A pattern of traits and behaviours which signify infatuation and
obsession with one’s self to the exclusion of all others and the
egotistic and ruthless pursuit of one’s gratification, dominance
and ambition.
Most narcissists (50-75%, according to the DSM-IV-TR) are men.
The Narcissistic Personality Disorder (NPD) is one of a “family”
of personality disorders (known as “Cluster B”). Other members
of Cluster B are Borderline PD, Antisocial PD and Histrionic PD.
NPD is often diagnosed with other mental health disorders
(”co-morbidity”) - or with substance abuse and impulsive and
reckless behaviours (”dual diagnosis”). NPD is new (1980) mental
health category in the Diagnostic and Statistics Manual (DSM).
There is only scant research regarding narcissism. But what
there is has not demonstrated any ethnic, social, cultural,
economic, genetic, or professional predilection to NPD. It is
estimated that 0.7-1% of the general population suffer from NPD.
Pathological narcissism was first described in detail by Freud.
Other major contributors are: Klein, Horney, Kohut, Kernberg,
Millon, Roningstam, Gunderson, Hare. 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. Narcissistic Supply is
outside attention - usually positive (adulation, affirmation,
fame, celebrity) - used by the narcissist to regulate his labile
sense of self-worth. 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
romantic or physical “conquests”). Narcissists are either
“classic” [see definition below] or they are “compensatory”, or
“inverted” [see definitions here: “The Inverted Narcissist”].
The classic narcissist is self-confident, the compensatory
narcissist covers up in his haughty behaviour for a deep-seated
deficit in self-esteem, and the inverted type is a co-dependent
who caters to the emotional needs of a classic narcissist. NPD
is treated in talk therapy (psychodynamic or
cognitive-behavioural). 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
behaviours (such as mood or affect disorders and
obsession-compulsion) - usually with some success. The ICD-10,
the International Classification of Mental and Behavioural
Disorders, published by the World Health Organisation in Geneva
[1992] regards Narcissistic Personality Disorder (NPD) as “a
personality disorder that fits none of the specific rubrics”. It
relegates it to the category “Other Specific Personality
Disorders” together with the eccentric, “haltlose”, immature,
passive-aggressive, and psychoneurotic personality disorders and
types.
The American Psychiatric Association, based in Washington D.C.,
USA, publishes the Diagnostic and Statistical Manual of Mental
Disorders, fourth edition, Text Revision (DSM-IV-TR) [2000]
where it provides the diagnostic criteria for the Narcissistic
Personality Disorder.
The DSM defines NPD as “an all-pervasive pattern of grandiosity
(in fantasy or behaviour), need for admiration or adulation and
lack of empathy, usually beginning by early adulthood and
present in various contexts.”
The DSM specifies nine diagnostic criteria. For NPD to be
diagnosed, five (or more) of these criteria must be met.
[In the text below, I have proposed modifications to the
language of these criteria to incorporate current knowledge
about this disorder. My modifications appear in bold italics.]
[My amendments do not constitute a part of the text of the
DSM-IV-TR, nor is the American Psychiatric Association (APA)
associated with them in any way.]
[Click here to download a bibliography of the studies and
research regarding the Narcissistic Personality Disorder (NPD)
on which I based my proposed revisions.]
Proposed Amended Criteria for the Narcissistic Personality
Disorder
Feels grandiose and self-important (e.g., exaggerates
accomplishments, talents, skills, contacts, and personality
traits to the point of lying, demands to be recognised 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
or her unreasonable expectations for special and favourable
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 or her frustration. Suffers from persecutory
(paranoid) delusions as he or she 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 or she considers inferior to him or her
and unworthy.