Narcissistic personality disorder (NPD), is defined as a mental illness primarily characterized by extreme focus on oneself, and is a maladaptive, rigid, and persistent condition that may cause significant distress and functional impairment. The term was first used by Heinz Kohut in 1971 and is a form of pathological narcissism acknowledged in the Diagnostic and Statistical Manual of Mental Disorders in 1980, in the edition known as DSM-III.
It is classed within the cluster B group of personality disorders in DSM IV-TR along with Borderline- , Histrionic- and Antisocial personality disorders. Most people fulfilling criteria for one personality disorder fulfill those for one or more others.
Causes
The etiology of this disorder is unknown, but, according to Groopman and Cooper, factors identified by researchers as possibly contributing to this disorder include:
• 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 in childhood
• Being praised for perceived exceptional looks or talents by adults
• Learning manipulative behaviors from parents
Diagnostic criteria
At least five of the following are necessary for a diagnosis (as with many DSM diagnoses, they must form a pervasive pattern; for example, a person who shows these criteria only in one or two relationships or situations would not properly be diagnosed with NPD):
1. has a grandiose sense of self-importance
2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. believes that he or she is "special" and unique and can only be understood by other special people
4. requires excessive admiration
5. strong sense of entitlement
6. takes advantage of others to achieve his or her own ends
7. lacks empathy
8. is often envious or believes others are envious of him or her
9. arrogant behavior
Prevalence, age, and gender features
According to DSM IV, the prevalence of NPD is less than 1% of the general population, though it manifests itself in 2-16% of psychiatric outpatients. Studies have not conclusively demonstrated any ethnic, social, cultural, economic, genetic, or professional predilection to NPD[. However, evidence for heritability greater than that of other personality disorders has been reported.
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. The disorder occurs 50 to 75 percent more frequently in men than in women. It has been suggested that NPD may be exacerbated by the onset of aging and the physical, mental, and occupational restrictions it imposes.
Clinical experience
Pathological narcissism occurs in a spectrum of severity. In its more extreme forms, it is narcissistic personality disorder. NPD is considered to result from a person's belief that he or she is flawed in a way that makes the person fundamentally unacceptable to others. 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 recognised their supposedly defective nature, such people make strong attempts to control others’ view of them and behaviour towards them.
Psychologists commonly believe that pathological narcissism results 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 attachment to them. This results in the child conceiving of themselves as unimportant and unconnected to others. The child typically comes to believe that he or she has some defect of personality which makes them unvalued and unwanted.
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. They may also demand certain behavior from their children because they see the children as extensions of themselves, and need the children to represent them in the world in ways that meet the parents’ emotional needs. (For example, a narcissistic father who was a lawyer demanded that his son, who had always been treated as the "favorite" in the family, enter the legal profession as well. When the son chose another career, the father rejected and disparaged him.)
These traits will lead overly narcissistic parents to be very intrusive in some ways, and entirely neglectful in others. The children are punished if they do not respond adequately to the parents’ needs. This punishment may take a variety of forms, including physical abuse, angry outbursts, blame, attempts to instill guilt, emotional withdrawal, and criticism. Whatever form it takes, the purpose of the punishment is to enforce compliance with the parents' narcissistic needs.
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, and/or defiance to any slight, real or imagined. To avoid such situations, some narcissistic people withdraw socially and may feign modesty or humility.
There is a broad spectrum of pathologically narcissistic personalities, styles, and reactions -- from the very mild, reactive and transient, to the severe and inflexible narcissistic personality disorder.
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. With narcissistic personality disorder, the person's perceived fantastic grandiosity, often coupled with a hypomanic mood, is typically not commensurate with his or her real accomplishments.
The exploitativeness, sense of entitlement, lack of empathy, disregard for others, and constant need for attention inherent in NPD, adversely affects interpersonal relationships. Individuals with NPD frequently select as mates, and engender in their children, "co-narcissism," which is a term coined to refer to a co-dependent personality style similar to co-alcoholism and co-dependency. Co-narcissists organize themselves around the needs of others. They feel responsible for others, accept blame readily, are eager to please, defer to others’ opinions, and fear being considered selfish if they act assertively.