What is a narcissistic personality disorder (NPD)?

Introduction

A person with a narcissistic personality shows a pattern of grandiosity, which is manifested by a strong tendency to overestimate one’s abilities and accomplishments. Together with this grandiosity is a central feature of entitlement. This produces an exaggerated sense of self-importance and preoccupation with being admired. People with a narcissistic personality expect other people to give them their undivided attention and admiration. It is their belief that unlimited success, power, intelligence, and beauty are due them regardless of their actual accomplishments. Their behavior is marked with repeated self-references and bragging. These actions make them the center of attention, and they fully expect that others comply with their fantasy of entitlement.

Narcissistic personality disorder is one of the psychiatric disorders described by the American Psychiatric Association. The behaviors associated with the condition are persistent and lead to difficulties in maintaining mutually respectful and satisfying interpersonal relationships.

Possible Causes

An additional central feature of the narcissistic personality relates to the inability to take the perspective of others. Persons with this personality cannot empathize with the feelings of others, since it is only their own emotions that are important. Although very young children have this narcissistic tendency, it usually disappears through the course of development as they acquire perspective-taking ability. This capacity allows people to look at the world through the eyes of other people. With perspective-taking ability, a person can sympathize with the hardships endured by others and empathetically feel the pain of and commiserate with the joy felt by others. Children who do not show the typical pattern of emotional development grow to become adult narcissistic personalities. As adults, these individuals often take advantage of others to achieve their own goals and become arrogant and snobbish toward other people. Envy is found among persons with a narcissistic personality, as they resent the success of others.

Basic personality traits or temperaments are factors in the development of narcissistic personality disorder. Temperament emerges early in infancy and affects how the child interacts with the environment. Some infants show shyness or are inhibited around novel situations, while others are outgoing and playful. Such temperaments are an early foundation for the development of an adult personality. Genetics may play a role in the formulation of these infant temperaments or character traits. The maladaptive style of the narcissistic personality may evolve from a disturbed parent-child attachment due to the particular early temperament found in the infant. It has also been argued that larger cultural and societal factors can encourage narcissistic tendencies, and that the increase in diagnoses of narcissistic personality disorder in the twenty-first century may be attributable to the influences of contemporary society, but researchers remain divided on the validity of this theory.

Diagnosis

A diagnosis of narcissistic personality disorder requires that a person shows a pervasive pattern of grandiosity, need for admiration, and lack of empathy beginning in early adulthood. Grandiosity produces a sense of unlimited power and intelligence and the feeling that only successful, high-status persons are worthwhile as friends and associates. The narcissistic personality disorder is described by an exaggerated sense of self-importance, a preoccupation with fantasies of unlimited success, a belief in being special, an exploitative style toward other people, a sense of entitlement, and arrogance. Formal diagnosis of narcissistic personality disorder by mental health professionals is often difficult because the diagnostic criteria are inferred from behavior rather than through direct observation. Personality characteristics exist on a continuum from normal to pathological. It is difficult to determine at what point particular behavioral tendencies have become the sign of a psychiatric disorder. In an attempt to address this difficulty, a major revision of the personality disorders category which would have eliminated NPD was proposed for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM); however, many clinicians objected to it, and in the end the diagnostic categories for personality disorders were not changed from those in the previous edition of the DSM.

Treatment and Impact

The narcissistic personality disorder is resistant to the traditional methods used for treatment. Patients do not believe that they need to change and typically enter treatment only at the insistence of someone else. Persons with narcissistic personality disorder put responsibility for treatment on other people and will avoid being the focus of therapy. Individual psychotherapy (talk therapy) and group therapy have been used for persons with this disorder. The psychotherapy approach is called cognitive behavior therapy. This therapy assumes that problem behaviors are caused by faulty ways of thinking about the environment and other people, and the focus of treatment is on the modification of the troublesome beliefs. However, psychotherapy and even the use of medications such as antidepressants have been found to be of limited value for persons with narcissistic personality disorder. No treatment has yet produced a cure. Because people with this disorder seldom seek therapy themselves, they may become involved with treatment in conjunction with another person’s therapy.

The negative impact of the disorder often falls on the family and friends of persons with a narcissistic personality. A narcissistic spouse may cause great difficulty in a marriage through constant demands and expectations of admiration. Conflicts may emerge when these expectations are not realized. A parent with narcissistic personality disorder may prevent a child from receiving adequate care and nurturance, as personal demands for attention dominate the child’s needs.

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