, such as exploitative behavior, entitlement-related rage, and grandiose fantasy, show limited associations with specific forms of harm, while many other narcissistic features do not. Key themes include: The difference between episodic abuse and chronic coercive control Why collapsing abuse into a single personality label is misleading The role of personality severity and impaired functioning across diagnoses The limits of trait-based and moralized explanations of harm Clinical implications for assessment, treatment, and stigma reduction Throughout, the conversation situates abuse as a highly overdetermined phenomenon influenced by many overlapping factors, rather than the inevitable outcome of narcissism or any single diagnosis. The session concludes by emphasizing the importance of dimensional, developmentally informed models of personality over reductive and stigmatizing narratives. This series is intended for clinicians, trainees, and viewers seeking a nuanced, non-moralizing understanding of narcissism, personality disorder severity, and relational harm. 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: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 Article Cited and Discussed: Day, N. J. S., Kealy, D., Biberdzic, M., Green, A., Denmeade, G., & Grenyer, B. F. S. (2025). Coercive control and intimate partner violence: Relationship with personality disorder severity and pathological narcissism. Personality and Mental Health, 19, e70038. Full text link: https://onlinelibrary.wiley.com/doi/p...
#55
January 9 · 13 min
The Ethics of Narc-Abuse Content: Why 'It Helps' Isn't Enough
In this episode, Dr. Mark Ettensohn examines a common defense of online “narcissistic abuse” content: the claim that, even if imperfect or inaccurate, it ultimately helps people leave harmful relationships. Rather than focusing on whether such content feels validating or empowering, Dr. Ettensohn explores the ethical and psychological implications of justifying misinformation, stigma, and moralized diagnostic narratives on the basis of perceived outcomes. He argues that this form of reasoning relies on a utilitarian logic that is fundamentally incompatible with responsible mental health communication. The discussion addresses why narc abuse frameworks often feel compelling to people in distress, how diagnostic language becomes moralized and expanded beyond its clinical meaning, and how this process reshapes viewers’ understanding of themselves, others, and psychology itself. Dr. Ettensohn distinguishes between recognizing real harm and adopting explanatory models that flatten psychological complexity, foreclose on nuance, and encourage rigid, adversarial interpretations of relational experience. The episode also clarifies common misunderstandings about pathological narcissism, emphasizing that narcissism is not synonymous with abusive behavior and that even when narcissistic pathology is present, it does not explain behavior in a deterministic or morally absolute way. Drawing on clinical ethics, developmental theory, and real-world examples, Dr. Ettensohn outlines why anger and moral clarity can be mobilizing without requiring diagnostic distortion or dehumanization. This video concludes with a reflection on boundaries in public mental health discourse and the importance of maintaining accuracy, restraint, and humanization when discussing stigmatized conditions. Referenced video: • From Validation to Isolation: The Narc-Abu... 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: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8
#54
Dec 19, 2025 · 31 min
From Validation to Isolation: The Narc-Abuse Pipeline
In this video, Dr. Ettensohn examines the online narc-abuse ecosystem and explores how content that initially feels validating and supportive can, over time, become thought-constraining and socially isolating for some viewers. Drawing on clinical experience and established research on high-demand systems, Dr. Ettensohn analyzes the rhetorical patterns commonly used across narc-abuse channels: the elevation of the viewer as a lone truth-seer, the narrowing of acceptable interpretations, the use of loaded psychological language, and the gradual erosion of trust in ordinary relationships. He shows how these dynamics can reshape identity, undermine critical thinking, and foster increasing dependence on content creators rather than encouraging reflection, complexity, or professional consultation. Throughout the video, Dr. Ettensohn carefully distinguishes between genuine abuse and the expanding, imprecise use of narc-abuse language online. He emphasizes that acknowledging harm and seeking clarity are legitimate and necessary, while also warning that one-size-fits-all narratives can distort meaning, escalate conflict, and contribute to unnecessary social rupture. The focus is not on dismissing people’s pain, but on examining how certain explanatory frameworks operate psychologically and what they may unintentionally cost the people who adopt them. This video continues Dr. Ettensohn’s clinically grounded effort to bring nuance, rigor, and psychological depth to public conversations about narcissism, offering a perspective that prioritizes complexity, reality testing, and relational context over certainty, moralization, or ideological alignment. 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 LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8
#53
Dec 19, 2025 · 1 hr 1 min
Understanding Empathy in Narcissistic Personality Disorder
This video continues the Heal NPD Seminar Series, featuring Dr. Mark Ettensohn with his associates, Deanna Young, Psy.D., and Danté Spencer, M.A. In this session, the group discusses Empathy and Narcissistic Personality Disorder: From Clinical and Empirical Perspectives (2014), examining the long-standing assumption that narcissistic personality disorder is defined by a lack of empathy. Drawing on the article’s review of empirical findings and clinical case material, the conversation explores empathy as a multidimensional and context-dependent capacity rather than a fixed trait. Key themes include the distinction between emotional and cognitive empathy, the variability of empathic functioning across grandiose and vulnerable narcissistic states, and the ways shame, threat, and affective overload can disrupt empathic engagement in intimate relationships. The discussion highlights how empathy may appear intact or even robust in some contexts, while collapsing in situations that feel most emotionally consequential. This video continues the Heal NPD Seminar Series, featuring Dr. Mark Ettensohn with his associates, Deanna Young, Psy.D., and Danté Spencer, M.A. In this session, the group discusses Empathy and Narcissistic Personality Disorder: From Clinical and Empirical Perspectives (2014), examining the long-standing assumption that narcissistic personality disorder is defined by a lack of empathy. Drawing on the article’s review of empirical findings and clinical case material, the conversation explores empathy as a multidimensional and context-dependent capacity rather than a fixed trait. Key themes include the distinction between emotional and cognitive empathy, the variability of empathic functioning across grandiose and vulnerable narcissistic states, and the ways shame, threat, and affective overload can disrupt empathic engagement in intimate relationships. The discussion highlights how empathy may appear intact or even robust in some contexts, while collapsing in situations that feel most emotionally consequential. The seminar also addresses common misunderstandings of neuroimaging findings related to empathy, emphasizing the limits of biological reductionism and the importance of viewing brain-based data as correlates of experience rather than determinants of destiny. Throughout, the group reflects on clinical implications for treatment, including the differentiation between motivation-based and deficit-based empathic disengagement, the role of affect tolerance and reflective capacity, and the relational conditions that support the gradual restoration of empathic availability. This series is intended for clinicians, trainees, and others interested in a nuanced, non-moralizing understanding of narcissistic personality disorder, empathy, and psychological development. 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: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 Citation for the article discussed: Baskin-Sommers A, Krusemark E, Ronningstam E. Empathy in narcissistic personality disorder: from clinical and empirical perspectives. Personal Disord. 2014 Jul;5(3):323-33. doi: 10.1037/per0000061. Epub 2014 Feb 10. PMID: 24512457; PMCID: PMC4415495. Full text link: https://pmc.ncbi.nlm.nih.gov/articles/PMC4415495/
#52
Nov 20, 2025 · 1 hr 6 min
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 SUBSCRIBE: 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 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

Showing 1–20 of 29 episodes