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Introduction|Whatisapersonalitydisorder?|NarcissisticPersonalityDisorderHowtorecognizeanarcissist|Traitsdiscussed|"NowWeAreSix"|"It'saGoodLife"

What'snormal?|Furtherreading|Attachment|Narcissusinart|Aftermath|Beyond|Music

Whatisapersonalitydisorder?[fromDiagnosticandStatisticalManualofMentalDisorders,4thedition,1994,commonlyreferredtoasDSMIV,oftheAmericanPsychiatricAssociation.EuropeancountriesusethediagnosticcriteriaoftheWorldHealthOrganization.]

Anenduringpatternofinnerexperienceandbehaviorthatdeviatesmarkedlyfromtheexpectationoftheindividual'sculture,ispervasiveandinflexible,hasanonsetinadolescenceorearlyadulthood,isstableovertime,andleadstodistressorimpairment.

Apersonalitydisorderisapatternofdeviantorabnormalbehaviorthatthepersondoesn'tchangeeventhoughitcausesemotionalupsetsandtroublewithotherpeopleatworkandinpersonalrelationships.Itisnotlimitedtoepisodesofmentalillness,anditisnotcausedbydrugoralcoholuse,headinjury,orillness.ThereareaboutadozendifferentbehaviorpatternsclassifiedaspersonalitydisordersbyDSMIV.Allthepersonalitydisordersshowupasdeviationsfromnormalinoneormoreofthefollowing:(1)cognitioni.e.,perception,thinking,andinterpretationofoneself,otherpeople,andevents(2)affectivityi.e.,emotionalresponses(range,intensity,lability,appropriateness)(3)interpersonalfunctions(4)impulsivity.

NarcissisticPersonalityDisorderWhilegrandiosityisthediagnostichallmarkofpathologicalnarcissism,thereisresearchevidencethatpathologicalnarcissismoccursintwoforms,(a)agrandiosestateofmindinyoungadultsthatcanbecorrectedbylifeexperiences,and(b)thestabledisorderdescribedinDSMIV,whichisdefinedlessbygrandiositythanbyseverelydisturbedinterpersonalrelations.Thepreferredtheoryseemstobethatnarcissismiscausedbyveryearlyaffectivedeprivation,yettheclinicalmaterialtendstodescribenarcissistsasunwillingratherthanunable,thustreatingnarcissisticbehaviorsasvolitionalthatis,narcissismistermedapersonalitydisorder,butittendstobediscussedasacharacterdisorder.Thisdistinctionisimportanttoprognosisandtreatmentpossibilities.IfNPDiscausedbyinfantiledamageandconsequentdevelopmentalshortcircuits,itprobablyrepresentsanirremediablecondition.Ontheotherhand,ifnarcissismisabehaviorpatternthat'slearned,thenthereissomehope,howevertenuous,thatit'sabehaviorpatternthatcanbeunlearned.

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TheclinicalliteratureonNPDishighlytheoretical,abstract,andgeneral,withsparsecasematerial,suggestingthatclinicalwritershavelittleexperiencewithnarcissismintheflesh.Thereareseveralreasonsforthistobeso:TheincidenceofNPDisestimatedat1%inthegeneralpopulation,thoughIhaven'tbeenabletodiscoverthebasisofthisestimate.Narcissistsrarelyentertreatmentand,onceintreatment,progressveryslowly.We'retalkingabouttwoormoreyearsoffrequentsessionsbeforethenarcissistcanacknowledgeeventhatthetherapistissometimeshelpful.It'sdifficulttokeepnarcissistsintreatmentlongenoughforimprovementtobemadeandfewpeople,narcissistsornot,havethemotivationorthemoneytopursuetreatmentthatproducessolittlesolate.Becauseoftheinfluenceofthirdpartypayers(insurancecompanies),therehasbeenastrongtrendtowardsshorttermtherapythatconcentratesonamelioratingacutetroubles,suchasdepression,ratherthandelvingintounderlyingchronicproblems.Narcissistsareveryreluctanttoopenupandtrust,soit'spossiblethattheirNPDisnotevenrecognizedbytherapistsinshorttermtreatment.PurelyanecdotalevidencefromcorrespondentsandfromobservationsofpeopleIknowindicatesthatselectiveserotoninreuptakeinhibitors,suchasProzac,aggravatenarcissists'grandiosityandlackofsocialinhibition.IthasalsobeensuggestedthatselfhelpliteratureaboutbolsteringselfesteemandgettingwhatyouwantoutoflifeorthatencouragesthefeelingofvictimizationhasaggravatingeffectsonNPDthinkingandbehavior.Mostclinicalwritersseemunawarethatnarcissists'selfreportsareunreliable.Thisistroubling,consideringthatlyingisthemostcommoncomplaintaboutnarcissistsandthat,inmanyinstances,defectsofempathyleadnarcissiststowildlyinaccuratemisinterpretationsofotherpeople'sspeechandactions,sothattheymaybelievethattheyarelikedandrespecteddespiteahistoryofcallousandexploitativepersonalinteractions.

[fromDiagnosticandStatisticalManualofMentalDisorders,4thedition,1994,commonlyreferredtoasDSMIV,oftheAmericanPsychiatricAssociation.EuropeancountriesusethediagnosticcriteriaoftheWorldHealthOrganization.]

Apervasivepatternofgrandiosity(infantasyorbehavior),needforadmiration,andlackofempathy.[jma:NPDfirstappearedinDSMIIIin1980beforethattimetherehadbeennoformaldiagnosticdescription.Additionally,thereisconsiderableoverlapbetweenpersonalitydisordersandclinicianstendtodiagnosemixesoftwoormore.Grandiosityisaspecialcase,butlackofempathyandexploitativeinterpersonalrelationsarenotuniquetoNPD,noristheneedtobeseenasspecialorunique.ThedifferentialdiagnosisofNPDismadeontheabsenceofspecificgrossbehaviors.BorderlinePersonalityDisorderhasseveralconspicuoussimilaritiestoNPD,butBPDischaracterizedbyselfinjuryandthreatenedorattemptedsuicide,whereasnarcissistsarerarelyselfharminginthisway.BPDmayincludepsychoticbreaks,andtheseareuncharacteristicofNPDbutnotunknown.TheneedforconstantattentionisalsofoundinHistrionicPersonalityDisorder,butHPDandBPDarebothstronglyorientedtowardsrelationships,whereasNPDischaracterizedbyaloofnessandavoidanceofintimacy.GrandiosityisuniquetoNPDamongpersonalitydisorders,butitisfoundinotherpsychiatricillnesses.Psychopathsdisplaypathological

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narcissism,includinggrandiosity,butpsychopathyisdifferentiatedfromNPDbypsychopaths'willingnesstousephysicalviolencetogetwhattheywant,whereasnarcissistsrarelycommitcrimesthenarcissistsI'veknownpersonallyare,infact,aversetophysicalcontactwithothers,thoughtheywilloccasionallystrikeoutinanimpulseofrage.Ithasbeenfoundthatcourtorderedpsychotherapyforpsychopathsactuallyincreasestheirrecidivismrateapparentlytreatmentteachespsychopathsnewwaystoexploitotherpeople.Bipolarillnessalsocontainsstrongelementsofgrandiosity.Seemoreongrandiosityandempathyanditslackbelow.]Thedisorderbeginsbyearlyadulthoodandisindicatedbyatleastfiveofthefollowing:

Translation:NarcissisticPersonalityDisorder(NPD)isapatternofselfcenteredoregotisticalbehaviorthatshowsupinthinkingandbehaviorinalotofdifferentsituationsandactivities.PeoplewithNPDwon't(orcan't)changetheirbehaviorevenwhenitcausesproblemsatworkorwhenotherpeoplecomplainaboutthewaytheyact,orwhentheirbehaviorcausesalotofemotionaldistresstoothers(orthemselves?noneofmynarcissistseveradmittobeingdistressedbytheirownbehaviortheyalwaysblameotherpeopleforanyproblems).Thispatternofselfcenteredoregotisticalbehaviorisnotcausedbycurrentdrugoralcoholuse,headinjury,acutepsychoticepisodes,oranyotherillness,buthasbeengoingonsteadilyatleastsinceadolescenceorearlyadulthood.NPDinterfereswithpeople'sfunctioningintheiroccupationsandintheirrelationships:Mildimpairmentwhenselfcenteredoregotisticalbehaviorresultsinoccasionalminorproblems,butthepersonisgenerallydoingprettywell.Moderateimpairmentwhenselfcenteredoregotisticalbehaviorresultsin:(a)missingdaysfromwork,householdduties,orschool,(b)significantperformanceproblemsasawageearner,homemaker,orstudent,(c)frequentlyavoidingoralienatingfriends,(d)significantriskofharmingselforothers(frequentsuicidalpreoccupationoftenneglectingfamily,orfrequentlyabusingothersorcommittingcriminalacts).Severeimpairmentwhenselfcenteredoregotisticalbehaviorresultsin:(a)stayinginbedallday,(b)totallyalienatingallfriendsandfamily,(c)severeriskofharmingselforothers(failingtomaintainpersonalhygienepersistentdangerofsuicide,abuse,orcrime).

1.Anexaggeratedsenseofselfimportance(e.g.,exaggeratesachievementsandtalents,expectstoberecognizedassuperiorwithoutcommensurateachievements)

Translation:Grandiosityisthehallmarkofnarcissism.Sowhatisgrandiose?

Thesimplesteverydaywaythatnarcissistsshowtheirexaggeratedsenseofselfimportanceisbytalkingaboutfamily,work,lifeingeneralasifthereisnobodyelseinthepicture.Whatevertheymaybedoing,intheirownview,theyarethestar,andtheygivetheimpressionthattheyarebearingheroicresponsibilityfortheirfamilyordepartmentorcompany,thattheyhavetotakecareofeverythingbecausetheirspousesorcoworkersareundependable,uncooperative,orotherwiseunfit.Theyignoreordenigratetheabilitiesandcontributionsofothers

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andcomplainthattheyreceivenohelpatalltheymayinspireyoursympathyoradmirationfortheirstoicisminthefaceofhardshiporunstintingselfsacrificeforthegoodof(undeserving)others.Butthiseverydaygrandiosityisanaspectofnarcissismthatyoumaynevercatchontounlessyouvisitthenarcissist'shomeorworkplaceandseeforyourselfthatothersareinvolvedandarepullingtheirshareoftheloadand,moreoftenthannot,arealsopullingthenarcissist'sshareaswell.Anexampleistheolderwomanwhotoldmewithasighthatsheknewshehadn'tbeenaperfectmotherbutshejustneverhadanyhelpatallandshesaidthisdespiteknowingthatIknewthatshehadwornoutanddiscardedtwodevotedhusbandsandhadlivedinherparents'pocket(andpocketbook)aslongastheylived,quicklyblowinghersubstantialinheritanceonflakybusinessschemes.Anotherexampleisclaimingunusualbenefitsorspectacularresultsfromordinaryeffortandinvestment,givingtheimpressionthatsomehowthenarcissist'stimeandmoneyareworthmorethanotherpeople's.[Hereisanarticleaboutrecognizingandcopingwithnarcissismintheworkplaceitisratherheavyonmanagementjargonandpsychobabble,butworthreading."TheImpactofNarcissismonLeadershipandSustainability"byBruceGregory,Ph.D."Whenthenarcissisticdefenseisoperatinginaninterpersonalorgroupsetting,thegrandiosepartdoesnotshowitsfaceinpublic.Inpublicitpresentsafrontofpatience,congeniality,andconfidentreasonableness."]

Inpopularusage,thetermsnarcissism,narcissist,andnarcissisticdenoteabsurdvanityandareappliedtopeoplewhoseambitionsandaspirationsaremuchgranderthantheirevidenttalents.Sometimesthesetermsareappliedtopeoplewhoaresimplyfullofthemselvesevenwhentheirrealachievementsarespectacular.Outstandingperformersarenotalwaysmodest,buttheyaren'tgrandioseiftheirselfassessmentsarerealistice.g.,MuhammadAli,thenCassiusClay,wasnotoriousforboasting"Iamthegreatest!"andalsopointingoutthathewastheprettiest,buthewasthegreatestandtheprettiestforanumberofyears,sohisselfassessmentsweren'tgrandiose.Somenarcissistsareflamboyantlyboastfulandselfaggrandizing,butmanyareinconspicuousinpublic,savingtheirconceitandautocraticopinionsfortheirnearestanddearest.Commonconspicuousgrandiosebehaviorsincludeexpectingspecialtreatmentoradmirationonthebasisofclaiming(a)toknowimportant,powerfulorfamouspeopleor(b)tobeextraordinarilyintelligentortalented.Asareallifeexample,IusedtohaveaneighborwhotoldhiswifethathewastheyoungestpersonsinceSirIsaacNewtontotakeadoctorateatOxford.Theneighborgavenoevidenceofaworldclasseducation,soIlookedupNewtonandfoundoutthatNewtonhadcompletedhisbaccalaureateattheageoftwentytwo(likemostpeople)andspenthisentireacademiccareeratCambridge.Thegrandioseclaimsofnarcissistsaresuperficiallyplausiblefabrications,readilypuncturedbyalittlecriticalconsideration.Thetestisperformance:dotheydeliverthegoods?(There'salsothespecialsituationofageniuswho'salsostronglynarcissistic,asperhapsFrankLloydWright.Justremindyourselfthattheoddsarethatyou'llmeetatleast1000narcissistsforeverygeniusyoucomeacross.)[Moreongrandiosity.]

2.Preoccupationwithfantasiesofunlimitedsuccess,power,brilliance,beauty,orideallove

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Translation:Narcissistscultivatesolipsisticor"autistic"fantasies,whichistosaythattheyliveintheirownlittleworlds(andreactwithaffrontwhenrealitydarestointrude).

3.Believesheis"special"andcanonlybeunderstoodby,orshouldassociatewith,otherspecialorhighstatuspeople(orinstitutions)

Translation:Narcissiststhinkthateveryonewhoisnotspecialandsuperiorisworthless.Bydefinition,normal,ordinary,andaveragearen'tspecialandsuperior,andso,tonarcissists,theyareworthless.

4.Requiresexcessiveadmiration

Translation:Excessiveintwoways:theywantpraise,compliments,deference,andexpressionsofenvyallthetime,andtheywanttobetoldthateverythingtheydoisbetterthanwhatotherscando.Sincerityisnotanissuehereallthatmatterarefrequencyandvolume.

5.Hasasenseofentitlement

Translation:Theyexpectautomaticcompliancewiththeirwishesorespeciallyfavorabletreatment,suchasthinkingthattheyshouldalwaysbeabletogofirstandthatotherpeopleshouldstopwhateverthey'redoingtodowhatthenarcissistswant,andmayreactwithhurtorragewhentheseexpectationsarefrustrated.

6.Selfishlytakesadvantageofotherstoachievehisownends

Translation:Narcissistsuseotherpeopletogetwhattheywantwithoutcaringaboutthecosttotheotherpeople.

7.Lacksempathy

Translation:Theyareunwillingtorecognizeorsympathizewithotherpeople'sfeelingsandneeds.They"tuneout"whenotherpeoplewanttotalkabouttheirownproblems.Inclinicalterms,empathyistheabilitytorecognizeandinterpretotherpeople'semotions.Lackofempathymaytaketwodifferentdirections:(a)accurateinterpretationofothers'emotionswithnoconcernforothers'distress,whichischaracteristicofpsychopathsand(b)theinabilitytorecognizeandaccuratelyinterpretotherpeople'semotions,whichistheNPDstyle.Thissecondformofdefectiveempathymay(rarely)gosofarasalexithymia,ornowordsforemotions,andisfoundwithpsychosomaticillnesses,i.e.,medicalconditionsinwhichemotionisexperiencedsomaticallyratherthanpsychically.Peoplewithpersonalitydisordersdon'thavethenormalbodyegoidentificationandregard

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theirbodiesonlyinstrumentally,i.e.,astoolstousetogetwhattheywant,or,inbadstates,astorturechambersthatinflictonthemmeaninglesssuffering.Selfdescribednarcissistswho'vewrittentomesaythattheyareawarethattheirfeelingsaredifferentfromotherpeople's,mostlythattheyfeelless,bothinstrengthandvariety(andwhichthenarcissistsinterpretasevidenceoftheirownsuperiority)somenarcissistsreport"numbness"andtheinabilitytoperceivemeaninginotherpeople'semotions.

8.Isoftenenviousofothersorbelievesthatothersareenviousofhim

Translation:Notranslationneeded.

9.Showsarrogant,haughty,patronizing,orcontemptuousbehaviorsorattitudes

Translation:Theytreatotherpeoplelikedirt.

[SomedescriptionsandexplanationsonthispagearebasedonmaterialfromWhatisapersonalitydisorder?byPaulJ.Hannig,Ph.D.,TheOnlineJournalofPsychiatry,NarcissisticPersonalityDisorder,and(defunct)InternetMentalHealthquestionnairefordiagnosisofNarcissisticPersonalityDisorder.Forafirsthandaccountofwhatit'sliketohaveNPD,see"MalignantSelfLoveNarcissismRevisited"byShmuel(Sam)Vaknin,Ph.D.]