- Psychological Issues
Narcissism is a pattern of traits and behaviors which signify infatuation and obsession with one’s self to the exclusion of all others and the egotistic and ruthless pursuit of one’s gratification, dominance and ambition.
Most narcissists (50-75%, according to the DSM IV-TR) are men.
NPD is one of a “family” of personality disorders (known as “Cluster B”).
Other members of Cluster B: Borderline PD, Antisocial PD and Histrionic PD.
NPD is new (1980) mental health category in the Diagnostic and Statistics Manual (DSM).
It is estimated that 0.7-1% of the general population suffer from NPD.
Pathological narcissism was first described in detail by Freud. Other major contributors are: Klein, Horney, Kohut, Kernberg, Millon, Roningstam, Gunderson, Hare.
The onset of narcissism is in infancy, childhood and early adolescence. It is commonly attributed to childhood abuse and trauma inflicted by parents, authority figures, or even peers.
There is a whole range of narcissistic reactions – from the mild, reactive and transient to the permanent personality disorder.
Narcissistic supply is outside attention – usually positive (adulation, affirmation, fame, celebrity) – used by the narcissist to regulate his labile sense of self-worth.
Narcissists are either “Cerebral” (derive their narcissistic supply from their intelligence or academic achievements) – or “Somatic” (derive their narcissistic supply from their physique, exercise, physical or sexual prowess and romantic or physical “conquests”).
Narcissists are either “Classic” – see definition below – or they are “Compensatory”, or “Inverted” – see definitions here: “The Inverted Narcissist”.
The classic narcissist is self-confident, the compensatory narcissist covers up in his haughty behavior for a deep-seated deficit in self-esteem, and the inverted type is a co-dependent who caters to the emotional needs of a classic narcissist.
NPD is treated in talk therapy (psychodynamic or cognitive-behavioral). The prognosis for an adult narcissist is poor, though his adaptation to life and to others can improve with treatment. Medication is applied to side-effects and behaviors (such as mood or affect disorders and obsession-compulsion) – usually with some success.
The American Psychiatric Association, based in Washington, DC, USA, publishes the Diagnostic and statistical manual of mental disorders, fourth edition, Text Revision (DSM IV-TR) (2000). =
The international equivalent of the DSM is the ICD-10, Classification of Mental and Behavioral Disorders, published by the World Health Organization in Geneva (1992).
The DSM defines NPD as “an all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts.”
The ICD regards NPD as “a personality disorder that fits none of the specific rubrics.” It relegates it to the category “Other Specific Personality Disorders” together with the eccentric, “haltlose”, immature, passive-aggressive, and psychoneurotic personality disorders and types.
The DSM specifies nine diagnostic criteria. For NPD to be diagnosed, five (or more) of these criteria must be met.
In the text below, I have proposed modifications to the language of these criteria to incorporate current knowledge about this disorder. My modifications appear in bold italics.
My amendments do not constitute a part of the text of the DSM-IV-TR, nor is the American Psychiatric Association (APA) associated with them in any way.
Proposed Amended Criteria for the narcissistic personality disorder
Feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to the point of lying, demands to be recognized as superior without commensurate achievements);
Is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion;
Firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions);
Requires excessive admiration, adulation, attention and affirmation – or, failing that, wishes to be feared and to be notorious (narcissistic supply);
Feels entitled. Demands automatic and full compliance with his unreasonable expectations for special and favorable priority treatment.
Is “interpersonally exploitative”, i.e., uses others to achieve his or her own ends;
Devoid of empathy. Is unable or unwilling to identify with, acknowledge, or acceptthefeelings, needs, preferences, priorities, and choices of others;
Constantly envious of others and seeks to hurt or destroy the objects of his frustration.Suffers from persecutory (paranoid) delusions as he believes that they feel the same about him or her and are likely to act similarly;
Behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient, invincible, immune, “above the law”, and omnipresent (magical thinking). Rages when frustrated, contradicted, or confronted by people he considers inferior to him and unworthy.