Narcissistic Personality Disorder

Pathological Narcissism is a term used by some psychologists and psychiatrists to refer to 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. Narcissistic Personailty Disorder (NPD) was introduced in the Diagnostic and Statistics Manual (DSM) in 1980. It is one of a "family" of personality disorders (formerly known as "Cluster B"). Other members of this cluster include Borderline PD, Antisocial PD and Histrionic PD. It is often diagnosed with other mental health disorders ("co-morbidity") - or with substance abuse, or impulsive and reckless behaviors ("dual diagnosis").

Pathological narcissism was first described in detail by Freud. Other major contributors are: Klein, Horney, Kohut, Kernberg, Millon, Roningstam, Gunderson, Hare. Nevertheless, there is only scant research regarding pathological narcissism. But what there is has not demonstrated any ethnic, social, cultural, economic, genetic, or professional predilection to NPD. Some have estimated that 0.7-1% of the general population suffer from NPD. Some have estimated that 75% of narcissists are men.

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.

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 "conquests"). They may also be classified as either "Classic" or "Compensatory" (or Inverted narcissists).

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.

Diagnostic Critera

An all-pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts. Five (or more) of the following criteria must be met:

Feels grandiose and self-important (e.g., exaggerates achievements and talents 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. Expects unreasonable or special and favorable priority treatment. Demands automatic and full compliance with his or her expectations

Is "interpersonally exploitative", ie, uses others to achieve his or her own ends

Devoid of empathy. Is unable or unwilling to identify with or acknowledge the feelings and needs of others

Constantly envious of others or believes that they feel the same about him or her

Arrogant, haughty behaviours or attitudes coupled with rage when frustrated, contradicted, or confronted The criteria above are based on or summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition (DSM IV). Washington, DC: American Psychiatric Association.

Sam Vaknin. (2003). Malignant Self Love - Narcissism Revisited, fourth, revised, printing. Prague and Skopje: Narcissus Publication.

Malignant Self Love - Narcissism Revisited

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