Narcissistic personality disorder

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**Narcissistic Personality Disorder**
*Classifications and external resources*

Narcissus, the mythical Greek youth, after whom narcissism is named, as depicted in John William Waterhouse's "echo and Narcissus." ca. 1903. Narcissus might have been diagnosed as a classic, somatic narcissist.
ICD-10	F 60.8
ICD-9	301.81

Narcissistic personality disorder (NPD), a term first used by Heinz Kohut in 1971<ref name=kohut1>Kohut, Heinz, The Analysis of the Self, 1971</ref>, is a form of pathological narcissism acknowledged in the Diagnostic and Statistical Manual of Mental Disorders in 1980, in the edition known as DSM III-TR. Narcissistic Personality Disorder, is a maladaptive, rigid, and persistent condition that may cause significant distress and functional impairment.

1 Classification
2 Diagnostic criteria
3 Prevalence, age, and gender features
4 Clinical experience
5 Treatment and prognosis
6 See also
7 References
8 Further Reading
9 External links

[edit] Classification

DSM-IV divides personality disorders into three clusters based on symptom similarities<ref name=DSMcrit>DSM IV-TR, Diagnostic criteria for 301.81 Narcissistic Personality Disorder</ref>:

Cluster A (paranoid, schizoid, schizotypal): odd or eccentric disorders
Cluster B (antisocial, borderline, histrionic, narcissistic): dramatic, emotional or erratic disorders
Cluster C (avoidant, dependent, obsessive-compulsive): anxious or fearful disorders

Narcissistic personality disorder is a "cluster B" personality disorder.

The ICD-10 (International Classification of Mental and Behavioural Disorders, published by the World Health Organisation 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] Diagnostic criteria

At least five of the following are necessary for a diagnosis:

has a grandiose sense of self-importance
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 other special people
requires excessive admiration
strong sense of entitlement
takes advantage of others to achieve his or her own ends
lacks empathy
is often envious or believes others are envious of him or her
arrogant affect.

(see also full list in DSM-IV-TR)

[edit] Prevalence, age, and gender features

According to DSM IV, the prevalence of NPD is less than 1% of the general population, though it manifests itself in 2-16% of psychiatric outpatients. Studies have not demonstrated any ethnic, social, cultural, economic, genetic, or professional predilection to NPD<ref name=DSM1>American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994, p. 660</ref>.

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. The disorder occurs 50 to 75 percent more frequently in men than in women. It has been suggested that NPD may be exacerbated by the onset of aging and the physical, mental, and occupational restrictions it imposes<ref name=DSM1/>.

[edit] Clinical experience

Narcissism is a psychological disorder resulting from a person’s belief that he or she is flawed in a way that makes the person fundamentally unacceptable to others <ref name=gol1>Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, pages 19-20</ref>. 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 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.

The common use of the term “narcissism” refers to some of the ways people defend themselves against this narcissistic dynamic: a concern with one’s own physical and social image, a preoccupation with one’s own thoughts and feelings, and a sense of grandiosity. There are, however, many other behaviors that can stem from narcissistic concerns, such as immersion in one’s own affairs to the exclusion of others, an inability to empathize with others’ experience, interpersonal rigidity, an insistence that one’s opinions and values are “right,” and a tendency to be easily offended and take things personally.

Among psychologists, narcissism is commonly believed to result from an impairment in the quality of the narcissistic person’s relationship with their primary caregivers, usually their parents, in that the parents were unable to form a healthy, empathic attachment to them. 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 <ref name=Johns>Johnson, Stephen M PhD (1987). Humanizing the Narcissistic Style. New York: Norton, page 39</ref>.

To the extent that people are narcissistic, they can be controlling, blaming, self-absorbed, intolerant of others’ views, unaware of other’s needs and of the effects of their behavior on others, and require that others see them as they wish to be seen <ref name=DSM1/>. 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<ref name=co>Rappoport, Alan, Ph. D.Co-Narcissism: How We Adapt to Narcissistic Parents. The Therapist, in press</ref>. (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 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<ref name=co/>.

People who are 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, real or imagined <ref name=DSM2>American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994, p. 659</ref>. To avoid such situations, some narcissistic people withdraw socially and may feign modesty or humility.

There is a broad spectrum of narcissistic personalities, styles, and reactions -- from the very mild, reactive and transient, to the severe and inflexible narcissitic personality disorder.

Though individuals with NPD are often ambitious and capable, the inability to tolerate setbacks, disagreements or criticism makes it difficult for such individuals to work cooperatively with others or to maintain long-term professional achievements <ref name=gol2>Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, pages 22</ref>. The narcissist's perceived fantastic grandiosity, often coupled with a hypomanic mood, is typically not commensurate with his or her real accomplishments.

The interpersonal relationships of patients with NPD are typically impaired due to the individual's lack of empathy, disregard for others, exploitativeness, sense of entitlement, and constant need for attention. They frequently select as mates, and engender in their children, "co-narcissism," which is a term coined to refer to a co-dependent personality style similar to co-alcoholism and co-dependency <ref name=co/>. Co-narcissists organize themselves around the needs of others. They feel responsible for others, accept blame readily, are eager to please, defer to other's opinions, and fear being considered selfish if they act assertively.

[edit] Treatment and prognosis

Though there is controversy in the profession, some psychologists view narcissism as a relatively stable condition that tends to remain relatively unchanged over one’s lifetime. James F. Masterson's A Therapist's Guide to the Personality Disorders: The Masterson Approach outlines a prominent approach to healing Narcissistic Personality Disorders.

It is unusual for people suffering from narcissism to seek treatment for their condition. The individual with narcissistic personality disorder has fears of inadequacy and consequently has great difficulty perceiving that there is any reason to seek treatment. <ref name=Gol3>Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, page 23</ref>.

Persons with NPD often fear a repetition of a critical and rejecting response, rather than a flattering mirroring, if they open up to a therapist. Essentially, they imagine that the therapist would relate to them as their parents did. They are very likely to be disdainful and disparaging towards in response to the notion of psychotherapy. <ref>Kohut, Heinz, (1971). The Analysis of the Self. </ref>