The Psychology of Narcissistic Personality Disorder: A Deeper Look

Narcissistic Personality Disorder (NPD) is a complex and often misunderstood condition that weaves a fascinating tapestry of grandiosity, vulnerability, and a relentless quest for admiration. At the heart of NPD lies a paradox: the outward appearance of an unshakeable self-confidence masks a fragile self-esteem, susceptible to the slightest criticism. This article delves into the intricate world of NPD, exploring the psychological mechanisms that underpin the disorder, the impact it has on interpersonal relationships, and the challenges it presents in therapeutic settings. As we unravel the layers of narcissism, we gain insight into not only the minds of those who live with NPD but also the broader human condition and our intrinsic need for self-worth.

Introduction to Narcissistic Personality Disorder

Narcissistic Personality Disorder (NPD) is characterized by a pervasive pattern of grandiosity, a constant need for admiration, and a lack of empathy. The word narcissism comes from the Greek myth of Narcissus. Narcissus, an attractive young man, was on a quest to find love. Narcissus sought the perfect mate, rejecting anyone that fell short of his idealistic expectation. One day, Narcissus discovered his own reflection in a pool of water. He was smitten by the beauty of his own image. Frozen in his uninterrupted gaze of admiration of himself, he eventually dies (Twenge & Campbell, 2010).

A primary dilemma of our human experience is balancing motivations for self-serving behaviors with behaviors that strengthen our connections to others. An extreme in either side of this dilemma is maladaptive. The narcissistic personality notably gives weight to self-serving behaviors. They try to establish relationships through alternate means of deception, manipulation, and power.

Narcissistic Personality Traits and Narcissistic Personality Disorder

Narcissistic personality traits and Narcissistic Personality Disorder (NPD) share a common focus on self-centeredness, but they differ in intensity, persistence, and impact on daily life. Here’s a comparison:

Similarities

• Both involve a sense of self-importance and entitlement.
• Individuals may seek admiration and have a preoccupation with success and power.

Differences

• Narcissistic Traits: These are characteristics that many people exhibit to some degree. They can be situational and may not significantly impair a person’s life. Traits like confidence and self-assurance can be positive when they do not lead to harmful behavior.
• Narcissistic Personality Disorder: This is a clinical diagnosis characterized by pervasive patterns of grandiosity, need for admiration, and a lack of empathy. To be diagnosed with NPD, individuals must meet specific criteria outlined in the DSM, including having these traits consistently across various contexts and over time.

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In essence, while narcissistic traits can be a normal part of personality and not necessarily harmful, NPD is a recognized mental disorder that leads to significant distress or impairment in social, occupational, or other important areas of functioning. The disorder’s traits are inflexible, maladaptive, and persist beyond the norms of typical narcissistic traits.

Personality Disorders

Before we can understand a diagnosable personality disorder, such as narcissistic personality, disorder, we first must understand the general definition of personality disorder. Basically, personality disorders are a group of mental health conditions characterized by enduring patterns of inner experiences and behavior that deviate significantly from societal norms and expectations. These patterns typically manifest in various areas of an individual’s life, including cognition, emotions, interpersonal relationships, and impulse control.

See Personality Disorders for more on this topic

Diagnosis Criteria for NPD

The DSM-5 criteria for Narcissistic Personality Disorder (NPD) outline a range of symptoms that are indicative of this condition. According to the DSM-5, a diagnosis of NPD requires the presence of at least five of the following criteria, which must be evident by early adulthood and across various contexts:

• A grandiose sense of self-importance: Overestimating one’s abilities and accomplishments, expecting to be recognized as superior without commensurate achievements.
• Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love: Frequently dreaming of unlimited power, success, brilliance, beauty, or ideal love.
• Belief that one is special and unique: Believing that one can only be understood by, or should associate with, other special or high-status people or institutions.
• A need for excessive admiration: Requiring constant, excessive admiration and attention.
• A sense of entitlement: Unreasonably expecting special, favorable treatment or compliance with his or her expectations.
• Interpersonally exploitative behavior: Taking advantage of others to achieve personal ends.
• Lack of empathy: Being unwilling or unable to recognize or identify with the feelings and needs of others.
• Envy of others or belief that others are envious of them: Feeling envious of others or believing that others are enviously regarding them.
• Arrogant, haughty behaviors or attitudes: Demonstrating arrogant, haughty behaviors or attitudes.

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These criteria are part of a broader set of diagnostic guidelines used by mental health professionals to ensure accurate and consistent diagnoses across the field. It’s important to note that NPD is a complex disorder that can significantly impact an individual’s interpersonal relationships and overall functioning. Professional evaluation and diagnosis are essential for anyone who may exhibit these symptoms.

Limitation to Diagnosis

Diagnosis of psychological disorders serves an essential purpose in the treatment field. It creates a uniformity. However, diagnoses through the DSM involves a medical model of disease which is only partially applicable to disorders completely diagnosed through symptoms.

Elsa Ronningstam wrote:

“The attention to narcissistic individuals’ external symptomatic, or social interpersonal patterns (i.e., their grandiosity; arrogance; and self-serving, self-enhancing, and disagreeable behavior) at the expense of their internal complexity (dysregulation in self-esteem, affects, and empathetic capability) and individual suffering (inferiority, insecurity, shame, and intense self-criticism) has also added to the diagnosis’ low clinical utility and limited guidance for treatment” (Ronningstam, 2010).

While Ronningstam’s comments are specifically pointing to the narcissistic personality disorder, the weakness in the diagnostic system can apply to psychological disorders across the board.

Randolph Nesse explains that mental disorders “are a bit different from most other diseases. They don’t have specific causes we have been able to identify, such as the bacteria that cause pneumonia.” Mental disorders “can’t be diagnosed with blood tests the ways diabetes can. They don’t have definitive tissue abnormalities, such as the dying neurons in multiple sclerosis. Instead, mental disorders are defined by clusters of symptoms (Nesse, 2019).

Essentially, Ronningstam is right. We must look beyond the clean, definable list of external behaviors when treating individuals. However, more complex lists, adding inner experiences and suffering, will most likely create more confusions in diagnosis.

History of Narcissistic Personality Disorder

The history of Narcissistic Personality Disorder (NPD) is a fascinating journey through the evolution of psychological thought. Here’s a brief overview:

• Ancient Roots: The term “narcissism” originates from the Greek myth of Narcissus, a young man who fell in love with his own reflection. This myth laid the groundwork for the concept of excessive self-love coupled with disdain for others.
• Early Psychiatric Thought: In the late 19th century, German psychiatrist Paul Nacke was the first to use the term “narcissism” to describe a sexual perversion where individuals took their own body as a sexual object. Havelock Ellis, an English physician, later described excessive masturbation as “narcissus-like” behavior.
• Psychoanalytic Contributions: Sigmund Freud introduced narcissism to psychoanalytic theory, initially describing it as a normal stage in child development and later as a pathological condition. He discovered that narcissistic individuals were not treatable by psychoanalysis (Freud, 1914).
• Modern Classification: It wasn’t until the 20th century that NPD was recognized as a distinct personality disorder. The American Psychiatric Association included NPD, along with the other personality disorders, in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in its third edition. They published this edition in 1981. This inclusion established the criteria for diagnosing NPD and marked its recognition as a distinct personality disorder within the field of mental health. Prior to this, the concept of narcissism had been explored in various contexts, but it was the DSM-III that formalized NPD as a clinical diagnosis.
• Contemporary Understanding: Today, clinical theories, such as those by Heinz Kohut and Otto Kernberg, suggest that adult narcissism has its roots in early childhood experiences, focusing on disturbances in early social relationships as the genesis of adult NPD.

Closer Look at the Key Components of Narcissistic Personality Disorder

Grandiose Sense of Self-Importance

The Grandiose Sense of Self-Importance is a key characteristic of Narcissistic Personality Disorder (NPD). Individuals with NPD often have an exaggerated sense of their own importance, believing that they are special, unique, and deserving of special treatment. They may exaggerate their achievements and talents, expecting constant admiration and recognition from others.

This inflated self-view can lead to behaviors such as dominating conversations, belittling others, and expecting preferential treatment in social or work situations. People with NPD may also become envious of others’ success or believe that others are jealous of them.

Preoccupation with Fantasies of Unlimited Success, Power, Brilliance, Beauty, or Ideal Love

The trait “Preoccupation with Fantasies of Unlimited Success, Power, Brilliance, Beauty, or Ideal Love” is a hallmark characteristic of Narcissistic Personality Disorder (NPD). Individuals with NPD often engage in elaborate daydreams or fantasies where they envision themselves achieving extraordinary levels of success, power, intelligence, physical attractiveness, or perfect love relationships.

This preoccupation with fantasies serves as a coping mechanism for individuals with NPD to escape feelings of inadequacy and insecurity. By immersing themselves in these idealized visions of themselves, they can temporarily boost their self-esteem and validate their sense of grandiosity.

However, this preoccupation with unrealistic fantasies can also lead to difficulties in distinguishing between fantasy and reality. People with NPD may become disappointed or frustrated when real-life experiences fail to measure up to their idealized expectations. This can contribute to interpersonal conflicts, as others may struggle to meet the inflated standards set by individuals with NPD.

Belief in Being Special and Unique

The belief of being special and unique is a core aspect of Narcissistic Personality Disorder (NPD). Individuals with NPD often hold an exaggerated sense of their own importance and believe that they are fundamentally different from others in a way that sets them apart as superior.

This belief in being special and unique can manifest in various ways, such as:

• Exceptionalism: People with NPD may see themselves as exceptional or above the rules that apply to others. They may believe that they deserve special privileges or treatment due to their perceived uniqueness.
• Uniqueness: Individuals with NPD may view themselves as one-of-a-kind, possessing qualities or talents that make them stand out from the crowd. This belief reinforces their need for admiration and validation from others.

Need for Excessive Admiration

The need for excessive admiration from others is a core component of Narcissistic Personality Disorder (NPD). Individuals with NPD have an insatiable desire for validation, praise, and adoration from those around them. This need for excessive admiration serves several functions in the context of NPD:

• Validation of Self-Worth: People with NPD often rely on external sources of validation to bolster their fragile self-esteem. They seek constant reassurance from others to confirm their belief in their own superiority and specialness.
• Maintaining Grandiosity: Excessive admiration helps individuals with NPD uphold their grandiose self-image. By seeking praise and admiration, they reinforce their inflated sense of importance and uniqueness.
• Masking Insecurities: The constant need for admiration can mask deep-rooted insecurities and feelings of inadequacy that individuals with NPD may harbor. Seeking approval from others becomes a way to cope with these underlying vulnerabilities.
• Manipulating Relationships: The need for excessive admiration can lead individuals with NPD to manipulate relationships in order to elicit the desired level of praise and attention. They may use charm, charisma, or elaborate stories to captivate others and gain the admiration they crave.

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We all need some level of affirmation. We need to know that we are accepted and loved. However, self-worth entirely dependent on the admiration of others suggests a lack of internal acceptance of our own personhood.

Basically, the narcissistic personality possesses what we refer to in psychology as contingent self-esteem. Gabor Maté explains contingent self-esteem “depends on circumstances. The greater the void within, the more urgent the drive to be noticed and to be ‘important,’ and the more compulsive the need for status” (Maté, 2010).

Sense of Entitlement

Expecting favorable treatment and compliance with one’s expectations. The narcissist feels entitled to their wants and desires without concern of the impact they may have on others. They are people of action. Todd Kashdan and Robert Biswas-Diener explain that when narcissistic people want something, they want it “without regret, guilt or second thought” (Kashdan & Biswas-Diener, 2015).

David Richo wrote, David Richo wrote that our ego is “indignant about having to kowtow to conditions that do not safeguard its entitlement to fame, fortune, health, happiness, and invincibility. The neurotic ego is not an identity but a set of encrustations: Fear, Attachment, Control, and Entitlement. This is the FACE we keep trying to save and will do anything not to lose” (Richo, 2006). 

See Entitlement for more on this topic

Interpersonally Exploitative Behavior

Interpersonally exploitative behavior is a characteristic trait often exhibited by individuals with Narcissistic Personality Disorder (NPD). This behavior involves taking advantage of others for personal gain, often without regard for the well-being or feelings of those being exploited. Interpersonally exploitative behavior serves several purposes:

• Sense of Entitlement: Individuals with NPD may feel entitled to exploit others as they believe they are special and deserving of preferential treatment. They may use manipulation, deceit, or coercion to achieve their goals at the expense of others.
• Lack of Empathy: People with NPD often lack empathy and may not consider how their actions impact others when engaging in exploitative behavior. Their primary focus is on fulfilling their own needs and desires, even if it means disregarding the rights or feelings of those around them.
• Validation of Superiority: Interpersonally exploitative behavior can reinforce the narcissist’s belief in their own superiority and power over others. By exploiting individuals whom they perceive as inferior, individuals with NPD may bolster their sense of grandiosity and control.
• Maintaining Self-Image: Exploiting others allows individuals with NPD to maintain a facade of success, charm, or influence that aligns with their idealized self-image. They may manipulate situations or people to create an illusion of achievement or dominance.
• Control and Dominance: Interpersonally exploitative behavior can also be driven by a desire for control and dominance over others. Narcissists may seek to assert power through manipulation and exploitation as a means to establish superiority in relationships.

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Interpersonally exploitative behavior reflects a pattern of using others for personal gain while disregarding ethical considerations or consequences for those affected by such actions. It highlights how individuals with NPD navigate interpersonal dynamics through manipulation, deceit, and exploitation to fulfill their own needs and maintain their inflated self-image.

See Manipulating Behaviors in Relationships for more on this topic

Lack of Empathy

Being unwilling or unable to recognize or identify with the feelings and needs of others. A lack of empathy typically in the narcissist suggests that they are “unable to step outside themselves and tune in to what other people experience” (LaBier, 2007). Robert Augustus Masters Ph.D. wrote that “the capacity to feel or emotionally resonate with what others are feeling—known as empathy—is essential to emotional intimacy. Without it we remain isolated from others, cut off from any sort of intimacy” (Masters, 2013).

A healthy experience of empathy is essential for self-regulation with the social environment. Empathy allows for individuals to experience a innate awareness between the self and other people. Ester di Giacomo and her colleagues explain that such ability “involves a governance on personal conduct and appropriateness to the social environment” (di Giacomo, 2023).

Neurobiological explanations for narcissistic personality disorder center around neural explanations for lack of empathy.

See Empathy Deficit Disorder for more on this topic

Envy of Others or Belief that Others are Envious of Them

The trait of “Envy of Others or Belief that Others are Envious of Them” is a common characteristic seen in individuals with Narcissistic Personality Disorder (NPD). People with NPD often struggle with feelings of envy towards others while simultaneously believing that others are envious of them. This dynamic reflects underlying insecurities and a fragile self-esteem that drive their thoughts and behaviors.

In the context of NPD, the envy of others can stem from a deep-seated sense of inadequacy masked by outward displays of grandiosity and superiority. Individuals with NPD may covet what they perceive as qualities, possessions, or achievements possessed by others, leading to feelings of resentment or bitterness. At the same time, their need for validation and admiration may fuel a belief that others harbor similar feelings of envy towards them.

This interplay between envy and perceived envy in individuals with NPD can manifest in various ways:

• Competitiveness: People with NPD may engage in competitive behaviors to outshine or undermine perceived rivals, driven by their own sense of inadequacy and desire for recognition.
• Projection: The belief that others are envious of them can serve as a defense mechanism to deflect attention away from their own feelings of unworthiness or insecurity.
• Validation Seeking: Envy towards others and the belief in being envied can reinforce the narcissist’s need for external validation and admiration to boost their fragile self-esteem.
• Interpersonal Conflict: Feelings of envy towards others coupled with suspicions about being envied can create interpersonal conflicts and strained relationships characterized by mistrust and defensiveness.

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Overall, “Envy of Others or Belief that Others are Envious of Them” in the context of Narcissistic Personality Disorder underscores the complex interplay between insecurity, grandiosity, competition, and validation-seeking behavior that shapes how individuals with NPD navigate social interactions and perceive themselves relative to others.

Arrogant, Haughty Behaviors or Attitudes

Arrogant and haughty behaviors or attitudes are common traits seen in individuals with Narcissistic Personality Disorder (NPD). These behaviors stem from a deep-seated belief in one’s superiority and entitlement over others. People with NPD may exhibit arrogance by displaying an attitude of disdain or condescension towards those they perceive as inferior.

Individuals with NPD may also engage in behaviors that reflect their sense of grandiosity, such as bragging about achievements, expecting special treatment, or belittling others to boost their own self-esteem. They may have a strong need for admiration and validation from others while simultaneously dismissing the opinions or feelings of those around them.

Arrogant and haughty behaviors can manifest in various aspects of the individual’s life, including personal relationships, work environments, and social interactions. These attitudes can create challenges in forming genuine connections with others, as people with NPD may struggle to empathize with or consider the perspectives of those they interact with.

Overall, arrogant and haughty behaviors are key characteristics of Narcissistic Personality Disorder that can significantly impact how individuals navigate their interpersonal relationships and view themselves relative to others.

Dark Personality Triad

The narcissistic personality is an honored member of the dark personality triad along with the machiavellianism and psychopathy personality types. Each of these personality types possess socially aversive characteristics. We can identify them by their varying degrees of self-centeredness, manipulativeness, callousness, and a lack of empathy. Individuals displaying these traits often pursue their own interests at the expense of others and may exhibit a disregard for ethical and moral considerations.

See Dark Personality Triad for more on these personality types

Causes for Narcissistic Personality Disorder

The causes of Narcissistic Personality Disorder (NPD) are not fully understood, but it is believed to result from a complex combination of factors. We can best understand the causes through Dr. George Engel and Dr. John Romano’s biopsychosocial model of health and illness.

• Genetic: There may be inherited genetic vulnerabilities to developing NPD.
• Neurobiological: Changes in the structure or functioning of the brain could contribute to the development of NPD.
• Psychological: Factors such as personality and temperament, and the ability to manage stress and emotions.
• Environmental:
  • Parenting Styles: Overly permissive parenting, excessive pampering, or excessive criticism can contribute to NPD.
  • Childhood Abuse or Neglect: Insufficient warmth, acceptance, or idealization during childhood can lead to disordered self-structure.
  • Cultural Influences: Societal and cultural factors that emphasize individualism and self-promotion over community and cooperation.

Compensating for Insecurity

Several theories about the cause of narcissism swirl around the concept of insecurity. These theories posit that narcissism is a defensive response to excessive fears of inadequacy. Melvin R. Lansky and Andrew P. Morrison wrote regarding the narcissist that “the awareness of defect in regard to one’s own aspirations of perfection or comparison with others—gives rise to shame.” A sense of injustice of having been cheated arises in reaction to that shame. Consequently, these feelings and associated narrative justify “the narcissistic rage” in response to the shame (Lansky & Morrison,1997).

Karen Horney’s Concept of Neurosis

Karen Horney, a German psychoanalyst who made significant contributions to psychology specifically to the concept of neurotic needs, defines neurosis in her book Neurosis and Human Growth, with similar characteristics found in the modern concept of narcissistic personality disorder. She posits that it is a maladaptive response to inner pressures. She wrote that under inner stress, “a person may become alienated from his real self. He will then shift the major part of his energies to the task of molding himself, by a rigid system of inner dictates, into a being of absolute perfection” (Horney, 1950).

Horney explains when the conditions of normal develop are lacking, a child develops alternate means to fulfill their security needs.

She wrote:

“Self-idealization always entails a general self-glorification, and thereby gives the individual the much-needed feeling of significance and of superiority over others. But it is by no means a blind self-aggrandizement…eventually the individual may come to identify himself with his idealized, integrated image. Then it does not remain a visionary image which he secretly cherishes; imperceptibly he becomes this image: the idealized image becomes an idealized self. And this idealized self becomes more real to him than his real self, not primarily because it is more appealing but because it answers all his stringent needs” (Horney, 1950).

Adler’s Concept of Inferiority

Adler proposed that the experience of inferiority is a fundamental motivation for action. He wrote that the “feeling of inferiority and insecurity is always present in the human consciousness. It is a constant stimulus to the discovery of better ways of adapting to life on earth. This stimulus forces humans to seek situations in which they do not appear at a disadvantage in relation to the rest of the natural world” (Adler, 1927). However, Adler proposes that there is also a maladaptive response to the insecurity of inferiority. He refers to this as the inferiority complex.

Adler explains in the inferiority complex that every “natural feeling” or expression of the child carries with it “a hypocritical element with the final aim of the subjugation of their environment.” The child employs several techniques to accomplish this goal. Some of these are “pride, vanity and the desire to get the better of everyone at any price.” The child quickly learns that they may succeed in “relative elevation…by belittling all those with whom they come into contact” (Adler, 1927).

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In summary, the characteristics of NPD reflects a deep-seated need for validation and admiration that real-world achievements or relationships do not easily satisfied. Accordingly, the individual suffering from this disorder constantly seeks validation from outside sources. However, because the constant feelings of inadequacy remain intact, the need from external sources is never satisfied.

Treatment for Narcissistic Personality Disorder

Treating Narcissistic Personality Disorder (NPD) can be challenging, but there are effective strategies that can help individuals manage their symptoms. The primary treatment for NPD is psychotherapy, also known as talk therapy. Here are some of the therapeutic approaches used:

• Cognitive Behavioral Therapy (CBT): Helps individuals recognize and change harmful thought patterns and behaviors.
• Psychodynamic Therapy: Focuses on understanding the underlying unconscious and past experiences that contribute to current behaviors.
• Transference-Focused Therapy: Aims to help patients understand their emotions and interpersonal difficulties through the relationship with the therapist.
• Schema Therapy: Combines elements of CBT with other forms of therapy to address deep-rooted patterns or schemas.

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In some cases, medications may be prescribed to treat co-occurring conditions such as depression or anxiety, although there are no medications specifically approved for NPD. It’s important for individuals with NPD to work with a therapist who has experience with personality disorders. Progress in therapy can be slow and requires patience, but change is possible with consistent effort and a willingness to engage in the therapeutic process.

Associated Concepts

• Cultural Narcissism: This refers to the phenomenon where a society or culture becomes excessively focused on itself, its image, and its importance, often at the expense of understanding or valuing other cultures.
• Self-Esteem Issues: Individuals with NPD often have a fragile self-esteem and require excessive admiration and validation from others.
• Empathy Deficit: A notable lack of empathy and understanding of others’ feelings and needs is a hallmark of NPD.
• Interpersonal Relationships: People with NPD may have difficulty maintaining healthy relationships due to their manipulative and exploitative behavior.
• Entitlement: Feeling entitled to special treatment and expecting others to cater to their desires without reciprocation.
• Vulnerability in Self-Concept: Despite their outward confidence, individuals with NPD can be very sensitive to criticism and may have a vulnerable self-concept.
• Cognitive Distortions (Thinking Errors): These include beliefs of being superior, unique, or associating only with high-status individuals or institutions.
• Emotional Regulation: Difficulty in regulating emotions, leading to impulsivity and mood swings, especially in response to perceived threats to self-esteem.
• Substance Abuse: There is an association between NPD and higher rates of substance abuse, as well as mood and anxiety disorders.

A Few Words by Psychology Fanatic

As we conclude this exploration of Narcissistic Personality Disorder, it’s clear that while the condition may present significant challenges, both for those diagnosed and their loved ones, there is a path forward. Treatment options like psychotherapy offer a beacon of hope, illuminating the journey towards self-awareness, empathy, and healthier relationships. The road to recovery may be arduous, marked by introspection and change, but it is a road worth traveling. With continued research and clinical advancements, our understanding and ability to effectively treat NPD will only improve, fostering compassion and healing for all affected by this complex disorder.

Last Update: August 26, 2025

References:

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Freud, Sigmund (1914) On Narcissism: An Introduction.
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di Giacomo, E., Andreini, E., Lorusso, O., & Clerici, M. (2023). The dark side of empathy in narcissistic personality disorder. Frontiers in Psychiatry, 14. DOI: 10.3389/fpsyt.2023.1074558
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Horney, Karen (1950/1991). Neurosis and Human Growth: The struggle toward self-realization. W. W. Norton & Company; 2nd edition.
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