Good Morning Dr. Ramani Durvasula! First, I’d like to introduce you to our readers, then talk about how narcissism intersects with bipolar disorder, and then finally discuss your new book “Should I Stay or Should I Go?” Let’s get started:

Please introduce yourself.

(My name is) Dr. Ramani Durvasula, Professor of Psychology at California State University Los Angeles, licensed clinical psychologist in private practice in Santa Monica, CA, author of two books and numerous peer reviewer journal articles and book chapters, and researcher and clinician focused on the issue of personality disorders as they relate to health and relationships. I am also divorced and the mother of two daughters. I am the daughter of Indian immigrants, and as a result also bring an exquisite understanding of how narcissism gets incentivized in other cultures.
Why did you choose to write about narcissism?

I have been conducting research on personality disorders for years, specifically how they relate to health, but then it became clear they are also associated with relationship havoc. At the same time, history was undergoing an interesting shift – society was becoming more consumerist, social media was morphing how we relate to each other, and superficiality and over focus on validation seeking was spiking through phenomena ranging from reality TV, to ubiquitous selfies, to choosing dating partners by swiping on a cellphone. I was seeing more and more of my clients frustrating themselves by trying to please unpleasable partners, parents, friends, and co-workers. So I started digging deeper.

What role does narcissism play in disorders like bipolar and borderline?

Bipolar disorder is a syndromal (albeit severe) mental health issue – but is also amenable to symptom management via medication, therapy, and monitoring. Narcissism is chronic so even if the bipolar symptomatology is well managed, the grandiosity, lack of empathy and myriad other symptoms are still present. Many of the symptoms of narcissism (e.g. grandiosity, lack of insight) can parallel the patterns observed during manic episodes, and in fact the emptiness and darkness of narcissism can parallel the depressive patterns. It can be so frustrating when you have these two disorders hanging together – because even the management of the bipolar doesn’t yield an easier person – even though the challenging symptoms of mania and/or depression are managed, the interpersonally challenging symptoms of narcissism (which are not amenable to change) sustain.

When it comes to borderline and narcissism – there is a lot of shared variance. The dysregulated moods and propensity to rage, the feelings of emptiness, emotional instability, the vulnerability and other patterns sometimes observed such as the seductiveness and acting out – look quite similar. Interestingly, although narcissists can be full of bluster and bravado – they are quite often very dependent – and dependency is a hallmark of the borderline personality picture. And in fact, narcissistic patterns in women are sometimes labeled borderline. In both personality patterns – the lack of insight and the inability to accurately tap into and reflect on the feelings and experiences of others leads people to feel very confused and destabilized in the presence of both narcissists and people with borderline personality patterns.

The presence of borderline or narcissistic patterns in the face of another major psychiatric issue (e.g mood disorder, anxiety disorder, substance use disorder, somatofom disorder) – makes clinical management FAR more difficult and often requires more lifelong and chronic management.

What is the biggest thing that people THINK they know about narcissism, that isn’t so?

That narcissism is self-love. It’s not. It’s a deficit in self regulation and sense of self. They often feel empty – and they proceed to fill it with the wrong stuff. Their sense of self is so driven by outside forces (what do people think of me?) that they are chronically vulnerable and reliant on the outside world (thus the need for validation). Their big blowhard bullying personalities are a defense against fear, vulnerability and shame. They are actually the weakest folks in the room, but instead of getting in touch with that vulnerability and working from the inside out – they are unable to mirror and engage in empathy and self-reflection. They always put themselves first, because they are not aware or tuned into the needs of others.

What is the most important thing that people DON’T know about narcissism, that they need to know?

You can’t really change them. They may have flashes of insight here and there, but it is highly unlikely to become a lifelong pattern of warmth, insight and empathy. As wonderful as each of us are, we are not powerful enough to change them – it has to come from them. As a result, when in a relationship with a narcissist – it can become the most frustrating experience of a lifetime, because you are waiting for normal stuff – respect, honesty, empathy, presence – and it rarely comes. So we do what we have always been told by fairy tales – we just love more and think we can turn the beast into a prince. It doesn’t work that way.

Sadly, narcissism starts young – and parents and society have to look inward to reflect on how we foster these characteristics in our children. We have become so accustomed to valuing our children for WHAT they do – straight A’s, sports teams, trophies, admission at Harvard – that we don’t often enough work with them on their inner worlds and ensure we are present and mindful with them so they do the heavy lifting of soul development and cultivate empathy, mutuality, and respect.

Are there misconceptions that people have about your book? If so, explain.

That I am telling everyone that because the narcissist will not change, that they have no option but to leave. That is not true. Too often in our culture, we view our relationships as one stop shops that are supposed to give us everything – friendship, romance, sex, material comfort, encouragement, support, companionship, respect, shared interests. Listen – if you are lucky – it happens that way – but it often does not. If you are going to stay with the narcissist, stop waiting for certain things that may never come (like mutual regard, emotional support) – and that may mean cultivating other networks such as friends and family to get those elements, and enjoy what you will from your partner. As I say in the book – “don’t be surprised if it is cold in the winter” with the corollary of “don’t be surprised if the narcissist lacks empathy” –

Some people think that it is an unforgiving book – how dare I say they won’t change. Get any psychologist behind closed doors and they will say the same. This book may actually bring compassion. Instead of futilely banging your head against the door asking something from them that they cannot deliver, it is a wakeup call to meet them where they are at. If the narcissists are so hurt my book – I have no doubt they can find an author to write an advocacy book for them. Fact is, narcissists run the world – I am glad to be an advocate for the rest of us. It’s a narcissist’s world – we just live in it. Thanks to my book – it is my hope that we don’t get our hearts broken in it. They may make innovative and visionary leaders and businessmen, they don’t tend to make compassionate partners.

Why does the narcissist always get the girl?

Obviously there are many female narcissists, but we are still in an era of inequity, and there are far more narcissistic men. Fact is – the traits of narcissism – self interest, lack of empathy, ability to ignore the needs of others, validation seeking, grandiosity, competitiveness, vanity, and greed – set a person up quite nicely in a capitalist system to succeed. They tend to be focused on material and “visible” success above all else. Nice guys rarely bring companies to billion dollar profits (they waste too much time worrying about the welfare of their families and employees). We still socialize girls to go for the “prince” with the car, stuff and prospects. The focus on the guy who is “good on paper’ too often misses the far more important relational traits of empathy, kindness, compassion, warmth, communication, and reciprocity. In addition, narcissists spend lots of time working on their facades so in many cases they are quite charming, magnetic, and charismatic at first blush – well put together and with impressive resumes (or they lie about their resumes) – and in that way may be more compelling than the rumpled why guy in the corner. Guess what – the rumpled shy guy may be more likely to get up for those 2 AM feedings, massage your feet after a tough day, and not at all likely to turn you in for a younger model when you get older and he gets bored. But the narcissists are often interesting bait, and by the time the desolation of the narcissist is recognized, too many women (or men) are too deep into the relationship and then start wasting years and decades trying to please their unpleasable, magnetic and charismatic narcissist.

In your quest for a “prince” – pay more attention to how he treats your heart and mind than the size of his success, wallet and ego.

Another thing I want to add is that we all have some narcissism in us – we need it. Sometimes we do need to put ourselves first, sometimes we do put our needs above others, sometimes we become over focused on ourselves to the detriment of others, some of us are frugal/cheap, some of us like to look nice (is that vanity?), some of us have been unfaithful in relationships. Narcissism requires a critical mass of traits, has to be consistent – and some traits – like the lack of empathy, grandiosity, chronic carelessness in relationships,superficiality – are largely required. When the rest of us have our bouts of narcissistic traits, we may even have insight into them, apologize ahead of time, or at least check in with others. Healthy narcissism can be mindful self-advocacy and sometimes being a bit more selfish than necessary . Pathological narcissism is throwing others under the bus and not caring about it.

You can purchase Should I Stay or Should I Go by Ramani Durvasula, PhD from amazon by clicking here.

This article previously appeared on PsychCentral as Let’s Discuss Narcissism: Should You Stay or Should You Go?