What is Narcissistic Personality Disorder?
Narcissistic Personality Disorder (NPD) is a condition in which people have a very high sense of self-importance, a craving for admiration, and a lack of understanding towards others’ feelings. These individuals might appear to be bragging, egotistical, or unlikable. This pattern of behavior continues over a long time and can have severe effects on social interactions and job performance. NPD may also go hand in hand with other mental illnesses, making it even harder for the person to function independently. Unfortunately, the treatment options for NPD are few and not always effective.
The word “narcissism” was first mentioned by the Roman poet Ovid in his work Metamorphoses: Book III, which tells the story of Narcissus, a character who was cursed to fall in love with his own reflection. But it wasn’t until the late 1800s that the term was used to describe a psychological state. The term NPD was further explored and defined by well-known psychologists like Havelock Ellis, Sigmund Freud, psychoanalyst Ernest Jones, and Robert Waelder. Despite the efforts, this disorder was not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-I) until 1968.
In the DSM, personality disorders are grouped into 3 categories (A, B, C) based on common characteristics. For example, group B, where NPD falls, includes disorders with dramatic or emotional behavior. However, this system of categorization has its drawbacks and is not always backed up by scientific research.
What Causes Narcissistic Personality Disorder?
Narcissistic Personality Disorder (NPD) has multiple factors contributing to its origin. It is often inherited, and certain medical conditions affecting the brain can also be linked to personality disorders. Psychological factors, such as negative experiences in early life or excessive praise, can contribute to the development of NPD in adulthood. Personality is a unique mix of various factors, including temperament, which is influenced by both genetics and life experiences. People with NPD tend to exhibit low harm avoidance, high novelty seeking, high reward dependence, and persistence. However, this persistence can become problematic when coupled with low harm avoidance, as they prioritize recognition and social status without considering potential consequences.
Risk Factors and Frequency for Narcissistic Personality Disorder
Diagnosing Narcissistic Personality Disorder (NPD) can be difficult as individuals with this condition don’t often seek psychiatric help. Reliable diagnosis tools that cover a wide range of populations are not readily available. Research has estimated that between 0% and 6.2% of the US population may have this disorder. A large-scale survey involving 34,653 adults showed that 6.2% of participants had experienced NPD at some point in their lives. The same study found that it was more common in men (7.7%) than women (4.8%).
- Diagnosing Narcissistic Personality Disorder (NPD) can be challenging as people with the disorder may not seek psychiatric evaluation.
- There isn’t a wide range of effective tools for diagnosing this condition.
- Studies in the US estimate that the disorder affects between 0% and 6.2% of the population.
- In a large-scale survey involving 34,653 adults, 6.2% were found to have experienced NPD in their lives.
- Within this survey, NPD was more common among men (7.7%) than women (4.8%).
Signs and Symptoms of Narcissistic Personality Disorder
People with Narcissistic Personality Disorder (NPD) show different signs and symptoms. They usually show extreme self-importance and demand or expect special treatment. They may act friendly with high-ranking professionals such as doctors and managers, while being unkind to other staff members. Notably, they often brag about their connections and their status. They cannot handle criticism and may get very angry.
People with NPD often have a history of unstable relationships, and their circle of friends may shrink as they get older. They might have legal charges against them because they believe the rules don’t apply to them. Their understanding and demonstration of empathy are limited, and they may deny feelings of sadness or weakness. However, they commonly experience depression due to their fragile sense of self and the negative impact of their behavior on their work and social relationships.
In a psychiatric evaluation, several factors should be carefully considered:
- Appearance: Pay attention to their grooming and fashion choices. Outfits or tattoos that seek attention could indicate NPD.
- Behavior: Notice if they show unchecked behaviors, exaggerated postures, smirking, or scoffing. Their behavior might change depending on who they are interacting with.
- Speech: People with NPD often talk a lot to boast about their achievements or connections. However, their speech initiation, volume, or vocabulary doesn’t necessarily pose a concern.
- Affect: Their mood might change significantly depending on the conversation, especially if they feel threatened.
- Thought content: Assess for delusions. Their pride might border between non-delusional and delusional grandiose thoughts. This doesn’t change the treatment approach but helps understand the severity of NPD.
- Thought process: Individuals with NPD are often logical and linear in their thinking, but the grandiosity is unchangeable.
- Cognition: In general, they do not show compromised cognition or orientation, but this should be assessed to rule out other mental health conditions.
- Insight: Individuals with NPD often lack understanding of their condition. Accepting self-deficit is usually not in line with NPD characteristics.
- Judgement: The severity of NPD can impact a person’s judgement. You can inquire about their legal and relationship histories to assess this.
- Impulse Control: People with NPD often show poor impulse control due to high reward dependence and low harm avoidance behaviors. This can also be assessed by asking about past legal and relationship history.
Testing for Narcissistic Personality Disorder
- Diagnosis of a personality disorder benefits from longitudinal observation of a patient’s behaviors over various circumstances to give a broader understanding of long-term functioning.
- Personality disorders should generally be diagnosed when no acute psychiatric process is concurrently occurring.
- In some cases, an underlying personality disorder may contribute significantly to hospitalizations or relapse of another psychiatric condition.
- It may take several visits with a patient to finally establish a firm diagnosis of NPD.
- Patients with cluster B personality disorders often display transference.
- Clinicians often develop counter-transference.
- Clinicians must recognize signs of counter-transference when they occur to remove any treatment bias.
- Sublimation is a psychological defense mechanism that helps individuals transform unwanted or unhelpful impulses into less harmful or helpful ones.
- Various structured interviews and inventories have been developed to assist in evaluating NPD.
- Other instruments may measure the severity of NPD.
Treatment Options for Narcissistic Personality Disorder
People with Narcissistic Personality Disorder (NPD) often don’t realize they have a problem because it doesn’t cause them distress. Treatment goals for NPD focus on lessening conflict with others and improving social functioning. Medications are not typically helpful for NPD, unless there is another mental health condition present. Psychotherapy, specifically transference-focused therapy, is the preferred treatment for NPD. Case management can also provide practical support for individuals with NPD.
What else can Narcissistic Personality Disorder be?
Narcissistic Personality Disorder (NPD) could be the case when one displays a pattern of inflexible behaviors over different situations. It can often be confused with other mental health disorders as they share similar traits. Important traits such as heightened self-importance, irritability, and being highly driven could also indicate a manic or hypomanic episode in bipolar disorder. However, there’s a difference. People with NPD do not experience a reduced need for sleep, which is common in bipolar disorder. Furthermore, while bipolar episodes are short-lived and manage well with medicines, NPD is long-lasting and doesn’t improve significantly with medication.
Other disorders that could look like NPD include antisocial personality disorder, histrionic personality disorder, and borderline personality disorder, all of which fall under the cluster B personality disorders. But here are the key differences: People with NPD do not share the impulsivity and self-destructive behaviors associated with borderline personality disorder. Nor do they feature noticeable outbursts of emotion, which are common in people with histrionic personality disorder. NPD and antisocial personality disorder have some parallels, such as lack of empathy and superficial charm. However, individuals with antisocial personality disorder tend to show disregard for right and wrong, which is less common in NPD, and they have likely been diagnosed with conduct disorder during their teenage years.
What to expect with Narcissistic Personality Disorder
Studies on Narcissistic Personality Disorder (NPD) are limited, but it’s generally agreed that this disorder tends to last a lifetime. With criteria similar to those from the DSM-III era, research shows that NPD is less likely to cause long-term problems with overall functionality when compared to personality disorders like schizoid, antisocial, borderline, histrionic, and avoidant.
However, Narcissistic Personality Disorder itself may not go away on its own or even with treatment. Even so, efforts to enhance the individual’s quality of life could help. This might include addressing other mental health issues and stabilising social influences, as these steps could potentially improve the outlook for someone with NPD.
Possible Complications When Diagnosed with Narcissistic Personality Disorder
Substance abuse is often seen in cases of personality disorders, but it’s not well understood which specific disorders are most likely to lead to substance misuse. People with these disorders are more likely to contemplate or attempt suicide compared to those without personality disorders. Hence, it’s important for those with Narcissistic Personality Disorder (NPD) to regularly be checked for thoughts of suicide.
- Substance abuse common in cases of personality disorders
- Lack of clarity on which specific disorders are most at risk for substance misuse
- Increase in suicidal thoughts or attempts among those with personality disorders
- Regular suicide risk screenings necessary for individuals with NPD
Preventing Narcissistic Personality Disorder
Treating Narcissistic Personality Disorder (NPD) relies heavily on forming a trusting relationship between the patient and the medical practitioner. This is important as individuals with this disorder may be extremely sensitive to suggestions or advice. Patients are urged to express any symptoms or emotional stresses they want to be addressed. This approach contrasts with health providers mainly focusing on altering behaviors. The focus is on individual distress and whether their social and professional lives have been affected.
Furthermore, patients are advised to lean on their existing social connections for support. The patient’s family can play a crucial role in watching for signs of worsening mental health and providing a consistent social environment. Using standard measures of quality of life can uncover ways to enhance important life functions for an individual with NPD.
