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Back to Psychiatry Diseases
Narcissism
Narcissism is the pattern of traits and behaviors which involve
infatuation and obsession with one's self to the exclusion of others and
the egotistic and ruthless pursuit of one's gratification, dominance and
ambition.
Psychologists and psychiatrists believe all individuals have, out of
need for survival, a certain amount of egoism and self-centeredness,
which ideally takes the form of healthy self-esteem and self-confidence.
However, individuals who have excessive, unhealthy amounts of these
traits are considered narcissistic.
In addition to exaggerated self-esteem, narcissists are also
characterized by a lack of empathy, that is, a lack of sensitivity to
the feelings of others.
The term narcissism was coined by Sigmund Freud, who named the
phenomenon after the figure of Narcissus in Greek mythology. Narcissus
was a handsome Greek youth who rejected the desperate advances of the
nymph Echo. As a punishment, he was doomed to fall in love with his own
reflection in a pool of water. Unable to consummate his love, Narcissus
pined away and changed into the flower that bears his name.
Clinical experience
Narcissistic Personality Disorder (NPD) is the clinical term for
narcissism. It was added as a mental health category to the Diagnostic
and Statistical Manual (DSM) in 1980. NPD is one of a "family" of
personality disorders (known as "Cluster B"). (Other Cluster B
personality disorders include Borderline, Antisocial, and Histrionic.)
It is estimated that 0.7-1% of the general population suffer from NPD.
Most narcissists (75%) are men.
NPD is often diagnosed with other mental health disorders
("co-morbidity") — or with substance abuse, or impulsive and reckless
behaviors ("dual diagnosis").
There is only scant research regarding pathological narcissism. But what
there is has not demonstrated any ethnic, social, cultural, economic,
genetic, or professional predilection to NPD.
The onset of narcissism is in infancy, childhood and early adolescence.
It is commonly attributed to childhood abuse and trauma inflicted by
parents, authority figures, or even peers.
There is a whole range of narcissistic reactions, from the mild,
reactive and transient to the permanent personality disorder.
Narcissists 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").
Narcissists are either "Classic" or they are "Compensatory", or Inverted
narcissists
The prognosis for an adult narcissist 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).
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Diagnostic Criteria
Narcissists are 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 he or she is 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 his
unreasonable expectations for special and favorable priority treatment.
- Is "interpersonally exploitative", i.e., uses others to achieve his or
her 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
his frustration. Suffers from persecutory (paranoid) delusions as he
believes that they feel the same about him or her 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 he considers inferior to him and unworthy.
The criteria above are based on or summarized from: Diagnostic and
Statistical Manual of Mental Disorders, fourth edition, text revision
(DSM IV-TR) 2000. American Psychiatric Association, Washington, DC.
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