One tragedy affecting these people is their inability to love. Healthy interpersonal relationships can be recognised by qualities such as empathy and concern for the feelings of others, a genuine interest in the ideas of others, the ability to tolerate ambivalence in long-term relationships without giving up, and a capacity to acknowledge one's own contribution to interpersonal conflicts. People who are characterised by these qualities may at times use others to gratify their own needs, but the tendency occurs in the broader context of sensitive interpersonal relatedness rather than as a pervasive style of dealing with other people. One the other hand, the person with a Narcissistic Personality Disorder approaches people as objects to be used up and discarded according to his or her needs, without regard for their feelings.

People are not viewed as having a separate existence or as having needs of their own. The individual with a Narcissistic Personality Disorder frequently ends a relationship after a short time, usually when the other person begins to make demands stemming from for his or her own needs. Most importantly, such relationships clearly do not 'work' in terms of the narcissist's ability to maintain his or her own sense of self-esteem."

"...These criteria [the DSM-IV-TR's] identify a certain kind of narcissistic patient - specifically, the arrogant, boastful, 'noisy' individual who demands to be in the spotlight. However, they fail to characterise the shy, quietly grandiose, narcissistic individual whose extreme sensitivity to slights leads to an assiduous avoidance of the spotlight."

The DSM-III-R alluded to at least two types of narcissists, but the DSM-IV-TR committee chose to delete this:

"...included criterion, 'reacts to criticism with feelings of rage, shame, or humiliation (even not if expressed)' due to lack of 'specificity'."

Other theoreticians, clinicians and researchers similarly suggested a division between "the oblivious narcissist" (a.k.a. overt) and "the hypervigilant narcissist" (a.k.a. covert

The Compensatory versus the Classic Narcissist

Another interesting distinction, suggested by Dave Kelly in his excellent PTYPES Web site (http://www.ptypes.com) is between the Compensatory Type NPD and the Classic NPD (described in the DSM-IV-TR).

Here are the Compensatory NPD criteria according to Dave Kelly:

"Personality Types proposes Compensatory Narcissistic Personality Disorder as a pervasive pattern of unstable, covert narcissistic behaviours that derive from an underlying sense of insecurity and weakness rather than from genuine feelings of self-confidence and high self-esteem, beginning by early adulthood and present in a variety of contexts, as indicated by six (or more) of the criteria below.

The basic trait of the Compensatory Narcissistic Personality Type is a pattern of overtly narcissistic behaviours (that) derive from an underlying sense of insecurity and weakness, rather than from genuine feelings of self-confidence and high self-esteem."

The Compensatory Narcissistic Personality Type:

• Seeks to create an illusion of superiority and to build up an image of high self-worth [Millon];
• Strives for recognition and prestige to compensate for the lack of a feeling of self-worth;
• May "acquire a deprecatory attitude in which the achievements of others are ridiculed and degraded" [Millon];
• Has persistent aspirations for glory and status [Millon];
• Has a tendency to exaggerate and boast [Millon];
  Is sensitive to how others react to him, watches and listens carefully for critical judgement, and feels slighted by disapproval [Millon];
• "Is prone to feel shamed and humiliated and especially (anxious) and vulnerable to the judgements of others" [Millon];
• Covers up a sense of inadequacy and deficiency with pseudo-arrogance and pseudo-grandiosity [Millon];
• Has a tendency to periodic hypochondria [Forman];
• Alternates between feelings of emptiness and deadness and states of excitement and excess energy [Forman];
• Entertains fantasies of greatness, constantly striving for perfection, genius, or stardom [Forman];
• Has a history of searching for an idealised partner and has an intense need for affirmation and confirmation in relationships [Forman];
• Frequently entertains a wishful, exaggerated and unrealistic concept of himself, which he can't possibly measure up to [Reich];
• Produces (too quickly) work not up to the level of his abilities because of an overwhelmingly strong need for the immediate gratification of success [Reich];
• Is touchy, quick to take offence at the slightest provocation, continually anticipating attack and danger, reacting with anger and fantasies of revenge when he feels himself frustrated in his need for constant admiration [Reich];
  Is self-conscious, due to a dependence on approval from others [Reich];
• Suffers regularly from repetitive oscillations of self-esteem [Reich];
• Seeks to undo feelings of inadequacy by forcing everyone's attention and admiration upon himself [Reich];
• May react with self-contempt and depression to the lack of fulfilment of his grandiose expectations [Riso].