they can't back it up. It's an unearned, undeserved
undeserved
self-confidence that they feel entitled
to even when they can't back it up.
That's the problem. It's that
grandiosity that causes problems in the
lives of others. It's not their
self-esteem. If low self-esteem and
self-doubt are what plague narcissists,
they would be easy to deal with. Low
self-esteem and self-doubt are not the
kind of interpersonal dynamics that
cause so much pain in the lives of
others. Lots of people live with low
self-esteem and self-doubt and never
cause the kinds of problems that
narcissists do because they don't
antagonize others the way narcissists
do. Trauma victims, by contrast, can
maintain good character and kindness
even while carrying profound shame and
low self-esteem. This shows us that
self-esteem, even if it's experienced as
fragile or low at times, is not the
problem. The real problem, the engine of
narcissism, is grandiosity. Consider
this comparison. Low self-esteem,
sensitivity to criticism, and feelings
of inferiority are core features of
avoidant personality disorder. So, why
don't we just call narcissists avoidance
instead? because their presentation is
fundamentally different. Avoidance are
not antagonistic. If they were, they
would be just as difficult as
narcissists to deal with. The DSM spells
out this distinction clearly. With
narcissistic personality disorder, some
individuals with narcissistic
personality disorder intentionally and
purposefully take advantage of others
emotionally, socially, intellectually,
and financially for their own purposes
and gains. with avoidant personality
disorder. The low self-esteem and hyper
sensitivity to rejection are associated
with restricted interpersonal contacts.
I'm not comparing which disorder is
worse. I'm simply pointing out that the
engine driving narcissism even when
self-esteem is fragile is grandiosity
and that is what leads to the
mistreatment of others. With avoidant
personality disorder, low self-esteem
leads to withdrawal and avoidance.
Grandiosity in the narcissist rooted in
antagonism leads to exploitation. This
is why self-esteem is not the issue. We
can harp on it and argue about it all
day long, but the reality is some
narcissists experience high self-esteem.
Some narcissists experience low
self-esteem. Some narcissists experience
fluctuations. Some narcissists
experience fragile self-esteem. Guess
what? So do individuals with avoidant
personality disorder. So do individuals
with depression. So do individuals with
anxiety. So do individuals who have no
mental disorders whatsoever.
Self-esteem fluctuates in life, but it's
not the driving force that makes
narcissists problematic. Now, this is
going to be one of my favorite sections
of this video. I hope you enjoy this. I
get a lot of people throwing the term
peer-reviewed in my face as if I didn't
earn a doctorate in psychology and I
don't know what the hell peer-reviewed
research means. Here's what I found out.
Most critics of me do not have a clue
what peer reviewed actually means. So, I
hope they are listening because now I'm
going to explain it the way you would
understand it if you went to school.
Where is the peer-reviewed research? I
have peer-reviewed research that shows
you don't know what you're talking
about. I get these comments a lot. As
you can see in this video, I have
already demonstrated that I do in fact
have peer-reviewed research to support
my claims. But let's define what peer
reviewed actually means. Peer review is
the process by which an academic journal
sends a submitted manuscript to other
scholars in the same field to evaluate
its clarity, logic, citations, and
adherence to the journal's standards. If
it passes, it's published. If not, it's
rejected or revised. That process
matters. It helps filter out poorly
written or unsupported work. But here's
the nuance. Peer review only means that
the paper met the editorial standards of
the journal. Many theoretical papers are
peer-reviewed, but their claims have not
held up to empirical testing. Entire
schools of psychoanalytic theory once
dominated journals. Melanie Klene,
Margaret Mer, Donald Winnott, Ronald
Fairbar, Hines Kohut, Otto Kernberg.
Their work is cited as if it is
evidence, but in reality, much of it was
opinion and speculation built upon the
assumption that we already knew all the
causes of psychopathology. In reality,
it was correlation without causation.
Peer-reviewing a research article is not
the same thing as saying that it is true
and accurate. Peer-reviewed research
does not make something true. To make
something true or accurate, it needs to
be based on controlled studies that can
be replicated and verified. A couple
examples of these genetic twin studies,
neurobiological imaging, longitudinal
designs, and quantitative analyses.
These controlled methods generate data
that can be tested again and again, not
simply asserted subjectively. In other
words, peer review is just a gateway to
publication. It's not synonymous with
truth. Empirical replication is the
gateway to truth. You can't just say
it's peer-reviewed and call it a day. It
has to be empirically replicated
objectively for validity. So, when my
critics argue that there's no
peer-reviewed research, not only are
they factually wrong, they are misusing
the term. The studies I reference come
from the APA and other empirical
journals. They meet the gold standard of
science. Evidence that is testable,
replicable, and falsifiable, and that
are peer- reviewviewed. A lay person who
thinks that peer review is synonymous
with truth is not properly educated or
informed. Now, let's look at something
else that's very interesting about
diagnoses like NPD.
NPD is a heterogeneous diagnosis. NPD's
diagnosis in the DSM5 and DSM5 TR
requires only five of nine possible
criteria producing vast heterogeneity.
One way to look at heterogeneity is
through the combinations. There are 256
possible ways to meet the threshold. We
also have something called phenotypic
heterogeneity. Traits vary. Some
emphasize grandiosity, others
vulnerability. So mathematically there
are 256 possible combinations. These
cluster into 126 distinct profiles. Some
resemble vulnerable presentations,
others grandiose. Let's go to the DSM5
TR page 761, which gets quoted often to
somehow show that I have no idea what
I'm talking about. Individuals with this
disorder, NPD, require excessive
admiration. Their self-esteem is almost
invariably fragile and their struggle
with severe internal self-doubt,
self-criticism, and emptiness results in
their need to actively seek others
admiration. Wonderful. Here's the
crucial point. That description is one
criterion, but it is not required
because only five of the nine criteria
are necessary. A person can be diagnosed
with NPD without ever showing fragile
self-esteem, self-doubt, or excessive
admiration seeking. One patient may
present with arrogance, entitlement, and
exploitation without insecurity, while
another may present with
hypersensitivity and withdrawal. Both
still qualify for the same diagnosis.
The key takeaway is that not every
patient with NPD looks the same.
Heterogeneity complicates diagnosis.
There can also be overlap with other
personality disorders, and so
interpreting NPD requires the capacity
for nuance. As I've shared research
earlier in this video, the grandiose
phenotype is the one most mapped onto
DSM criteria for NPD. And the grandiose
phenotype is the one that's associated
with grandiosity, entitlement, high
self-esteem, interpersonal
gregariousness, and assertiveness. The
reason why the peer-reviewed research
that insists that shame and low
self-esteem and insecurity are the
driving forces of narcissistic
personality disorder, the reason why
those theories are so problematic is
because there are so many exceptions to
them. But instead of acknowledging the
exceptions, they simply say, "Well, we
already know everything we need to know,
and so if anybody else researches
anything else," they're wrong. Period.
That is not any way to conduct research.
As I stated earlier, recently I was
publicly defamed by a lay person who
goes by the name of Batwolf on
Instagram. He stitched a video of an
interview with me with a video of Dr.
Mark Etinson to label me a liar. He
claimed I fabricated research, which I
just demonstrated I did not. I want to
touch quickly on Dr. Mark Etinson. While
we may disagree on certain points, he is
a licensed professional. I also am a
licensed professional. Professionals can
and do disagree. That's how scholarship
advances actually. But lay antagonists
like Batwolf exploit these disagreements
to justify hostility, defamation, and
harassment. Pairing my remarks with
another clinician in a video the way
Batwolf did actually showcases my point.
Professionals can disagree thoughtfully.
His attempt at jabbing and defaming me
just highlighted who the professional
actually is. False accusations like this
highlight a very important lesson.
Disagreement is healthy. Antagonistic
impulsive misrepresentation is not. It's
slander and defamation of character. And
all of this could have been prevented if
he just had the decency to reach out to
me and politely request my peer-reviewed
research. I have consistently been
accused of being a reductionist, a
determinist. And the reality is people
take a one minute clip of a particular
thing I said. They completely ignore
nuance. They completely ignore the gray
area. They don't have the capacity to do
anything other than dichotomize. And
when they do that, they run the risk of
falsely accusing me, getting reactive
for no reason instead of just clarifying
things politely and respectfully. If you
read my book, you will see that I am not
a reductionist or a determinist. I'm not
an environmental determinist and I'm not
a biological determinist. I'm somebody
who is looking to bridge the gap between
science and clinical practice. I'm
somebody who is interested in bridging
the gap related to exceptions to these
rules in research that people ignore or
dismiss due to confirmation bias rather
than looking at the reality. We don't
know everything we're ever going to need
to know. So, we need to keep doing more
research to fill in the gaps. I like
that. To me, that's the responsible
thing to do. You can hate my
presentation. You can hate the way I
look. You can hate my tone of voice.
Whatever it is you want to hate, go
ahead. Those are your opinions. Those
are your experiences. No problem there.
But when you falsely accuse me of making
stuff up that is as serious as the
disorders in the DSM, when you falsely
accuse me of making stuff up about that,
that's where I draw the line. Thank you
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