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Narcissistic personality disorder

In order for a person to be diagnosed with narcissistic personality disorder (NPD) they must meet five or more of the following symptoms:

· 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 very strong sense of entitlement, e.g., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

· Is exploitative of others, e.g., takes advantage of others to achieve his or her own ends

· Lacks empathy, e.g., 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

· Regularly shows arrogant, haughty behaviors or attitudes

Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year.

Narcissistic personality disorder is more prevalent in males than females, and is thought to occur in up to 6.2 percent of the general population.

Like most personality disorders, narcissistic personality disorder typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s.

Learn more about the symptoms and characteristics of someone with narcissitic personality disorder.

2. How is Narcissistic Personality Disorder Diagnosed?

Personality disorders such as narcissistic personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood or genetic tests that are used to diagnose personality disorder.

Many people with narcissistic personality disorder don't seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person's life. This most often happens when a person's coping resources are stretched too thin to deal with stress or other life events.

A diagnosis for narcissistic personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.

3. Causes of Narcissistic Personality Disorder

Researchers today don't know what causes narcissistic personality disorder. There are many theories, however, about the possible causes of narcissistic personality disorder. Most professionals subscribe to a biopsychosocial model of causation -- that is, the causes of are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual's personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible -- rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be "passed down" to their children.

4. How Does the Disorder Work?

Narcissists build a false sense of self-worth from narcissistic supply (attention, adoration, adulation) which helps to regulate their ego and they often do this by using and slandering the people around them, sometimes showing off and putting other people down in order to make themselves feel and look good; they may carelessly and severely damage the lives of people around them in doing so.

Narcissists are experts at psychological manipulation and mental and emotional abuse. When confronted narcissists make projections, they twist the evidence to make it look like everyone else is wrong and that they are right and furthermore, that they are the one being victimized - they play the victim oh so convincingly. If in a relationship the narcissist manipulates their relationship partner to reflect the behavior desired in them so that the partner acts out the narcissist's rage for them - the partner will have already been ostracized behind their back, usually starting very early into the relationship, so that people around them start to believe that the real victim is the one who is mentally unstable.

Over long-term periods of time the disguised abuse gradually wears down at the psyche of the partner of the narcissist, eventually leaving them feeling like their soul is being worn down and crushed, though the victim often does not consciously realize or understand what is happening or why, the abuse is simply too well disguised and insidious in nature - usually it's the narcissist's partner who ends up having to go to therapy to learn how to deal with them and is the one left scratching their head wondering 'is it me?'

Narcissists can sometimes be extremely paranoid to the point where they will go off the rails if they so much as hear that someone has mentioned their name, even if in innocent conversation. Narcissists develop an obsessive compulsion to uphold the false sense of self that they have created, it has become a part of them and it needs to be consistently and constantly fed.

When in conversation narcissists usually discuss everything in the manner of how it relates to them or their own past experiences therefore giving the illusion that they are in love with themselves - In reality the opposite is usually the case, deep down inside narcissists are emotionally scarred and weak and have repressed their true emotions resulting in a callous, shallow exterior - a highly evolved and highly elaborate defense mechanism which acts to protect the hidden inner emotions. psychological narcissistic personality disorder

There are actually various types and sub-types of malignant narcissism/NPD, despite what you may read about narcissists being either cerebral or somatic. A somatic narcissist is someone who uses their body for constant attention by becoming a satyr (if male) or a nymphomaniac (if female). A cerebral narcissist gains this attention by showing off their intelligence and sometimes finances to make others seem inferior. There are also many other forms of the disorder.

Covert (or stealth) narcissists can be extremely difficult to detect and it's actually possible to live with a covert narcissist for all of your life without even realizing it. Don't be fooled by the statistics that shows most sufferers of NPD to be male. This is an inevitable misconception and statistical research shows that the figures may actually be closer to 50% male and 50% female. Females are naturally more narcissistic in their nature anyway, it's part of the natural female defense mechanism so it's much easier for female narcissists to remain unrecognized.

Despite the original belief that only approximately 1% of the world's population suffer with Narcissistic Personality Disorder, more recent research indicates that the true figure could be as many as 13%-16%. Narcissists are masters of invisibility, they don't get picked up by the standard radar of human perception, only intuition and even then you won't quite be able to put your finger on what's really going on.

5. How Do I Recognize a Narcissist?

In many cases the narcissist often has an ex-partner (or several) who they will claim is mentally ill in some way and who may have become dependent on alcohol or drugs (therefore, in the narcissist's opinion, it's all their fault). This is commonly the result of being subject to narcissistic abuse over a long period of time. In extreme cases, this alien behavior can go as far as to develop into full blown psychological murder. Narcissists are experts at using very cleverly plotted, calculated, emotional, mental and verbal abuse, guilt and sympathy to manipulate and exploit the people around them. In covertly narcissistic relationships this is usually solely the narcissist's partner (victim) and in a lot of cases the covertly narcissistic behaviour gradually becomes more and more overt over the years.

Narcissists naturally use hypnotic forms of communication to very cleverly disguise abuse within embedded verbal commands and they use subliminal persuasion tactics, undermining the perception of their victim(s). Seeing as they have been practicing this hypnotic art since they were a child they become experts in it and have what is commonly described as a super human capacity for manipulation. So much so, that narcissists can use other people as pawns and can use them to carry out their manipulative tactics and deceit on their behalf without the pawns even being aware of what's really happening (abuse by proxy), it is as though the narcissist's subconscious mind is their conscious mind.

Malignant narcissism can be described as a severe or complete lack of empathy whereby the narcissist is unable to put themselves in anybody elses shoes, they are unable to relate to other people's emotions, although they often pretend to - this is simply learned behavior and is recalled from script as and when needed - it is not genuine empathy.

Narcissism starts to develop naturally at the age of about six years old and continues to develop from there, it is a necessity for life but for some people traumatic experiences can cause this aspect of personality development to become stunted and as they grow into adulthood, the narcissist remains 'stuck' in the frame of mind of a child or, at the other end of the spectrum, they are overly spoiled and smothered as a child (also a form of abuse).

That is, narcissists go through life playing pretend in the same way that a child does - they remain in the self-love stage of development and do not go on to learn love of another.

When confronted and guilty a narcissists deny everything outright to the point where they will swear on their own children's lives without so much as a flinch then will try to convince their victim that they were imagining everything and that it was all imagined and didn't really happen. They will go as far as to try to convince their victim that they need professional help (and medication). Narcissists are highly skilled expert liars and some can even beat the polygraph due to a lack of physiological response (no empathy).

Over the years it's a possibility that people closest to and who live near the narcissist, particularly family and friends around them, may start to point the finger and make accusations, which are often wrongly targeted at the narcissist's victim. Sometimes people may gradually begin to realize the shocking truth and will eventually have no choice but to break off all contact with the narcissist (and family) and move away, there may even be a great deal of damage done - however, this will only ever take place over the course of several years and it involves somewhat of an 'awakening' process.

The narcissist will act innocent usually having everybody around them fooled, thinking that everybody is incorrectly pointing the finger at them, no matter what. They play the victim better that a professional actor could.

Many narcissist's have one very close friend in particular, a kind of 'scapegoat' who trusts them. Someone they turn to for sympathy, someone they can rely and depend upon, someone who believes they see the narcissist for who they really are despite being fooled by their charismatic facade; narcissists really are that naturally skilled.

6. What's So Bad About NPD?

The worst thing about malignant narcissism is that it's so infectious, not contagious but infectious. Someone who is brought up by parents who are narcissists will inevitably suffer with similar related symptoms and it's not uncommon for children of narcissists to be diagnosed with ADD (Attention Deficit Disorder) or ADHD (Attention Deficit Hyperactivity Disorder). It's a rapidly increasingly problem in society and is spreading at a fast rate - not just from people who suffer with the disorder naturally but from people who are manipulated or abused resulting in them becoming narcissistic resulting from the abuse itself which, essentially, seems to be how the disorder manifests in the first place. It's a vicious cycle yet recognizing a narcissist can be extremely difficult.

Whereas psychopathy is a lack of guilt or remorse and sociopathy is a lack of conscience, narcissism is a lack of empathy - a narcissist cannot relate to another persons emotional needs or understand the pain they may be inflicting upon them. However, they certainly know the difference between right and wrong and between good and evil.

Note: The terms psychopath and sociopath (which are considered derogatory) have now been merged into the new diagnosis of Anti-Social Personality Disorder.

7. Treatment of Narcissistic Personality Disorder

Treatment of narcissistic personality disorder typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to help with specific troubling and debilitating symptoms.

Clinical strategies are outlined by Heinz Kohut, Stephen M. Johnson and James F. Masterson, while Johns discusses a continuum of severity and the kinds of therapy most effective in different cases. Schema Therapy, a form of therapy developed by Jeffrey Young that integrates several therapeutic approaches (psychodynamic, cognitive, behavioral etc.), also offers an approach for the treatment of NPD. It is unusual for people to seek therapy for NPD. This is partly due to the NPD sufferers' not believing they have a problem. Most, if not all, are unable to see the destructive damage they are causing to themselves and to others and usually only seek treatment at the insistence of relatives and friends. Unconscious fears of exposure or inadequacy often cause defensive disdain of therapeutic processes. Pattern change strategies, over a long period of time, are for narcissists to work on increasing their ability to become more empathetic in everyday relationships. To help modify their sense of entitlement and self-centeredness schema, the strategy is to help them identify how to utilize their unique talents and to help others for reasons other than their own personal gain. This is not so much to change their self-perception of their "entitlement" feeling but more to help them empathize with others. Another type of treatment would be temperament change.

Anger, rage, impulsivity and impatience can be worked on with skill training. Therapy is not one hundred percent effective because patients receive feedback poorly and defensively. Anxiety disorders and somatoma dysfunctions are prevalent but the most common would be depression. Medication has proven ineffective for treating narcissistic personality disorder, but psychoanalytic psychotherapy has a higher success rate. Therapists must recognize the patient's traits and use caution in tearing down narcissistic defenses too quickly.

Group treatment has its benefits as the effectiveness of receiving peer feedback rather than the clinician's may be more accepted, but group therapy can also contradict itself as the patient may show "demandingness, egocentrism, social isolation and withdrawal, and socially deviant behavior." Researchers originally thought group therapy among Narcissists would fail because it was believed that group therapy required empathy that NPD patients lack. However, studies show group therapy does hold value for patients because it lets them explore boundaries, develop trust, increase self-awareness, and accept feedback. Relationship therapy stresses the importance of learning and applying four basic interpersonal skills: "...effective expression, empathy, discussion and problem solving/conflict resolution."

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