Narcissism and Narcissistic Abuse in Relationships (Part XI)

Associated features

People with NPD exaggerate their skills, accomplishments, and their degree of intimacy with people they consider high-status. Such a sense of personal superiority may cause them to monopolize conversations, or to become impatient and disdainful when other persons talk about themselves.  When wounded in the ego, either by a real or a perceived criticism, the narcissist's displays of anger can be disproportionate to the nature of the criticism suffered; but typically, the actions and responses of the NPD person are deliberate and calculated.  Despite occasional flare-ups of personal insecurity, the inflated self-concept of the NPD person is primarily stable.

To the extent that people are pathologically narcissistic, the person with NPD can be a self-absorbed control freak who passes blame and is intolerant of contradictory views and opinions; is apathetic towards the emotional, mental, and psychological needs of other people; and is indifferent to the negative effects of his or her behaviors, whilst insisting that people should see him or her as an ideal person.  To protect their fragile self-concept, narcissists use psycho-social strategies, such as the tendency to devalue and derogate and to insult and blame other people, usually with anger and hostility towards people's responses to the narcissist's anti-social conduct.  Because their fragile egos are hypersensitive to perceived criticism or defeat, people with NPD are prone to feelings of shame, humiliation, and worthlessness over minor incidents of daily life and imagined, personal slights, and usually mask such feelings from people, either by way of feigned humility, or by socially isolating themselves, or by responding with outbursts of rage and defiance, or by seeking revenge.  The merging of the inflated self-concept and the actual self is evident in the grandiosity component of narcissistic personality disorder; also inherent to that psychological process are the defense mechanisms of idealization and devaluation and of denial.

The DSM-5 indicates that: "Many highly successful individuals display personality traits that might be considered narcissistic. Only when these traits are inflexible, maladaptive, and persisting, and cause significant functional impairment or subjective distress, do they constitute narcissistic personality disorder."  Given the high-function sociability associated with narcissism, some people with NPD might not view such a diagnosis as a functional impairment to their lives.  Although overconfidence tends to make people with NPD very ambitious, such a mindset does not necessarily lead to professional high achievement and success, because they might be unwilling to compete, or refuse to take risks, in order to avoid failure or the appearance of failure.  Moreover, the psychological inability to tolerate disagreement, contradiction, and criticism, and their apathy towards other people, make it difficult for persons with NPD to work cooperatively or to maintain long-term, professional relationships with superiors and colleagues.

Comorbidity

The occurrence of narcissistic personality disorder presents a high rate of comorbidity with other mental disorders.  People with NPD are prone to bouts of psychological depression, often to the degree that meets the clinical criteria for a co-occurring depressive disorder.  Moreover, the occurrence of NPD is further associated with the occurrence of bipolar disorder, of anorexia, and of substance use disorders, especially cocaine use disorder.  In that vein, NPD also might be comorbid with the occurrence of other mental disorders, such as histrionic personality disorder, borderline personality disorder, antisocial personality disorder, or paranoid personality disorder.

Causes

The causes of narcissistic personality disorder are unknown.  Researchers apply a biopsychosocial model of causation, whereby the occurrence and the expression of NPD – a pathological amplification of the traits of the narcissistic personality – are consequent to a combination of nature and nurture, of environmental and social, genetic and neurobiological factors.