Narcissistic Personality Disorder NPD

NPD is a type of psychological personality disorder characterized primarily by grandiosity, need for admiration, and lack of empathy. Narcissism occurs in a spectrum of severity, but the pathologically narcissistic tend to be extremely self-absorbed, intolerant of others' perspectives, insensitive to others' needs and indifferent to the effect of their own egocentric behavior.

It is not uncommon for persons with this disorder to frequently compare themselves to the accomplished, well-known and well-to-do. They feel entitled to great praise, attention, and deferential treatment by others. Those with NPD crave the limelight and are quick to abandon situations in which they are not the center of attention. Defects of empathy may cause narcissists to misperceive other people's speech and actions, causing them to believe that they are well-liked and respected despite a history of negative personal interactions.

Those with Narcissistic Personality Disorder are often ambitious and capable, but are unable cope with setbacks, disagreements or criticism. These emotional limitations, along with lack of empathy, make it difficult for such individuals to work well with others and to build a successful career (Kernberg 2003, 2004, APA 2000).

Diagnosis of Narcissistic PD

Considerable overlap between the characteristics of different personality disorders makes diagnosis of NPD a challenge. Grandiosity, lack of empathy and exploitative interpersonal relations are not unique to NPD, nor is the need to be seen as special or unique. The differential diagnosis of Narcissistic Personality Disorder is typically made based on the absence of certain behaviors. Borderline Personality Disorder has several conspicuous similarities, but unlike NPD, is characterized by self-injury, whereas narcissists are rarely physically self-injurious. The need for constant attention is also found in Histrionic Personality Disorder, but HPD and BPD are both relationship oriented, whereas NPD is characterized by the avoidance of intimacy. Psychopathy, or Antisocial Personality Disorder is differentiated from NPD by the psychopaths' willingness to use physical violence whereas narcissists rarely commit crimes Kernberg 2003, Vaknin 2007).

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), a patient must exhibit five or more of the following traits in order to be diagnosed with NPD:

• grandiose sense of self-importance
• preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
• belief that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
• need for excessive admiration
• sense of entitlement
• takes advantage of others to achieve his or her own ends
• lack of empathy
• envious of others or believes that others are envious of him or her
• arrogant, haughty behaviors or attitudes

Prevalence and Treatment of NPD

According to DSM IV, Narcissistic Personality Disorder occurs in less than 1% of the general population, and shows no difference in prevalence along any ethnic, social, cultural, economic, or professional lines, although the disorder is 50 to 75 percent more prevalent in men than in women.

It is unusual for narcissists to seek therapy, and those who do are generally reluctant to be truthful and open with mental health professionals. Unfortunately, individuals treated for NPD tend to progress very slowly, and rarely remain in treatment long enough for significant improvement to be made.

This article, originally published in Suite101 online magazine, is a summary of NPD. The contents of this article are not meant to be used for diagnosis and are not a substitute for professional help and counseling.

Sources

Dobbert, D. (2007) Understanding Personality Disorders: An Introduction. Greenwood Press.

Kernberg, Otto (2004) Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Relationship: New Developments in the Psychopathology and Psychotherapy of Severe Personality Disorders.

Kernberg, Otto and Akhtar, Salman. (2003) Broken Structures: Severe Personality Disorders and Their Treatment.

Vaknin, S (1999-2007). Malignant Self Love: Narcissism Revisited.

American Psychiatric Association APA (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).