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Narcissistic Personality Disorder (NPD)

Narcissistic Personality Disorder, or NPD, is one of a cluster of Personality Disorders that includes border-line personality disorder, antisocial personality disorder and histrionic personality disorder. Patients suffering from NPD exhibit a pattern of traits and characteristics that display self-infatuation, self-obsession to the exclusion of all others and an egotistic and often extreme pursuit of self-gratification, ambition and dominance over others. dominance and ambition. This disorder was first diagnosed by Sigmund Freud. It includes a wide range of symptom severity from mild, reactive or transient to the most severe permanent personality disorder. Narcissists are classified as ‘Cerebral’, obtaining self-gratification from academic or intellectual achievements, or ‘Somatic’, deriving gratification from their physical appearance or prowess, or from sexual conquests. Narcissists need adulation, and worship from others, but they exhibit no feelings or signs of empathy toward others. Children of narcissistic parents often suffer from a lack of confidence and habitual shame at never ‘getting it right’, since narcissists feel they are always right and often treat others as if they are inferior. The narcissistic personality preys on those around him and exploits others for his own gain. The narcissist attempts to control and manipulate others and must always be the center of attention. Narcissistic Personality Disorder has been diagnosed in infancy, childhood and early adolescence, and is typically attributed to abuse or trauma in childhood, inflicted by parents or others in authority, or even by peers. Often, when the narcissist learns about his disorder, he believes he can change. This is especially true when his world and relationships are in jeopardy. The narcissist typically admits his illness when he is abandoned, destitute, or devastated by loss. This may be followed by a period of change, which fades, and is followed by reversion to his previous behavior. Many doctors report a cyclical remission and repetition of behavior, and while narcissistic patients respond to treatment, they usually suffer chronic, lifetime, symptoms of this disorder. Narcissism will sometimes lessen with age and many patients exhibit narcissistic patterns that are reactive and transient, rather than persistent. In these patients, episodes are typically brought on by stress, or the loss of a person or environment that gratified the ego of the narcissist.

What are the symptoms?

• Suppression of anger, envy, lashes out over perceived inferiority or flaws of others. Anger is often directed at those considered insignificant (waiters, taxi drivers)
• Saccharine sweetness and/or excessive flattering following an outburst toward friends, family or sexual partners
• Grandiose beliefs, claims about superiority, skills, attractiveness, sexual encounters
• Believes that he/she is ‘special’ or unique and can only be understood by and associate with special or important people.
• Preoccupied with fantasies (success, power, brilliance, beauty, ideal love)
• Excessive talking, inappropriate self-disclosure, causing social friction
• Sense of self-importance, exaggerating achievements, expects to be recognized as superior without appropriate accomplishments
• Lack of empathy, unwilling to recognize or identify with the feelings and needs of others
• Envious of others or believes others are envious of him/her
• Cynicism or paranoid thinking, inability to trust friends or family, quarrels and picks fights, tells lies, is rude or inconsiderate and alienates friends, limits social support, lack of respect for social conventions
• Difficulty adapting to social/personal change, low tolerance for differing points of view, emotionally bland, inability to understand/verbalize feelings, limited range of interests, insensitivity to art and beauty
• Sulking, withdrawal, expressed boredom, drinking or taking drugs to address boredom with others and with life
• Avoidance of intimacy and attachment, attempts to control and manipulate others
• Has a sense of entitlement, unreasonable expectations of favorable treatment or compliance with his/her expectations
• Inability to spend time alone; attention seeking and overly dramatic
• Reckless excitement seeking, inappropriate attempts to dominate and control others
• Unrealistic expectations, perfectionist demands, unwarranted pessimism, unfounded somatic concerns, dependence on others for emotional support
• Exhibits vanity, superiority, hubris, is overbearing or haughty, egocentric, hypocritical, and skeptical of others
• Exploitive, takes advantage of others to achieve his or her own ends
• Underachievement in intellectual or artistic potential, poor academic performance relative to ability, disregard of rules or responsibilities will not discipline self even when required for medical reasons, exhibits personal and occupational aimlessness
• Arrogant, haughty behaviors or attitudes

How is it diagnosed and treated?

Narcissistic Personality Disorder is often coincident with other mental health disorders. It can occur with or show symptoms similar to Histrionic Personality Disorder, Antisocial Personality Disorder, Borderline Personality Disorder, Obsessive-Compulsive Personality Disorder, Schizotypal Personality Disorder, or personality changes from general medical conditions, or chronic substance use. Doctors will look for the following signs:

• Pervasive pattern of grandiosity, need for admiration, lack of empathy or concern for feelings of others, beginning by early adulthood and present in various contexts
• Preoccupied with fantasies of success, power, brilliance, beauty, or idealized love
• Interpersonally exploitative and manipulative, takes advantage of others to achieve goals
• Grandiose sense of self-importance exaggerating achievements and talent, expects recognition without commensurate achievement
• Sense of entitlement, expectation of favorable treatment, believes he/she is special and can only associate with other special people
• Arrogant attitude, envious of others or believes others are envious of him/her

Treatment(s) can include:

• Cognitive Behavioral Therapy
• Medication as appropriate for mood or affect disorders or obsessive-compulsive coincidence
• Group Therapy
• Psychodynamic Therapy
• Hospitalization in severe cases

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