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NARCISSISTIC PERSONALITY DISORDER
 


Prediction: Lasts For Decades

      Occupational-Economic:
  • Works poorly with others (self-centered, can't tolerate criticism or defeat)
      Wisdom vs Irrationality: N/A
      Courage vs Negative Emotion: N/A
      Community vs Detachment: N/A
      Moderation vs Disinhibition:
  • Attention-seeking (requires excessive admiration)
      Justice vs Antagonism:
  • Arrogant, manipulative, greedy, callous, has a sense of entitlement, snobbish or patronizing attitudes
      Medical: N/A


SYNOPSIS

Narcissistic Personality Disorder F60.8 - ICD10 Description, World Health Organization

Narcissistic personality disorder is not classified as a specific personality disorder by the World Health Organization's ICD-10. In contrast, the American Psychiatric Association's DSM-5 does classify this as a specific personality disorder; characterized by a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy.
Narcissistic Personality Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with narcissistic personality disorder needs to show at least 5 of the following criteria:

  • Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).

  • Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.

  • Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).

  • Requires excessive admiration.

  • Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations.

  • Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends.

  • Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.

  • Is often envious of others or believes that others are envious of him or her.

  • Shows arrogant, haughty behaviors or attitudes.
Like all personality disorders, narcissistic personality disorder is a deeply ingrained and enduring behaviour pattern, manifesting as an inflexible response to a broad range of personal and social situations. This behavior represents an extreme or significant deviation from the way in which the average individual in a given culture relates to others. This behaviour pattern tends to be stable. It causes subjective distress and problems in social performance.

Core Features

Individuals with narcissistic personality disorder grow up feeling superior and needing to be admired. They have a longstanding pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy. The core feature of this disorder is antagonism (grandiosity, attention-seeking, callousness) which repeatedly puts the individual at odds with other people. This disorder is only diagnosed if: (1) it begins no later than early adulthood, (2) these behaviors occur at home, work, and in the community, and (3) these behaviors lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Lack Of Social Skills And Personality Disorders

There are social skills that are essential for healthy social functioning. Individuals with narcissistic personality disorder lack the essential social skills of humility, cooperation/generosity, and kindness. They also lack genuineness (that is also lacking in Histrionic Personality Disorder).

    Social Skills That Are Lacking In Narcissistic Personality Disorder

    SOCIAL SKILL LOW LEVEL HIGH LEVEL
    Humility Arrogance Being humble (not arrogant, boastful or excessively proud)
    Cooperation and Generosity Being manipulative or greedy Cooperating with others and doing a fair share of the work; unselfishly helping others
    Kindness Callousness Being a kind, considerate, loving person; feeling another’s suffering & wanting to alleviate it
    Genuineness Attention-Seeking Being genuine (not overly theatrical or attention-seeking)

Antisocial personality disorder, narcissistic personality disorder, histrionic personality disorder, and borderline personality disorder are so closely related that they are referred to as the "antagonistic" cluster of personality disorders.

    Social Skills That Are Lacking In The "Antagonistic" Cluster Of Personality Disorders

    PERSONALITY DISORDER LACKING LACKING LACKING
    Antisocial Personality Respect (instead has disrespect) Responsibility (instead has irresponsibility) Honesty (instead has dishonesty)
    Narcissistic Personality Humility (instead has arrogance) Cooperation or Generosity (instead has being manipulative or greedy) Kindness (instead has callousness)
    Borderline Personality Emotional Stability (instead has emotional instability) Stable Self-Image (instead has unstable self-image) Social Stability (instead has social instability)
    Histrionic Personality Genuineness (instead has attention-seeking) Chastity (instead has desire for casual or illicit sex) Caution (instead has harmful impulsiveness)

Social Functioning

Interpersonal relations of individuals with narcissistic personality disorder are typically impaired because of their feelings of entitlement, need for admiration, and callousness. Although these individuals are usually very ambitious and confident; vocational functioning often is impaired because of intolerance of criticism or defeat.

Narcissistic Traits

Individuals with narcissistic personality disorder show an exaggerated sense of self-importance, insensitivity towards the feelings and needs of others, and callous exploitation of others. They alienate others with their arrogance, self-centeredness, greed, and lack of kindness. They have feelings of entitlement; they often expect to be catered to and are furious when this does not happen. They are attention-seeking and admiration seeking. In severe cases, this disorder can develop into "malignant narcissism" with manipulativeness, deceitfulness, and callousness. This malignant narcissism is identical to the selfish, callous and remorseless use of others that is seen in psychopaths. Some individuals with malignant narcissism rise to high positions of power in society by becoming masters of manipulation and deceit.

    Narcissistic Traits
    • Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
    • Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
    • Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
    • Requires excessive admiration.
    • Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations.
    • Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends.
    • Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
    • Is often envious of others or believes that others are envious of him or her.
    • Shows arrogant, haughty behaviors or attitudes.

Effectiveness Of Therapy

The effectiveness of treatment for narcissistic personality disorder is unknown because there are no randomized controlled trials. Individuals with this disorder seldom voluntarily present for treatment. However, individuals with this disorder may threaten suicide during a crisis (e.g., when discovering their spouse's infidelity). The individual may then use hospitalization as a manipulative ploy to win back their spouse, or to publicly expose their spouse's infidelity. Usually only brief hospitalization is required, with the goal being to de-escalate the crisis. Apart from such crisis intervention, most therapists believe that this disorder is very difficult to treat. However, with long-term therapy, some patients do gain insight into how they have become addicted to wealth, fame, or power, and how callous they have become. Admitting that they do have this addiction is the first step to recovery.

Which Behavioral Dimensions Are Involved?

The ancient Greek civilization lasted for 1,300 years (8th century BC to 6th century AD). The ancient Greek philosophers taught that the 5 pillars of their civilization were: wisdom, courage, community, moderation, and justice. Psychiatry named the opposite of each of these 5 ancient themes as being a major dimension of psychopathology (i.e., irrationality, negative emotion, detachment, disinhibition, and antagonism). (Psychology named these same factors the "Big 5 dimensions of personality": "intellect", "neuroticism", "extraversion", "conscientiousness", and "agreeableness")

    Narcissistic Personality Disorder: Disinhibition And Antagonism
            Wisdom vs Irrationality: N/A
            Courage vs Negative Emotion: N/A
            Community vs Detachment: N/A
            Moderation vs Disinhibition:
      • Attention-seeking (requires excessive admiration)
            Justice vs Antagonism:
      • Arrogant, manipulative, greedy, callous, has a sense of entitlement, snobbish or patronizing attitudes

Prevalence

The prevalence of narcissistic personality disorder is ranges from 0% to 6.2% in community samples, and 50% to 75% are males.

Course

Narcissistic traits are very common in adolescents, but most adolescents grow out of this behavior. Unfortunately, for some, this narcissistic behavior persists and intensifies into adulthood; thus they become diagnosed with this disorder.

Comorbidity

Some other disorders frequently occur with this disorder:

    Non-Personality Disorders

            Depressive Disorders:
      • Persistent depressive disorder (dysthmia); major depressive disorder
            Feeding and Eating Disorders:
      • Anorexia nervosa
            Substance-Related and Addictive Disorders:
      • Substance use disorders, especially cocaine

    Personality Disorders

            Detached Cluster:
      • Paranoid personality disorder
            Antagonistic Cluster:
      • Antisocial, borderline and histrionic personality disorders
        Note: Antisocial, narcissistic, borderline, and histrionic personality disorders are all closely related since they all share the same core feature of antagonism. If an individual has one of these antagonistic personality disorders, they are very likely to have another.

Associated Laboratory Findings

No laboratory test has been found to be diagnostic of narcissistic personality disorder.

Primate Evolution

There appears to be three different ways in which primates have evolved socially:
  • The chimpanzees have evolved to be socially antagonistic, competitive, callous, and manipulative. Thus chimpanzee social behavior most closely mirrors the antagonistic behavior of the antisocial-narcissistic-borderline-histrionic cluster of personality disorders.

  • In contrast, the bonobos have evolved to be socially anxious, peaceful, cooperative, and loving. Thus bonobo social behavior most closely mirrors the negative emotion (anxious) behavior of the avoidant-dependent cluster of personality disorders.

  • Another separate evolutionary path was followed by the orangutans. They evolved to become solitary hermits. Thus orangutan social behavior most closely mirrors the detached behavior of the paranoid-schizoid-schizotypal cluster of personality disorders.


Core Behaviors Of The Antagonistic Cluster Of Personality Disorders

Cleopatra Seducing Caesar and Mark Antony


In this cluster of personality disorders, the males tend to be like Caesar and have antisocial and/or narcissistic personality disorders, and the females tend to be like Cleopatra and have borderline and/or histrionic personality disorders. The core feature of this cluster of personality disorders is antagonism. These individuals seem to be unconcerned about how their actions harm or upset others.

    Antagonism: The Core Feature Of The Antagonistic Cluster Of Personality Disorders

    • manipulativeness:
      In the past week, did you "con" or take advantage of someone?
    • callousness:
      In the past week, did you harm someone, but not care?
    • deceitfulness:
      In the past week, did you lie, steal, or cheat?
    • hostility:
      In the past week, were you actively hostile towards someone?
    • attention-seeking:
      In the past week, did you go out of your way to be the center of attention?
    • grandiosity:
      In the past week, did you treat others as if they were inferior to you?

There is a brilliant definition of Narcissistic Personality Disorder in the song "God Help The Outcasts" (from the "Hunchback Of Notre Dame")

Parental Behaviors Which Increase The Risk Of Developing A Personality Disorder

Research has shown that genetic, environmental, and prenatal factors all play important roles in the development of personality disorder. Recent research has also shown that low parental affection and harsh parenting increase the risk of a child later developing a personality disorder.

"Low affection" was defined as: low parental affection, low parental time spent with the child, poor parental communication with the child, poor home maintenance, low educational aspirations for the child, poor parental supervision, low paternal assistance to the child's mother, and poor paternal role fulfillment. "Harsh parenting" was defined as: harsh punishment, inconsistent maternal enforcement of rules, frequent loud arguments between the parents, difficulty controlling anger toward the child, possessiveness, use of guilt to control the child, and verbal abuse.

Setting Goals In Therapy

    Questions To Ask When Setting Goals

    In The Past Week:
    • WHO: was your problem?
    • EVENT: what did he/she do?
    • RESPONSE: how did you respond to that event?
    • OUTCOME: did your response help?
    • TRIGGER: what did you do that could have triggered this problem?
    • GOAL: what life skill(s) do you have to work on? (from checklist)

    Example Of Setting Goals In Interviewing A Person With Narcissistic Personality Disorder

    In The Past Week:
    • WHO: was your problem?
      "The doctors in my university hospital."

    • EVENT: what did he/she do?
      "I am the newly appointed chairman of our department, but the physicians in my department are insubordinate."

    • RESPONSE: how did you respond to that event?
      "I complained to the Dean of Medicine, and asked that he support me against these doctors."

    • OUTCOME: did your response help?
      "No, my going to the Dean has escalated the problem. Now these doctors have gone to their Medical Association alleging that I am asking for a "kickback" on their salaries."

    • TRIGGER: what did you do that could have triggered this problem?
      "At the first meeting I had with these doctors; I asked them all to contribute a portion of their salaries to my research fund. I told them that this was a condition of their continued employment."

    • GOAL: what life skill(s) do you have to work on? (from checklist)
      "I don't think there is anything wrong with my life skills." (Patient refuses to cooperate.))."

Individuals With Narcissistic Personality Usually Don't Seek Therapy

Individuals with narcissistic disorder are difficult to treat. They view themselves as being superior, and thus feel entitled to be callous, self-centered, and greedy. Their viewpoint is that life is the "survival of the fittest", and they are the "fittest". These individuals lust after fame, fortune and power. Many of these individuals achieve high positions in politics, religion and commerce. Most religious cult leaders have severe narcissistic personality disorder.

Dictators Usually Have A Dangerous Combination of Personality Disorders

All of history's worst dictators had a combination of Paranoid + Narcissistic + Psychopathic Personality Disorders.

    Social Skills That Are Lacking In History's Worst Dictators

    PERSONALITY DISORDER LACKING LACKING LACKING
    Paranoid Personality Trust (had suspiciousness) Forgiveness (had bearing grudges) Gratitude (had feeling victimized)
    Narcissistic Personality Humility (had arrogance) Cooperation or generosity (had being manipulative or greedy) Kindness (had callousness)
    Psychopathic Personality Respect (had disrespect) Responsibility (had irresponsibility) Honesty (had dishonesty)

Given the amount of harm that these dictators created (e.g., Hitler, Mussolini, Stalin, Mao Zedong); it could be argued that the social skills that dictators lack are the most important of all the social skills. Thus it should come as no surprise that all of the world's religions emphasize the importance of these social skills (e.g., trust, forgiveness, gratitude, humility, cooperation, generosity, kindness, respect, responsibility, and honesty).


Dictators have a total disregard for the casaulties they cause in war. To them, war is just a chess game, and soldiers are just pawns to be sacrificed. For example, during the Napoleonic Wars, Napoleon had 3 million troops, of which 1.7 million were killed. The following movie correctly depicts how Napoleon sacrificed his troops for his own personal glory and wealth.

Waterloo (full movie)


The story of Adolf Hitler will always be a testament to how extremely dangerous a leader with Paranoid + Narcissistic + Psychopathic Personality Disorder can be. The following documentary movie is an excellent summary of the senseless slaughter of millions caused by Adolf Hitler.

Adolf Hitler (1 hour documentary)


Hate-filled, Hitler-like individuals with Paranoid + Narcissistic + Psychopathic Personality Disorder must be stopped before they ever assume power.

How Would You Diagnose Bill O'Reilly?


Research has found that that people with more money are more likely to be rude and break rules. Researcher Paul Piff found that “narcissism is not evenly distributed across social strata" ... “higher social class is associated with increased entitlement and narcissism.”

Having Money Makes You Ruder And Less Empathetic


Certain individuals with Narcissistic + Psychopathic Personality Disorder have amassed great power and wealth. These fabulously rich individuals totally neglect the poor and the starving, and care only about accumulating more wealth, fame and power - even if it means oppressing half of humanity.

The 85 Richest People Are As Wealthy As The Poorest Half Of The World

Description

Stories

Free Diagnosis Of This Disorder

Rating Scales

Note: This rating scale lacks a question for narcissistic personality disorder. There should be a question #9: "In general, are you superior to others?".

Treatment

Research

Other Web Pages

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