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The US National Library of Medicine describes a person with narcissistic personality disorder as having an excessive sense of self-importance, an intense preoccupation with themselves, and no empathy for others. The term comes from a character in Greek mythology, called Narcissus. He saw his reflection in a pool of water and fell in love with it.
The Cleveland Clinic says that narcissistic personality disorder belongs to a group of conditions known as dramatic personality disorders. Afflicted people have very unstable and intense emotions and a distorted image of “self”. However, this seeming abnormal love of self, an excessive sense of importance and superiority, combined with a preoccupation with success and power do not, in fact, reflect real self-confidence. The individual has a deep sense of insecurity. His or her self-esteem is extremely fragile.
It is common for people with narcissistic personality disorders to set unrealistic goals. A study carried out by the National Institute on Alcohol Abuse and Alcoholism and published in the Journal of Clinical Psychiatry found that 7.7% of men and 4.8% of women develop narcissistic personality disorder (NDP) during their lifetime. The researchers also found that NPD rates are much higher among black men and women, Hispanic women, younger adults, and people who either never married or became divorced, widowed or separated.
Signs and symptoms
A symptom is something that the patient feels and describes, such as anger, pain, or dizziness, while a sign is something everybody, including the nurse or doctor, can see, such as a rash or swelling. Below are the most common signs and symptoms found in people with narcissistic personality disorder:
- An insatiable appetite for the attention of other people.
- Generally prone to extreme feelings of jealousy.
- Behave is if they deserve special treatment.
- Commonly exaggerate their achievements, talents and importance.
- Extremely sensitive.
- Find it difficult to maintain healthy relationships.
- Have fantasies regarding their own intelligence, success, power and good looks.
- If they have to take advantage of others in order to get what they yearn for, they will without regret or conscience.
- It does not take much for a person with NPD to feel rejected.
- Lack empathy – empathy is the ability to understand and share the feelings of other people. People with NPD lack empathy and disregard other people’s feelings.
- Many believe that only others – “special” people – are really able to understand their uniqueness.
- May consider themselves as very skilled in romance; more skilled than anybody else.
- Most people see narcissists’ goals as selfish ones.
- Obsessed with themselves.
- Respond to criticism with anger.
- Respond to criticism with humiliation.
- Respond to criticism with shame.
- Seem arrogant.
- Tend to seek out praise and positive reinforcement from others.
- They may be perceived by others as tough-minded or without emotion.
- Usually expect others to agree with them or go along with what they ask for or want blindly.
- Very easily hurt.
- Whatever they crave or yearn for must be “the best”.
What are the causes?
Nobody is sure why some people develop narcissistic personality disorder while others don’t. Some suggest it may be associated with certain circumstances during childhood, such as very high expectations, over-pampering, neglect, and even abuse. Perhaps the individual learnt manipulative behaviors from their parents or household members during childhood. Some experts say there may also be a genetic link, as well as the way the brain behaves, thinks and reacts to environmental stimuli. If a child is brought up to think that vulnerability is not acceptable, their ability to tune into other people’s feelings and needs may become undermined, some suggest. The NewYork-Presbyterian Hospital states that recent evidence has pointed to a genetic predisposition and other biological or biochemical factors that are probably linked to NPD.
Diagnosing narcissistic personality disorder
The doctor will most likely check the patient’s medical history and carry out a physical exam if some signs and symptoms are present. Even though no specific lab tests exist which can point towards NPD, some may be ordered, such as X-rays and blood tests. The aim here is to rule out possible physical illnesses and conditions which may be causing the symptoms. There are several different types of personality disorders, some of them overlap, and it is possible to be diagnosed with more than one type. A NPD diagnosis must follow the criteria written in the Diagnostic and Statistical Manual of Mental Disorders, published by the APA (American Psychiatric Association).
The following must be present for a diagnosis of Narcissistic Personality Disorder to be made:
- The patient’s idea and importance of self is exaggerated
- Fantasies about beauty, success and power over-dominate the patient’s thoughts
- Patients think they are special, and relate only to other “special” people
- They need to be admired all the time
- They believe they are entitled to most things
- They manipulate and take advantage of other people
- They lack empathy – the ability to feel and recognize the feelings of and needs of others
- They envy other people
- Their behavior comes over as haughty or arrogant.
The latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes some changes in how personality disorders are diagnosed. According to the American Psychiatric Association, which published DSM-5, “(DSM-5) moves from the multiaxial system to a new assessment that removes the arbitrary boundaries between personality disorder and other mental health disorders.” More details are included in its communiqué “Personality Disorders Fact Sheet”.