Narcissistic personality disorder (NPD) is named for Narcissus from Greek mythology, the same guy who gave us the words narcissism and narcissist. A person with this personality disorder has extreme feelings of self-love and superiority, and believes that they are deserving of special attention and consideration from others. A narcissistic person often also has serious difficulties with self-esteem, jealousy, and depression. This is a Cluster B 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).
  • 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, 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.
  • --From the DSM-IV-TR.

To count as a personality disorder, the narcissism must not only meet at least five of the criteria listed above, but must also interfere with a person's ability to function in everyday life.

The DSM is used in America, but if you live in Europe, or much of the rest of the world, your psychologist is more likely to refer to the ICD-10 (ICD-10 Classification of Mental and Behavioural Disorders, put out by the World Health Organization). The ICD doesn't recognize NPD as a full-fledged personality disorder. Instead it lists it as a possible diagnoses for a personality disorder that does not match the 'rubric' (list of symptoms) for any of the seven personality disorders that it does have full listings for.

NPD occurs in about 1% of the population, although it is hard to get good information on this, as those with NPD are unlikely to seek out help. Also keep in mind that somewhat narcissistic attitudes are not unusual in teenagers -- this is probably why the DSM states that NPD begins in early adulthood. NPD is not just the possession of the traits listed above, it is the lack of getting past these traits while you are still young, and developing your personality.

There is much debate over just what is the best method to treat NPD; check with your therapist for recommendations.

WHAT IS NPD (Narcissistic Personality Disorder)?

An all-pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts. Five (or more) of the following criteria must be met:

(1) Feels grandiose and self-importance (e.g., exaggerates achievements and talents to the point of lying, demands to be recognized as superior without commensurate achievements)

(2) Is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion

(3) Firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions)

(4) Requires excessive admiration, adulation, attention and affirmation - or, failing that, wishes to be feared and to be notorious (narcissistic supply).

(5) Feels entitled. Expects unreasonable or special and favourable priority treatment. Demands automatic and full compliance with his or her expectations

(6) Is "interpersonally exploitative", i.e., uses others to achieve his or her own ends

(7) Devoid of empathy. Is unable or unwilling to identify with or acknowledge the feelings and needs of others

(8) Constantly envious of others or believes that they feel the same about him or her

(9) Arrogant, haughty behaviours or attitudes coupled with rage when frustrated, contradicted, or confronted.

The language in the criteria above is based on or summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition (DSM IV). Washington, DC: American Psychiatric Association.

Sam Vaknin. (1999). Malignant Self Love - Narcissism Revisited, first edition. Prague and Skopje: Narcissus Publication.

Most narcissists (75%) are men.

NPD (=the Narcissistic Personality Disorder) is one of a "family" of personality disorders (formerly known as "Cluster B").

Other members: Borderline PD, Antisocial PD and Histrionic PD.

NPD is often diagnosed with other mental health disorders ("co-morbidity") - or with substance abuse, or impulsive and reckless behaviours ("dual diagnosis").

NPD is new (1980) mental health category in the Diagnostic and Statistics Manual (DSM).

There is only scant research regarding narcissism. But what there is has not demonstrated any ethnic, social, cultural, economic, genetic, or professional predilection to NPD.

It is estimated that 0.7-1% of the general population suffer from NPD.

Pathological narcissism was first described in detail by Freud. Other major contributors are: Klein, Horney, Kohut, Kernberg, Millon, Roningstam, Gunderson, Hare.

The onset of 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.

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

Narcissists 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 "conquests").

Narcissists are either "Classic" - see definition below - or they are "Compensatory", or "Inverted".

NPD is treated in talk therapy (psychodynamic or cognitive-behavioral).

The prognosis for an adult narcissist is poor, though his adaptation to life and to others can improve with treatment. Medication is applied to side-effects and behaviours (such as mood or affect disorders and obsession-compulsion) - usually with some success.

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