Etiology
 
Developmental/Psychodynamic Theory
 

O. Kernberg believes that in many persons with Narcissistic Personality Disorder have parents who were covertly but intensely aggressive.1  He describes this pattern as follows:

“A composite picture of a number of cases that I have been able to examine or to treat shows consistently a parental figure, usually the mother or a mother-surrogate, who functions well on the surface in a superficially well-organized home, but with a degree of callousness, indifference, and nonverbalized, spiteful aggression.  When intense oral frustration, resentment, and aggression have developed in the child within such an environment, the first condition is laid for his need to defend against extreme envy and hatred.  In addition, these patients present some quite specific features which distinguish them from other borderline patients.  Their histories reveal that each patient possessed some inherent quality which could have objectively aroused the envy or admiration of others.  For example, unusual physical attractiveness or some special talent became a refuge against the basic feelings of being unloved and of being the objects of revengeful hatred.  Sometimes it was rather the cold hostile mother’s narcissistic use of the child which made him ‘special,’ set him off on the road in a search for compensatory admiration and greatness, and fostered the characterological defense of spiteful devaluation of others. . . .  These patients often occupy a pivotal point in their family structure, such as being the only child, or the only ‘brilliant’ child, or the one who is supposed to fulfill the family aspirations; a good number of them have a history of having played the role of ‘genius’ in their family during childhood.”2

P. Kernberg identifies five groups of children at potential risk for developing Narcissistic Personality Disorder:3

Children of Narcissistic Parents:  Such parents are incapable of empathy and thus unable to meet the emotional needs of their child.  In this case the child can develop compensatory feelings of superiority or of being destined for greatness “by way of shoring up a sense of self-worth in the absence of the ordinary parental praise . . . .  [And] whereas the overly praised child may regard himself as better than her really is, the neglected child may present a dual picture: an outward sense of (compensatory) specialness covering an inward sense of worthlessness.  Neglected children of the very wealthy [also] often show these paradoxical features.”4

Adopted Children: Although these children can feel they are special because they were chosen from among all the other babies, they can also develop a deep sense of being abandoned, unwanted by their biological parents.

Abused Children: They create an idealized loving version of the abusive parent in order to escape from the terrifying reality of the parent’s sadistic behavior.  “Parental cruelty can have . . . [a] dual effect, teaching the child not only to undervalue himself, but also to conclude that ‘it’s every man for himself’—a narcissistic assumption.”5

Overindulged, Overly Praised (the "Nobel Prize
Complex"), or Wealthy Children:  Having every whim gratified has the effect of prolonging infantile narcissism, and, if the parents are narcissists, there is a strong likelihood that the child will develop this disorder as well.  These children develop “a strong sense of entitlement and omnipotent control (infantile narcissism and grandiosity) that later in life, when combined with frustration and anger, can turn into a pathological character style.  In addition, the child develops a social handicap with very little capacity for mutual interaction, cooperation, sharing, and empathic understanding.”6

Children of Divorced Parents:  The child can develop a grandiose sense of self to compensate for the deep sense of rejection brought about by the dissolution of the family or from filling the role of  the absent parent.
 

O. Kernberg believes that, “an integrated but highly pathological grandiose self develops some time between ages 3 and 5, and helps to defend toward early projected rage and envy.  The pathological grandiose self interferes with normal ego and superego development, as well as with the formation of internal and external object relations.”7   In contrast, Kohut, “suggests that parental empathic failure to support normal narcissistic development results in a developmental arrest at the stage of an archaic (pre stage) grandiose self.  Parents’ empathic interaction with the child stimulates the normal narcissistic development and integration toward healthy self-esteem.”8
 
 

Biological Theory
 

Neurophysilogical research indicates that a caregiver’s early interaction with an infant—particualrly during the second year of life—is essential not only for character formation but, equally important, for biopsychological development.  Ronningstam summarizes Schorer’s (1994) theory as follows:

“Of specific importance for the development of NPD are the neurophysiological origins of hypersensitivity, strong aggressive drive, low anxiety or frustration tolerance, and defects in affect regulation.  Under normal circumstances, the caregiver helps the child to handle intense and stressful affects.  The child’s inner representations of the caregiver promote normal psychobiological affect regulation (which includes both the bodily and the psychological systems).  This helps the child to neutralize grandiosity, modulate narcissistic distress, and regulate both excitement and self-esteem.  However, inconsistent attunement between caregiver and child, and the caregivers failure to help the child to modulate positive and negative hyperaroused states such as excitement, anger, or anxiety, as well as low aroused states such as shame and depression, can lead to failure to develop adequate affect regulation. . . .

“. . . Two types of caregiver-child interactional patterns . . . lead to the development of the arrogant and shy types of NPD.  An ‘insecure-resistant’ attachment contributes to states of hyperactivation and affect underregulations, reulting in overt grandiosity, entitlement, arrogance, and aggressive reactions to others.  A ‘depressed-hyperarousing’ attachment contributes to an affect overrregulation, leading to inhibition, shyness, and prodominant shame, which hides grandiose strivings . . . .”9
 
 

Metapsychological Theory
 

O. Kernberg describes this theory as follows:  “Metapsychological analysis postulates that self-esteem regulation is dependent on, among other factors, the pressures that the superego exerts on the ego:  the more demanding the superego (the more excessive the infantile morality of unconscious demands for perfections and prohibitions), the more self-esteem may be lowered.  At bottom, such a lowering of self-esteem would reflect a predominance of self-directed aggression (stemming from the superego) over the libidinal investment of the self.

“A lowering of self-esteem also may be caused by the lack of gratification of instinctual needs of both a libidinal and an aggressive nature (reflected in dependent, sexual, and aggressive strivings).  In other words, unconscious ego defenses that repress that awareness and expression of instinctual needs would impoverish the ego (self) of gratifying experiences and thus ‘deplete’ libidinal ego (self) investments and diminish self-esteem.

“In addition, the internalization of libidinally invested objects in the forms of libidinally invested object representations greatly reinforces the libidinal investment of the self—the presence in our mind of the images of those we love and by whom we feel loved strengthens our self love . . . .  In contrast, when excessive conflicts around aggression weaken our libidinal investments of others and, secondarily, their corresponding object representations, the libidinal investment of the self and self-love also suffer.”10

Millon also has developed a theoretical construct involving biosocial learning in which he described a constellation of characteristics.11

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Overt:  expressive, cognitive, interpersonal
Covert:  self-image, defensive funcitons

Millon also described a set of narcissistic subtypes.

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Normal Narcissistic Type:  self-assured and competitive
Amorous Narcissist:  seductive and erotic
Compensatory Narcissist:  because of insecurities and past
     wounds, constantly seeks out support of self-esteem
Elitist Narcissist:  self-assertive, arrogant, intrusive
Fanatical Narcissist:  paranoid thinking and illusions of
     omnipotence clash painfully with reality
Unprincipled Narcissist:  deceitful, vengeful, lacks loyalty
 
 

Cognitive Theory
 

Young postulates three core operating schema moods in narcissists that he bases on Beck’s theory of dysfunctional schemes12:

 And three secondary schema: These schema are then grouped into clusters representing different aspects of the self:
 
The Special Self:  This mood results in superior, entitled, critical and unempathic behavior and thinking. Young assumes that the pathological narcissist vascillates among these moods according to the stimuli of his or her environment.
 


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1O. Kernberg, 1984, p. 234
2O. Kernberg, 1984, p. 235
3P. Kernberg, 1998; Stone, 1993
4Stone, 1993, p. 260
5P. Kernberg, 1998, p. 117
6Ronningstam, 1999, p. 686
7Ronningstam, 1999, p. 685, citing O. Kernberg, 1975 & 1984
8Ronningstam, 1999, p. 685, citing Kohut, 1971
9Ronningstam, 1999, p. 685
10O. Kernberg, 1998, pp. 30-31
11Millon, 1981; Millon, 1998
12Young, 1998