The narcissist is described as being excessively preoccupied with issues of personal adequacy, power, and prestige.[2] Narcissistic personality disorder is closely linked to self-centeredness The term derives from the Greek and Latin ἑγώ / ego, meaning "I," "me," and "self". An egocentric person cannot fully empathize, i.e. "put himself in other peoples' shoes," and believes everyone sees what she/he sees.
History
For history of the term "narcissism" see history of narcissism In 1898 Havelock Ellis, an English sexologist, used the term "narcissus-like" in reference to excessive masturbation, whereby the person becomes his or her own sex object.
The term "narcissistic personality structure" was introduced by Kernberg in 1967[3] and "narcissistic personality disorder" first proposed by Kohut in 1968.[4]
Diagnostic criteria (DSM-IV-TR = 301.81)
The Diagnostic and Statistical Manual of Mental Disorders The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders. It is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders A mental disorder or mental illness is a psychological or behavioural pattern that occurs in an individual and is thought to cause distress or disability that is not expected as part of normal development or culture. The recognition and understanding of mental health conditions has changed over time and across cultures, and there are still, defines narcissistic personality disorder (in Axis II Cluster B Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors that the American Psychiatric Association defines as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it". Personality disorders) as:[1]
- A pervasive pattern of grandiosity Grandiosity is chiefly associated with narcissistic personality disorder, but also commonly features in manic or hypomanic episodes of bipolar disorder (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- 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 Entitlement is a guarantee of access to benefits because of rights or by agreement through law. It also refers, in a more casual sense, to someone's belief that one is deserving of some particular reward or benefit. It is often used pejoratively in common parlance, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
- is interpersonally exploitative In political economy, economics, and sociology, exploitation involves a persistent social relationship in which certain persons are being mistreated or unfairly used for the benefit of others. This corresponds to one ethical conception of exploitation, that is, the treatment of human beings as mere means to an end — or as mere "objects", i.e., takes advantage of others to achieve his or her own ends
- lacks empathy The English word is derived from the Greek word ἐμπάθεια , "physical affection, passion, partiality" which comes from ἐν (en), "in, at" + πάθος (pathos), "passion" or "suffering". The term was adapted by Theodore Lipps to create the German word Einfühlung ("feeling into") from: is unwilling to recognize or identify with the feelings and needs of others
- is often envious Envy may be defined as an emotion that "occurs when a person lacks another’s (perceived) superior quality, achievement, or possession and either desires it or wishes that the other lacked it." It can also derive from a sense of low self-esteem that results from an upward social comparison threatening a person's self image: another of others or believes others are envious of him or her
- shows arrogant, haughty behaviors or attitudes
It is also a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors that the American Psychiatric Association defines as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it". Personality disorders.
Diagnostic criteria (ICD-10)
The World Health Organization The World Health Organization is a specialized agency of the United Nations (UN) that acts as a coordinating authority on international public health. Established on 7 April 1948, and headquartered in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health Organization, which had been an agency of the's ICD-10 The International Statistical Classification of Diseases and Related Health Problems 10th Revision is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). The code set allows more than 155,000 different codes lists narcissistic personality disorder under (F 60.8) Other specific personality disorders.[5]
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors that the American Psychiatric Association defines as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it". Personality disorders.
Millon's subtypes
Theodore Millon Theodore Millon is an American psychologist known for his work on personality disorders identified five subtypes of narcissist:[2][6]. Any individual narcissist may exhibit none or one of the following:
- unprincipled narcissist - including antisocial The individual must be age 18 or older, as well as have a documented history of a conduct disorder before the age of 15. People having antisocial personality disorder are sometimes referred to as "sociopaths" and "psychopaths", although some researchers believe that these terms are not synonymous with ASPD features. A charlatan A charlatan is a person practicing quackery or some similar confidence trick in order to obtain money, fame or other advantages via some form of pretence or deception - is a fraudulent, exploitative, deceptive and unscrupulous individual.
- amorous narcissist - including histrionic Histrionic personality disorder is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriate seductiveness, usually beginning in early adulthood. These individuals are lively, dramatic, enthusiastic, features. The Don Juan Don Juan is a legendary, fictional libertine whose story has been told many times by many authors. El burlador de Sevilla y convidado de piedra (The Trickster of Seville and the Stone Guest) by Tirso de Molina is a play set in the fourteenth century that was published in Spain around 1630. Evidence suggests it is the first written version of the or Casanova Casanova often refers to Giacomo Casanova, an 18th-century Italian adventurer now best known for his legendary womanizing. It may also refer to: of our times - is erotic, exhibitionist.
- compensatory narcissist - including negativistic (passive-aggressive Passive–aggressive behavior is passive, sometimes obstructionist resistance to following through with expectations in interpersonal or occupational situations), avoidant Avoidant personality disorder (or anxious personality disorder) is a personality disorder recognized in the DSM-IV TR handbook in a person over the age of eighteen years as characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of social interaction features.
- elitist narcissist - variant of pure pattern. Corresponds to Wilhelm Reich's Wilhelm Reich was an Austrian-American psychiatrist and psychoanalyst, known as one of the most radical figures in the history of psychiatry. He was the author of several notable textbooks, including The Mass Psychology of Fascism and Character Analysis, both published in 1933 "phallic narcissistic" personality type.
- fanatic type - including paranoid Paranoid personality disorder is a psychiatric diagnosis characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others features. A severely narcissistically wounded individual, usually with major paranoid tendencies who holds onto an illusion of omnipotence. These people are fighting the reality of their insignificance and lost value and are trying to re-establish their self-esteem through grandiose fantasies and self-reinforcement. When unable to gain recognition of support from others, they take on the role of a heroic or worshipped person with a grandiose mission.
Differential diagnosis: associated and overlapping conditions
The following conditions commonly coexist (comorbid) with narcissistic personality disorder:[7]
- Dysthymia Dysthymia is a chronic mood disorder that falls within the depression spectrum, the opposite of hyperthymia. It is considered a chronic depression, but with less severity than major depressive disorder. This disorder tends to be a chronic, long-lasting illness
- Major depressive disorder Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable activities. The term "major depressive disorder" was selected by the American Psychiatric Association to designate this symptom cluster as a mood disorder in
- Hypomania Hypomania is a mood state characterized by persistent and pervasive elevated or irritable mood, and thoughts and behaviors that are consistent with such a mood state. People experiencing hypomanic symptoms typically have a flight of ideas, a decreased need for sleep and/or rest, are extremely outgoing and daring, and have a great deal of energy
- Anorexia nervosa Anorexia nervosa is an eating disorder characterized by extremely low body weight, distorted body image and an obsessive fear of gaining weight
- Substance-related disorders Although the term substance can refer to any physical matter, substance abuse has come to refer to the overindulgence in and dependence of a drug or other chemical leading to effects that are detrimental to the individual's physical and mental health, or the welfare of others (especially cocaine Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system and an appetite suppressant. Specifically, it is a serotonin-norepinephrine-dopamine reuptake inhibitor, which)
- Histrionic personality disorder Histrionic personality disorder is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriate seductiveness, usually beginning in early adulthood. These individuals are lively, dramatic, enthusiastic,
- Borderline personality disorder Borderline personality disorder is a personality disorder defined in DSM-IV and described as a prolonged disturbance of personality function in a person (generally over the age of eighteen years, although it is also found in adolescents), characterized by depth and variability of moods. The disorder typically involves unusual levels of instability
- Antisocial personality disorder The individual must be age 18 or older, as well as have a documented history of a conduct disorder before the age of 15. People having antisocial personality disorder are sometimes referred to as "sociopaths" and "psychopaths", although some researchers believe that these terms are not synonymous with ASPD
- Paranoid personality disorder Paranoid personality disorder is a psychiatric diagnosis characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others
Prevalence (epidemiology)
Lifetime prevalence is estimated at 1% in the general population and 2% to 16% in clinical populations.[8]
Causes (etiology)
The etiology Etiology is the study of causation, or origination. The word is derived from the Greek αἰτιολογία, aitiologia, "giving a reason for" (αἰτία, aitia, "cause"; and -λογία, -logia) of this disorder is unknown, according to Groopman and Cooper. However, they list the following factors identified by various researchers as possibilities.[8]
- An oversensitive temperament at birth
- Overindulgence and overvaluation by parents
- Valued by parents as a means to regulate their own self-esteem
- Excessive admiration that is never balanced with realistic feedback
- Unpredictable or unreliable caregiving from parents
- Severe emotional abuse Psychological abuse, also referred to as emotional abuse, is a form of abuse characterized by a person subjecting or exposing another to behavior that is psychologically harmful. Such abuse is often associated with situations of power imbalance, such as abusive relationships, bullying, child abuse and in the workplace in childhood
- Being praised for perceived exceptional looks or talents by adults
- Excessive praise In its common usage, praise is the act of making positive statements about a person, object or idea, either in public or privately. Praise is typically, but not exclusively, earned relative to achievement and accomplishment. Praise is often contrasted with criticism, where the latter is held to mean exclusively negative statements made about for good behaviors or excessive criticism Criticism is the judgement of the merits and faults of the actions or work of another individual. Criticism can mean merely to evaluate without necessarily finding fault; however, usually the word implies the expression of disapproval. Criticism that leaves the receiver feeling upset or depressed is rarely useful.[citation needed] for poor behaviors in childhood
Some narcissistic traits are common and a normal developmental phase. When these traits are compounded by a failure of the interpersonal environment and continue into adulthood they may intensify to the point where NPD is diagnosed.[9] Some psychotherapists believe that the etiology of the disorder is, in Freudian Sigmund Freud , born Sigismund Schlomo Freud (May 6, 1856 – September 23, 1939), was an Austrian neurologist who founded the psychoanalytic school of psychology. Freud is best known for his theories of the unconscious mind and the defense mechanism of repression and for creating the clinical practice of psychoanalysis for treating terms the result of fixation, to early childhood development.[10] If a child does not receive sufficient recognition for their talents during about ages 3–7 they will never mature and continue to be in the narcissistic early development stage. It has been suggested[10] that NPD may be exacerbated by the onset of aging and the physical, mental, and occupational restrictions it imposes as can most personality traits.[11][dubious – discuss]
A 1994 study by Gabbard and Twemlow[12] reports that histories of incest, especially mother-son incest are associated with NPD in some male patients.
Treatment
Most psychiatrists and psychologists regard NPD as a relatively stable condition when experienced as a primary disorder.[13] James F. Masterson outlines a prominent approach to healing NPD, while[14] discussing a continuum of severity and the kinds of therapy most effective in different cases. Typically, as narcissism is an ingrained personality trait, rather than a chemical imbalance, medication and therapy are not very effective in treating the disorder.[citation needed] Schema Therapy Schema Therapy was developed by Dr. Jeffrey Young for use in treatment of personality disorders. Schema Therapy is intended for use when patients fail to respond or improve after having been through other therapies, for example, DBT therapy. It can also be used to treat major depressive disorders, and other psychological issues of individuals and, a form of therapy developed by Jeffrey E. Young that integrates several therapeutic approaches (psychodynamic The original concept of "psychodynamics" was developed by Sigmund Freud. Freud suggested that psychological processes are flows of psychological energy in a complex brain, establishing "psychodynamics" on the basis of psychological energy, which he referred to as libido, cognitive, behavioral etc.), also offers an approach for the treatment of NPD.[15] It is unusual for people to seek therapy Therapy , or treatment, is the attempted remediation of a health problem, usually following a diagnosis. In the medical field, it is synonymous with the word "treatment" for NPD. Subconscious fears of exposure or inadequacy often cause defensive disdain of therapeutic processes.[16][17] Pharmacotherapy Pharmacotherapy is the treatment of disease through the administration of drugs. As such, it is considered part of the larger category of therapy is rarely effective.
Clinical views
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Pathological narcissism occurs in a spectrum of severity. In its more extreme forms, it is narcissistic personality disorder (NPD). NPD is considered to result from a person's belief that they are flawed in a way that makes them fundamentally unacceptable to others.[18] This belief is held below the person's conscious awareness; such a person would typically deny thinking such a thing, if questioned. In order to protect themselves against the intolerably painful rejection and isolation that (they imagine) would follow if others recognized their supposedly defective nature, such people make strong attempts to control others’ view of them and behavior towards them.
Pathological narcissism can develop from an impairment in the quality of the person's relationship with their primary caregivers, usually their parents, in that the parents were unable to form a healthy, empathic The English word is derived from the Greek word ἐμπάθεια , "physical affection, passion, partiality" which comes from ἐν (en), "in, at" + πάθος (pathos), "passion" or "suffering". The term was adapted by Theodore Lipps to create the German word Einfühlung ("feeling into") from attachment to them.[citation needed] This results in the child conceiving of themselves as unimportant and unconnected to others. The child typically comes to believe they have some personality defect that makes them unvalued and unwanted.[14]
Narcissistic personality disorder is isolating, disenfranchising, painful, and formidable for those living with it and often those who are in a relationship with them. Distinctions need to be made among those who have NPD because not each and every person with NPD is the same. Even with similar core issues, the way in which one's individual narcissism manifests itself in his or her relationships varies.[citation needed]
To the extent that people are pathologically narcissistic, they can be controlling, blaming, self-absorbed, intolerant of others’ views, unaware of others' needs and of the effects of their behavior on others, and insistent that others see them as they wish to be seen.[11]
People who are overly narcissistic commonly feel rejected, humiliated and threatened when criticised. To protect themselves from these dangers, they often react with disdain, rage Narcissistic rage is a term coined by Heinz Kohut in 1972. This article on rage pertains to Kohut's use of the concept in Kohut's Self Psychology, a school of thought within the psychodynamic/psychoanalytic theory. Narcissistic rage is a reaction to narcissistic injury, and/or defiance to any slight criticism, real or imagined.[19] To avoid such situations, some narcissistic people withdraw socially and may feign modesty or humility. In the case of feeling the lack of admiration, adulation, attention and affirmation the person can also manifest wishes to be feared and to be notorious (narcissistic supply).
Though individuals with NPD are often ambitious and capable, the inability to tolerate setbacks, disagreements or criticism, along with lack of empathy, make it difficult for such individuals to work cooperatively with others or to maintain long-term professional achievements.[20] With narcissistic personality disorder, the person's perceived fantastic grandiosity, often coupled with a hypomanic Hypomania is a mood state characterized by persistent and pervasive elevated or irritable mood, and thoughts and behaviors that are consistent with such a mood state. People experiencing hypomanic symptoms typically have a flight of ideas, a decreased need for sleep and/or rest, are extremely outgoing and daring, and have a great deal of energy mood, is typically not commensurate with his or her real accomplishments.
The exploitative, sense of entitlement, lack of empathy, disregard for others, and constant need for attention inherent in NPD adversely affect interpersonal relationships.
Theories on narcissistic personality disorder and shame
It has been suggested that narcissistic personality disorder may be related to defenses against shame Shame is, variously, an affect, emotion, cognition, state, or condition. The roots of the word shame are thought to derive from an older word meaning to cover; as such, covering oneself, literally or figuratively, is a natural expression of shame.[21]
Glen Gabbard Glen Owens Gabbard is an American psychiatrist known for authoring professional teaching texts for the field. He is Brown Foundation Chair of Psychoanalysis and Professor of Psychiatry at Baylor College of Medicine in Houston. He is also training and supervising analyst at the Houston/Galveston Psychoanalytic Institute suggested NPD could be broken down into two subtypes.[22] He saw the "oblivious" subtype as being grandiose, arrogant and thick-skinned and the "hypervigilant Hypervigilance is an enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect threats. Hypervigilance is also accompanied by a state of increased anxiety which can cause exhaustion. Other symptoms include: abnormally increased arousal, a high responsiveness to stimuli and a constant" subtype as easily hurt, oversensitive and ashamed.
He suggested that the oblivious subtype presents a large, powerful, grandiose self to be admired, envied and appreciated. This self is the antithesis of the weakened and internalized self that hides in a generic state of shame. This is how the internalized self fends off devaluation, while the hypervigilant Hypervigilance is an enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect threats. Hypervigilance is also accompanied by a state of increased anxiety which can cause exhaustion. Other symptoms include: abnormally increased arousal, a high responsiveness to stimuli and a constant subtype neutralizes devaluation by seeing others as unjust abusers. This hypervigilant type does not fend off devaluation; he is obsessed with it.
Jeffrey Young, who coined the term "Schema Therapy", a technique originally developed by Aaron T. Beck (1979), also links shame to NPD. He sees the so-called Defectiveness Schema as a core schema of NPD, next to the Emotional Deprivation and Entitlement Schemas.[23] All Schemas may incorporate maladaptive coping styles, for example, the defectiveness schema may include:
- Surrender: Chooses critical partners and significant others; puts him- or herself down.
- Avoidance: Avoids sharing "shameful" thoughts and feelings with partners and significant others due to fear of rejection.
- Overcompensation: Behaves in a critical or superior way toward others; tries to come across as perfect.
Note that an individual with this schema might not employ all three maladaptive coping responses.
See also
- DSM-IV codes (personality disorders)
- ICD-10 codes (personality disorders)
- Narcissism
- Malignant narcissism
- Narcissistic parents
- Narcissistic rage
- Narcissism of small differences
- Narcissistic Personality Inventory
- Megalomania
- Hubris
- Superiority complex
- Egotism
- Vanity
- Selfishness
- Histrionic personality disorder
- Antisocial personality disorder
- Brian Blackwell
- Eric Harris and Dylan Klebold
Footnotes
- ^ a b Narcissistic personality disorder - Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)
- ^ a b Millon, Theordore (1996). Disorders of Personality: DSM-IV-TM and Beyond. New York: John Wiley and Sons. p. 393. ISBN 0-471-01186-X.
- ^ Kernberg O, Borderline Conditions and Pathological Narcissism, 1967
- ^ Kohut H The Psychoanalytic Treatment of Narcissistic Personality Disorders: Outline of a Systematic Approach, 1968
- ^ name="narcissistic">Narcissistic personality disorder - International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
- ^ Millon, Theodore - Personality Subtypes
- ^ Internet Mental Health - narcissistic personality disorder
- ^ a b "Narcissistic Personality Disorder". Personality Disorders - Narcissistic Personality Disorder. Armenian Medical Network. 2006. http://www.health.am/psy/narcissistic-personality-disorder/. Retrieved 2007-02-14.
- ^ Cooper AM: Narcissism in normal development, in Character Pathology. Edited by Zales M. New York, Brunner/Mazel, 1984, pp. 39-56.
- ^ a b Joseph Fernando, MPSY, M.D., The Etiology of Narcissistic Personality Disorder, (1998). Psychoanalytic Study of the Child, 53:141-158.
- ^ a b full list in DSM-IV-TR, p. 717.
- ^ Gabbard, Glen O., Stuart W. Twemlow. 1994. The Role of Mother-Son Incest in The Pathogenesis of Narcissistic Personality Disorder. Journal of the American Psychoanalytic Association, Vol. 42, No. 1, 171-189 (1994) DOI: 10.1177/000306519404200109.
- ^ Alan Rappoport Co-Narcissism: How We Adapt to Narcissistic Parents. The Therapist, in press.
- ^ a b Johnson, Stephen M PhD (1987). Humanizing the Narcissistic Style. New York: Norton, p. 39.
- ^ Young, Klosko, Weishaar: Schema Therapy - A Practitioner's Guide, 2003, chapter 10, pp. 373-424.
- ^ Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, p. 23.
- ^ Kohut, Heinz, (1971). The Analysis of the Self.
- ^ Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, pp. 19-20.
- ^ American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994, p. 659.
- ^ Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, p. 22.
- ^ Wurmser L, Shame, the veiled companion of narcissism, in The Many Faces of Shame, edited by Nathanson DL. New York, Guilford, 1987, pp. 64–92.
- ^ Gabbard GO, subtypes of narcissistic personality disorder. Bull Menninger Clin 1989; 53:527–532.
- ^ Young, Klosko, Weishaar: Schema Therapy - A Practitioner's Guide, 2003, p. 375.
References
- The Culture of Narcissism, C. Lasch, New York: Norton; Revised edition (May 1991). ISBN 978-0393307382
External links
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Categories: Personality disorders | Psychoanalytic theory | Narcissism
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