Kerry: [00:00:00] Are narcissists made or born? That's the question Dr. Peter Salerno is going to address in this episode. He's a psychotherapist who recently authored the book The Nature and Nurture of Narcissism. Today, I'm so excited. I'm joined by Dr. Peter Salerno. He's a psychotherapist practicing in California. I came across him on Instagram and was really blown away by his understanding of narcissists and the narcissistic mind as well as personality. How did you get interested in this, Dr. Salerno? What drew you to this type of personality or type of person?
Dr. Peter Salerno: Like most people, probably personal experience, but also professionally, I have all my degree programs—my master's degree, my doctoral degree. There's not much emphasis on personality science, personality pathology. So, we obviously are trained and licensed. Once we get licensed, we treat them and diagnose [00:01:00] them. But what I noticed is there's just a lot of theory biases that kind of get in the way of really understanding what's going on in the narcissist and personality-disordered individuals.
These treatment interventions or these symptom-oriented psychotherapies just don't seem to be working on a particular group of people. But we keep attributing it to the same thing. You know, these individuals must be traumatized. They must have an inferiority complex. I investigated that because the interventions weren't working, and in my personal life, I was trying to apply what I knew to get out of a pretty difficult, dangerous situation, and it was just making things worse. And what I noticed is that's what happens in therapy, too, with victims of these individuals.
So, I was kind of on a quest to figure out if there's anything else that's not common knowledge, that's not widely accepted but makes more sense. And so, I just started reaching out to and studying under, through continued education, like, the experts in personality pathology who [00:02:00] seem to be getting it right, not according to popular media. That's really what kind of jump-started this interest. And I would say that in hindsight now, a lot of the dynamics of even my family, spanning back generations, probably had a lot to do with some of this personality pathology as well. It's really important to know what you're dealing with and to make sense of it. So, it's a combination of professional and personal experience.
Kerry: What was one of the first myths that you blew apart for yourself that you realized you had been getting wrong?
Dr. Peter Salerno: That individuals who meet the criteria for pathological narcissism or narcissistic personality disorder are behaving the way they do because there was some stunting in early development that interfered with their ability to attach, or there was an empathic failure or an overindulgence, or some sort of a chaotic, traumatic, neglectful environment that was the cause of why they are doing what they're doing. That's the first myth. It just doesn't hold up in clinical practice. It doesn't hold up in research outside the [00:03:00] fields of, like, we'll say, psychodynamic, psychoanalytic, or humanistic backgrounds—those modalities. It's just not consistent as far as what research is saying now from behavioral genetics, molecular genetics, neuroscience, neurobiology.
I mean, there's definitely a division in the research, and there are people who are on one side or the other, and some who are kind of in between, but that was the main one: these ideas that trauma causes narcissism. This has been discredited decades ago, and most people aren't aware of that.
Kerry: I often say to people, you know, I got to hear Dr. Van der Kolk speak at a Washington D.C. workshop. So, I got to hear him personally say this. And he said that in the United States, roughly 80 percent of the population has experienced what he called the class A trauma, which—I'm not for sure exactly how he categorizes what a class A is, but to me, it sounds pretty significant. Then he goes on and talks about trauma recovery. But if you just use that statistic for a moment, 80 percent, and if we think based on the best [00:04:00] statistics from the government right now, which says 7 percent—which I still think is too low—but let's just use 7 percent. If 7 percent of the population is narcissistic, but it doesn't correlate—if 80 percent of the public has been traumatized and only 7 percent of the public ends up being a narcissist, then how could you say trauma causes narcissism? You can just see it's not a strong correlation. Definitely not causal because then 80 percent of the population would be narcissistic, but it's not even a strong correlation. It feels random almost to me.
So, you've mentioned there are two camps. What are the two camps of beliefs about how narcissistic personality disorder gets formed?
Dr. Peter Salerno: The two mainstream popular camps are trauma, neglect, abuse, chaotic upbringing, or overindulgence, overvaluation. And then where both of these fall short is, like you just said, only some are narcissistic in those environments. So, we have to look at ideology, cause versus risk factor, and even correlation. If this environment isn't consistently producing the same [00:05:00] thing, or even something similar, then we have to go back to the drawing board and figure out, well, what are we missing here?
The less widely accepted camp that is starting to rear its head—and the facts are just kind of discrediting what most people either don’t want to believe is true or they don't quite understand what it means—is that we're kind of starting to understand that we've been wrong. For almost a hundred years, mental health science has been just wrong when it comes to classifying personality disorders. The adult problems we see in narcissists are not the direct result of something breaking down in childhood. If somebody is a narcissist as an adult—when we talk about narcissism, we're talking about pathological narcissism, not this cultural narcissism, where we're all kind of narcissistic to a degree and we outgrow it. Not that type. The diagnostic form of narcissism, which is the problematic one, is highly heritable. That's what we are learning and have learned based on controlled studies, right? Objective studies. Not studies [00:06:00] based on self-reports of patients or interpretations from therapists, where they have a specific lens of how they conceptualize a patient and how they conceptualize psychology in general.
These are now controlled studies that are producing the same results and can be replicated. Longitudinal studies that can examine two different points in time are showing that this has a lot to do with genetics, with heritability, just like physical traits are heritable. So, moving into that realm, we have to look at neurobiology, neuroscience. We have to look at the way these brains are operating, like an operating system. We have to look at how it's different from what we typically refer to as a normal or neurotypical brain.
Kerry: There's a fascinating article in Nature where they actually have images of the brain and compare a typical brain to a narcissistic brain, and they do look different. It's obvious, the kind of discrepancy between the two, but why do you think this matters—the inheritability of it? Why does [00:07:00] that matter?
Dr. Peter Salerno: Because we have to know how to treat it. Treatments have historically failed with these patients. I mean, personality-disordered individuals in general—not just narcissists, but even the ones that share the same cluster. So, the antisocial, the histrionic, the borderline. They don't respond to treatment—symptom-oriented psychotherapy treatment—and they don't respond to trauma treatment in the way that other people do.
So right there, we're also wondering, well, if it is all related to trauma, why are only some people who are not narcissistic responding to the trauma interventions, and the ones who are narcissistic are either getting worse, or there's just no impact whatsoever? If we don't know what the cause of the dysfunction is, then we cannot sufficiently treat it. And so, one of the things that most people complain about is, "These people don't change. They don't want to change. They know what they're up to and they refuse to change." So, if that's true, maybe it's because one of the reasons that they're not changing in treatment is that we're using the wrong tools. [00:08:00] And so, we need to look at what might actually work with these individuals because these trauma-oriented interventions and symptom-oriented interventions just are not getting the job done.
Kerry: I also think it's really important because victims get told that trauma—first of all, that elicits a lot of sympathy.
Dr. Peter Salerno: Yes.
Kerry: Here's somebody who's had a bad childhood or maybe things went wrong with their parents, that you end up thinking, "Okay, we can overcome this." And also, there's some reason for me to have a lot of compassion because then it's not their fault. We see that as sort of an excuse or an explanation. But knowing this—for me, I know if I had really understood that more deeply at the time that I was in a narcissistically abusive relationship, it would have helped me be able to say, "I'm not going to save this person. It's okay to leave."
Dr. Peter Salerno: Yeah, because you hold on to this kind of, what I'd call, fear-based hope that if it is trauma, something's going to eventually get through. We can convert this person into a nicer human being with the right treatment. But the problem is the treatment fails with victims because of what you just said. [00:09:00] They're being told by the professional they hired that their partner just needs to do a little bit of therapy. Maybe they do the really dangerous thing where they ask their patient to invite their partner, their pathological partner, into therapy, which is a huge no—like, it's not good. But basically, that's one of the main treatment failures: the therapist is telling the victim, "You are dealing with a trauma victim at home, and that trauma victim just needs that wound or wounds healed, and then your relationship can get better." Well, the research is showing that because a lot of this personality pathology is hardwired, you can't give people this false hope that they're going to change. It's just causing a lot more harm.
Kerry: So, let's get into what is the truth about a narcissist? What is their mindset? To the degree that you and I can try to imagine, how would they see and experience the world? What is their point? What is their goal?
Dr. Peter Salerno: So, narcissists, in the way that I understand the research—and the research that I [00:10:00] typically share and promote—is we have to start looking at these disorders as trait deficiency and trait excess disorders. We all have a psychological toolkit that we call a personality, and we can pull out these different aspects of our personality, these different traits, which make up our character. And we typically, if we are reasonably within the spectrum of what we call "normal" in the sense of culturally, socially, morally acceptable, we have a distinct number of traits. I don't have to convince myself or teach myself how to behave at a wedding versus a funeral. To me, and to you, it's kind of common sense. I know which trait I need to pull out and how to behave that's appropriate so that I don't cause any trouble in those settings. Even being interviewed here, there's a certain adaptability that's required just in having a dialogue.
Kerry: I once heard Dr. Gregory Lester say it's like they know one song. Say they know "Jaws," the theme song to Jaws.Yes. And they know that it's really good at a horror flick to play that theme song—it makes people [00:11:00] scared. But they pull it out at the wedding, keep playing that one song in every situation.
Dr. Peter Salerno: Right. And so, going off of Dr. Lester's research—who, that guy is, I mean, he's incredible. He's worked for the Department of Justice. He's the personality disorder guy. His office was the site of the DSM-5 for personality disorders. He knows what he's talking about. So, that one trait, that predominant trait for narcissists, for example, is grandiosity. What that causes them to be deficient in is the idea of equality. They don't believe or perceive in equality. So, from their fixed trait of grandiosity—it's an unearned, undeserved sense of self-importance that can't actually be backed up by anything. It's just the expectation that you know they are better. It prevents them from being able to see other people as equal to them. This has been shown to start to develop and actually be seen in preschool-aged children. Regardless of upbringing, regardless of environment, regardless of adoption, regardless of biological parents—[00:12:00] like, whatever your environment is, this is a trait that is not being caused by an environmental factor. Right? It could absolutely be amplified by certain environments, but that would be a risk factor, not a cause.
Kerry: I came across an example with my ex. He had his identity stolen, and the person who had stolen his identity—I actually had proof, so I know it was real. And I found the individual, by the way. I found the individual on Facebook who was using his name and his social security number, and this individual had gone on and earned an MBA. Now, my ex had a college degree, but he confessed to me that he had paid people to write his paper, and that it was a non-accredited program. So really, it wasn't worth a lot. He said that the person who was using his name and social security number has this MBA. He should contact the school for another copy of the diploma as well as for the transcript because it's in his name. So technically, wasn't it his? Thinking—you can't pull it off. How would you pull off that you have an MBA just because it's in your [00:13:00] name? But in his mind, that kind of ties into this grandiosity. He really believed that it was his because his name was on it—that he had earned it just because of who he is in the world, he thinks. Whereas the rest of us would say, "Well, you need to show knowledge base. You need to show education. Can you back it up with work experience?" We would say there are all these markers of credibility, and you don't have them. But in his mind, he did because he believed he did.
Dr. Peter Salerno: Yeah.
Kerry: It's just wild.
Dr. Peter Salerno: This brings up a really important point, too, is they really do believe these things. There's this other myth that has already been discredited but is pervasive in culture. If someone's acting this way, it's because they are compensating for some inferiority, some deep-seated fear, low self-esteem, or self-loathing—like, these people go home and they hate themselves. And everything we see of them is this mask that's artificial and is really just a front to conceal this deep-seated inferiority. When narcissists believe something, they believe it [00:14:00] 100%. So if they believe that they earned a diploma they didn't earn, and they portray it as if they did earn it, that's not a facade. They truly do believe that they are entitled to that. It has nothing to do with low self-esteem or low self-worth. That is one of the biggest misconceptions and one of the most dangerous ones because that is what keeps perpetuating this idea that we can just find the wound here and heal it, and then they're going to stop being narcissistic. We have to start realizing these traits are, for the most part, hardwired.
Now, some people, including Dr. Lester, whom you mentioned—he can work with these individuals and get them to no longer meet the criteria for narcissism. That would require the narcissist to be very collaborative in treatment, to stick with it, and it would require a clinician who knows exactly how to talk to these types of individuals because you don't talk to them the way you'd talk to a trauma survivor or victim.
Kerry: Right.
Dr. Peter Salerno: They don't respond to that.
Kerry: To follow up on that, do you then disagree with the fact that there is a core of shame at the root of them? Because I know that Dr. Simon—George Simon—says he sees it more as a lack of conscience versus a core of shame. What's your thought on that?
Dr. Peter Salerno: I'm more on board with Dr. Simon. I'm a huge fan of his work. I've attended his seminars and Dr. Lester's seminars. I don't believe narcissists are suffering from this deep shame. And it depends on how you define shame, too. But I think people need to understand that there's a difference between even the emptiness that is experienced by a cluster B personality like a narcissist. It comes from these trait deficiencies. It doesn't come from an experience that has wounded them to the core and they feel bad. They don't feel bad about themselves. When they feel bad, they feel bad for themselves, which is a huge distinction. One is, "Feel sorry for me." The other is, "I'm so displeased or disgusted with myself." They don't go there. They have an emptiness in them, for sure, but it's because they are lacking these traits that most of us take for granted [00:16:00]—which would be the ability to collaborate, cooperate, be agreeable enough, be sensitive enough. Because they don't have that, there is an emptiness that they experience, but it's coming from a deficiency that's not related to not being loved or some empathic failure. That's not why they feel the way they do. So, I don't agree that they are experiencing shame.
Kerry: 'Cause that example—if I had tried to promote myself in some way that I knew was false and I knew that it wasn't true, but I wanted to take it on and attribute it to myself, I would feel shame for myself for doing it. I would feel embarrassed. And if my partner questioned me on it, I'd feel really embarrassed. I would regret that I even had that thought and want to go hide. But what I've watched with him was there was no awareness that that was a problem. He was truly mystified about why I saw it as an issue, and he believed that he deserved that just because of him being in the world.
Dr. Peter Salerno: Right.
Kerry: And the times I caught him feeling shame, it was for being called out or being uncomfortable in a [00:17:00] moment, but it wasn't like it created some crisis, some psychological despair for him. It was more of, "Oh shoot. You saw that. I don't like that you saw that." And then we'd move on.
Dr. Peter Salerno: Yeah. And I would actually say that's more of a humiliation than shame, because it has to do with impression and image management. And sometimes when they get caught where they can't be in full control of managing the image and the impression, they get humiliated. It doesn't always look like they get enraged. It can look like something else. They can respond to it in a more covert way. But I'd say it seems to be with narcissists in particular, they get humiliated when somebody potentially sees a flaw in their character. But that's not the same thing as shame.
Kerry: 'Cause shame is an internal experience.
Dr. Peter Salerno: Shame comes down to a belief almost, with a moral-emotional component to it that, like, "I am bad at my core." You can't find a narcissist who believes that about themselves. I mean, no, they'll say it. They know the language. They'll say things like that and try to sell it to you. They do it to therapists too. A lot of their [00:18:00] complaints in therapy are very vague. It's sort of like you can't really pinpoint a symptom or an experience. It's more like they come in and they'll say, "People don't understand me. I have low self-esteem." And then they just kind of throw out these random things that aren’t very—superficially they're saying important words, but there's no emotional depth to them. It's almost like, "Did you just hear this before you walked in?" Because it doesn't really add up to the presentation.
Kerry: Well, there's no psychological distress.
Dr. Peter Salerno: No.
Kerry: I will say things that, if I was to say them, I would be in tears. It would be difficult to say out loud, an internal conflict with what I'm describing. I've seen a lot of narcissists in my practice—back in the day when I had my private practice—and I experienced that too. Sort of this shallowness, this detachment from what should be a psychologically distressing experience, and they're not that distressed.
Dr. Peter Salerno: Yeah.
Kerry: It made it very difficult to work with them because that's what you need in the office to have an effective outcome. And that's what I even noticed in that relationship. I talked about this with Dr. Les [00:19:00] Carter recently—I likened it to playing hokey pokey. I felt like I got my ex's arm and maybe a leg, but he never put his whole self into the ring. So, there's this detachment. That's what I experienced. This psychological detachment with the world. Do you think that's the core, that emptiness? And we use that word a lot, but I don't think people know what we mean when we say that. To me, what I saw was this lost, restless angst that just kept driving him for more.
Dr. Peter Salerno: There's a difference between emptiness—or, we'll say, the kind of emptiness that a narcissist experiences—and the emptiness that you would attribute to somebody who has just suffered a profound loss, or is grieving, or is depressed, or even has major depression, or somebody who has deep, low self-worth where they just really do hate themselves. That's not the kind of emptiness we're talking about here. The emptiness we're talking about here is, there is an inability to attach, and so there is a disconnect in them that doesn't allow for the type of relating that most of us would take for [00:20:00] granted. Because of those missing pieces, those missing traits, they don't have it in their toolkit—their psychological toolkit—to feel the way or feel about relationships the way that other people do. So, I would say that we don't want to see the emptiness as, "I feel so sorry for them because they're in such despair." It's more of, an emptiness is like there's much less there than meets the eye. And it's because they don't have all the traits that we have decided collectively make us human. Maybe this is going off on a tangent, but I wouldn't say that the emptiness is something to, you know, feel sorry for. It's almost just like there's so much less substance there, and that can cause them distress sometimes. It can also cause them to feel fragile because all they have is this image—there's not really a real self behind it.
Kerry: I liken it to the buildup we have with Christmas. We can over-romanticize, idealize—it’s going to be this incredible experience. We can even fantasize about what that Christmas meal is going to be, having family in the room, how people are going to react when they open the gifts. It’s [00:21:00] going to look like a Hallmark card movie. And then we experience the experience, and it doesn't match. And we have this big letdown between the discrepancy of what actually happened and what we hoped would happen. To me, I think narcissists walk through their world living life like that—that life is constantly like that. My ex used to say he had an addiction to fantasy. I think he's right—that he had in his head an imagination of what he thought it was going to be. Fell in love with that. The problem is, life is life, and people are people.
Dr. Peter Salerno: Right.
Kerry: They're not a Hallmark movie, but he kept expecting that.
Dr. Peter Salerno: Yes. There’s a lot of fantasy in their day-to-day. However, that is not the same thing as lacking reality testing. They're not psychotic or delusional. In that sense, they are sane.
Kerry: Yeah.
Dr. Peter Salerno: But that fantasy and that idealization that they chase is what causes the disappointment in their life. Things that aren't consistent with their worldview—you know, they fall off the pedestal. This is one of the things that is the major contributing factor to the discarding of people, because [00:22:00] you were supposed to be a certain way for me, and you're not. And so, now I can't tolerate that. I’ve got to go find what is. The problem is, just like Narcissus looking at himself in the pool of water, he's going to starve to death because that's the only thing that he feels is sufficient. So, if you don't find that out in the world—if you don't find your own reflection, your own idealized reflection in the world—you're going to mistreat people. You're going to be disappointed. And so, they don't know that that's why they're having problems, but this is one of those things. And I think that's a very good example. If things fall short for them, if the buildup is there and then the delivery falls short—which it inevitably will, because nothing's perfect—they can't tolerate that. But they also present themselves as being the pathway to Christmas—like, everything's going to be great. If you just hang out with them, it's going to feel like Christmas Eve every day, which isn't true.
Kerry: I always say they lie first to themselves and then to everybody else.
Dr. Peter Salerno: Yeah.
Kerry: And you're right. That disappointment that happens with us could be something subtle. Like, maybe you used the wrong fork at dinner [00:23:00] and in their mind, you should have known better to not do that. And then suddenly, the caricature of you, the fantasized, idealized caricature of you, is destroyed, and then they're done, and they're going to start to look for somebody new and do this all over again. So, I'd love to jump over to the podcast extra and talk to you about the callousness with which they use relationships and just kind of dissect that better with you, but I could already tell I could talk to you for hours. This has been so much fun. Thank you so much for being on the podcast today—it was just a delight.
Dr. Peter Salerno: Thank you for having me.
Kerry: Where can people find you?
Dr. Peter Salerno: I have a website, drpetersalerno.com. I'm on Instagram, @DrPeterSalerno. I have a YouTube channel, same name. I just released a book called The Nature and Nurture of Narcissism, which just kind of covers all of the research that we're discussing here. It's kind of a new perspective on things, which can be found on Amazon and Audible and all those places.
Kerry: Well, you're a welcomed voice. When I came across you, I thought, "Oh, finally someone's saying some things that need to be said." So, thank you for [00:24:00] doing that.
Well, that's a wrap for this week's episode. Are you following me on TikTok, Facebook, Instagram, and YouTube? Find me at Kerry McAvoy PhD. And whether you're in, out, considering leaving, or have left a narcissistic relationship, find community support at my Toxic Free Relationship Club. You can learn about this resource as well as others at kerrymcavoyphd.com. And I'll see you back here next week.