Narcissistic personality disorder

See also: Narcissism and Malignant narcissism

Narcissistic personality disorder
Classification and external resources
Narcissus by Caravaggio. Narcissus gazing at his own reflection.
ICD-10	F60.8
ICD-9	301.81
MeSH	D010554

Personality disorders
Cluster A (odd)
Paranoid · Schizoid Schizotypal
Cluster B (dramatic)
Antisocial · Borderline Histrionic · Narcissistic
Cluster C (anxious)
Avoidant · Dependent Obsessive-compulsive
Not specified
Depressive Passive–aggressive Sadistic · Self-defeating
v · personality disorder[1] in which the individual is described as being excessively preoccupied with issues of personal adequacy, power, prestige and vanity.[2] Narcissistic personality disorder is closely linked to self-centeredness. Causes The cause of this disorder is unknown, according to Groopman and Cooper. However, they list the following factors identified by various researchers as possibilities.[3] An oversensitive temperament at birth is the main symptomatic chronic form Being praised for perceived exceptional looks or abilities by adults Excessive admiration that is never balanced with realistic feedback Excessive praise for good behaviors or excessive criticism for poor behaviors in childhood Overindulgence and overvaluation by parents Severe emotional abuse in childhood Unpredictable or unreliable caregiving from parents Valued by parents as a means to regulate their own self-esteem Some narcissistic traits are common and a normal developmental phase. When these traits are compounded by a failure of the interpersonal environment and continue into adulthood, they may intensify to the point where NPD is diagnosed.[4] Some psychotherapists believe that the etiology of the disorder is, in Freudian terms, the result of fixation to early childhood development.[5] A 1994 study by Gabbard and Twemlow[6] reports that histories of incest, especially mother-son incest, are associated with NPD in some male patients. Theories Pathological narcissism occurs in a spectrum of severity. In its more extreme forms, it is narcissistic personality disorder (NPD). NPD is considered to result from a person's belief that they are flawed in a way that makes them fundamentally unacceptable to others.[7] This belief is held below the person's conscious awareness; such a person would, if questioned, typically deny thinking such a thing. In order to protect themselves against the intolerably painful rejection and isolation that (they imagine) would follow if others recognised their (perceived) defective nature, such people make strong attempts to control others’ views of them and behavior towards them. Pathological narcissism can develop from an impairment in the quality of the person's relationship with their primary caregivers, usually their parents, in that the parents were unable to form a healthy and empathic attachment to them.[citation needed] This results in the child's perception of himself/herself as unimportant and unconnected to others. The child typically comes to believe they have some personality defect that makes them unvalued and unwanted.[8] To the extent that people are pathologically narcissistic, they can be controlling, blaming, self-absorbed, intolerant of others’ views, unaware of others' needs and of the effects of their behavior on others, and insistent that others see them as they wish to be seen.[9] People who are overly narcissistic commonly feel rejected, humiliated and threatened when criticised. To protect themselves from these dangers, they often react with disdain, rage, and/or defiance to any slight criticism, real or imagined.[10] To avoid such situations, some narcissistic people withdraw socially and may feign modesty or humility. In cases where the narcissistic personality-disordered individual feels a lack of admiration, adulation, attention and affirmation, he/she may also manifest wishes to be feared and to be notorious (narcissistic supply). Although individuals with NPD are often ambitious and capable, the inability to tolerate setbacks, disagreements or criticism, along with lack of empathy, make it difficult for such individuals to work cooperatively with others or to maintain long-term professional achievements.[11] With narcissistic personality disorder, the individual's self-perceived fantastic grandiosity, often coupled with a hypomanic mood, is typically not commensurate with his or her real accomplishments. Splitting Main article: Splitting (psychology) People who are diagnosed with narcissistic personality disorder use splitting as a central defense mechanism. According to psychoanalyst Kernberg, “the normal tension between actual self on the one hand, and ideal self and ideal object on the other, is eliminated by the building up of an inflated self concept within which the actual self and the ideal self and ideal object are confused. At the same time, the remnants of the unacceptable images are repressed and projected onto external objects, which are devalued.”[12] The merging of the "inflated self concept" and the "actual self" is seen in the inherent grandiosity of narcissistic personality disorder. Also inherent in this process is the defense mechanisms of devaluation, idealization and denial.[13] Other people are either manipulated as an extension of one's own self, who serve the sole role of giving "admiration and approval"[14] or they seen as worthless (because they are unable to collude with the narcissist's grandiosity).[15] Relationship to shame It has been suggested that narcissistic personality disorder may be related to defenses against shame.[16] Psychiatrist Glen Gabbard suggested NPD could be broken down into two subtypes.[17] He saw the "oblivious" subtype as being grandiose, arrogant, and thick-skinned and the "hypervigilant" subtype as being easily hurt, oversensitive, and ashamed. In his view, the oblivious subtype presents for admiration, envy, and appreciation a powerful, grandiose self that is the antithesis of a weak internalized self, which hides in shame, while the hypervigilant subtype neutralizes devaluation by seeing others as unjust abusers. Dr. Jeffrey Young, who coined the term "Schema Therapy", a technique originally developed by psychiatrist Aaron T. Beck (1979), also links NPD and shame. He sees the so-called Defectiveness Schema as a core schema of NPD, along with the Emotional Deprivation and Entitlement Schemas.[18] Diagnosis DSM-IV-TR 301.81 The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines narcissistic personality disorder (in Axis II Cluster B) as:[1] 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 others are envious of him or her Shows arrogant, haughty behaviors or attitudes It is also a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria. Proposed removal from DSM-5 The Personality and Personality Disorders Work Group has proposed[19] the elimination of NPD as a distinct disorder in DSM-5[20] as part of a major revamping of the diagnostic criteria for personality disorders, replacing a categorical with a dimensional approach based on the severity of dysfunctional personality trait domains. Some clinicians have objected, characterizing the new diagnostic system as an "unwieldy conglomeration of disparate models that cannot happily coexist" and may have limited usefulness in clinical practice.[21] ICD-10 The World Health Organization's ICD-10 lists narcissistic personality disorder under (F60.8) Other specific personality disorders.[22] It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria. Millon's subtypes Theodore Millon identified five subtypes of narcissist.[2][23] Any individual narcissist may exhibit none or one of the following: Unprincipled narcissist - including antisocial features. A charlatan - is a fraudulent, exploitative, deceptive and unscrupulous individual. Amorous narcissist - including histrionic features. The Don Juan or Casanova of our times - is erotic, exhibitionist. Compensatory narcissist - including negativistic (passive-aggressive), avoidant features. Elitist narcissist - variant of pure pattern. Corresponds to Wilhelm Reich's "phallic narcissistic" personality type. Fanatic narcissist - including paranoid features. An individual whose self-esteem was severely arrested during childhood, who usually displays major paranoid tendencies, and who holds on to an illusion of omnipotence. These people are fighting delusions of insignificance and lost value, and trying to re-establish their self-esteem through grandiose fantasies and self-reinforcement. When unable to gain recognition or support from others, they take on the role of a heroic or worshipped person with a grandiose mission. Alexander Lowen has also specified five major subtypes from Phallic ("Skirtchasing") to Sociopathic (i.e., dissociative, capable of mayhem and murder) as outlined in his famous book, "Narcissism: Denial of the True Self". Treatment Prominent clinical strategies are outlined by Heinz Kohut, Stephen M. Johnson and James F. Masterson, while Johns[8] 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.[24] It is unusual for people to seek therapy for NPD. Subconscious fears of exposure or inadequacy often cause defensive disdain of therapeutic processes.[25][26] Pharmacotherapy is rarely effective. Epidemiology Lifetime prevalence is estimated at 1% in the general population and 2% to 16% in clinical populations.[3][27] Twenge and Campbell conducted studies suggesting that the incidence of NPD has more than doubled in the US in the last 10 years and now 1 in 16 of the population have experienced NPD.[28] History The history of narcissism predates the discovery of narcissistic personality disorder. The term "narcissistic personality structure" was introduced by Kernberg in 1967[29] and "narcissistic personality disorder" first proposed by Heinz Kohut in 1968.[30] Cultural depictions In the film To Die For, Nicole Kidman's character wants to appear on television at all costs, even if this involves murdering her husband. A psychiatric assessment of her character noted that she "was seen as a prototypical narcissistic person by the raters: on average, she satisfied 8 of 9 criteria for narcissistic personality disorder... had she been evaluated for personality disorders, she would receive a diagnosis of narcissistic personality disorder."[31] See also Anorexia nervosa Brian Blackwell Egomania Egotism Hubris Malignant narcissism Megalomania Model minority Narcissism Narcissism of small differences Narcissistic leadership Narcissistic mortification Narcissistic parents Narcissistic Personality Inventory Narcissistic rage and narcissistic injury Narcissistic supply Selfishness Superiority complex True self and false self References ^ a b Narcissistic personality disorder - Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000) ^ a b Millon, Theodore (1996). Disorders of Personality: DSM-IV-TM and Beyond. New York: John Wiley and Sons. p. 393. ISBN 0-471-01186-X.  ^ a b "Narcissistic Personality Disorder". Personality Disorders - Narcissistic Personality Disorder. Armenian Medical Network. 2006. http://www.health.am/psy/narcissistic-personality-disorder/. Retrieved 2007-02-14.  ^ Cooper AM: Narcissism in normal development, in Character Pathology. Edited by Zales M. New York, Brunner/Mazel, 1984, pp. 39-56. ^ Joseph Fernando, MPSY, M.D., The Etiology of Narcissistic Personality Disorder, (1998). Psychoanalytic Study of the Child, 53:141-158. ^ Gabbard, Glen O., Stuart W. Twemlow. 1994. The Role of Mother-Son Incest in The Pathogenesis of Narcissistic Personality Disorder. Journal of the American Psychoanalytic Association, Vol. 42, No. 1, 171-189 (1994) DOI: 10.1177/000306519404200109. ^ Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, pp. 19-20. ^ a b Stephen M. Johnson (1 May 1987). Humanizing the narcissistic style. W.W. Norton. p. 39. ISBN 9780393700374. http://books.google.com/books?id=WxV2QgAACAAJ. Retrieved 31 March 2011.  ^ full list in DSM-IV-TR, p. 717. ^ American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994, p. 659. ^ Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, p. 22. ^ Kernberg, O.F. (1970). Factors in the psychoanalytic treatment of narcissistic personalities. Journal of the American Psychoanalytic Association, 18:51-85, p. 56 ^ Siegel, J.P. (2006). Dyadic splitting in partner relational disorders. Journal of Family Psychology, 20 (3), 418–422 ^ Kernberg, O.F. (1970). Factors in the psychoanalytic treatment of narcissistic personalities. Journal of the American Psychoanalytic Association, 18:51-85, p. 52 ^ Kernberg, O.F. (1970). Factors in the psychoanalytic treatment of narcissistic personalities. Journal of the American Psychoanalytic Association, 18:51-85 ^ Wurmser L, Shame, the veiled companion of narcissism, in The Many Faces of Shame, edited by Nathanson DL. New York, Guilford, 1987, pp. 64–92. ^ Gabbard GO, subtypes of narcissistic personality disorder. Bull Menninger Clin 1989; 53:527–532. ^ Young, Klosko, Weishaar: Schema Therapy - A Practitioner's Guide, 2003, p. 375. ^ DSM-5: Proposed Revisions: Personality and Personality Disorders. American Psychiatric Association. 2010-02-13. http://www.dsm5.org/ProposedRevisions/Pages/PersonalityandPersonalityDisorders.aspx.  ^ Zanor, Charles (29 November 2010). "A Fate That Narcissists Will Hate: Being Ignored". The New York Times. http://www.nytimes.com/2010/11/30/health/views/30mind.html. Retrieved 30 November 2010.  ^ Shedler, Jonathan; Aaron Beck, Peter Fonagy, Glen O. Gabbard, John Gunderson, Otto Kernberg, Robert Michels, and Drew Westen (September 2010). "Personality Disorders in DSM-5". American Journal of Psychiatry 167 (9): 1026–1028. doi:10.1176/appi.ajp.2010.10050746. PMID 20826853. http://ajp.psychiatryonline.org/cgi/pdf_extract/167/9/1026. Retrieved 30 November 2010.  ^ Narcissistic personality disorder - International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) ^ Millon, Theodore - Personality Subtypes ^ Young, Klosko, Weishaar: Schema Therapy - A Practitioner's Guide, 2003, chapter 10, pp. 373-424. ^ Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, p. 23. ^ Kohut, Heinz, (1971). The Analysis of the Self. ^ Megalomaniacs abound in politics/medicine/finance Business Day 2011/01/07 ^ Twenge, Jean M. & Campbell, W. Keith The Narcissism Epidemic: Living in the Age of Entitlement (2009) ^ Kernberg O, Borderline Conditions and Pathological Narcissism, 1967 ^ Kohut H The Psychoanalytic Treatment of Narcissistic Personality Disorders: Outline of a Systematic Approach, 1968 ^ Hesse, Morten; Schliewe S, Thomsen RR (2005). "Rating of personality disorder features in popular movie characters". BMC Psychiatry (London: BioMed Central) 5 (45): 45. doi:10.1186/1471-244X-5-45. PMC 1325244. PMID 16336663. http://www.biomedcentral.com/1471-244X/5/45.  Further reading The Culture of Narcissism, C. Lasch, New York: Norton; Revised edition (May 1991). ISBN 978-0-393-30738-2 How to Survive Working for a Narcissistic Leader (2011-05-19) BNet External links DSM-IV-TR Narcissistic Personality Disorder Diagnostic Criteria Narcissistic personality disorder PubMed Narcissistic personality disorder Mayo Clinic Narcissistic Personality Disorder Cleveland Clinic Wikimedia Foundation. 2010. Игры ⚽ Нужно решить контрольную? Rail transport in Germany Arrakis Look at other dictionaries: narcissistic personality disorder — n a personality disorder characterized esp. by an exaggerated sense of self importance, persistent need for admiration, lack of empathy for others, excessive pride in achievements, and snobbish, disdainful, or patronizing attitudes * * * [DSM IV] …   Medical dictionary narcissistic personality disorder — noun a personality disorder characterised by an excessive sense of self importance and a lack of empathy with others, combined with a conviction of having a special role in life entitling one to associated prestige and the admiration of others …   Personality disorder — Classification and external resources ICD 10 F60 ICD 9 301.9 …   Wikipedia Narcissistic Personality Inventory — The Narcissistic Personality Inventory (NPI) is the most widely used measure of narcissism in social psychological research. Although several versions of the NPI have been proposed in the literature, a forty item forced choice version (Raskin… …   Wikipedia Personality disorder not otherwise specified — Personality disorder, unspecified Classification and external resources ICD 10 F60.9 ICD 9 301.9 …   Wikipedia Antisocial personality disorder — Not to be confused with Anti social behaviour, Avoidant personality disorder, Schizoid personality disorder, or Dissociative identity disorder. Antisocial personality disorder Classification and external resources ICD 10 F60.2 …   Wikipedia Histrionic personality disorder — Infobox Disease Name = Histrionic personality disorder Caption = DiseasesDB = ICD10 = ICD10|F|60|4|f|60 ICD9 = ICD9|301.50 ICDO = OMIM = MedlinePlus = eMedicineSubj = eMedicineTopic = MeshID = D006677 Histrionic personality disorder (HPD ) is a… …   Wikipedia personality disorder — Psychiatry. any of a group of mental disorders characterized by deeply ingrained maladaptive patterns of behavior and personality style, which are usually recognizable as early as adolescence and are often lifelong in duration. [1935 40] * * *… …   Universalium narcissistic personality — noun personality marked by self love and self absorption; unrealistic views about your own qualities and little regard for others • Hypernyms: ↑personality * * * Psychiatry. a personality disorder characterized by extreme self centeredness and… …   Useful english dictionary narcissistic personality — Psychiatry. a personality disorder characterized by extreme self centeredness and self absorption, fantasies involving unrealistic goals, an excessive need for attention and admiration, and disturbed interpersonal relationships. [1970 75] * * * …   Universalium 18+ © Academic, 2000-2024 Contact us: Technical Support, Advertising Dictionaries export, created on PHP, Joomla, Drupal, WordPress, MODx. Mark and share Search through all dictionaries Translate… Search Internet Share the article and excerpts Direct link … Do a right-click on the link above and select “Copy Link”