NPD Brains Work Differently

According to research, people with NPD have reduced gray matter volume in areas of the brain related to empathy and heightened activity during rest in brain regions associated with self-directed and self-absorbed thinking.

“Our data shows that the amount of empathy is directly correlated to the volume of gray brain matter of the corresponding cortical representation in the insular region, and that the patients with narcissism exhibit a structural deficit in exactly this area,” states Dr. Röpke, commenting on the findings. “Building on this initial structural data, we are currently attempting to use functional imaging (fMRI) to understand better how the brains of patients with narcissistic personality disorder work.”

Narcissists reject children who are not like them

Survival in a narcissistic family depends on each family member’s ability to take on and reinforce the assigned roles, toxic attitudes, and habits of the narcissist. No one is safe from a narcissist’s pernicious scrutiny, not even their children.

In the narcissist’s view, anyone who does not echo their image of themselves is rejecting them. Failure to reflect and affirm their false self is a threat. Thus, a child who does not accept the role assigned by the narcissistic parent triggers a narcissistic injury.

A lot of different personalities develop in the narcissist’s ecosystem.

The narcissist cannot process negative feedback, and by extension, nor can their family unit. They have zero tolerance for any person or thing they believe may endanger their fragile false self. When faced with such a threat, narcissists attack — even if the source of their ire is an infant.

Narcissists see a child’s individuality as an act of insubordination. Their response to this perceived narcissistic injury is contempt, oppression, and rejection of the offending child. As an act of expediency, the narcissist casts the child in the psychologically devastating role of the family scapegoat. The narcissist condemns the child to bear the blame for all of the family’s dysfunctional behavior and its outcomes.

Childhood Emotional Neglect

Childhood trauma has consistently been identified as a risk factor for PPD, in at least 4 cross-sectional studies and one longitudinal study. The longitudinal study found that childhood emotional neglect, physical neglect, and supervision neglect predicted PPD symptom levels in adolescence and early adulthood [63]. In adolescence, PPD has been cross-sectionally associated with elevated physical abuse in childhood and adolescence, but not sexual abuse [64]. In this study, patients with PPD were also more likely to have PTSD. In a study of psychiatric adult outpatients, PPD was found to associated with both sexual and physical abuse [65]. These relationships were found with other personality disorders as well, and were not specific to PPD. Childhood abuse was also related to PPD symptom level, suggesting a dose-response relationship, even when PPD symptoms were subthreshold for the diagnosis [66] [67]. Although these studies have focused on chronic trauma from caregivers, acute physical trauma in the form of childhood burn injury has also found to be a risk factor for adult PPD traits [68].

Brain trauma has been hypothesized to be a risk factor for paranoia [69]. Empirical, cross-sectional research finds that between 8.3 – 26% of brain injury patients meet PPD criteria [70] [71]. PPD was the second most common PD following TBI [71]. Longitudinal studies in this area are lacking, but are needed to establish the temporal sequence of the association. Another important question regarding the associating with brain injury and PPD is if the relationship is due to neural circuit dysfunction, or if a change in function as result of the injury alters social interactions. As an example of this, persons who are hard of hearing are more likely to develop paranoia, likely through increased difficulty with and stress from communication with others [72].

DSM-5 Criteria for Paranoid Personality Disorder

A. A pervasive distrust and suspiciousness of others such that their motives are interpret- ed as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

  • 1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
  • 2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
  • 3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
  • 4. Reads hidden demeaning or threatening meanings into benign remarks or events.
  • 5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
  • 6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
  • 7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or a depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.

The right hemisphere of the brain dominates self recognition

The right hemisphere of the brain dominates self recognition, emotional familiarity and ego boundaries. After injury, the left hemisphere tends to have a creative narrator leading to excessive, false explanations. The resistance of delusions to change despite clear evidence that they are wrong likely reflects frontal dysfunction of the brain, which impairs the ability to monitor self and to recognize and correct inaccurate memories and familiarity assessments. Thus, right hemisphere lesions may cause delusions by disrupting the relation between and the monitoring of psychic, emotional and physical self to people, places, and even body parts. This explains why content specific delusions involve people places or things of personal significance and distort ones relation to oneself, the author explains.

Delusions associated with consistent pattern of brain injury

“Problems caused by these brain injuries include impairment in monitoring of self, awareness of errors, and incorrectly identifying what is familiar and what is a work of fiction,” said Dr. Devinsky, professor of Neurology, Psychiatry and Neurosurgery and Director of the NYU Epilepsy Center at NYU Langone Medical Center. “However, delusions result from the loss of these functions as well as the over activation of the left hemisphere and its language structures, that ‘create a story’, a story which cannot be edited and modified to account for reality. Delusions result from right hemisphere lesions, but it is the left hemisphere that is deluded.” 

Often bizarre in content and held with absolute certainty, delusions are pathologic beliefs that remain fixed despite clear evidence that they are incorrect. “Delusions are common problems in a variety of psychiatric and neurological disorders,” said Dr. Devinsky. “Psychiatric disorders with delusions, for example- schizophrenia, have been proven to have functional and structural brain pathology. But now improved diagnostic techniques are allowing us to have increased identification of neurologic disorders among other patient populations with delusions.”

Cognitive neuropsychiatric models of persecutory delusions

People with persecutory delusions selectively attend to threatening information, jump to conclusions on the basis of insufficient information, attribute negative events to external personal causes, and have difficulty in envisaging others’ intentions, motivations, or states of mind. Presence of the “reality distortion” cluster of psychotic symptoms correlates with cerebral blood flow in the left lateral prefrontal cortex, ventral striatum, superior temporal gyrus, and parahippocampal region. Social cognitive processing (selective attention to threat, attribution of causation or mental states) in normal subjects involves similar areas. Neural network models of persecutory delusions highlight the importance of disordered neuromodulation in their formation and of disordered neuroplasticity in their maintenance.

Neurobiology of Delusions

Delusions are the false and often incorrigible beliefs that can cause severe suffering in mental illness. We cannot yet explain them in terms of underlying neurobiological abnormalities. However, by drawing on recent advances in the biological, computational and psychological processes of reinforcement learning, memory, and perception it may be feasible to account for delusions in terms of cognition and brain function. The account focuses on a particular parameter, prediction error – the mismatch between expectation and experience – that provides a computational mechanism common to cortical hierarchies, frontostriatal circuits and the amygdala as well as parietal cortices. We suggest that delusions result from aberrations in how brain circuits specify hierarchical predictions, and how they compute and respond to prediction errors. Defects in these fundamental brain mechanisms can vitiate perception, memory, bodily agency and social learning such that individuals with delusions experience an internal and external world that healthy individuals would find difficult to comprehend. The present model attempts to provide a framework through which we can build a mechanistic and translational understanding of these puzzling symptoms.

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