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Narcissistic personality disorder
Narcissistic personality disorder (NPD) is a personality disorder that is characterized by extreme feelings of self-importance, a high need for admiration, and a lack of empathy. NPD can be considered as a pathological form of narcissism. It is estimated that 0.7-1% of the general population are afflicted with NPD. Most people with NPD (50-75%, according to the DSM) are men.
There is only scant research regarding pathological narcissism, but what research there is has not demonstrated any ethnic, social, cultural, economic, genetic, or professional predilection to NPD.
There is a whole range of narcissistic reactions, from the mild, reactive and transient to the permanent personality disorder.
People with narcissistic defenses 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").
People with narcissistic defenses are either "classic" (meet five of the nine diagnostic criteria included in the DSM) or they are "compensatory" (their narcissism compensates for deepset feelings of inferiority and lack of self-worth).
Some people with narcissistic defenses are covert or inverted narcissists — as codependents, they derive their narcissistic supply from their relationships with classic narcissists.
The prognosis for an adult suffering from the pathological form of narcissism is poor, though his adaptation to life and to others can improve with treatment. Medication is applied to side-effects and behaviors (such as mood or affect disorders and obsession-compulsion) — usually with some success. NPD is also treated in talk therapy (psychodynamic or cognitive-behavioral).
Diagnostic Criteria (DSM-IV-TR)
A narcissistic personality disorder as defined by the DSM (see DSM cautionary statement) is characterized by an all-pervasive pattern of grandiosity (in fantasy or behavior), 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 are considered necessary for the clinical diagnosis to be met:
- Feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to the point of lying, demands to be recognized as superior without commensurate achievements);
- 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;
- Firmly convinced that they are 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);
- Requires excessive admiration, adulation, attention and affirmation — or, failing that, wishes to be feared and to be notorious (narcissistic supply);
- Feels entitled. Demands automatic and full compliance with their unreasonable expectations for special and favorable priority treatment.
- Is "interpersonally exploitative", i.e., uses others to achieve their own ends;
- Devoid of empathy. Is unable or unwilling to identify with, acknowledge, or accept the feelings, needs, preferences, priorities, and choices of others;
- Constantly envious of others and seeks to hurt or destroy the objects of their frustration. Suffers from persecutory (paranoid) delusions stemming from a belief that others are envious of them and are likely to act similarly;
- Behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient, invincible, immune, "above the law", and omnipresent (magical thinking). Rages when frustrated, contradicted, or confronted by people they consider inferior to themselves and unworthy.
- Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR) 2000. American Psychiatric Association, Washington, DC.
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- Narcissistic Personality Disorder page on mentalhealth.com
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