 I'm Sam Vagnin and I'm the author of Malignant Self-Love, Narcissism Revisited. When narcissistic supply is deficient, the narcissist decompensates. He acts out in bizarre and unusual ways. He becomes aggressive and violent. Narcissists sometimes experience psychotic micro-episodes, for instance during therapy, or when they suffer narcissistic injuries in a severe life crisis. But can the narcissists go completely over the edge? Do narcissists ever become full-fledged psychotics? The definition of psychosis in the Diagnosticist and Statistical Manual is restricted to delusions or prominent hallucinations, with the hallucinations occurring in the absence of insight into their pathological nature. A delusion is a false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes, despite what constitutes incontrovertible and obvious proof or evidence to the contrary. In contrast, a hallucination is a sensory perception that has the compelling sense of reality over true perception, but that occurs without external stimulation of the relevant sensory organ. The narcissists hold on reality is tenuous. Narcissists sometimes fail the reality test. Admittedly, narcissists often seem to believe in their own confabulations and lies. They are unaware of the pathological origin and nature of their self-delusions, and so they are technically delusional. But narcissists rarely suffer from true hallucinations, disorganized speech, disorganized or catatonic behavior, and so on. So, in the strictest sense of the word, we can say that narcissists appear to be only partly psychotic, but actually, they are not psychotic at all. There is a qualitative difference between benign, though well-entrenched, self-deception, or even malignant current artistry, and losing it altogether. Pathological narcissism should not be construed as a form of psychosis, because the narcissist is usually fully aware of the difference between true and false, real and make-believe, invented in the extant, right and wrong. The narcissist cautiously chooses to adopt one version of the events, an aggrandizing narrative, fairy tale existence, a what-if counterfactual life. He is emotionally invested in his own personal myth. The narcissist feels better as fiction than as fact, but he never loses sight of the fact that it is all just fiction. Additionally, throughout, the narcissist is in full control of his faculties, cognizant of his choices, and goal-orientated. His behavior is intentional and directional. He is a manipulator, and his delusions are in the service of his strategies. Hence, his chameleon-like ability to change guises, his conduct, and his convictions on a dime. Narcissistic delusions rarely persist in the face of blanket opposition and realms of evidence to the contrary. The narcissist usually tries to convert his social milieu to his point of view. He attempts to condition his nearest and dearest to positively reinforce his delusional false self. But if he fails, he modifies his profile on the fly. He plays it by ear. His false self is extemporaneous, a perpetual work of art, permanently improvised and reconstructed in a reiterative process designed around intricate and complex feedback loops. Though the narcissistic personality is rigid, its content is always in flux. Narcissists forever reinvent themselves, adopt the consumption of narcissistic supply to the marketplace. They are attuned to the needs of their suppliers. Like the performers and the actors that they are, they resonate with their audience, giving it what it expects, what it wants and what it demands. Narcissists are efficient instruments for the extraction and consumption of human reactions. As a result of this interminable process of fine-tuning, narcissists have no loyalties, no values, no doctrines, no beliefs, no affiliations, no convictions. The only constraint is their addiction to human attention, positive or negative. Psychosis and psychotics by comparison are fixated on a certain view of the world and of their place in it. They ignore any and all information that might challenge their delusions. Gradually, psychotics retreat into the inner resources of their tormented mind that become completely dysfunctional. This never happens to the narcissists. Narcissists cannot afford to shut out the world because they are so heavily dependent on it for the regulation of their labile sense of self-worth. Owing to this dependence on narcissistic supply, narcissists are hypersensitive and hyper-vigilant. They are alert to every bit of new data. They are continuously busy rearranging their self-delusions to incorporate new information in an egocentamic manner. This is why the narcissistic personality disorder, in my view, is insufficient grounds for claiming a diminished capacity or insanity defense. Narcissists are never divorced from reality. They crave it. They need it. They consume reality in order to maintain the precarious balance of their disorganized, borderline psychotic personality. All narcissists, even the freakiest ones, can tell right from wrong, act with intent and are in full control of their faculties and actions.