 My name is Sam Vatnin. I'm the author of Malignancy Flug, Narcissism Revisited. Narcissistic personality disorder is often diagnosed with other mental health disorders. Other personality disorders, such as borderline, is trionic or antisocial. This phenomenon of multiple diagnosis in the same patient is called co-morbidity. It is also often accompanied by substance abuse and other reckless and impulsive behaviors. And this is called dual diagnosis. Narcissists are often paranoid. Some of them are schizoid. They avoid contact with other people. The basic dynamic of this particular brand of co-morbidity goes like this. The narcissist feels superior, unique, entitled, and better than his fellow men. He thus tends to despise other people, to hold them in contempt and to regard them as lowly and subservient beings. The narcissist feels that his time is invaluable. His mission is of cosmic importance. His contributions to humanity are priceless. He therefore demands total obedience and catering to his ever-changing needs. Any demands on his time and resources is deemed to be both humiliating and wasteful. But the narcissist is dependent on input from other people for the performance of certain ego functions, such as the regulation of his sense of self-worth. Without narcissistic supply, without adoration or attention from other people, the narcissist shrivels, crumbles, and withers, and he becomes dysphoric, or in other words depressed. So on the one hand, he despises other people and holds them in contempt and regards them as inferior, but on the other hand, he is completely and utterly dependent on them. The narcissist resents this dependence. He is furious at himself for his own neediness and clinging. And in a typical narcissistic manoeuvre, which is called alloplastic defense, the narcissist blames other people for his own anger and fury. He displaces his rage and its roots. Many narcissists are paranoid. This means that they are afraid of people and of what people might do to them. Wouldn't you be scared and paranoid if your very life dependent continually on the good will of others? The narcissist's very life depends on others providing him with narcissistic supply. He becomes suicidal if they stop doing it. In the absence of narcissistic supply, the narcissist dies either mentally or physically. So this dependence on others creates paranoia. Will they cease? Will they stop supplying him with the narcissistic supply? Will they doom? Will they judge him? Will they condemn him to death? To counter this overwhelming feeling of helplessness, dependence on narcissistic supply, the narcissist becomes a control freak. He sadistically manipulates others to satisfy his own needs. He derives pleasure from the utter subjugation of his human environment. Pleasure and relief from anxiety. Finally, the narcissist is a latent masochist. He seeks punishment, castigation and excommunication. This self-destruction is the only way to validate powerful voices that he had internalized as a child. His parents told him, you are bad, rotten, hopeless. You are an evil child. And so these voices inside him still go on, and they go on in the form of what we call a satistic superego. He wants to satisfy this superego, and so he punishes himself, self-destructs and self-defeats. The narcissistic landscape is therefore fraught with contradictions. The narcissist depends on people, but hates them and despises them. He wants to control people unconditionally, but is also looking to punish himself savagely. He is terrified of persecution and his persecutory anxiety, but he seeks the company of his own persecutors compulsively. The narcissist is the victim of incompatible inner dynamics, ruled by numerous vicious circles, pushed and pulled simultaneously by irresistible forces and urges. A minority of narcissists choose the schizoid solution. They choose in effect to disengage both emotionally and socially. They become recluses and hermits, but they are no more in the social sense and even in the psychological sense.