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Marisa Mauro
Marisa Mauro Psy.D.

The Narcissistic Family: Diagnosis and Treatment

When meeting parental needs takes primary importance within a family.

Key points

  • In a narcissistic family, the needs of the parents take precedence over the children's needs.
  • The consequence of this parenting style is that the children become a reflection of their parents' expectations.
  • Adult children of narcissistic families often suffer from depression, chronic dissatisfaction, and poor self-confidence.

If you are confused about your own people-pleasing tendencies, need for external approval, and even your own feelings, I suggest you read The Narcissistic Family: Diagnosis and Treatment by Stephanie Donaldson-Pressman and Robert M. Pressman.

In their work as therapists, the authors discovered an unusual trend—patients with traits similar to adult children of alcoholics, but no evidence that their parents were substance abusers. Moreover, many of the patients did not recall any overt abuse as children. So why then were these patients exhibiting the dysfunctional psychological, interpersonal, and work traits of abuse survivors?

Defining the narcissistic family

The answer was a different type of dysfunctional family. Coined by the authors as the narcissistic family, what these patients all had in common was that as children, the needs of their parents took precedence over their needs. This is in contrast to healthy families, who put the needs of their children first. Without further explanation, this discovery might not seem wholly worthy of the label "dysfunction."

So to explain, a basic goal for most families is to raise healthy children who will one day become independent adults. In a healthy family, parents work to accomplish this task by assuming responsibility for their children's emotional and physical needs. Over time, parents gradually teach their children to be independent by allowing them to assume responsibility for meeting their own needs in a developmentally appropriate manner. Thus, the primary work of children is to learn to become independent adults. Along the way, they learn to identify and act on their feelings, wants, and needs. Parents take care of their own needs or seek help from adults. As a bonus, the children have also learned how to be good parents through the process of observational learning.

In narcissistic families, this basic goal becomes skewed and the meeting of parental needs becomes of primary importance for the family. This twist generally takes place sometime after infancy, as the authors point out that most children of narcissistic families were well cared for as babies. In fact, it is most likely to occur sometime after the child begins to differentiate him- or herself from the parents and begins to assert their own needs.

This normal developmental process is difficult for parents who are most concerned with fulfilling their own needs as a result of job stress, physical or mental disability, or lack of parenting skills, to name a few reasons. To compensate, the parents fight back, ignoring the child's needs and at the same time forcing the child to respond to their own by withholding attention and affection until they do so. In this way, the children's emotional needs go unattended and they are deprived of the opportunity to experience gradual independence and learn about themselves. Instead, they learn to wait to see what their parents expect and then react, negatively or positively, to those expectations.

Effects on children

The consequence of this parenting style is that the children become a reflection of their parents' expectations and are deprived of the opportunity to be unique. Furthermore, the children learn to ignore their feelings or become completely detached from them altogether. As a result of having no emotions on which to direct their actions, the children become dependent upon others for guidance. This is the process of becoming what the authors term a reactive and reflective individual.

The tendency towards reacting and reflecting will follow children of narcissistic families into adulthood. Eventually, they are likely to become distressed by their own pervasive need to please others, chronic need to seek external validation, and difficulty identifying their own feelings, wants, and needs. They tend to suffer from a myriad of emotional stressors including anger that lies just below the surface, depression, chronic dissatisfaction, and poor self-confidence. Many also struggle with indecisiveness as they have learned to make decisions on the basis of others' needs and expectations. Interpersonally, they tend to share a history of failed romances and have difficulty trusting others. Sometimes their inclination towards distrust is shattered by periods of total self-disclosure, usually made injudiciously, and met with poor outcomes. At work, they are overachievers, workaholics even, who are never satisfied with their success.

So why bother to identify yourself or your patient as a survivor of a narcissistic family? The answer is that there is hope for improvement. Identification is just the first step. Please check back for part two including steps for recovery.

If you see these traits in yourself or your patients, I strongly recommend The Narcissistic Family: Diagnosis and Treatment. It is written for therapists but includes great strategies and tips for healing appropriate for survivors.

About the Author
Marisa Mauro

Marisa Mauro, Psy.D., is a clinical psychologist at the California Department of Corrections and Rehabilitation.

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