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Narcissistic Personality Disorder

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In-depth look at Narcissistic Personality Disorder - signs and symptoms, diagnosis, causes, and treatment.

Pathological narcissism is a life-long pattern of traits and behaviors which signify infatuation and obsession with one's self to the exclusion of all others and the egotistic and ruthless pursuit of one's gratification, dominance and ambition.

As distinct from healthy narcissism, which we all possess, pathological narcissism is maladaptive, rigid, persisting, and causes significant distress, and functional impairment.

Narcissistic Personality Disorder (NPD) (formerly known as megalomania or, colloquially, as egotism) is a form of pathological narcissism. It is a Cluster B (dramatic, emotional, or erratic) personality disorder. Other Cluster B personality disorders are Borderline Personality Disorder (BPD), Antisocial Personality Disorder (APD), and Histrionic Personality Disorder (HPD).

The DSM-IV-TR defines Narcissistic Personality Disorder (NPD) as "an all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts", such as family life and work. According to DSM IV, the prevalence of NPD is less than 1% of the general population.

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What are the signs and symptoms of Narcissistic Personality Disorder?

Signs and symptoms of narcissistic personality disorder may include:

  • Grandiose sense of one's own abilities or achievements

  • Fantasies about having exceptional power, attractiveness or success

  • Sense of belonging to an exclusive group of people who truly understand each other

  • Need for constant praise

  • Expectations of special treatment

  • Exploitation of other people

  • Lack of empathy for other people

  • Envy of other people or a belief that you are the subject of other people's envy

  • Haughty or arrogant behaviors

  • Reacts to criticism with feelings or rage, shame, or humiliation

In-depth look at Narcissistic Personality Disorder - signs and symptoms, diagnosis, causes, and treatment.Individuals with narcissistic personality disorder may come across as conceited or snobbish. They often monopolize conversation. They may belittle or look down on people they perceive as inferior. When they don't receive the special treatment to which they feel entitled, they may become very impatient or angry.

People with narcissistic personality disorder tend to seek out individuals whom they perceive as equal to their own self-image or to whom they attribute the same special talents and qualities they see in themselves. They may insist on having "the best" of everything car, athletic club or social circles.

Their personal relationships and interactions are driven by the need for admiration and praise. Consequently, people with narcissistic personality disorder value others primarily according to how well those individuals affirm their unrealistic self-image. This limited value of others usually means that people with the disorder aren't interested in or aren't capable of perceiving the feelings or needs of others. They may take advantage of other people to make themselves look as good as they imagine.

On the other hand, seeking admiration also makes people with narcissistic personality disorder vulnerable to criticism. If someone criticizes an individual's contribution to a project at work, for example, he or she will perceive this comment as an assault on an image that needs to be protected at all costs and may respond with feelings of shame, humiliation or sadness or may express rage, disdain or defensive behaviors.

DSM IV Criteria for Narcissistic Personality Disorder

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  • has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

  • 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: 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

What causes someone to develop Narcissistic Personality Disorder?

The exact cause of narcissistic personality disorder is not known. However, many mental health professionals believe it results from extremes in child rearing. For example, the disorder might develop as the result of excessive pampering, or when a child's parents have a need for their children to be talented or special in order to maintain their own self-esteem. On the other end of the spectrum, narcissistic personality disorder might develop as the result of neglect or abuse and trauma inflicted by parents or other authority figures during childhood. The disorder usually is evident by early adulthood.

Childhood developmental factors and parenting behaviors that may contribute to the disorder include:

  • An oversensitive temperament at birth

  • Overindulgence and overvaluation by parents

  • Valued by parents as a means to regulate their own self-esteem

  • 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