A pervasive
pattern of grandiosity (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, 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.
DSM-IV Code: 301.81.
Associated
Features:
Depressed
Mood
Dramatic or Erratic or
Antisocial Personality
Differential Diagnosis
Some disorders
have similar or even the same symptom. The clinician, therefore,
in his diagnostic attempt has to differentiate against the following
disorders which he needs to rule out to establish a precise
diagnosis.
Histrionic
Personality Disorder
Antisocial
Personality Disorder
Borderline
Personality Disorder
Obsessive-Compulsive
Personality Disorder
Schizotypal
Personality Disorder
Paranoid Personality
Disorder
Manic
Episodes
Hypomanic
Episodes
Personality
Change Due to a General Medical Condition;
Symptoms
that may develop in association with chronic substance use.
Cause:
The cause
of Narcissistic Personality Disorder is unknown at this time,
but several theories are being investigated. There is some evidence
that genetic predisposition and other biological or biochemical
factors are involved for some people. Psychological factors
are also involved for most people.
Treatment:
Treatment
of Narcissistic Personality Disorder usually consists of individual,
group or family therapy, structure (scheduling one's time so
that there are no long periods of unplanned time), support,
medications, limit-setting, consistent rules, education about
the illness, social skills training, behavior modification and
learning more effective communication and coping skills. Inpatient
or day hospitalization may be necessary when symptoms make the
patient a danger to self or others
Counseling
and Psychotherapy [ See
Therapy Section ]:
Most psychiatrists
will, as a practical matter, treat most of their severely narcissistic
patients for symptoms related to crises and relatively external
Axis I diagnoses, rather than in an effort to address the personality
disorder itself. The therapist must be aware of the importance
of narcissism to the contiguity of the patient's psyche, refrain
from confronting the need for self-aggrandizement, and help
the patient use his or her narcissistic characteristics to reconstitute
an intact self-image. Positive transference and therapeutic
alliance should not be relied upon, since the patient may not
be able to acknowledge the real humanness of the therapist but
may have to see him/her as either superhuman or devalued.
Group
Therapy
The goals
are to help the patient develop a healthy individuality (rather
than a resilient narcissism) so that he or she can acknowledge
others as separate persons, and to decrease the need for self-defeating
coping mechanisms. The first step toward developing a working
alliance is empathy with the surprise and hurt that the patient
experiences as a result of confrontations within the group.
The external structuring group therapy provides can control
destructive behavior in spite of ego weakness. In groups, the
therapist is less authoritative (and less threatening to the
patient's grandiosity); intensity of emotional experience is
lessened; and regression is more controlled, creating a better
setting for confrontation and clarification.
