Therapy For Narcissists With Childhood CPTSD.

Cold therapy follows the premise that narcissistic personality disorder (NPD) is a form of complex traumatic stress disorder (CPTSD) developed from childhood trauma. Cold therapy draws from the successes of child psychology and in treating trauma.

The ICD-11 classification for diseases already recognises personality disorders (PD’s) as CPTSD. According to the ICD-11, the only time a personality disorder is diagnosed instead of CPTSD is when a PD diagnosis might be clinically valuable for the client.

“When the diagnostic requirements for both C-PTSD and PD are met, only the C-PTSD diagnosis should be assigned” — Feilding, Mikkelsen, & Bach.

CPTSD symptoms resonate with victims of narcissistic abuse. Victims of narcissistic abuse often present with symptoms of CPTSD such as emotional flashbacks, where they feel the same emotions they did following traumatic episodes, and difficulties controlling their emotions, specifically shame, fear, and anger.

Though narcissistic abuse syndrome is not officially recognised, it presents as a form of CPTSD. Victims often wonder if they have a narcissistic personality disorder (NPD) by the time the narcissist is done with them or they’re done with the narcissist. Victims’ perceptions distort through emotional abuse, and they effectively pick up on narcissistic traits over time.

Sam Vaknin’s cold therapy proposes to treat adult narcissistic responses to childhood CPTSD through techniques that re-traumatise narcissists, forcing them to challenge the use of specific coping mechanisms such as the false self and grandiosity.

What is CPTSD?

The ICD diagnosis for CPTSD or complex post-traumatic stress disorder requires symptoms of disturbances of self-organisation (DSO) and symptoms from each of the three criteria for post-traumatic stress disorder (PTSD) in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-V). DSO symptoms include difficulty recovering from distress, somatic signs of distress, recklessness, self-harm, and an inability to express emotions.

The DSM-V does not recognise CPTSD though there are significant overlaps with CPTSD and PTSD, such as emotional dysregulation, altered core self-beliefs, and detachment in relationships. Emotional flashbacks are a feature of complex PTSD and PTSD where patients relive the emotions and physical experience of a traumatic event through, often unrelated, triggers.

Common symptoms of CPTSD include frequent emotional numbing, relationship hostility from attachment issues, hypervigilance, avoiding triggers, emotional flashbacks, and difficulty controlling fear, anger, guilt, and shame.

PTSD trauma more likely develops from single traumatic experiences such as war, a severe car accident, a natural disaster, a life-threatening illness, or witnessing a sudden and unexpected violent episode.

Whereas, examples of CPTSD traumatic experiences include torture, slavery, being a prisoner of war, constant manipulation, and witnessing or being exposed to continuous physical, emotional, and sexual abuse.

CPTSD symptoms can differ from PTSD in that CPTSD patients experience increased feelings of being unsafe, different from others, and detached from reality.

People with CPTSD frequently exhibit histories of neglect, emotional, physical, or sexual abuse. Family violence, parental mental illness, criminality, and substance abuse foster vulnerabilities in children that lead to CPTSD. Inconsistent, insecure, and abusive attachments to a child’s primary caregiver also increase the risk of CPTSD.

Gillian May outlines the following eight symptoms of CPTSD:

Narcissism and CPTSD.

CPTSD was proposed as an alternative diagnosis to borderline personality disorder (BPD). CPTSD has been referred to as a “repackaging or duplication of BPD”, with several common symptoms.

There are many differences between CPTSD and BPD, such as fear of abandonment and idealisation/devaluation, specific to a BPD diagnosis. People with CPTSD and BPD have shown significant distinctions in brain structure and functioning.

But what about narcissistic personality disorder (NPD) as a set of symptoms developed from childhood CPTSD?

A child raised by a narcissist suffers throughout their prime years; in that birth to the five-year range, we learn how to experience, regulate, and express our emotions.

“If the parents are dysfunctional, then so will be the messages the child receives about self, others, the world, relationships, and love” — Lisa A. Romano.

CPTSD symptoms don’t appear to resonate with the symptoms of narcissism. However, significant impairments of the self, attachment, and emotional regulation reflect trauma and CPTSD.

According to Sam Vaknin, the creator of cold therapy, NPD results from attachment dysregulation and arrested development along with the creation of a false self as a transcendent safe place.

What is Cold Therapy?

Sam Vaknin, a professor in psychology and diagnosed pathological narcissist, has been developing the cold therapy method since 2011. Cold therapy is re-traumatising a person with narcissistic personality disorder (NPD) to manage and survive the trauma as an adult.

The method has been successful with 47 clients; it has been particularly effective for depression and other comorbid disorders such as BPD. None of the clients reverted to narcissism, and many no longer relied on their dysfunctional narcissism after only three months of therapy.

The goal is to process the original trauma, replacing existing harmful coping mechanisms to form an internal resolution with new tools to replace the need for a false self.

“The adult patient successfully tackles this second round of hurt and thus resolves early childhood conflicts and achieves closure rendering his now maladaptive narcissistic defences redundant” — Sam Vaknin.

Cold therapy aims to treat the heart of the trauma that created narcissistic traits; it exposes the person’s core, allowing them to be vulnerable and face the trauma as an adult to deconstruct the false self.

Speculations that NPD is regression, a schema, defence, or personality disorder is rejected in cold therapy, which takes a broader approach to treatment.

How Cold Therapy Works.

Cold therapy recognises NPD as an attachment dysfunction stemming from restrictions in maturity. It works with the core trauma and encourages a hostile environment where the patient can process it.

The first step in cold therapy is identifying the core trauma to recreate through the therapy process. Cold therapy treats the child within the narcissist using various techniques drawn from treating trauma and child psychology.

“If we treat the narcissist as a child … here are two successes, trauma and child, when you put them together and you are likely to cure narcissism” — Sam Vaknin.

Cold therapy resolves existing issues with treating NPD such as false self-reporting, therapists developing burnout, treating child trauma with adult techniques, and transference and counter-transference.

Cold therapy instead makes use of some of these adverse effects of existing treatments. The tendency for a person with NPD to see their therapist as a representation of their trauma source is helpful in cold therapy, where re-traumatisation is part of the process.

Cold therapy goes against traditional treatments, creating a hostile environment rather than a holding empathic environment.

The patient is led through a skilled reliving of the experience while the trained therapist monitors the patient’s responses, coordinating and allowing them to apply better coping mechanisms and resolution.

Cold therapy applies 25 techniques along with three levels. Examples of these techniques include erasure, grandiosity reframing, guided imagery, negative iteration, other-scoring, happiness map, mirroring, escalation, role play, assimilative confabulation, hypervigilant referencing, and re-parenting.

These 25 techniques reflect methods also used in other areas such as child psychology and psychoanalytic theory. Such practices have been modified, and their application often goes right against the goals of traditional therapy. For example, the victim stance and grandiosity is encouraged in grandiosity framing and guided imagery, and patients speech is suppressed in erasure.

“In all other therapies we encourage people to share and communicate, but in cold therapy, we actually encourage the patient to shut up” — Sam Vaknin.

In erasure, keywords that link to the original trauma are suppressed when the therapist either actively silences the patient or renders the keywords irrelevant. Cold therapy works with fear-based memory rather than against it, virtually filling in the gaps that produced the fear in the memory.

Another technique is grandiosity reframing, where the false self is leveraged and used against itself in a type of self-destruction. Cold therapy also encourages the patient to fantasise and catastrophise, acknowledging the patient’s thoughts and feelings, then comparing them to reality in a controlled manner.

The Challenges.

Though the sample was small, as of January 2020, the 47 clients that had cold therapy were all said to have recovered from depression and narcissism, and results were still positive up to 6 years after treatment.

Sam Vaknin has many critics, and his credentials have been under great scrutiny. However, he is a professor in psychology and diagnosed with NPD, so he likely has a strong perception of narcissism. It would be interesting to learn how the therapy has worked on him, assuming he’s taken the plunge.

People with NPD may be on medication and suffer considerable mental distress, so trained professionals must carefully monitor cold therapy to prevent risks of re-traumatising an individual and generating further problems.

Cold therapy is not yet tried and tested enough to indicate its long-term efficacy as with any new treatment. More research and more trained therapists taking up the practice in a clinical setting should uncover the benefits and drawbacks of cold therapy over time.

Sam Vaknin holds small workshops for therapists to train in cold therapy and certifies therapists following successful completion of the workshops. These workshops should increase the practice of cold therapy to identify its progress and success in treating NPD.

Thank you for reading.