Narcissistic Personality Disorder Symptoms
Narcissism is fairly common in every day life, but some people pull it off better than others. Some of those who seem self-centered may in fact not be all that narcissistic. However, there are some people who can hide it very well. Unfortunately, there is a point where it becomes pathological and becomes a disorder. Not everyone is a narcissist (obviously), and it depends on how you use the word to qualify it. Not everyone abused succumbs to the disease, but this doesn’t justify trauma. Narcissism, at least in the long term, is hard to hide, even if the person limits interaction and hides it well. Learn about narcissistic personality disorder symptoms.
Insensitive parenting, over-praising and excessive pampering, unpredictable or negligent care, excessive criticism, abuse, trauma, and extremely high expectations are know to cause a narcissistic personality.
Those who can hide it can be seen as borderline psychopaths, but this doesn’t mean that the person can’t at least appear to care. Sometimes, the person you least expect to have it can end up being narcissistic. Other times, it can be clear as day; a person with sociopathic tendencies. Sociopathy, psychopathy, and narcissism can be linked, but they’re not synonymous. One certainly doesn’t mean the other, because they’re two separate things. You can find a narcissist that has a longing desire for love but doesn’t allow it because of their problems; this would help them. Regardless of the inner workings of someone’s mind, the ultimate conclusion to draw when trying to understand this is if the person(s) has/have a narcissistic personality.
Background (Narcissistic Personality Disorder Symptoms)
Narcissistic personality disorder (NPD) is a personality disorder characterized by a long-term pattern of exaggerated feelings of self-importance, an excessive craving for admiration, and struggles with empathy. People with NPD often spend much time daydreaming about achieving power and success, or on their appearance. This is a pattern of obsessive thoughts and unstable sense of identity, often to cope with a sub-par real life. People with the diagnosis in recent years have spoken out about its stigma in media, and it’s possible links to abusive situations and childhood trauma. Such narcissistic behavior typically begins by early adulthood, and occurs across a broad range of situations.
A true narcissist is unlikely to become an empathic and selfless individual. However, if a narcissist believes their behavior is harmful to others and themselves, wants to change, and is willing to actively participate in therapy, some change can occur.
The causes of narcissistic personality disorder are unknown, but it’s theorized to be linked to certain types of traumas. The condition of NPD is included in the cluster B personality disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). A diagnosis of NPD is made by a healthcare professional interviewing the person in question. The condition of NPD should be differentiated from mania and substance use disorder.
Further conceptual developments and refinements of the mental condition of Narcissism produced the term narcissistic personality structure, which was introduced by Otto Friedmann Kernberg, in 1967; and the term narcissistic personality disorder, which was proposed by Heinz Kohut, in 1968.
Treatments for narcissistic personality disorder have not been well studied. Therapy is difficult, because people with Narcissistic Personality Disorder usually do not consider their own issues as symptoms, despite mental distress. People with NPD may have other conditions as well, making it harder to notice symptoms. About one percent of people are believed to be affected with NPD at some point in their lives. It occurs more often in men than women, and typically affects younger as opposed to older people. The narcissistic personality was first described by the psychoanalyst Robert Waelder, in 1925. The term narcissistic personality disorder (NPD) was coined by Heinz Kohut in 1968.
Signs and Narcissistic Personality Disorder Symptoms
People with narcissistic personality disorder (NPD) are characterized by the personality traits of persistent grandiosity, an excessive need for admiration, and a personal disdain and lack of empathy for other people. As such, the person with NPD usually displays arrogance and a distorted sense of personal superiority, and seeks to establish abusive power and control over others.
Regarding the adult neurotic’s sense of omnipotence, Sigmund Freud said that “this belief is a frank acknowledgement of a relic of the old megalomania of infancy”; and concluded that: “we can detect an element of megalomania in most other forms of paranoic disorder. We are justified in assuming that this megalomania is essentially of an infantile nature, and that, as development proceeds, it is sacrificed to social considerations.”
Self-confidence(a strong sense of self) is a personality trait different from the traits of narcissistic personality disorder; thus, people with NPD typically value themselves over others, to the extent of openly disregarding the wishes and feelings of anyone else, and expect to be treated as superior, regardless of their actual status or achievements. Socially, the person with narcissistic personality disorder usually exhibits a fragile ego (self-concept), intolerance of criticism, and a tendency to belittle other people, in order to validate their own superiority.
What causes NPD based on the diagnostic requirements in the DSM-5:
- 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 they are “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 their expectations).
- Is interpersonally exploitative (i.e., takes advantage of others to achieve their 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 them.
- Shows arrogant, haughty behaviors or attitudes.
Narcissistic personality disorder usually develops either in adolescence or in early adulthood, and it is common for children and adolescents to display personality traits that resemble NPD, but such occurrences are usually transient, and register below the clinical criteria for a formal diagnosis of NPD. True symptoms of NPD are pervasive, apparent in varied social situations, and are rigidly consistent over time.
The historical use of the term narcissism, to describe a person’s excessive vanity and self-centeredness, predates the modern medical classification of NPD (narcissistic personality disorder). The mental condition of narcissism is named after the Greek, mythological character Narcissus, a beautiful boy, born of a nymph, who became infatuated with his own reflection in a pool of water. At first, Narcissus did not understand that the image he saw in the pool of water was a reflection of himself; when he did understand that fact, he pined for the unattainable image and died of grief, for having fallen in love with someone who did not exist outside of himself.
Severe symptoms of NPD can significantly impair the person’s mental capabilities to develop meaningful human relationships, such as friendship, kinship, and marriage. Generally, the symptoms of NPD also impair the person’s psychological abilities to function socially, either at work, or at school, or within important societal settings. The DSM-5 indicates that, in order to qualify as symptomatic of NPD, the person’s manifested personality traits must substantially differ from the cultural norms of society.
Comorbidity/Additional Information and Features
The occurrence of narcissistic personality disorder presents a high rate of comorbidity with other mental disorders. People with NPD are prone to bouts of psychological depression, often to the degree that meets the clinical criteria for a co-occurring depressive disorder. Moreover, the occurrence of NPD is further associated with the occurrence of bipolar disorder and substance use disorders, especially cocaine use disorder. In that vein, NPD also might be co-morbid with the occurrence of other mental disorders, such as histrionic personality disorder, borderline personality disorder, antisocial personality disorder, or paranoid personality disorder.
Megalomania is a mental state in which the affected individual is subject to an obsession with power and the belittling of others, as well as feelings of grandiosity. Its characteristics are similar to that of grandiose narcissism, with the exception of a few variations. Megalomania was not mentioned in the DSM-5 as an independent disorder, instead being forged with Narcissistic Personality Disorder.
People with NPD exaggerate their skills, accomplishments, and their degree of intimacy with people they consider high-status. Such a sense of personal superiority may cause them to monopolize conversations, or to become impatient and disdainful when other persons talk about themselves. When wounded in the ego, either by a real or a perceived criticism, the narcissist’s displays of anger can be disproportionate to the nature of the criticism suffered; but typically, the actions and responses of the NPD person are deliberate and calculated. Despite occasional flare-ups of personal insecurity, the inflated self-concept of the NPD person is primarily stable.
In the second half of the 20th century, in contrast to Freud’s perspective that megalomania is an obstacle to psychoanalysis, in the U.S. and in Britain, Kleinian psychologists used the object relations theory to re-evaluate megalomania as a defense mechanism, a circumstance that offered the psychotherapist access to the patient for treatment. Such a Kleinian therapeutic approach built upon Heinz Kohut’s view of narcissistic megalomania as an aspect of normal mental development, by contrast with Otto Kernberg’s consideration of such grandiosity as a pathological distortion of normal psychologic development.
To the extent that people are pathologically narcissistic, the person with NPD can be a self-absorbed control-freak who passes blame and is intolerant of contradictory views and opinions; is apathetic towards the emotional, mental, and psychological needs of other people; and is indifferent to the negative effects of their behaviors, whilst insisting that people should see them as an ideal person. To protect their fragile self-concept, narcissists use psycho-social strategies, such as the tendency to devalue and derogate and to insult and blame other people, usually with anger and hostility towards people’s responses to the narcissist’s anti-social conduct.
The lifetime rates of narcissistic personality disorder are estimated at 1% in the general population; and between 2% to 16% in the clinical population. A 2010 review found rates of NPD of up to 6% in community samples, and that the yearly number of new cases of NPD in men is slightly greater than in women. A 2015 review found that the rates of NPD have been relatively stable for men and women throughout the thirty-year period in which data were collected.
Because their fragile egos are hypersensitive to perceived criticism or defeat, people with NPD are prone to feelings of shame, humiliation, and worthlessness over minor incidents of daily life and imagined, personal slights, and usually mask such feelings from people, either by way of feigned humility, or by responding with outbursts of rage and defiance, or by seeking revenge. The merging of the inflated self-concept and the actual self is evident in the grandiosity component of narcissistic personality disorder; also inherent to that psychological process are the defense mechanisms of idealization and devaluation and of denial.
The effectiveness of psychotherapeutic and pharmacological interventions in the treatment of narcissistic personality disorder has yet to be systematically and empirically investigated. Clinical practice guidelines for the disorder have not yet been created, and current treatment recommendations are largely based on theoretical psychodynamic models of NPD and the experiences of clinicians with afflicted individuals in clinical settings. The presence of NPD in patients undergoing psychotherapy for the treatment of other mental disorders is associated with slower treatment progress and higher dropout rates.
The DSM-5 indicates that: “Many highly successful individuals display personality traits that might be considered narcissistic. Only when these traits are inflexible, maladaptive, and persisting, and cause significant functional impairment or subjective distress, do they constitute narcissistic personality disorder.” Given the high-function sociability associated with narcissism, some people with NPD might not view such a diagnosis as a functional impairment to their lives.
Those with megalomania often show symptoms such as: condescension, overestimation of one’s abilities, feelings of uniqueness, inflated self-esteem, and have a drive to maintain control over others. In addition to this, megalomaniacs have dreams of power, success and wealth. Overall, megalomania involves intense feelings of grandiosity. Those with this condition are believed to have internal feelings of inferiority, which they attempt to suppress by seeking admiration from others.
Although overconfidence tends to make people with NPD very ambitious, such a mindset does not necessarily lead to professional high achievement and success, because they refuse to take risks, in order to avoid failure or the appearance of failure. Moreover, the psychological inability to tolerate disagreement, contradiction, and criticism, make it difficult for persons with NPD to work cooperatively or to maintain long-term, professional relationships with superiors and colleagues.
It shares many similarities to narcissism, though there are a few differences. Perhaps most noteworthy of all, megalomaniacs are generally more concerned with superiority, while narcissists are more associated with feelings of excessive self-worth. Megalomania does not share narcissistic traits such as a sense of entitlement, attention-seeking behavior, desire for admiration or intolerance towards criticism.
While narcissists are preoccupied with attempting to belittle others, megalomaniacs believe they have already dominated others, and need to maintain the domination. Also, megalomaniacs are highly conceited, while narcissists, particularly the vulnerable type, can often have low levels of self-esteem and self-confidence.
Treatment of Narcissistic Personality Disorder Symptoms
Narcissistic personality disorder is rarely the primary reason for which people seek mental health treatment. When people with NPD enter treatment (psychologic or psychiatric), they usually are prompted by difficulties in their lives, or are seeking relief from some other disorder of their mental health, such as a major depressive disorder, a substance use disorder (drug addiction), or bipolar disorder (manic depression). The reason for such an indirect path to psychotherapeutic treatment is partly because narcissists generally possess poor insight, and are unaware that their actions produced their mentally unhealthy circumstance, and so fail to recognize that their perceptions and behaviors are socially inappropriate and problematic, because of their very positive self-image (inflated self-concept).
In The Psychology of Gambling (1957), Edmund Bergler considered megalomania to be a normal occurrence in the psychology of a child, a condition later reactivated in adult life, if the individual takes up the vice of gambling. In The Psychoanalytic Theory of Neurosis (1946), Otto Fenichel said that people who, in their later lives, respond with denial to their own narcissistic rage and narcissistic injury, usually undergo a similar regression to the megalomania of childhood.
In general, psychotherapy is the basis for treating narcissistic personality disorder. In the 1960s, Heinz Kohut and Otto Kernberg challenged the conventional wisdom of the time with clinical strategies that applied psychoanalytic therapy to NPD clients, which, they claimed, effectively treated that personality disorder. Contemporary psychotherapy treatments include transference-focused therapy; metacognitive therapy; and schema-therapy, to treat the client’s particular subtype of NPD.
The term megalomania first came into usage in the late 1800s and began to be used popularly by the public in the early 1900s. A former mental disorder, Megalomania has since been removed from the DSM, and forged in with narcissistic personality disorder.
Improvements to the mental health of patients with NPD are possible with psychopharmaceutical treatment of the symptoms of the comorbid disorders; despite such drug therapy, the psychologist Elsa Ronningstam said that “alliance-building and engaging the patient’s sense of agency and reflective ability are essential for [achieving] change in pathological narcissism.” Psychiatric medications usually are not indicated for treating NPD, but can be used to treat the co-occurring symptoms of psychological depression, anxiety, and impulsiveness, when present in the NPD client. In the field of relationship counseling mental health therapy is most beneficial when both partners participate in the treatments.
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