Narcissistic
Personality Disorder
The prevalence of Narcissistic Personality Disorder
(NPD) in the general population is estimated to be
less than 1% although it is found in 2 -16% of psychiatric
outpatients, usually in conjunction with other Personality
Disorders. It is also diagnosed up to 75% more often
in men, than women. People with NPD have a great
need for admiration, a fragile self esteem and lack
empathy. They believe that they are special or unique.
Diagnostic Criteria
At least 5 of the following are necessary for a
diagnosis:
- Has a grandiose sense of self importance
- Is preoccupied with fantasies of unlimited success,
power, brilliance, beauty or ideal love
- Believes that they are 'special' and unique and
can only be understood by other special people
- Requires excessive admiration
- Has a strong sense of entitlement (i.e. unreasonable
expectations or automatic compliance with their
expectations)
- Takes advantage of others to achieve their own
ends
- Lacks empathy, unwilling to recognize or identify
with the feelings or needs of others
- Is often envious or believes others are envious
of them
- Shows arrogant, haughty behaviours or attitudes
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Causes
Like most Personality Disorders, the cause of NPD
is unsure. It has been suggested that a shaming event
which occurs early in the person's life, before which
they had seen themselves as perfect, may cause them
to build a narcissistic exterior to avoid any recurring
shameful experience. Other factors identified as
possibly contributing to this disorder include:
- Overindulgence and over evaluation by parents
- Valued by parents mainly as a means to regulate
their own self esteem
- Excessive admiration never balanced by realistic
feedback
- Unpredictable or unreliable care giving by parents
- Severe emotional childhood abuse
- Learnt manipulative behaviours from parents
Prognosis
Narcissism occurs in a spectrum of severity with
NPD at the extreme end of the spectrum. People with
NPD are controlling, blaming, self absorbed and intolerant
of other's views. They often feel humiliated or rejected
when criticized and will protect themselves from
this by reacting with anger or disdain to any real
or imagined slight.
The lack of empathy and inability to tolerate criticism
makes it very difficult for these individuals to work
co-operatively with others or to maintain personal
relationships. Sadly, it is unusual for people with
NPD to seek therapy for this problem, either because
they view themselves as nearly perfect and in no need
of personal change, or because of their subconscious
fears of exposure of their inadequacies. However, treatment
for co-existing problems such as depression or anxiety
may be sought and treated successfully.
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