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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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