T3 - Narcissistic Personality Disorder

Narcissistic Personality Disorder gets its name from Greek mythology about Narcissus, a man who was renowned for his beauty. He was very cruel in some of the stories about him, disdaining some people who love him. As divine punishment, he falls in love with a reflection in a pool, not realizing it was his own. He dies there, unable to leave the beautiful image. For more info, read this article.

So, in the spirit of Narcissus, individuals who are in love with themselves get diagnosed with this personality disorder. Typically, they have an inflated view of themselves, deeply crave admiration from others, and show a lack of empathy. But behind the facade is a very vulnerable person, sensitive to the slightest criticism.

There are nine criteria for determining this PD, and five of them are required for diagnosis.

1) grandiose sense of self - often will appear boastful, pretentious, inflate their accomplishments or overestimate their abilities; inherent in this judgment of their own worth is the devaluation of the worth of others

2) preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love - to their way of thinking, their admiration and privilege are long overdue; they may compare themselves with famous, rich, privileged people; sometimes, this is called the "God complex"

3) believe that they are superior, special and unique and expect others to recognize this - they only want to associate with other high-status people or institutions; people of lesser rank can't "understand" them; they may attribute these qualities of perfection to those they do associate with, which in turn enhances their own value; they only want the "best" doctors and restaurants

4) require excessive admiration - due to a fragile self-esteem, constant attention is required, and it had better be of the positive, "you-look-so-good" variety; they fish for compliments and actually expect their arrival at a party to be greeted with fanfare and fawning; they may be genuinely astonished if others don't covet their possessions, looks, charm, etc.

5) has a sense of entitlement - they expect (unreasonably so) to be treated favorably over others; they feel they should be catered to and can be quite furious/confused when this isn't the case

6) is interpersonally exploitative - this could be conscious or unwitting; romantic relationships might only be entered into if the person can see some "gain" from it (like advancing their social status or enhancing their self-esteem); they expect to be given whatever they want or feel they need, no matter the cost to others

7) lacks empathy - has a hard time recognizing or identifying with the desires/feelings of others; they may go into lengthy detail about their own concerns at inappropriate times; they might grow contemptuous and impatient with others talking about their problems (i.e., not the center of attention); they often are oblivious to how hurtful their remarks can be (i.e., telling a coworker who wanted the same job promotion how wonderful the new job is); others who relate to people with Narcissistic PD find "emotional coldness and lack of reciprocal interest"

8) often envious of others or believe that others are envious of them - when others have possessions of successes, people with NPD begrudge them and feel that they are more deserving; they will devalue accomplishments of others, even more so if those accomplishments are praised or acknowledgment

9) display arrogant, haughty behaviors or attitudes - snobbish/patronizing/disdainful ways of thinking, behaving and relating to others

Now that you've gotten an idea for the type person a Narcissist really is, I want you to think about how in the world this person would maintain any type of relationship. No one can say anything remotely negative about them. If their partner/spouse isn't constantly admiring them, there's problems in paradise. They disregard the sensitivities of others, which doesn't bode well for a mutual respectful relationship. So the above characteristics have to be looked at in terms of how this person relates to others. This disorder has to cause some clinical impairment in social, occupational or other important are of functioning. See treatment below.

Of all the people diagnosed with this disorder, 50-75% of them are male. Adolescents seem to go through a stage where many have some of these traits, but that doesn't mean they will go on to have NPD. (Adolescents are generally just more into themselves!) For a diagnosis, the individual has to be 18 years old.

A couple of risk factors have been pieced together from various researchers. Here's a list:

• An oversensitive temperament as a young child
• Overindulgence and overvaluation by parents
• Excessive admiration that is never balanced with realistic feedback
• Unpredictable or unreliable caregiving from parents
• Severe emotional abuse in childhood
• Being praised for perceived exceptional looks or talents by adults
• Learning manipulative behaviors from parents

I found a cool quiz online here if you're interested. Personality disorders are very hard to treat, but I haven't found them hard to diagnose. A high number of individuals with PDs also have an Axis I diagnosis (like depression, anxiety, or an eating disorder, see my post on Axes here) that usually becomes the focus of treatment. By the very nature of Narcissism, the individual would never want to admit they have a problem. Sometimes hospitalization is required for treatment of this disorder.

People with this disorder might not realize they have a problem until they are educated about the illness. Personally, I focus on behavioral modification and communication and social skills training. These individuals aren't necessarily bad people, but they need someone to help them understand the illness and how they can combat it to make their life better.

Questions about this disorder? Drop them to me in the comment section and I'll do my best to answer.

Q4U: This disorder is commonly found in political leaders and entertainment industry professionals. Who are some people you think might fit the bill (don't let my photo pic bias you)?