Narcissism and Narcissistic Personality Disorder: Placing Self First
Narcissistic personality disorder produces feelings of exaggerated self-worth and personal importance. To the narcissist the world and other people exist only to verify his or her superiority and to cater to all his or her needs. The disorder is characterized by a lack of regard or empathy for others, selfishness, and an unrealistic sense of self-entitlement in all situations.
Narcissistic personality disorder affects between 0.7 and 1 percent of the general population, and has a negative affect on the families and life partners of the narcissist. Narcissism appears to affect men more then women, but gender estimates vary — different reports estimate between fifty to seventy percent of narcissistic personality disorder cases are male.
Causes of Narcissistic Personality Disorder
The cause of narcissistic personality disorder is unknown, but narcissism usually develops in early adulthood. While elements of narcissism may be present during adolescence, this can be part of a person's normal development that diminishes with maturity. For this reason, diagnosis of narcissistic personality disorder is not made before adulthood.
Symptoms of Narcissism
Narcissistic personality disorder symptoms stem from the narcissist's self-absorption and over-exaggerated sense of self-worth. People with narcissistic personality disorder are quite willing to take advantage of, manipulate, or lie to others to achieve their own desires and gratification. When a narcissist values a person, it is only because that person has something to offer. Narcissism reduces other people to the status of servants or useful tools.
Common symptoms include:
- a lack of feeling, empathy, or concern for others
- a willingness to take advantage of others
- excessive feelings of self-importance
- exaggerated personal achievements and abilities
- an expectation to be seen as superior without cause
- a fantasy or is preoccupation with power, wealth, beauty, personal abilities, or success
- a demand for favorable treatment without appropriate reasons
- an insiststance on being the object of admiration and attention.
Narcissistic Personality Disorder and Relationships
The attitude of a narcissist towards others is one of superior contempt. Narcissism also makes people envy the accomplishments of others; the success of others is perceived as stealing the narcissist's "rightful" rewards or possessions.
People with narcissistic personality disorder demand that others provide them with comfort, gifts, and other desires, but refuse to acknowledge any indebtedness. Rather than offer thanks, the narcissist will mock and degrade both gift and giver.
This contempt for others is also expressed towards intimate partners and children. When narcissists feel family members are not meeting their needs, they may resort to emotional, physical, or sexual abuse. Sexual abuse of children is also a danger with severe narcissist personality disorder, as the narcissist sees his children as extensions of his self with no real individual identity or rights.
Narcissism and Reality Conflicts
The self-importance characteristic of narcissism and the narcissist's demand for preferential treatment will inevitably come into conflict with reality. Narcissists are adept at explaining discrepancies between reality and their self-image, but occasionally circumstances shake the narcissist's belief in his superiority. When this happens, the person may become enraged, experience feelings of emptiness, or develop clinical depression.
Diagnosing Narcissistic Personality Disorder
Seeking treatment for narcissism is rare. The narcissistic individual sees nothing wrong with his or her narcissism; to narcissists, their "natural" superiority is obvious to them, and therefore should be obvious to all.
When narcissists seek medical help, it's usually because their self-image has been disrupted by an occurrence that casts doubt on their assumed superiority. Such a crisis can result in clinical anxiety and depression, and it if for these emotions that the narcissist seeks treatment.
Diagnosis of narcissistic personality disorder requires a thorough psychological evaluation, the gathering of personal history, and personal observations made by the diagnosing doctor. In accordance with the DSM-IV, a diagnosis of narcissistic personality disorder is considered when five or more of the following criteria are present:
- has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
- is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- believes 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)
- requires excessive admiration
- has a sense of entitlement, i.e. unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
- is interpersonally exploitative (i.e. takes advantage of others to achieve his or her own ends)
- lacks empathy, i.e. is unwilling to recognize or identify with the feelings and needs of others
- is often envious of others or believes that others are envious of him or her
- shows arrogant, haughty behaviors or attitudes.
From the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. American Psychiatric Association, 1994.
A number of conditions can mimic symptoms of narcissism, and must be ruled out before a definitive diagnosis is possible. These conditions include:
- antisocial personality disorder
- borderline personality disorder
- histrionic personality disorder
- manic or hypomanic episodes
- obsessive compulsive disorder
- paranoid personality disorder
- personality changes due to an underlying medical condition
- schizotypal compulsive disorder
- substance abuse.
Narcissistic Treatment
Narcissism treatment must overcome a number of challenges. People with narcissistic personality disorder often resist treatment; their self-concept refuses to accept that their narcissism is abnormal, and they consider mental treatment "beneath them," or "demeaning" and they adopt adversarial attitudes towards mental professionals.
Antidepressants may be used to treat anxiety and depression in the narcissist, but as with many personality disorders, the patient must be monitored carefully for signs of noncompliance or substance abuse.
Psychotherapy, both individually and in group settings, can help the patient with narcissistic personality disorder identify and change his or her symptoms. The goal of treatment is to help the narcissist become more sensitive to others' rights and emotions. Treatment outcomes are dependent on the severity of the disorder — the less willing the narcissist is to view others with any degree of empathy, the more likely treatment will fail.
Resources
American Psychiatric Association. Diagnostic criteria for 301.81: Narcissistic personality disorder. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. American Psychiatric Association, Washington, DC, 1994.
Ekleberry, S. (2000). Dual diagnosis and narcissistic personality disorder.
Long, P. (nd). Narcissistic personality disorder.
Narcissistic Personality Disorder.com. (nd). What is narcissism?
National Library of Medicine. (updated 2003). Narcissistic personality disorder. MedlinePlus Medical Encyclopedia .
Vaknin, S. (nd). Ideas of reference.
Psychiatric Disorders