A Neuroscience Video on Brain Studies of People with Clinically Diagnosed Narcissistic Personality Disorder, and Brain Studies on Veterans and Victims of Narcissistic Abuse

Here is the video by Richard Grannon, and I highly recommend it. It explains so much, and I'm sorry that I didn't follow these studies myself. What an eye-opener!:

In an explanation about my own failures at studying the neuroscience angle, I knew about Dr. Lars Sulze writing in The Journal of Psychiatric Research called "Gray Matter Abnormalities in Patients with Narcissistic Personality Disorder" (2013). I discovered the article in the summer of 2014. 

Anyway, I figured that article was a huge breakthrough, but I didn't think to follow through on the possibilities of more professional science based papers on brain studies. Since it was the first of its kind, I thought studies would halt there for a long time. Wow, was I wrong!

So many narcissistic traits are actually a brain matter, which changes things quite a bit (doesn't it?), including:

* Not being able assess social situations accurately when the narcissist feels under threat - coming from low volume in the anterior insula. 

* "My feelings and thoughts are like your feelings and thoughts" - also from low volume in the anterior insula of people with NPD.

But before I go into more of the NPD studies, I'll do what Richard Grannon did, I'll talk about what was discovered with the victim's brains in comparison first. 

When studying the brains of the victims of narcissistic abuse (and soldiers with PTSD), they found similar low volume in the anterior insula. However, why don't victims act like the narcissists? 

From Richard Grannon's video on the victims of narcissistic abuse: 

(4:37) "Scientists found not only low volume in the anterior insula, but impaired emotional regulation and heightened threat sensitivity. It was also found in 2011 that the female survivors of CSA with Post Traumatic Stress have reduced anterior insula volume relative to controls. So, how's neuroscience effectively shown us that traumatized targets of narcissistic abuse effectively have the mirrored brain of a person with NPD? Perhaps in some sense the answer is 'yes', structurally, but perhaps not functionally. When I pursued the question 'Has the research indicated that the person with PTSD been shown to have less affective empathy, the answer is very, very interesting and very pertinent to the victims of narcissistic abuse. According to this research shown on the screen (5:32), veterans with PTSD showed altered anterior insula activation during empathy-for-pain tasks. They didn't lack empathy, instead their responses were exaggerated and dysregulated, often blending into personal distress. In a study published in 2009, survivors of trauma from PTSD did not show global empathy loss, but had impaired perspective-taking and increased personal distress when confronted with other's suffering. So it's not that those with Complex Post Traumatic stress responses lack empathy, but when they see another person in pain, it generates a strong emotional flashback response and they become very dysregulated in an exaggerated disproportionate way (video shows a woman crying). In these studies, they didn't seem to be able to adopt a perspective that allowed them to understand that another person was in distress without going into deep personal distress themselves at the same time. Thus blurring the boundaries between self and other. If all of this is getting a bit confusing, don't worry. The neuroscientists are here again to save the day with some functional findings. If you look at the study on the screen here, it showed that FRMI studies show that when PTSD sufferers see someone else in pain, the anterior insula over-activates. Now this is crucially different to what is observed in patients with NPD when the anterior insula is structurally reduced, producing no empathy, under-activation or only shallow displays of empathy. The brain of a target and the NPD is somewhat mirrored in structure, but clearly not in functioning." (7:32)

I would say they were quite the opposite. 

I just got through publishing a post days ago about how, as a Kindergartener, I would experience the pain of other children. One was from a girl in school with scraped up knees and another from seeing a girl on a playground getting her hair ripped out from a boy. I talk about that in the linked post. 

I was told from a mental health practitioner that it was most likely HSP, a genetic anomaly which I attributed to my father and my father's side of the family. I had it in childhood and way beyond. Only recently has it subsided a bit so that it is manageable instead of overwhelming. 

Then I saw this video only two days later, and it changed my whole perspective.

And now I find out that it is actually a PTSD trait. Wow. For me it is shocking because it probably means I had PTSD (or actually C-PTSD) by Kindergarten. Not that it is surprising because my childhood was absolutely miserable and barely survivable, at least for me. The only respite were summers where life drastically changed (and that's what I hung in for). I can't say I really noticed the symptoms attributed to PTSD until they got really, really bad: by age 10. 

Of course I didn't know I had CPTSD when I was a child, but when I found out about the physical symptoms attributed to PTSD as an adult, it was clear that those symptoms peaked in a huge way at ten. First came lack of sleep as it does for a lot of humans with PTSD. 

What it also showed me was how impossible relationships between people with NPD and PTSD are. NPD empathy is dead when people are under stress, and the empathy of people with PTSD becomes hyper activated - what a recipe for a disastrous relationship between the two!

You'd hope that the person with NPD would stay away from the person with PTSD, but NPDs see PTSD and empathy as exploitable. And they'd have to have empathy to say to themselves, "I must not hurt a person with PTSD." - clearly that won't happen if the empathy is very low or non-existent. 

Which brings me to the discussion of hoovering by narcissists with victims of narcissistic abuse. Women go back to their violent partners seven times before breaking free. The question has to be asked, "Why so many times?" And I bet those NPDs know exactly what buttons to push to activate the person to go back to them: rain real tears from their eyes and act like they are in so much pain.

Of course, it has to be convincing to the person with PTSD. If there's any of the "You are the perpetrator, and I am the victim", then hoovering won't work for the narcissist (i.e. pretending to be a victim of the PTSD person - having empathy does not mean empaths are stupid). Narcissists who are scary, punishing or vengeful will most likely not get their victims back either unless there is no immediate way out for the victim (like the NPD using false imprisonment on the PTSD person). Putting victims in extreme poverty sometimes works in getting them back if the victims are homeless, hungry and getting more battered on the streets than they were with the narcissist, but more of them stay away than go back even with those dire circumstances or they leave soon after going back (from what I see in forums).

But when an NPD shows up with tears, and pain, and an inability to get relief, the PTSDer feels their pain and takes him or her back. And then the abuse invariably starts again because even if the NPDer is in pain does not mean the NPDer has changed.

I think it is good for all survivors to be aware of this. You can cry when they cry, and feel the pain that they feel when this happens (you probably don't have a choice anyway), but watch that the boundaries you've built against the NPD's abuse don't melt away altogether. I have often been unsuccessful at it myself in the past (though not so much in the present), so I know it is really, really hard as it's natural in "neuroscience terms" for the boundaries between you and them to melt away, especially when they are in pain. Relief of their pain, if they are in pain at all, I figure, has to come in another form other than taking them back.

If they rage over the fact that you won't take them back, or if they threaten you, that's the tell tale sign they haven't changed. That's a showing of typical NPD behavior. 

I think that NPDers are sorry for people with empathy, that it can be exploited, and that predatory people will take advantage of it and burden and hurt the empath. However, it also works the other way around too. People with heightened empathy can feel sorry for people with NPD because they don't fit in social situations very well. NPDers often complain in their own forums that they have to pretend to feel empathy in order to make friends with other people, and that they feel awful because they have to fake it and lie a great deal, and that it is only an inconvenient exhausting cover-up.

There is a lot they will just not understand in conversations, and most people will usually choose an empath over a person without empathy to be their closest friends and confidantes.

In fact maybe NPDers are kind of damned in social situations because they have to be a lot more inauthentic than they'd like to be (hiding behind masks), and they feel they can't say what they really feel and think except with people who they think are hopelessly powerless to buck their control, or with other NPDs (who may compete with them and beat them at their own game, and abuse them, particularly if the other NPD is higher on the spectrum).

Another question I ask is if there is even more empathy in scapegoat children of narcissistic families than there are adults with PTSD? After all, scapegoating is a pretty egregious act of abuse, and it is happening during the most impressionable years of childhood when the neuroplasticity of the brain is at its most malleable. 

As I've hinted at before, I will try to look into more on this entire topic.

I know that trauma therapy is very much about the neuroscience of the brain. It takes knowing the brain of people who are experiencing trauma to know what to do to change a person from experiencing terrible symptoms into a space where they are experiencing peace and joy instead. A lot of the methods are about tricking the brain in such a way that you feel peace. However, it is a long haul. 

And guess what? You can't experience healing when you are re-traumatized over and over again. So the company you keep can have a lot to do with how well you heal, and experience joy and peace. 

Anyway, to continue with other data about the brains of NPDs that this video enlightens us to ...

With these other parts of the brain, NPDs don't have much in common with people with PTSD, only in the region of the anterior insula as discussed in prior paragraphs.

So here are the other brain studies on NPD that the video enlightens us about:

* Evidence of the shrinking of the dorsa lateral prefrontal cortex, an area of the brain that is responsible for planning, self control, and understanding others' perspectives. What this adds up to is a difficulty going from self-focus to other-focus, and poor impulse control.

* Evidence of the shrinking of the medial prefrontal cortex.
     This area controls moral reasoning, understanding what is ethically right from what is ethically wrong, and the ability (or inability in NPD) to take the "moral high ground" instead of giving into impulses that would compromise that. People who are moral are also capable of imagining what someone else is thinking or feeling enough to know that their own image as a moral person might suffer if they exploit or hurt the other person. What this means is that narcissists have a diminished capacity for this and can easily act on aggressive tendencies and solutions instead. This is also the main area of the brain that makes it hard for NPDs to take criticism (because they can't understand the other person's perspectives, and because their first thought is not going to be to "take the moral high ground").

* Evidence of shrunken part of the anterior cingulate cortex, posterior cingulate cortex and superior temporal gyrus. 
     Can mean grandiosity, "contingent morality or morality based on only certain outcomes", a belief they are right and being really, really stuck only in one's own viewpoint, a hypersensitivity to criticism, a tendency to break from empathetic responses.

From Richard Grannon (15:32): "Now the more science-y among you will be asking at this point 'Okay, this is all very cool. Was this study ever successfully replicated?' And the answer is 'Yes, multiple times with consistent results - by neuroscientists, Dr. Nenadic and Jauk. So, Nenadic produced brain structure correlates with Narcissistic Personality Disorder and then he did it again in 2021 in a paper called "Brain Structure Correlates of Narcissistic Traits in a Clinical Sample." ... 
     ... (the scientists) "cannot determine whether the PD, the personality disorder, is caused by these brain differences or if having the PD, the personality disorder, causes the brain differences. So we don't know which is causing which. It's a 'chicken and egg' scenario."

Okay, I'm going to step in here and interrupt because there is also enough evidence that the Golden Child in a narcissistic family system is the most likely to become another narcissist. This is the favorite, most often "spoiled child". So that would point to upbringing more than being born with an atrophied brain.

There is also evidence that people who hold on to power for too long become unempathetic. Golden children have so much power over their siblings, too much even, and if they get in the habit of using it constantly, perhaps a whole childhood full of it, their empathy disappears. This might also point to upbringing or life circumstances more than being born with an atrophied brain. 

So it seems to me that it would have some, if not more, of a nurture component compared to a nature component (i.e. be more about upbringing than heredity and genes). But I'm not a scientist. I just like to research. Perhaps an answer can become clear over time.

Also, I have trouble with just chalking up all NPD traits to an atrophied brain. Obviously it has much more to do with the brain than I otherwise knew, but it doesn't account for narcissists trying very hard to keep their abuses, lack of morals, and not having much, if any empathy, a secret from others. They know enough to keep secrets and display a personality style that others might like that hides the rage, the abuse, putting their children into awful rigid roles, and their addictions and affairs, and so much more, so since that takes conscious thought, it can't be all an involuntary brain matter. 

One other reason I am bound to think that their behaviors aren't just an involuntary brain matter is because people with PTSD who also have an atrophied anterior insula sometimes experience PTSD as a phase (in other words, some of them don't have PTSD for life, or where some of their symptoms disappear). The hippocampus can reduce in volume due to prolonged stress, including post traumatic stress, but can start to repair, regenerate and grow in volume when stress factors are removed. 

And while the anterior insula of PTSDers cannot grow new neurons, other parts of the brain can repair the damage through compensatory networks, most commonly the cingulate cortex. 

So it would stand to reason that if something was removed from an NPDers life, the brain could also change. 

The other thing I wonder about is that alcohol also atrophies the brain. One part of the brain after another becomes damaged the more an addicted a person becomes and when they stay an addict (more or less permanently) until even the part of the brain that controls motor skills (the motor cortex) is deeply compromised. How does that work with NPD?

My own experience with an NPDer with alcohol use disorder is that I was in imminent danger. The flight response I experienced did not even have a modicum of a double-take.

But, back to Richard Grannon:
"The brain is malleable. This is called neuroplasticity. And like a muscle that is practiced frequently grows in strength. What is neglected or injured atrophies and gets smaller ... So, if you're not practicing empathy, seeing other people's point of view, being humble, being kind ... if you're not practicing it, you might just actually experience atrophy. ... 
     ... "So the indications for therapy for Narcissistic Personality Disorder, as far as I can tell, would be to try to develop the parts of the brain that are shrunk in their volume through consistent daily practice, and progressive overload, much in the way that you would do strength training. You would need to generate neuroplasticity, select an attribute, and then work on that attribute over, and over, and over again ... attributes like humility, mental flexibility, the capacity to see things from other people's point of view, being resilient in the face of criticism. And I think that would take quite a lot of work to do. And neuroplasticity peaks in the first quarter of a life that we are gifted with. And then it drops off. So I wanted to know how long it would take an adult to actually start to make these changes in their brain in such a way as that could actually effect the person's personality functioning. And if someone was doing exercises like this daily with consistency, that the effect on brain volume would be observable inside of  six months. But don't get excited yet. To actually have an impact that would actually effect the personality in a way that was consistent would be more like three to five years. The question here is: 'Why is the theoretical human being with Narcissistic Personality Disorder that we have created in this fantasy scenario is doing this if they believe their Narcissistic Personality Disorder is an advantage to them and flawed forward/all, and they don't think they have anything wrong with them and that the problems are out there in the world ("the problem is with my wife who wants me to get better or she's going to divorce me; or my boss who wants me to change or else she's going to fire me; or on and on and on; it's all you, you, you, you, you, and why would I engage in this difficult, and what I'd imagine would be a fairly grueling task that's going to last years, for a fairly small, meager return on investment? Why would I be motivated to do that?")" .... 

Richard Grannon has a university degree in psychology and has been researching CPTSD, Narcissistic Personality Disorder, Healing Modalities, and Narcissistic Abuse for over a decade and has written a number of books on the subject, including one that is autobiographical. He is not a PhD with a lab, but I still think he is relevant. 

I think that researchers who are not PhDs can offer up more ideas and questions than the people with degrees. We are allowed to bring up holes in the research, like why are NPD parents not monitored for child abuse, why isn't it clear whether NPD is caused by a shrunken brain or whether the Personality Disorder contributes to shrinking the brain? And what do we do with NPDs in society (other than elect them to a national office with terrible consequences ... and why are they elected in the first place, when the dictates of their personality disorder will always come first)? There are so many questions that PhDs don't dare to ask, especially if they can't know the answers. So I do think people like Richard Grannon bring something to overall conversations in this domain.