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Narcissistic Personality Disorder: Beyond the DSM Diagnosis

Beyond Textbook Definitions: The Reality Of Npd

Understanding Eating Disorders: Types, Signs, And Treatment by Som Dutt From https://embraceinnerchaos.com

Last updated on December 18th, 2024 at 04:11 am

Have you ever felt like you’re walking on eggshells around someone, constantly second-guessing your every move? If so, you might have encountered a person with Narcissistic Personality Disorder (NPD).

But hold on – this isn’t just another clinical diagnosis to be tucked away in a dusty DSM manual. It’s a complex, often heart-wrenching reality that affects millions of lives every day.

Imagine feeling invisible, unworthy, and emotionally drained, all because of someone else’s insatiable need for admiration. That’s the devastating impact NPD can have on its victims. But here’s the kicker: understanding NPD goes far beyond textbook definitions. It’s about unraveling the intricate web of manipulation, gaslighting, and emotional abuse that narcissists weave.

In this eye-opening blog post, we’re diving deep into the murky waters of NPD, exposing the raw truth that lurks beneath the surface. You’ll discover shocking insights that will make you question everything you thought you knew about narcissism.

Get ready to embark on an emotional rollercoaster as we explore the hidden facets of NPD that the DSM doesn’t tell you about. Buckle up – this ride might just change your life.

Limitations of DSM in Identifying Covert Narcissism

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has long been the gold standard for diagnosing mental health conditions. However, when it comes to Covert Narcissism, the DSM falls short. Its criteria primarily focus on overt manifestations of narcissism, leaving subtler forms unrecognized.

This oversight can lead to misdiagnosis or missed diagnoses altogether. Covert narcissists often fly under the radar, their behaviors less flamboyant than their overt counterparts. They may present as shy, insecure, or even self-deprecating, masking their true narcissistic tendencies.

The DSM’s limitations become particularly problematic in clinical settings. Mental health professionals relying solely on DSM criteria might overlook the subtle signs of covert narcissism. This can result in inadequate treatment plans and prolonged suffering for those affected by this insidious form of narcissism.

Moreover, the DSM’s rigid categorization doesn’t account for the spectrum nature of narcissistic traits. It fails to capture the nuanced expressions of narcissism that exist between the extremes of ‘normal’ and ‘disordered’. This black-and-white approach can leave many individuals in a diagnostic gray area.

Professional Approaches to Accurate Diagnosis

Given the DSM’s shortcomings, mental health professionals are adopting more comprehensive approaches to diagnose Narcissistic Personality Disorder (NPD). These methods aim to capture the full spectrum of narcissistic behaviors, including those exhibited by covert narcissists.

One such approach involves extensive clinical interviews. These in-depth conversations allow therapists to explore the patient’s thoughts, feelings, and behaviors beyond surface-level symptoms. By delving into past experiences and current relationships, clinicians can uncover patterns indicative of covert narcissism.

Psychological testing also plays a crucial role in accurate diagnosis. Tests like the Narcissistic Personality Inventory (NPI) and the Pathological Narcissism Inventory (PNI) can reveal narcissistic traits that might not be immediately apparent. These assessments help differentiate between overt and covert forms of narcissism.

Observing interpersonal dynamics during therapy sessions provides valuable insights. Covert narcissists may exhibit subtle manipulative behaviors or show a lack of empathy in their interactions. Skilled therapists can pick up on these cues, even when they’re not explicitly stated.

Multi-informant assessments are gaining traction in NPD diagnosis. This approach involves gathering information from various sources, including family members, friends, and colleagues. It helps create a more comprehensive picture of the individual’s behavior across different contexts.

Longitudinal assessments have proven effective in identifying covert narcissism. By observing patients over extended periods, clinicians can detect patterns and consistencies in behavior that might not be apparent in short-term interactions. This approach is particularly useful in distinguishing between temporary states and enduring personality traits.

Some professionals employ the use of projective tests, such as the Rorschach inkblot test. These can reveal underlying thought patterns and defense mechanisms characteristic of covert narcissism. While controversial, these tests can provide additional data points for diagnosis when used in conjunction with other methods.

Comparing Symptoms with Other Personality Disorders

Differentiating covert narcissism from other personality disorders can be challenging due to overlapping symptoms. Understanding these similarities and differences is crucial for accurate diagnosis and effective treatment.

Covert narcissism shares several traits with Borderline Personality Disorder (BPD). Both conditions involve emotional instability and fear of abandonment. However, while those with BPD often engage in self-harm and impulsive behaviors, covert narcissists typically maintain a façade of control and composure.

Avoidant Personality Disorder (APD) and covert narcissism can appear similar at first glance. Both involve social withdrawal and feelings of inadequacy. The key difference lies in the underlying motivations: APD stems from genuine fear of rejection, while covert narcissists withdraw to protect their fragile self-image.

Dependent Personality Disorder (DPD) might be confused with covert narcissism due to the apparent neediness in relationships. However, individuals with DPD genuinely seek support and guidance, while covert narcissists manipulate others to meet their needs while maintaining an illusion of self-sufficiency.

Passive-aggressive Personality Disorder shares the indirect expression of negative emotions with covert narcissism. The distinction lies in the intent: passive-aggressive individuals often feel powerless, while covert narcissists use indirect aggression as a tool for control and manipulation.

Narcissistic Personality Disorder: Beyond the DSM Diagnosis
-By Som Dutt from https://embraceinnerchaos.com
Narcissistic Personality Disorder: Beyond the DSM Diagnosis
-By Som Dutt from https://embraceinnerchaos.com

Covert narcissism can sometimes mimic depression, with both conditions involving low self-esteem and social withdrawal. However, the covert narcissist’s self-absorption and lack of genuine empathy set them apart from those with clinical depression.

Anxiety disorders may also present similarly to covert narcissism, particularly social anxiety. Both involve fear of judgment and social discomfort. The difference lies in the narcissist’s underlying belief in their superiority, despite their anxious behaviors.

The Spectrum of Narcissistic Personality Disorder

Overt vs. Covert Narcissism: Key Differences

Narcissistic Personality Disorder (NPD) manifests on a spectrum, with overt and covert narcissism representing two distinct ends. Understanding these differences is crucial for identifying and addressing narcissistic behaviors effectively.

Overt narcissists are typically easy to spot. They’re often charismatic, attention-seeking, and openly boastful. Their grandiosity is on full display, and they crave admiration from others. In contrast, covert narcissists are more subtle in their narcissistic traits, often appearing shy, insecure, or even self-deprecating.

While overt narcissists dominate conversations and seek the spotlight, covert narcissists may withdraw from social situations. This withdrawal isn’t due to genuine shyness, but rather a defense mechanism to avoid potential criticism or failure that could damage their fragile self-image.

Overt narcissists often have an inflated sense of self-importance and aren’t afraid to show it. They may brag about their accomplishments or exaggerate their abilities. Covert narcissists, on the other hand, harbor secret feelings of superiority while outwardly appearing modest or self-effacing.

In relationships, overt narcissists tend to be more overtly controlling and manipulative. They may use charm or intimidation to get their way. Covert narcissists employ more subtle tactics, such as passive-aggression, guilt-tripping, or playing the victim to manipulate others.

What Sets Covert Narcissists Apart from Traditional Narcissists?

Covert narcissists possess unique characteristics that distinguish them from their overt counterparts. These traits can make them particularly challenging to identify and deal with in everyday life.

Unlike traditional narcissists who seek constant praise, covert narcissists often engage in self-pity and victimhood. They may constantly complain about being misunderstood or unappreciated, seeking attention and sympathy rather than direct admiration.

Covert narcissists tend to be hypersensitive to criticism. While overt narcissists might react with anger or dismissal when criticized, covert narcissists are more likely to withdraw, ruminate, or seek revenge in subtle ways. This heightened sensitivity stems from their fragile self-esteem.

Another distinguishing feature is their tendency towards passive-aggressive behavior. Instead of direct confrontation, covert narcissists may use sarcasm, subtle put-downs, or the silent treatment to express their displeasure or assert control.

Covert narcissists often exhibit a strong sense of envy towards others. While overt narcissists might dismiss others’ achievements, covert narcissists are more likely to feel deeply threatened by them, leading to resentment and attempts to undermine others’ success.

Narcissists in general lack empathy, but covert narcissists may present a façade of caring and understanding. This false empathy is typically self-serving, used to manipulate others or maintain their image as a “good person.”

Covert narcissists often struggle with a persistent sense of emptiness or boredom. This inner void drives them to seek constant external validation and excitement, albeit in less obvious ways than their overt counterparts.

Covert Narcissists: Hidden in Plain Sight

Covert narcissists are masters of disguise, often blending seamlessly into social environments. Their ability to camouflage their narcissistic traits makes them particularly dangerous in personal and professional relationships.

In social settings, covert narcissists may present as quiet, thoughtful individuals. They might even come across as empathetic listeners. However, this behavior is often a calculated move to gather information they can later use for manipulation or self-promotion.

At work, covert narcissists might appear as dedicated team players. They may volunteer for projects or offer help to colleagues. Yet, their motives are seldom altruistic. Instead, they’re looking for opportunities to prove their superiority or gain leverage over others.

Narcissistic Personality Disorder: Beyond the DSM Diagnosis
-By Som Dutt from https://embraceinnerchaos.com
Narcissistic Personality Disorder: Beyond the DSM Diagnosis
-By Som Dutt from https://embraceinnerchaos.com

In romantic relationships, covert narcissists often play the role of the perfect partner initially. They may be attentive, supportive, and seemingly devoted. This façade, however, gradually crumbles as their true self emerges over time.

Covert narcissists frequently adopt a victim mentality. They may constantly complain about being wronged or misunderstood by others. This behavior serves to deflect responsibility and manipulate others into providing comfort and support.

In family dynamics, covert narcissists might position themselves as the martyr. They may make grand gestures of sacrifice, only to use these actions later as ammunition for guilt-tripping or manipulation.

Spotting a covert narcissist often requires keen observation over time. Pay attention to discrepancies between their words and actions, their reactions to others’ successes, and their ability to maintain long-term, healthy relationships.

Psychological Underpinnings of Covert Narcissism

The Intricate Relationship Between Insecurity and Narcissism

At the core of covert narcissism lies a complex interplay between deep-seated insecurity and grandiose self-perception. This paradoxical relationship forms the foundation of the covert narcissist’s psychological makeup.

Covert narcissists often struggle with intense feelings of inadequacy. Unlike their overt counterparts who mask insecurities with bravado, covert narcissists internalize these feelings, leading to a constant state of self-doubt and anxiety.

This insecurity manifests in a hypersensitivity to criticism. Even minor perceived slights can trigger intense emotional reactions in covert narcissists. They may ruminate on these criticisms for extended periods, further fueling their insecurity.

Paradoxically, covert narcissists maintain a secret belief in their own superiority. This inflated self-image serves as a defense mechanism against their deep-rooted insecurities. It’s a fragile construct that requires constant maintenance through external validation.

The covert narcissist’s insecurity often leads to social comparison and envy. They constantly measure themselves against others, feeling threatened by others’ successes and secretly relishing in their failures.

This insecurity-driven narcissism creates a cycle of seeking validation while simultaneously fearing exposure of their perceived inadequacies. This internal conflict drives many of the covert narcissist’s behaviors and relationship patterns.




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Frequently Asked Questions

How Does Narcissistic Personality Disorder Differ From Other Cluster B Personality Disorders?

Narcissistic Personality Disorder (NPD) is one of four Cluster B personality disorders, alongside borderline, histrionic, and antisocial personality disorders. While they share some common features, NPD is distinguished by its core characteristics of grandiosity, need for admiration, and lack of empathy. Unlike borderline personality disorder, which is characterized by unstable relationships and self-image, individuals with NPD maintain a relatively stable, albeit inflated, sense of self.

The American Psychiatric Association notes that NPD differs from antisocial personality disorder in that NPD doesn’t typically involve a pattern of criminal behavior or lack of remorse. Histrionic personality disorder, while also attention-seeking, lacks the pervasive grandiosity and entitlement seen in NPD. Understanding these distinctions is crucial for accurate diagnosis and effective treatment planning in mental health services.

What Are The Different Types Of Narcissism Recognized In Current Research?

Current research recognizes several types of narcissism, moving beyond the traditional view of a single narcissistic personality type. The two main subtypes widely discussed are grandiose narcissism and vulnerable narcissism. Grandiose narcissism is characterized by overt displays of superiority, entitlement, and self-importance, while vulnerable narcissism manifests as hypersensitivity to criticism, social withdrawal, and feelings of inadequacy masked by grandiose fantasies.

The Journal of Personality and Social Psychology has published studies exploring these subtypes, highlighting their distinct cognitive and behavioral patterns. Additionally, some researchers propose a third subtype called “high-functioning” narcissism, which combines elements of both grandiose and vulnerable traits, often seen in successful individuals who maintain their narcissistic traits while achieving societal success.

How Does Childhood Trauma Contribute To The Development Of Narcissistic Personality Disorder?

Childhood trauma plays a significant role in the development of Narcissistic Personality Disorder (NPD). Early life experiences, particularly those involving emotional neglect, excessive criticism, or inconsistent parenting, can contribute to the formation of narcissistic traits. The American Journal of Psychiatry has published research suggesting that childhood emotional abuse and neglect are strongly associated with the development of NPD in adulthood.

These traumatic experiences can lead to the development of a false self as a defense mechanism, where the individual creates an idealized self-image to protect against feelings of inadequacy or shame. This process can result in the characteristic grandiosity and lack of empathy seen in NPD. Understanding the link between childhood trauma and NPD is crucial for developing effective therapeutic interventions and prevention strategies.

What Are The Most Effective Psychotherapy Approaches For Treating Narcissistic Personality Disorder?

Several psychotherapy approaches have shown promise in treating Narcissistic Personality Disorder (NPD), although treatment can be challenging due to the nature of the disorder. Psychodynamic therapy, particularly transference-focused psychotherapy, has been found effective in addressing the underlying emotional and relational patterns in NPD. Cognitive-behavioral therapy (CBT) can help individuals with NPD recognize and modify maladaptive thought patterns and behaviors.

The Journal of Clinical Psychology has published studies on the efficacy of schema-focused therapy, which addresses early maladaptive schemas that contribute to narcissistic traits. Mentalization-based therapy, which focuses on improving the ability to understand one’s own and others’ mental states, has also shown promise. These approaches aim to enhance self-awareness, improve interpersonal functioning, and develop more adaptive coping mechanisms in individuals with NPD.

How Does Narcissistic Personality Disorder Affect Interpersonal Relationships?

Narcissistic Personality Disorder (NPD) significantly impacts interpersonal relationships, often leading to patterns of dysfunction and conflict. Individuals with NPD typically struggle with maintaining genuine, reciprocal relationships due to their lack of empathy and preoccupation with self. The Journal of Personality Disorders has published research highlighting how narcissistic traits can lead to manipulative behaviors, emotional abuse, and a lack of emotional intimacy in relationships.

Partners of individuals with NPD often report feeling devalued, criticized, and emotionally neglected. In professional settings, those with NPD may have difficulty collaborating, accepting feedback, or recognizing others’ contributions. Understanding these relational patterns is crucial for both individuals with NPD and their loved ones in navigating and potentially improving interpersonal dynamics.

What Role Does Empathy Play In Narcissistic Personality Disorder?

Empathy, or the lack thereof, plays a central role in Narcissistic Personality Disorder (NPD). Individuals with NPD typically demonstrate a significant deficit in emotional empathy, which is the ability to share and understand others’ feelings. However, research published in the Journal of Abnormal Psychology suggests that cognitive empathy, or the ability to recognize others’ emotions, may be intact or even enhanced in some individuals with NPD.

This discrepancy can lead to manipulative behaviors, as those with NPD may understand others’ emotions but fail to genuinely care about them. The empathy deficit in NPD is thought to stem from early developmental experiences and serves as a defense mechanism against vulnerability. Understanding and addressing this empathy deficit is a key focus in therapeutic interventions for NPD.

How Does Narcissistic Personality Disorder Manifest Differently In Men And Women?

Narcissistic Personality Disorder (NPD) can manifest differently in men and women, influenced by societal expectations and gender norms. Research published in the Journal of Personality Assessment indicates that men with NPD are more likely to exhibit overt grandiosity, entitlement, and aggression. They may seek admiration through achievements, power, or physical attractiveness.

Women with NPD, on the other hand, might display more covert narcissistic traits, such as passive-aggressiveness, and may seek admiration through appearance or relationships. However, these gender differences are not absolute, and individual variations exist. Cultural factors also play a role in how NPD manifests across genders. Understanding these gender-specific manifestations is crucial for accurate diagnosis and tailored treatment approaches.

What Are The Comorbid Conditions Often Associated With Narcissistic Personality Disorder?

Narcissistic Personality Disorder (NPD) frequently co-occurs with other mental health conditions, complicating diagnosis and treatment. The Journal of Clinical Psychiatry has published studies showing high rates of comorbidity between NPD and mood disorders, particularly depression and bipolar disorder. Anxiety disorders, especially social anxiety disorder, are also common comorbidities.

Substance use disorders are frequently observed in individuals with NPD, often as a means of coping with underlying emotional distress. Other personality disorders, particularly from Cluster B (antisocial, borderline, histrionic), may co-occur with NPD. Additionally, eating disorders and body dysmorphic disorder have been associated with NPD in some cases. Understanding these comorbidities is crucial for comprehensive treatment planning and addressing the full spectrum of an individual’s mental health needs.

How Does Narcissistic Personality Disorder Impact Professional And Academic Performance?

Narcissistic Personality Disorder (NPD) can have significant impacts on professional and academic performance, often in complex and contradictory ways. Research published in the Journal of Applied Psychology suggests that individuals with NPD may initially excel in professional settings due to their confidence, ambition, and ability to make positive first impressions. However, their long-term performance often suffers due to difficulties with teamwork, accepting feedback, and maintaining consistent effort when not receiving constant admiration.

In academic settings, students with narcissistic traits may struggle with collaborative projects and may react poorly to criticism or grades that don’t meet their inflated self-expectations. The grandiosity associated with NPD can lead to overestimation of abilities and underpreparation for challenges. Understanding these dynamics is crucial for educators and employers in managing and supporting individuals with narcissistic traits.

What Are The Challenges In Diagnosing Narcissistic Personality Disorder?

Diagnosing Narcissistic Personality Disorder (NPD) presents several challenges for mental health professionals. One major difficulty is that individuals with NPD often lack insight into their condition and may not seek help voluntarily. The American Journal of Psychiatry has published research highlighting the complexities of NPD diagnosis.

Another challenge is the overlap of NPD symptoms with other personality disorders, particularly other Cluster B disorders. The presentation of NPD can vary significantly between individuals, and the disorder exists on a spectrum of severity. Additionally, cultural factors play a role in how narcissistic traits are expressed and perceived, complicating cross-cultural diagnosis. The DSM-5 criteria for NPD have been criticized for focusing primarily on grandiose narcissism, potentially overlooking vulnerable narcissism. These challenges underscore the need for comprehensive assessment and clinical expertise in accurately diagnosing NPD.

How Does Narcissistic Personality Disorder Affect Self-Esteem And Self-Image?

Narcissistic Personality Disorder (NPD) has a complex relationship with self-esteem and self-image. While individuals with NPD often present with grandiose self-views and high self-esteem, research published in the Journal of Personality suggests that this is often a facade masking deep-seated insecurities and fragile self-esteem. The grandiose self-image in NPD serves as a defense mechanism against feelings of inadequacy or shame.

This results in a constant need for external validation and admiration to maintain their inflated self-view. When this validation is not received, individuals with NPD may experience significant distress and fluctuations in self-esteem. The discrepancy between their idealized self-image and reality can lead to internal conflict and emotional instability. Understanding this complex self-esteem regulation is crucial in therapeutic approaches to NPD.

What Are The Genetic And Environmental Factors Contributing To Narcissistic Personality Disorder?

The development of Narcissistic Personality Disorder (NPD) is influenced by a combination of genetic and environmental factors. Research published in the Journal of Personality Disorders suggests that there is a heritable component to narcissistic traits, with studies on twins indicating a genetic influence. However, environmental factors play a significant role in the manifestation of NPD.

Childhood experiences such as excessive praise or criticism, inconsistent parenting, emotional neglect, or trauma can contribute to the development of narcissistic traits. Cultural factors, including societal emphasis on individualism and self-promotion, may also play a role. The interplay between genetic predisposition and environmental influences is complex, with certain environmental triggers potentially activating genetic vulnerabilities. Understanding these multifaceted origins is crucial for developing comprehensive prevention and treatment strategies for NPD.

How Does Narcissistic Personality Disorder Affect Emotional Regulation And Expression?

Individuals with Narcissistic Personality Disorder (NPD) often struggle with emotional regulation and expression. Research published in the Journal of Personality Disorders indicates that people with NPD may have difficulty identifying and expressing their own emotions, particularly vulnerable emotions like sadness or fear. They often react with intense anger or shame when their self-image is threatened, demonstrating poor emotional regulation.

The grandiosity associated with NPD can lead to a disconnect between their emotional experiences and their outward expression, often resulting in incongruent emotional displays. This difficulty in emotional regulation can contribute to interpersonal problems and internal distress. Understanding these emotional patterns is crucial for developing effective therapeutic interventions that focus on improving emotional awareness and regulation skills in individuals with NPD.

What Are The Long-Term Outcomes For Individuals With Narcissistic Personality Disorder?

The long-term outcomes for individuals with Narcissistic Personality Disorder (NPD) can vary significantly. Research published in the Journal of Personality Disorders suggests that without intervention, many individuals with NPD may experience persistent difficulties in relationships, career instability, and emotional distress. Over time, the inability to maintain stable relationships and the constant need for admiration can lead to social isolation and depression.

However, with appropriate treatment and self-awareness, some individuals with NPD can experience improvements in interpersonal functioning and emotional regulation. The prognosis is generally better for those who seek treatment early and maintain consistent engagement in therapy. Long-term studies have shown that narcissistic traits may naturally decrease with age for some individuals, a phenomenon known as “narcissistic mellowing.” Understanding these potential outcomes is crucial for setting realistic treatment goals and providing hope for individuals with NPD.

How Does Narcissistic Personality Disorder Affect Family Dynamics And Parenting?

Narcissistic Personality Disorder (NPD) can have profound effects on family dynamics and parenting. Research published in the Journal of Personality Disorders indicates that parents with NPD may struggle to provide emotional support and empathy to their children, often viewing them as extensions of themselves rather than independent individuals. This can lead to a pattern of either excessive praise or harsh criticism, depending on how well the child’s behavior aligns with the parent’s grandiose self-image.

Children of narcissistic parents may develop low self-esteem, anxiety, or their own narcissistic traits as coping mechanisms. In spousal relationships, the partner of an individual with NPD may experience emotional neglect and manipulation. Family therapy can be beneficial in addressing these dynamics, helping family members set healthy boundaries and improve communication patterns.

What Are The Cultural Variations In The Presentation And Diagnosis Of Narcissistic Personality Disorder?

Cultural variations play a significant role in the presentation and diagnosis of Narcissistic Personality Disorder (NPD). Research published in the Journal of Cross-Cultural Psychology highlights that the expression of narcissistic traits can vary considerably across different cultural contexts. In individualistic cultures, NPD may manifest more overtly through self-promotion and explicit grandiosity. In collectivist cultures, narcissistic traits might be expressed more subtly or through different domains, such as family reputation or group achievements.

Cultural norms also influence what is considered pathological narcissism versus culturally acceptable self-confidence. This cultural variation poses challenges in applying standardized diagnostic criteria across different populations. Mental health professionals must be culturally competent to accurately assess and diagnose NPD, considering the cultural context of an individual’s behaviors and beliefs.

How Does Narcissistic Personality Disorder Interact With Social Media And Online Behavior?

Narcissistic Personality Disorder (NPD) has a complex interaction with social media and online behavior. Research published in the Journal of Personality and Social Psychology suggests that individuals with narcissistic traits are often drawn to social media platforms due to the opportunities for self-promotion and seeking admiration. They may engage in excessive self-presentation, carefully curating their online image to garner likes and followers.

Social media can serve as a source of narcissistic supply, providing instant gratification and validation. However, it can also exacerbate narcissistic vulnerabilities, as the constant comparison with others and potential for negative feedback can trigger feelings of inadequacy. The online disinhibition effect may lead to more overt displays of narcissistic behaviors in digital spaces. Understanding this interaction is crucial for developing interventions that address the role of social media in maintaining and exacerbating narcissistic traits.

About the Author :

Som Dutt, Top writer in Philosophy & Psychology on Medium.com. I make people Think, Relate, Feel & Move. Let's Embrace Inner Chaos and Appreciate Deep, Novel & Heavy Thoughts.

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