Narcissistic Personality Disorder

What is Narcissistic Personality Disorder?

Narcissistic personality disorder is where a person has a feeling of grandiosity and superiority over others and demands attention; such people tend to be arrogant and lack empathy for others.

Narcissistic personality disorder is classified under Cluster B personality disorders which are characterized by dramatic, emotional or erratic behavior. Other personality disorders in this cluster include borderline personality disorder, antisocial personality disorder and histrionic personality disorder.

Many of us are familiar with the mythological story of Narcissus and Echo, from Ovid’s Metamorphoses. Narcissus, a young lad rejects the love of Echo and falls in love with his own reflection in the pond. A person with Narcissistic personality disorder is in a similar situation, where he falls in love with a false image of himself.

It affects around 0.5% to 1% individuals. Most of those affected are males, though it can also affect females. Though the condition is usually diagnosed at adulthood, more often than not, the trauma that causes the condition can be traced to childhood. A genetic predisposition has also been suggested.

Narcissistic personality disorder is diagnosed based on the DSM-5 criteria and the ICD-10 criteria. It may be difficult to convince the patient that he has a problem and to consult a therapist for treatment due to the grandiose attitude. However, the patient may benefit with counseling and other therapies.

Causes of Narcissistic Personality Disorder

The exact cause of narcissistic personality disorder is not known, though several have been suggested. These include:

• Genetic factors: Some individuals who developed narcissistic personality disorder in adulthood have shown different temperaments while they were infants. This indicates the possibility of genetic factors in the causation of narcissistic personality disorder
• Environmental factors: The relationship of a child with the parent/parents can have an impact on the child and influence the development of narcissistic personality disorder. Trauma experienced by a person in childhood at the hands of parents or others can have a deep impact resulting in narcissistic personality disorder in later years. Thus, the development of narcissistic personality disorder can be considered as a form of defense mechanism, where the person generates a false self-image that he/she can idolize and expect others to do the same.

Symptoms of Narcissistic Personality Disorder

The severity of narcissistic personality disorder may vary from a mild and transient condition to a permanent condition. The following symptoms may be present:

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• Presence of symptoms common to personality disorders which include problems with perception (understanding people, events and things), affectivity, control over impulses and interpersonal relationships
• Features of grandiosity, where the person has an unrealistic feeling of superiority over others
• Preoccupation with fantasies like those of unlimited success, power, beauty, or ideal love
• Insistence in mixing up only with people who are of high status, whom they consider equivalent to themselves
• Expectation of excessive admiration and attention and favorable treatment. This is referred to as narcissistic supply. The affected individuals may feel angry if they are not given importance
• Lack of empathy for others. The affected individual exploits them to achieve his / her personal gains
• Envious of others; The individual also feels that others are envious of him/ her
• Arrogance in attitude

• Inability to take criticism positively; the individual may react with anger or social withdrawal

People with narcissism often suffer from additional disorders including eating disorders, mood disorders, other Cluster B personality disorders and substance abuse disorders

Narcissistic Personality Disorder can be classified into:

• Overt, where the patient shows regular features of narcissism
• Covert, where the person is a narcissist but appears shy and vulnerable

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Complications of Narcissistic Personality Disorder

• Chances of self-injury due to reckless behavior
• Indulgence in alcoholism and drug abuse, which gives the patient a false feeling of wellbeing
• Depression
• Problems in creaseslife since it is very difficult for the spouse and other relatives to get along with the patient

• Problems in the professional life of the patient
• Increased risk for suicide

Diagnosis of Narcissistic Personality Disorder

There are no specific tests to diagnose narcissistic personality disorder. Diagnosis is based on interview of the patient and response to questionnaires like the Millon Clinical Multiaxial Inventory III (MCMI-III) and Narcissistic Personality Inventory; often, more than one interview may be necessary to arrive at a diagnosis. The ICD-10 diagnostic criteria requires the presence of general features of personality disorders and at least five out of nine other criteria.

Treatment for Narcissistic Personality Disorder

It is often difficult to convince a patient with narcissistic personality disorder to seek help. Though the prognosis may not be good despite treatment, some patients may benefit through counseling. Therapies that have been used to treat patients with narcissistic personality disorder include psychotherapy and behavioral therapies like cognitive behavioral therapy. Medications are not effective against narcissistic personality disorder but may be necessary to combat associated conditions like depression and mood disorders.