Internal Absence: Emptiness in NPD

Added: 2026-05-22

[00:00:00]Hi everyone, my name is Dr. Eatensson.

[00:00:02]Welcome to Heal NPD.

[00:00:04]I remember when I first started to study psychology.

[00:00:07]I was maybe in my first or second year of undergrad and I was taking some general psychology courses. One of them included an overview of diagnostic categories and that included personality disorders.

[00:00:22]At that point in time, I knew basically nothing about personality disorders.

[00:00:27]This was really my first introduction to the concept and two things stood out to me very clearly. The first was the idea that these disorders don't get better. I can't recall the exact wording, but I'm pretty sure the textbook we were using said almost exactly that. Personality disorders were life sentences. They're conditions that don't really improve.

[00:00:52]And I remember that idea frightened me.

[00:00:55]The notion that there could be a psychological condition that you might have without even realizing it and that once you discovered it was there, nothing could be done about it was terrifying.

[00:01:06]The other thing that struck me was how mysterious these disorders seemed. They were defined mostly by clusters of behaviors and traits, supposedly stable attributes of a person's personality and functioning. And if you had enough of those traits or if you engaged in enough of those behaviors, then at some ambiguous point, you crossed over into having a personality disorder. I also remember that I had a friend who younger sibling behaved in ways that seemed to line up with borderline personality disorder. And I thought, maybe this person has BPD. But that insight was immediately followed by a sense of dread. because according to what I was learning, if that was true, there was absolutely nothing that anybody could do about it. So, I had this thought that I could never say anything about that possibility to either my friend or their family. Now, admittedly, I'm starting to get up there in age, and this was decades ago. Public opinion about BPD has shifted dramatically, but unfortunately, narcissistic personality disorder still carries a lot of that same stigma. It has the same aura of mystery. Ask anyone on the street what NPD actually is, and they'll be hardressed to tell you. You'll get all sorts of answers, of course, but most will be about arrogance, manipulation, and abuse. I also teach doctoral level clinicians and even many of them will give you similar responses.

[00:02:40]For most people, NPD is defined by traits and behaviors rather than a coherent psychology.

[00:02:47]If you have the traits or behaviors in some unspecified quantity, then you have NPD. And if you have NPD, then you're basically [ __ ] There's nothing you or anyone else can do.

[00:03:00]Now, of course, I don't believe any of this, but this is what I think most people believe about NPD. And if I had stopped at just that class that I took, the overview of diagnosis that included personality disorders, it's what I would believe, too. I can certainly understand how ideas about this disorder among the public end up becoming distorted and charged with fear, loathing, dread, and stigma. But I also hear many of these ideas from people who come to me and to my associates for assessment and psychotherapy.

[00:03:35]We also work with loved ones who believe someone in their life might have narcissistic personality disorder or significant pathological narcissism. And I hear a lot of the same dread and anxiety coming from them as well.

[00:03:48]What I've come to believe is that personality disorders are not really defined by collections of traits and they're not simply a matter of behaviors that appear in certain situations beyond some mysterious diagnostic threshold.

[00:04:03]These are disorders of identity involving an internal model of the self, the subjective experience of what it is to be a self across different situations and relationships.

[00:04:17]And the different categories of personality disorder are really just variations on that theme. They're sort of like different flavors of ice cream.

[00:04:27]Same underlying substance, different superficial presentation.

[00:04:32]I've used that analogy before.

[00:04:34]To my mind, there aren't really a bunch of separate diagnosible personality disorders.

[00:04:42]There is personality disorder as a general category of disturbance in identity. And the diagnosis describe the particular flavor that that disturbance tends to take in a person's life. For example, in BPD, the internal experience of self tends to be organized around states of merger and abandonment. When the person feels close to someone, when the feeling of connection or merger is activated, the self-representation can become idealized. The person feels loved, valuable, connected. And when the feeling of separation or abandonment is triggered, the self-representation collapses into typically emotionally disregulated, chaotic experiences.

[00:05:28]Narcissistic personality disorder also involves disturbances in identity, but the internal polarity tends to revolve around grandiosity and devaluation.

[00:05:39]But just like in BPD, the shifts between those states are often triggered by relational experience. And that makes sense because identity itself is forged relationally.

[00:05:52]Without the experience of other people, there can be no self. Self only exists as a coherent construct when juxtaposed with other. They are mutually co-constructing phenomena. The problems arise when a child grows up in circumstances where their experience of being a self is not reliably recognized, mirrored or found to use Winnott's language. When that happens, the sense of self can remain poorly defined. The experience of being a self can become dysphoric, empty or unstable.

[00:06:30]So then when admiration, praise or belonging is present, the internal identity meter shoots up into grandiosity, the person may feel powerful, perfect or exceptional. But when those experiences are absent or when rejection or criticism occurs instead, the meter can crash down into feelings of worthlessness, emptiness, anxiety or depression. And at that point, the system becomes disregulated.

[00:06:58]And this is where a lot of popular descriptions of narcissism get things wrong. When people define narcissism as arrogance or entitlement, low empathy or grandiosity, they're focusing only on one part of the system. But pathological narcissism is actually a higher order construct that involves both grandiose states and states of internal collapse or vulnerability.

[00:07:24]What really puzzled me when I was a younger clinician though was the experience that many of these patients describe as emptiness.

[00:07:33]Why do so many people with personality disorders describe an abiding internal feeling of emptiness? I couldn't fully make sense of that until I began to understand personality disorder primarily as disturbance in identity. If you reflect on your own experience of being a self, in other words, what it's like to be you, you might notice something interesting. When you think about that, it's not just you sitting alone inside your mind. Your sense of self is actually composed of many relational experiences.

[00:08:11]What it's like to be you with your mom or with your dad, with your sibling, with your friends, with your partner, with your colleagues. All of those experiences blend together to create the impression of a stable continuous self.

[00:08:26]But that sense is actually built from countless relational moments over time.

[00:08:33]In personality disorders, the quality of many of those experiences was too inconsistent, too painful. In other words, they were traumatic, but not the kind of trauma we tend to think about. Trauma with a capital T. What I'm talking about is relational trauma. That sort of trauma tends to be more quiet, less noticeable.

[00:08:54]It tends to unfold across years rather than a single flashbulb moment. It's complex and intertwined with identity.

[00:09:04]And that sort of trauma has a particular effect on the mind, especially when it occurs during the first four or five years of development. It tends to drive experiences apart.

[00:09:17]through dissociation.

[00:09:19]For example, imagine a child who has a memory of a birthday party where things felt good and safe. But that same child also has lots of memories of terrifying conflicts at home, of being demeaned or humiliated by the very people who were supposed to care for them. For a young child, holding those two experiences together might feel intolerable. So the psyche tends to separate them in order to protect the possibility of good memories existing without immediately being contaminated or subsumed by traumatic ones. They remain dissociatively isolated from each other.

[00:09:58]And when patterns of self-experience consolidate over time around those separate clusters of experience, we call that splitting. Different internal models of the self develop and the person can flip between them depending on the situation. But there can also be sectors of identity organized around the absence of relational recognition. Parts of the self that were never mirrored, never supported, never fully brought into mutual recognition within the context of a relational experience. And those parts often carry feelings of emptiness. Not the feeling of being bad and certainly not the feeling of being good, but rather the sense that something that should be there simply isn't. And that experience can be extraordinarily difficult to tolerate.

[00:10:49]Sometimes even more difficult than aspects of self-experience that are actively devalued. In some cases, people attempt to cope with that feeling of emptiness by organizing it around a physical sensation like sexual activity, substance use, or even self harm. These can represent attempts to substitute intolerable emptiness with something else, anything else, even if that thing is itself painful or disruptive to their life and relationships. And this is why such behaviors can be so difficult to change because they're not just behaviors. They're attempts to establish some form of organized internal self-experience. When you look at personality disorders through this lens, a common theme begins to appear. And that theme is contingent self-experience.

[00:11:41]The sense of self becomes reactive.

[00:11:44]Self-experience rises, falls or collapses depending on what is happening in the relational environment in that moment. Whether someone feels admired or rejected, connected or abandoned, dominant or dominated, safe or threatened, grandiose or worthless. That contingency is what produces the instability in identity that we see across many personality disorder categories. And when we begin to understand personality disorders in this way, the clinical implications also become more clear. Treatment can't focus only on behaviors. If you only target behaviors, then you're missing the central disturbance in identity that generates the problems. Instead, treatment has to involve helping the person recognize the shifts in their self-experience as they occur. It involves paying careful attention to the relational process unfolding in the therapy diia. What's happening between the two people in the room, the moments of connection, of rupture, and of misunderstanding, and helping the patient begin to make connections inside themselves, not just intellectually, but emotionally. so that the parts of self-experience that have always existed sort of outside the glow of the communal campfire can gradually move closer in the parts carrying emptiness, disorganization, or what Winnott might have called primitive agonies, experiences that were never recognized, never spoken to, never held in mutual recognition in relationship.

[00:13:23]And over time, those experiences can begin to enter the circle of things that can be known, articulated, and understood together. To my mind, without addressing those deeper aspects of identity disturbance, treatment will always fall short. And I think that's one of the reason why so many studies that are analyzing short-term treatments or treatments that are based on behavior and coping end up concluding that narcissistic personality disorder is untreatable.

[00:13:58]But it's not untreatable.

[00:14:00]It's just that if you're targeting the wrong level of the problem, then you're unlikely to see much change.

[00:14:08]Okay, so that's it for today. Just a reminder that heal NPD is also a clinical practice. My associates and I specialize in assessing and treating pathological narcissism, NPD, and related issues. And we also offer consultations to family members and loved ones. These are chances to speak with someone who really understands the psychology of narcissism to ask questions and get answers based on the clinical science rather than the stigma and misunderstanding that you so frequently hear online. If you or someone you love is struggling with these issues, please reach out through our website at www.healnpd.org.

[00:14:47]And until next time, take good care.

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