Narcissistic
Personality Disorder (NPD)
Recent thinking
about NPD considers this personality pattern having three primary dimensions (see
DSM-5 reference below):
1. grandiosity
2. need for
admiration
3. lack of empathy
for others
From a diagnostic
perspective, these features should be pervasive rather than episodic and NPD is
not usually diagnosed until adulthood. In addition, to warrant the diagnosis of
a disorder, there needs to be evidence that the pattern produces significant personal
distress or produces a significant impairment in how the person functions in
important areas of life such as relationships or work.
Clinicians look for
evidence of at least five features from a list of common features. The person
with an SPD pattern may be described as:
1. Grandiose with a
strong sense of self-importance
2. Preoccupied with
fantasies of great success, power, exceptional intelligence, attractiveness
3. Believe they
are very special and even unique. They are so special that they should only connect with important people who are able to understand them.
4. Requires
excessive praise, approval, and admiration
5. Entitled with an
unreasonable expectation of being treated with great respect
6. Exploits others, skilled in taking advantage of other people
7. Lacking empathy
emotional empathy but may display cognitive empathy
8. Appears envious, jealous, distrustful or concerned that others feel that way toward them
9. Arrogant,
haughty, scornful
*****
The following abbreviated
summary comes from NIH, which should be consulted for details and updated
information (Mitra & Fluyua, 2023)
What causes NPD?
Researchers have
focused on a few possibilities. They find common traits of aggression, low
tolerance for distress and problems regulating their emotions. Others have
identified rejection in childhood and excessive praise and communicating that
the child has extraordinary talents.
How common is
NPD?
In the US, NPD
ranges from .5 to 5% of the population but in a clinical setting rates may be
as high as 15%.
What other
conditions occur with NPD?
The most common
condition contributing to difficulties is the cooccurrence of antisocial
personality disorder.
Are there
subtypes?
Researchers have
considered two subtypes of NPD:
1. Grandiose- overt
grandiosity, aggression, boldness
2. Vulnerable- hypersensitivity,
defensiveness
Biopsychology
There is some
evidence for brain differences in German studies.
Measurement
See Narcissistic
Personality Inventory
*****
Information from
the American
Psychiatric Association (APA, 2024)
The US rate of NPD
was estimated as 1-2% of the population.
Considering the two
subtypes noted above, see this quote from the APA.
In addition to
grandiosity, narcissistic personality disorder has a significant vulnerability
aspect, and individuals may alternate between the two (Edershile 2022).
Vulnerability may make individuals very sensitive to criticism or defeat and
although they may not show it, those experiences may leave them feeling
ashamed, degraded and empty. People with the disorder may react to criticism or
defeat with disdain and defiance, or with social withdrawal or an appearance of
humility, which masks the grandiosity (APA 2022). Although they seem like quite
different traits, researchers have found that both aspects of narcissism have
in common selfishness, deceitfulness and callousness (Kwon 2023).
See the APA link for more details.
Other
comments
1. People with a
personality disorder may have traits of other disorders including sufficient
traits to meet the criteria for more than one condition.
2. People with a
personality disorder may have other conditions such as a mood disorder.
3. Treatment is
difficult and may be complicated by other more salient conditions like
depression or substance abuse. See the links to NIH and the APA for more about
treatment.
4. Research can
change our understanding of NPD so, the 3 key features and the list of 9
features may change in the future. The DSM is updated periodically to reflect
the latest research.
5. People may have
narcissistic traits without meeting the criteria for a disorder. Personality traits are durable
and pervasive patterns of behavior. Some personality traits can interfere with work and
family relationships. So, not everyone who has a grandiose view of themselves
meets criteria for NPD, but they may still have difficulties in various
situations.
6. Narcissistic characteristics such as having a sense of entitlement, low empathy, desiring admiration, and appearing self-centered are a matter of degree. They may cause some difficulties but do not reach the point of severe impairment for the person or others. Sometimes these narcissistic characteristics may appear in a situation but not be present on a long-term basis.
Related
Posts
Psychology’s
Toxic Triad – Narcissism, Psychopathy, Machiavellianism
Narcissistic
Personality Inventory
Reference
American
Psychiatric Association. (2013). Personality disorders. In Diagnostic and
Statistical Manual of Mental Disorders (Fifth Edition ed.). Washington, DC:
American Psychiatric Publishing Inc.
Geoffrey W. Sutton, PhD is Emeritus Professor of Psychology. He retired from a clinical practice and was credentialed in clinical neuropsychology and psychopharmacology. His website is www.suttong.com
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