 We are beginning to see the seamless integration of all so-called separate personality disorders and clinical entities. Each one of them functions as primary or secondary, foundational and overlay. That's why people who are traumatized, for example victims of complex trauma, CPTSD, that's why they suddenly develop borderline traits or become narcissistic or become secondary psychopaths. Because trauma doesn't create a single personality disorder. Trauma creates all personality disorders. And then a few of them, one or two, usually one actually, becomes primary, becomes the cornerstone, the core. And around this there are overlays. This core personality disorder, this core disturbance, picks up traits and behaviors and affect and emotions and memories and fears and wishes and hopes and elements of identity because the identity is shattered, that's identity diffusion, identity disturbance. So the core serves as a giant black hole, as a giant magnetic Jewish and accumulates an overlay or actually a series of overlays like an onion of other personality disorders. But these personality disorders, which are visible to the therapist, visible to the intimate partner, visible to colleagues and friends, this personality disorder, let's call them the presenting personality disorder, the facade personality disorder. They're hiding, they're hiding the core personality disorder or the core, the core disturbance. The core disturbance in identity formation, the core disturbance in effect and emotion and regulation, the core disturbance in memory, dissociation, that's the core. So covert narcissists, probably the core is avoidant schizoid or what Melanie Klein described as a schizoid posture position. A overt or grandiose narcissist may be compensating for something else, for example, a psychopath. So when we are presented with a personality disorder, we should take it with a mountain of salt. It's like a visit card, you know, the person is giving you a visit card, hello, my name is Sam, I'm a narcissist, wait a minute, hello, what is your narcissism hiding, narcissism is compensatory. What is it compensating for Sam dude, what is your problem, the real one, not the one you're presenting to me, don't forget that most personalities are engaging in numerous defense mechanisms, including fantasy, confabulation, rationalization, intellectualization. I mean, you name it, everything is distorted endlessly in an infinite hall of mirrors. You're not getting real information by interrogating the personality disorder person. Summary. Personality disorders in general are storylines, storyboards, narratives, they're intended to disguise and camouflage discontinuities in identity caused by post traumatic dissociation. However, narcissism is not a personality disorder, it's an integral part of personal growth, evolution and development over the lifespan. We all have healthy narcissism. We all start with primary narcissism as infants, and it is primary narcissism that allows us to develop and evolve and become adults. So narcissism stays with us for life. The malignant forms of narcissism, the sick forms, pathological forms of narcissism, the overt, the covert, the malignant. These forms could be conceived of as cancer. There are cells everywhere, and so cancer can appear anywhere. It's the same with narcissism, cancerous or malignant narcissism. It can appear anywhere. People with an underlying mental illness, a mood disorder, affect disorder, eating disorder, psychotic disorder, another personality disorder, people with a mental health issue are likely to be traumatized twice, once by the trauma that had led to the mental health issue and the second time by the mental illness itself, which is highly traumatic. To compensate for these traumas, to paper over the resulting dissociation, to cope somehow, everyone who is mentally ill employs and deploys narcissistic defenses. Everyone who is mentally ill with any kind of mental illness whatsoever becomes a narcissist of one kind or another, depending on the mental illness. This expression of narcissistic defenses, if it is sufficiently long, if you've been mentally ill for 20 years and you've been using narcissistic defenses for 20 years, if it is sufficiently all pervasive and above all, if it is successful, if it's a positive adaptation, allows you to cope properly with your mental illness. This narcissistic adaptation becomes entrenched, becomes fossilized and ossified, becomes an integral part of your identity and you become, in this particular sense, a narcissist. So narcissism is an overlay, sometimes a rigid overlay, sometimes an integrated overlay, over and above some underlying condition, mental disruption, mental health problem, usually in reaction to a trauma, trauma can be an early childhood, trauma could be with your husband, trauma could be a natural disaster. But whenever mental illness erupts, all the arsenal of defenses comes into life and into action and a core, core feature of these defenses is narcissism. So narcissism is with us as healthy people and with us if we get mentally ill and its manifestations vary so there's no type constancy because it is attached to a primary disorder which is not narcissism and it acquires its features, it acquires its attributes, it acquires its symptoms, expressive symptoms, presenting symptoms. So narcissism is like a chameleon, it shape shifts, it adapts itself to the problem it has to solve, it's a problem solving tool. The problem starts with the fact that one of the narcissistic defenses suspends reality testing, involves cognitive deficits. Another problem is lack of emotional regulation in narcissism. When narcissism goes up, emotional regulation goes down. These two put together create behaviors, foster and gender encourage behaviors which are essentially anti-social and abrasive and hurtful and abusive. That's when the problem starts. Thank you for surviving this.