Narcissistic personality disorder

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Narcissistic personality disorder
Classification and external resources
ICD-10 F60.8
ICD-9 301.81
MeSH D010554

Narcissistic personality disorder (NPD) is a personality disorder defined by the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic classification system used in the United States, as "a pervasive pattern of grandiosity, need for admiration, and a lack of empathy." [1]

The narcissist is described as turning inward for gratification rather than depending on others and as being excessively preoccupied with issues of personal adequacy, power and prestige.[2] Narcissistic personality disorder is closely linked to self-centeredness.

Contents

[edit] Classification

DSM-IV divides personality disorders into three clusters based on symptom similarities.[1] This clustering categorizes the narcissistic personality disorder as a cluster B personality disorder, those personality disorders having in common an excessive sense of self importance. Also in that cluster are the borderline personality disorder, the histrionic personality disorder and the antisocial personality disorder.

The ICD-10 (International Classification of Mental and Behavioral Disorders, published by the World Health Organization in Geneva 1992) regards narcissistic personality disorder (NPD) as "a personality disorder that fits none of the specific rubrics". It relegates it to the category known as "Other specific personality disorders", which also includes the eccentric, "haltlose", immature, passive-aggressive, and psychoneurotic personality disorders.

[edit] DSM IV-TR criteria

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:[1]

  1. has a grandiose sense of self-importance
  2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  3. believes that he or she is "special".
  4. requires excessive admiration
  5. has a sense of entitlement
  6. is interpersonally exploitative
  7. lacks empathy
  8. is often envious of others or believes others are envious of him or her
  9. shows arrogant, haughty behaviors or attitudes

[edit] ICD-10 criteria

While the ICD-10 does not specifically define the characteristics of this personality disorder, it is classified in the category "Other Specific Personality Disorders".

ICD-10 states that narcissistic personality disorder is "a personality disorder that fits none of the specific rubrics F60.0-F60.7". That is, this personality disorder does not meet the diagnostic criteria for any of the following:

[edit] Epidemiology

Lifetime prevalence is estimated at 1% in the general population and 2% to 16% in clinical populations. [3]

[edit] Hypothetical causes

The etiology of this disorder is unknown according to Groopman and Cooper. However, they list the following factors identified by various researchers as possible factors.[3]

  • 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
  • Excessive praise for good behaviors or excessive criticism for poor behaviors in childhood

Some narcissistic traits are common and a normal developmental phase. When these traits are compounded by a failure of the interpersonal environment and continue into adulthood they may intensify to the point where NPD is diagnosed.[citation needed] It has been suggested[who?] that NPD may be exacerbated by the onset of aging and the physical, mental, and occupational restrictions it imposes as can most personality traits.[4][dubious – discuss]

[edit] Various clinical views

 This article needs additional citations for verification. Please help improve this article by adding reliable references (ideally, using inline citations). Unsourced material may be challenged and removed. (February 2008)

Pathological narcissism occurs in a spectrum of severity. In its more extreme forms, it is narcissistic personality disorder. NPD is considered to result from a person's belief that he or she is flawed in a way that makes the person fundamentally unacceptable to others [5]. This belief is held below the person's conscious awareness; such a person would typically deny thinking such a thing, if questioned. In order to protect themselves against the intolerably painful rejection and isolation that (they imagine) would follow if others recognized their supposedly defective nature, such people make strong attempts to control others’ view of them and behavior towards them.

Pathological narcissism can develop from an impairment in the quality of the person's relationship with their primary caregivers, usually their parents, in that the parents were unable to form a healthy, empathic attachment to them.[citation needed] This results in the child conceiving of themselves as unimportant and unconnected to others. The child typically comes to believe that he or she has some defect of personality which makes them unvalued and unwanted [6].

Narcissistic personality disorder (NPD) is isolating, disenfranchising, painful, and formidable for those diagnosed with it and often those who are in a relationship with them. Distinctions need to be made among those who have NPD because not each and every person with NPD is the same. Even with similar core issues, the way in which one's individual narcissism manifests itself in his or her relationships varies.[citation needed]

To the extent that people are pathologically narcissistic, they can be controlling, blaming, self-absorbed, intolerant of others’ views, unaware of others' needs and of the effects of their behavior on others, and insistent that others see them as they wish to be seen [4]. They may also demand certain behavior from their children because they see the children as extensions of themselves, and need the children to represent them in the world in ways that meet the parents’ emotional needs [7]. (For example, a narcissistic father who was a lawyer demanded that his son, who had always been treated as the "favorite" in the family, enter the legal profession as well. When the son chose another career, the father rejected and disparaged him.)

These traits will lead overly narcissistic parents to be very intrusive in some ways, and entirely neglectful in others. The children are punished if they do not respond adequately to the parents’ needs. This punishment may take a variety of forms, including physical abuse, angry outbursts, blame, attempts to instill guilt, emotional withdrawal, and criticism. Whatever form it takes, the purpose of the punishment is to enforce compliance with the parents' narcissistic needs[7].

People who are overly narcissistic commonly feel rejected, humiliated and threatened when criticised. To protect themselves from these dangers, they often react with disdain, rage, and/or defiance to any slight criticism, real or imagined [8]. To avoid such situations, some narcissistic people withdraw socially and may feign modesty or humility. In the case of feeling the lack of admiration, adulation, attention and affirmation the person can also manifest wishes to be feared and to be notorious (narcissistic supply).

Though individuals with NPD are often ambitious and capable, the inability to tolerate setbacks, disagreements or criticism, along with lack of empathy, make it difficult for such individuals to work cooperatively with others or to maintain long-term professional achievements [9]. With narcissistic personality disorder, the person's perceived fantastic grandiosity, often coupled with a hypomanic mood, is typically not commensurate with his or her real accomplishments.

The exploitative, sense of entitlement, lack of empathy, disregard for others, and constant need for attention inherent in NPD adversely affect interpersonal relationships.


[edit] Theories on narcissistic personality disorder and shame

 This section needs additional citations for verification. Please help improve this article by adding reliable references (ideally, using inline citations). Unsourced material may be challenged and removed. (February 2008)

It has been suggested that narcissistic personality disorder may be related to defenses against shame. [10]

Gabbard suggested NPD could be broken down into two subtypes[11]. He saw the "oblivious" subtype as being grandiose, arrogant and thick skinned and the "hypervigilant" subtype as easily hurt, oversensitive and ashamed.

He suggested that the oblivious subtype presents a large, powerful, grandiose self to be admired, envied and appreciated. This self is the antithesis of the weakened and internalized self that hides in a generic state of shame. This is how the internalized self fends off devaluation, while the hypervigilant subtype neutralizes devaluation by seeing others as unjust abusers. This hypervigilant type does not fend off devaluation; he is obsessed with it.

Jeffrey Young, who coined the term "Schema Therapy", a technique originally developed by Aaron T. Beck (1979), also links shame to NPD. He sees the so-called Defectiveness Schema as a core schema of NPD, next to the Emotional Deprivation and Entitlement Schemas. [12]. The Defectiveness Schema is compensated with three Schema Modes (coping strategies):

  • Surrender: Chooses critical partners and significant others; puts him- or herself down.
  • Avoidance: Avoids sharing "shameful" thoughts and feelings with partners and significant others due to fear of rejection.
  • Overcompensation: Behaves in a critical or superior way toward others; tries to come across as perfect.

Note that an individual with this schema might not employ all three schema modes.

[edit] Treatment and prognosis

Most psychiatrists and psychologists regard NPD as a relatively stable condition when experienced as a primary disorder [7]. James F. Masterson outlines a prominent approach to healing NPD, while [6] discussing a continuum of severity and the kinds of therapy most effective in different cases. Typically, as narcissism is an ingrained personality trait, rather than a chemical imbalance, medication and therapy are not very effective in treating the disorder.[citation needed] Schema Therapy, a form of therapy developed by Jeffrey E. Young that integrates several therapeutic approaches (psychodynamic, cognitive, behavioral etc.), also offers an approach for the treatment of NPD. [13] It is unusual for people to seek therapy for NPD. Subconscious fears of exposure or inadequacy are often met with defensive disdain of therapeutic processes.[14][15] Pharmacotherapy is rarely effective; in a review of the literature, one patient responded to Wellbutrin.[16]

[edit] See also

[edit] Footnotes

  1. ^ a b c DSM IV-TR, Diagnostic criteria for 301.81 Narcissistic Personality Disorder
  2. ^ Millon, Theordore (1996). Disorders of Personality: DSM-IV-TM and Beyond. New York: John Wiley and Sons. pp. 393. ISBN 0-471-01186-X. 
  3. ^ a b "Narcissistic Personality Disorder". Personality Disorders - Narcissistic Personality Disorder. Armenian Medical Network. 2006. http://www.health.am/psy/narcissistic-personality-disorder/. Retrieved on 2007-02-14. 
  4. ^ a b full list in DSM-IV-TR, p. 717
  5. ^ Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, pages 19-20
  6. ^ a b Johnson, Stephen M PhD (1987). Humanizing the Narcissistic Style. New York: Norton, page 39
  7. ^ a b c Rappoport, Alan, Ph. D.Co-Narcissism: How We Adapt to Narcissistic Parents. The Therapist, in press
  8. ^ American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994, p. 659
  9. ^ Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, pages 22
  10. ^ Wurmser L, Shame, the veiled companion of narcissism, in The Many Faces of Shame, edited by Nathanson DL. New York, Guilford, 1987, pp 64–92
  11. ^ Gabbard GO, subtypes of narcissistic personality disorder. Bull Menninger Clin 1989; 53:527–532
  12. ^ Young, Klosko, Weishaar: Schema Therapy - A Practitioner's Guide, 2003, Page 375
  13. ^ Young, Klosko, Weishaar: Schema Therapy - A Practitioner's Guide, 2003, chapter 10, Pages 373-424
  14. ^ Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, page 23
  15. ^ Kohut, Heinz, (1971). The Analysis of the Self.
  16. ^ [1]. mhc.com

[edit] References

  • The Culture of Narcissism, C. Lasch, New York: Norton; Revised edition (May 1991). ISBN 978-0393307382

[edit] External links

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Personality Disorders
DSM-IV
Antisocial · Borderline · Histrionic · Narcissistic
ICD-10 only
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