Narcissistic Personality Disorder (NPD) at a Glance - Clinical Features of the Narcissistic Personality Disorder

Written by Dr. Sam Vaknin

Clinical Features of the Narcissistic Personality Disorder

The onset of pathological narcissism is in infancy, childhood and early adolescence. It is commonly attributed to childhood abuse and trauma inflicted by parents, authority figures, or even peers. Pathological narcissism is a defense mechanism intended to deflect hurt and trauma from the victim's "True Self" into a "False Self" which is omnipotent, invulnerable, and omniscient. The narcissist uses the False Self to regulate his or her labile sense of self-worth by extracting from his environment narcissistic supply (any form of attention, both positive and negative).

There is a whole range of narcissistic reactions, styles, and personalities - from the mild, reactive and transient to the permanent personality disorder.

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Patients with Narcissistic Personality Disorder (NPD) feel injured, humiliated and empty when criticized. They often react with disdain (devaluation), rage, and defiance to any slight, real or imagined. To avoid such situations, some patients with Narcissistic Personality Disorder (NPD) socially withdraw and feign false modesty and humility to mask their underlying grandiosity. Dysthymic and depressive disorders are common reactions to isolation and feelings of shame and inadequacy.

The interpersonal relationships of patients with Narcissistic Personality Disorder (NPD) are typically impaired due to their lack of empathy, disregard for others, exploitativeness, sense of entitlement, and constant need for attention (narcissistic supply).

Though often ambitious and capable, inability to tolerate setbacks, disagreement, and criticism make it difficult for patients with Narcissistic Personality Disorder (NPD) to work in a team or to maintain long-term professional achievements. The narcissist's fantastic grandiosity, frequently coupled with a hypomanic mood, is typically incommensurate with his or her real accomplishments (the "grandiosity gap").

Patients with Narcissistic Personality Disorder (NPD) are either "cerebral" (derive their Narcissistic Supply from their intelligence or academic achievements) or "somatic" (derive their Narcissistic Supply from their physique, exercise, physical or sexual prowess and romantic or physical "conquests").

Patients with Narcissistic Personality Disorder (NPD) are either "classic" (meet five of the nine diagnostic criteria included in the DSM), or they are "compensatory" (their narcissism compensates for deep-set feelings of inferiority and lack of self-worth).

Some narcissists are covert, or inverted narcissists. As codependents, they derive their narcissistic supply from their relationships with classic narcissists.

1. High functioning or Exhibitionist: "(H)as an exaggerated sense of self-importance, but is also articulate, energetic, outgoing, and achievement oriented." (The equivalent of the Cerebral narcissist).

2. Fragile: "(W)ants to feel important and privileged to ward off painful feelings of inadequacy and loneliness" (The equivalent of the Compensatory narcissist).

3. Grandiose or Malignant: "(;(H)as an exaggerated sense of self-importance, feels privileged, exploits others, and lusts after power." (The equivalent of the Classic narcissist).

Treatment and Prognosis

The common treatment for patients with Narcissistic Personality Disorder (NPD) is talk therapy (mainly psychodynamic psychotherapy or cognitive-behavioural treatment modalities). Talk therapy is used to modify the narcissist's antisocial, interpersonally exploitative, and dysfunctional behaviors, often with some success. Medication is prescribed to control and ameliorate attendant conditions such as mood disorders or obsessive-compulsive disorders.

The prognosis for an adult suffering from the Narcissistic Personality Disorder (NPD) is poor, though his adaptation to life and to others can improve with treatment.

Bibliography

• Goldman, Howard H., Review of General Psychiatry, fourth edition, 1995. Prentice-Hall International, London.
• Gelder, Michael, Gath, Dennis, Mayou, Richard, Cowen, Philip (eds.), Oxford Textbook of Psychiatry, third edition, 1996, reprinted 2000. Oxford University Press, Oxford.
• Vaknin, Sam, Malignant Self Love - Narcissism Revisited, eighth revised impression, 1999-2006. Narcissus Publications, Prague and Skopje.
• Westen, Drew et al. Refining the Construct of Narcissistic Personality Disorder: Diagnostic Criteria and Subtypes (Posted at http://ajp.psychiatryonline.org/pap.dtl )

next: The Workings of Pathological Narcissism