The Narcissistic Personality

Among the numerous personality disorders present in the Diagnostic and Statistical Manual of Mental Disorders (IV) TR published by the American Psychiatric Association, one that has consistently been broadened in its definition and has been subject to increasing research by mental health professionals and clinicians is the Narcissistic Personality Disorder (NPD). This character or personality disorder often resembles symptoms similar to its sister disorders, falling under the Cluster B personality disorders, which all share a commonality of grandiose self-importance. Unique to the narcissistic personality disorder is the perpetual belief that one remains superior to those around it. Like most personality disorders, much of the problems are not experienced by the individual (directly), but rather by those around him or her.

The symptoms for a classification of narcissistic personality disorder typically revolve around a patient's self-importance, need for admiration, belief in their own entitlement, lack of empathy - especially for those seen as inferior, and lack of compassion for the needs/wants of others. Since the narcissistic personality sees life in terms of "better" or "worse," often themselves occupying the position of "better," they tend to show little concern or even outright scorn for those they perceive to be their inferiors. For instance, often times the narcissistic personality will look down upon the mentally/physically disabled, the homeless, the less fortunate, and others who are seen as socially vulnerable. Sometimes their perception of themselves can be severely delusional; sometimes based on their own social status, physical appearance, or abilities and capacities.

The criteria necessary for a diagnosis of narcissistic personality disorder is outlined in the DSM-IV. Typically symptoms begin around early adulthood and include a pervasive sense of grandiosity in behavior and cognition. For instance, believing oneself to be destined for great things that separates him or her in some way from the rest of the population. As noted before, lack of empathy and a need for admiration is also indicative of NPD, though it can manifest itself in various contexts. Strictly speaking, a diagnosis requires at least five (or more) of the outlined symptoms or traits in the patients' history in order to make a clear diagnosis. These symptoms include:

1) grandiose sense of self-importance

2) preoccupation with fantasies of immense wealth, power, or success

3) believes oneself to be special or superior, and can only be understood or should only associate with other people of equal special status.

4) the need for excessive admiration

5) unreasonable expectations for their own actions and a sense of entitlement

6) takes advantage of others for achieving one's own ends

7) lacking empathy - unwilling to identify with the pain of others

8) either envious of others, or sincerely believes others are envious of him/her

9) arrogant or excessively proud behaviors (DSM-IV TR).

Like most other personality disorders, the effects of narcissistic personality have more effects on the relationships of the narcissistic personality rather than the individual himself. Typically, when relationships fail or end they see it as the unworthiness or envy of others, not their own behavior. Often times these individuals will not initiate therapy on their own nor see a mental health professional, since they do not consider themselves to have any problems and consider the therapist worthless. Usually a spouse, mate, or friend will have to threaten in order to get the narcissist to commit to a therapeutic program.

The pathological explanations of narcissistic personality disorder vary. However, researchers have speculated that it very well formulates from an early perception of one's own vulnerabilities or personality failures that makes them feel inadequate in the eyes of others. This belief though is not in the conscious awareness of the individual, so he or she will vehemently reject any such classification or explanation for their behavior - often times making psychotherapy a difficult task for both the provider and the patient. Typically primary caregivers (such as parents) seem to imply the base origins for an individual who will later on develop narcissism to the point of a personality disorder.

When parents fail to make a certain type of empathetic relationship to their child it can foster certain types of beliefs within that child that can later on lead to NPD. Without this important connection the child will later be forced to see himself as creating his own pathological sense of self-importance, that which he was not given through a healthy relationship with his parents. This does not suggest that a relationship between child and parents must have been abusive, but rather not as fulfilling as the child might have needed in order to get a healthy sense of their own self-worth and self-efficacy.

In terms of prognosis and treatment, NPD is seen as a relatively stable disorder, though it can vary in degrees of severity. After all, pride and healthy levels of self-esteem are natural attributes to human behavior and personality, and in many ways we all exhibit some behaviors that could be considered narcissistic. However, the severity to which this plays in our actual perception of our own abilities or worth, and how we relate to others will greatly determine healthy amounts of pride from a personality disorder. Psychopharmacological methods are rarely (if ever) used to treat narcissistic personality disorder. Since it represents an ingrained personality trait (not a chemical imbalance) drugs and chemicals are not needed. Behavior therapy seems to imply the best means of treating the disorder, though instead of trying to "cure" the problem, the focus should instead look towards finding ways of helping the patient manage his disorder in order to maintain stable, healthy, and fulfilling relationships with others.

Source:

(DSM-IV-TR) Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Washington, DC: American Psychiatric Press, Inc.