Narcissism and Narcissitic Abuse in Relationships (Part X)

Narcissistic Personality Disorder

Narcissistic personality disorder (NPD) is a personality disorder characterized by a long-term pattern of exaggerated feelings of self-importance, an excessive need for admiration, and a lack of empathy toward other people.  People with NPD often spend much time thinking about achieving power and success, or on their appearance.  Typically, they also take advantage of the people around them.  Such narcissistic behavior typically begins by early adulthood, and occurs across a broad range of situations.

The causes of narcissistic personality disorder are unknown.  The condition of NPD is included in the cluster B personality disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM).  A diagnosis of NPD is made by a healthcare professional interviewing the person in question.  The condition of NPD should be differentiated from mania and substance use disorder.

Treatments for narcissistic personality disorder have not been well studied. Therapy is difficult, because people with narcissistic personality disorder usually do not consider themselves to have a mental health problem.  About one percent of people are believed to be affected with NPD at some point in their lives.  It occurs more often in men than women, and typically affects younger as opposed to older people.  The narcissistic personality was first described by the psychoanalyst Robert Waelder, in 1925; and the term narcissistic personality disorder (NPD) was coined by Heinz Kohut, in 1968.

Signs and symptoms

People with narcissistic personality disorder (NPD) are characterized by the personality traits of persistent grandiosity, an excessive need for admiration, and a personal disdain and lack of empathy for other people.  As such, the person with NPD usually displays arrogance and a distorted sense of personal superiority, and seeks to establish abusive power and control over others.  Self-confidence (a strong sense of self) is a personality trait different from the traits of narcissistic personality disorder; thus, people with NPD typically value themselves over others, to the extent of openly disregarding the wishes and feelings of anyone else, and expect to be treated as superior, regardless of their actual status or achievements.  Socially, the person with narcissistic personality disorder usually exhibits a fragile ego (self-concept), intolerance of criticism, and a tendency to belittle other people, in order to validate his or her own superiority.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5, 2013) indicates that a person with NPD possesses at least five of the following nine criteria, typically without possessing the commensurate personal qualities or accomplishments for which they demand respect and status:

·         Grandiosity with expectations of superior treatment from other people

·         Continually demeaning, bullying and belittling others

·         Exploiting others to achieve personal gain

·         Lack of empathy for the negative impact they have on the feelings, wishes, and needs of other people

·         Fixation on fantasies of power, success, intelligence, attractiveness, etc.

·         Self-perception of being unique, superior, and associated with high-status people and institutions

·         Need for continual admiration from others

·         Sense of entitlement to special treatment and to obedience from others

·         Intense envy of others, and the belief that others are equally envious of them

Narcissistic personality disorder usually develops either in adolescence or in early adulthood; and it is common for children and adolescents to display personality traits that resemble NPD, but such occurrences are usually transient, and register below the clinical criteria for a formal diagnosis of NPD.  True symptoms of NPD are pervasive, apparent in varied social situations, and are rigidly consistent over time. Severe symptoms of NPD can significantly impair the person's mental capabilities to develop meaningful human relationships, such as friendship, kinship, and marriage. Generally, the symptoms of NPD also impair the person's psychological abilities to function as a social animal, either at work, or at school, or within important societal settings. The DSM-5 indicates that, in order to qualify as symptoms of NPD, the person's manifested personality traits must substantially differ from the cultural norms of society.