What is Narcissistic Personality Disorder?

Just about everyone knows someone that they can classify as a narcissist, but very few of these people will actually be clinically identified as someone with narcissistic personality disorder. The disorder involving the narcissistic personality includes these types of individuals that present in a clinically extreme manner in what is commonly and colloquially referred to as a God complex.

According to the DSM-IV, these individuals exhibit, a pervasive pattern of grandiosity, need for admiration, and a lack of empathy for others.

The type of narcissism that is required for a clinical diagnosis of NPD occurs at the pathological level and is considered high on the spectrum of narcissistic severity. Oddly enough, this disorder often results from the thought process that the individual is flawed in some manner that makes them unacceptable to others.

Key Characteristics of the Narcissistic Personality

The NPD is one that is continuously aware of what others think of them, or creates perceptions based on this belief. This person is on a constant mission to deny rejection or isolation, and thus use a grandiose image of themselves to convey their esteem and delusions to the world.

Because this grandiose perception actually stems from extreme low self esteem, this is a disorder that is extremely isolating to the sufferer. It is painful and disenfranchising and it often results in a series of relationships that can not be maintained or sustained.
In order to sustain their relationships, the narcissistic personality will be controlling, manipulative, and blame others in their primary relationships frequently for petty problems.

DSM-IV Criteria for NPD

Narcissistic Personality Disorder falls on Axis II and the Cluster B of the DSM IV personality disorders. As mentioned, the DSM IV classifies the NPD as: 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. Grandiose delusions of exaggerated self importance, exaggerates talents and achievements with the expectation that they are considered as superior or authorities on any subject;
  2. Preoccupation with fantasies involving power, success, love, and brilliance;
  3. Believes that they are unique and special and are only understood by people or institutions considered to be high in status;
  4. Excessive admiration is required;
  5. Unable to exhibit empathy or to identify and recognize needs and feelings of others;
  6. Envious of those in high power or status positions, but also believes those people are envious of themselves;
  7. Often described as arrogant, haughty, or over confident; and
  8. Must satisfy the set of general personality disorder criterion.

To put in a layman's terms, Narcissistic Personality Disorder is an extreme version of thinking very highly of one's self. A diagnosis of this disorder will be applicable for an individual that thinks they are very important, and exaggerates their achievements and talents in a manner that they believe leads others to believe they are "something special". An example of this would be the person that frequently name drops people or names of importance. A person that has NPD would do this on a regular basis to portray the notion that they know important people and thus are important themselves.

The classic clinical narcissist has a great deal of difficulty accepting accountability for their actions, and will frequently justify wrong behavior in order to meet their own needs. They will use their grandiose delusions in order to get what they want from the world, and have a very difficult time empathizing with those that they "step on" in their efforts to "get to the top". They will require constant admiration, and when those needs are not met, excessive behavior that makes those around them uncomfortable will be the result in order to manipulate others to get their own way.

It is important to note that delusions of a grandiose nature are so severe in the NPD profile that the individual very often believes them themselves, thus making it very difficult for anyone to convince them otherwise. NPD is one of the more difficult personality disorders to treat, but treatment can be effective with cognitive behavioral methods, and in some cases, pharmaceutical support.

Sources:
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
Cooper AM: Narcissism in Normal Development, in Character Pathology. Edited by Zales M. New York, Brunner/Mazel, 1984, pp. 39-56.


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