Narcissistic personality disorder
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Narcissistic personality disorder (NPD) is a personality disorder in which a person is excessively preoccupied with personal adequacy, power, prestige and vanity, mentally unable to see the destructive damage they are causing to themselves and others. It is a cluster B personality disorder.[1]
It is estimated that this condition affects one percent of the population, with rates greater for men. First formulated in 1968, NPD was historically called megalomania, and is a form of severe egocentrism.[2]
People with narcissistic personality disorder are characterized by exaggerated feelings of self-importance. They have a sense of entitlement and demonstrate grandiosity in their beliefs and behavior. They have a strong need for admiration, but lack feelings of empathy.[3]
DSM-5[edit]
Symptoms of this disorder, as defined by the DSM-5, include:[4]
A. Significant impairments in personality functioning manifested by:
1. Impairments in self functioning (a or b):
a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.
b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.
AND
2. Impairments in interpersonal functioning (a or b):
a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.
b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others' experiences and predominance of a need for personal gain
B. Pathological personality traits in the following domain:
Antagonism, characterized by:
a. Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others.
b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.
C. The impairments in personality functioning and the individual's personality trait expression are relatively stable across time and consistent across situations.
D. The impairments in personality functioning and the individual's personality trait expression are not better understood as normative for the individual's developmental stage or socio-cultural environment.
E. The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).
DSM-IV-TR[edit]
Symptoms of this disorder, as defined by the DSM-IV-TR, include:[1]
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 inter-personally exploitative, i.e., takes advantage of others to achieve his or her own ends.
Lacks empathy: 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.
Other symptoms in addition to the ones defined by DSM-IV-TR include: Is inter-personally exploitative, i.e., takes advantage of others to achieve his or her own ends, has trouble keeping healthy relationships with others, easily hurt or rejected, appears unemotional, and exaggerating special achievements and talents, setting unrealistic goals for himself/herself.[5]
Narcissistic personality disorder is characterized by an over-inflated sense of self-importance, as well as dramatic, emotional behavior that is in the same category as antisocial and borderline personality disorders.[6]
In addition to these symptoms, the person may display arrogance, show superiority, and seek power.[7] The symptoms of narcissistic personality disorder can be similar to the traits of individuals with strong self-esteem and confidence; differentiation occurs when the underlying psychological structures of these traits are considered pathological. Narcissists have such an elevated sense of self-worth that they value themselves as inherently better than others, when in reality they have a fragile self-esteem, cannot handle criticism, and often try to compensate for this inner fragility by belittling or disparaging others in an attempt to validate their own self-worth. Comments and criticisms about others are vicious from sufferers of NPD, in an attempt to boost their own poor self-esteem.[8]
Another narcissist symptom is a lack of empathy. They are unable to relate, understand, and rationalize the feelings of others. Instead of behaving in a way that shows how they are feeling in the moment, they behave in the way that they feel they are expected to behave or that gives them the most attention.[5]
An extensive US survey found a high association with other disabilities, especially amongst men: mental disability, substance use, mood, anxiety disorders and other personality disorders, bipolar I disorder, post-traumatic stress disorder, and schizotypal and borderline personality disorders were among the associated disabilities.[9]
