Narcissistic personality disorder (NPD) is a disorder with preoccupied thoughts of grandiosity, extreme self-admiration, the desire of being the centre of attention, and lack of empathy for others.Narcissistic personality disorder is a category of personality disorder out of 10 conditions recognized by the American Psychiatric Association. Narcissist people show persistent patterns of behaving, feeling, thinking, and interacting that result in distress in their lives.
Origin of Narcissistic Personality Disorder
The concept of narcissism was known thousands of years ago, however, the Narcissistic personality disorder became a known illness within the last 50 years.
Narcissism is originated from a Greek myth where a beautiful boy named “Narcissus” watched his reflection in the water and fell in love with it. He was not aware of the fact that the mirror image was his own.
Psychoanalysts named as Heinz Kohut and OtooKernberg took more interest in the phenomenon of narcissism. Later in 1967, Kernberg defined “Narcissistic Personality Structure”.
He described a theory with three types such as:
1. Normal Adult Narcissism
2. Normal Infantile Narcissism
3. Pathological Narcissism
After one year, Kohut explained NPD in his way and expanded Freud’s ideas about narcissism in more depth. His theory suggested that narcissism is an essential part of self-development in childhood and that difficulties with relationships could lead a person to narcissistic disorders.
Finally, in 1980, NPD was officially recognized and categorized in the Diagnostic and Statistical Manual of Mental Disorders. Its criteria were established for separate diagnosis.
Recently there was a debate regarding the category of personality disorders in DSM5, but Narcissistic personality disorder and other important personality disorders remained intact.
Narcissistic Personality Disorder: Other Names
- Dependent Personality Disorder
- Anxious Personality Disorder
- Eccentric Personality Disorder
- Anxious Personality Disorder
- Dramatic Personality Disorder
These specific patterns begin in early teenage or adulthood, but may not be identified until later adulthood.
Narcissistic Personality Disorder: Symptoms
Dominating discussions? Demeaning others? Feelings of control and power? These are all typical signs and symptoms of narcissistic personality disorder. Given below is a list of common symptoms of narcissist.
In need of constant attention
Engrossed with imaginations of infinite fantasies about power, success, beauty, brilliance, and the perfect mate
Hopes of being recognized as superior even without attainments that permit it
In need of constant admiration
Amplification of accomplishments and abilities
Having a sense of entitlement and control
Being jealous of others and the overstated belief that others are spiteful of you
Self-admiration and self-promotion
Expectation special favors from others
Manipulative behavior with other
Behave in a haughty and arrogant manner, coming across as proud, conceited and showy
Emotional and able to feel rejected easily
Inability or reluctance to recognize the emotional needs of others
NPD also have trouble managing anything that they perceive as criticism. They behave as:
When narcissist don’t get special favors or attention, they become impatient.
They have more interpersonal problems because they take everything personally and feel insulted easily.
Narcissist react with fury and try to put down the other person. It gives them the satisfaction of being superior.
They are prone to stress and behave in a bizarre manner.
They become moody and depressed on little problems
They have hidden feelings of shame, insecurity, disgrace, and vulnerability.
People get attracted to NPD easily because of their confidence, excitement, and assertiveness. Later, after knowing them, they start to loathe the same traits that attracted them initially.
Narcissistic Personality Disorder: Causes
Personality disorders are transmissible to some extent. It is still not sure about what causes NPD. It may be caused by childhood circumstances, parenting styles, home environment, childhood traumas, and abuse. A child can learn manipulative behaviors from their family members while growing up.
Let’s look at the impact of parenting on developing NPD.
Authoritarian and Perfectionist Parents: A child’s life can suffer badly when parents demand perfection in each aspect of life. The self-esteem of a child is badly damaged when parents put them under pressure to give the best performance. Growing in such an environment, a child can retreat into narcissism, coping with his fragile ego by self-defenses of being superior and perfect.
Inconsistent Parenting: When parents give mix messages to children, they grow up into confuse and insecure adults. To manage this, they become narcissistic to create an exaggerated powerful self-image.
Abuse in Childhood: Childhood abuse (sexual, emotional, and physical) can damage a child’s self-esteem to a great extent. The rude behaviors of parents, bullying by peers, and abuse by close adult caregivers can all be a reason in developing NPD. A child raised in such an environment is emotionally unstable.
As a result of above-mentioned reasons, the person hideaway in the shell of narcissism and finds it an effective strategy for coping with these problems. The lack of self-confidence, low self-esteem, and broken self-image are the basis to narcissism and will persist as denied and repressed internal self. This will cause a split between actual elf and repressed unconscious motives that will cause dysfunction.
Narcissistic Personality Disorder: Diagnosis
In order to diagnose an NPD, a complete range of criteria needs to be fulfilled. There are various types of personality disorders and can easily overlap with one another. Below are a few essentials to be diagnosed with NPD:
The criteria written in the Diagnostic and Statistical Manual (DSM) of mental health must be met.
Behavioral observation approves the following characteristics:
- Exaggerated self-importance
- Fantasies about power, success, and beauty
- Strong desire to be the center of attention
- Consider themselves as superior to others
- Need constant admiration
- Manipulated and emotionally detached behavior
- Lack of empathy for others
- Feeling of jealousy
- Arrogance and pride
The diagnosis can be done by a trained professional such as a psychiatrist or psychologist. The symptoms of this disorder are prominent and usually reported by other family members or friends. The trained professional look for the Mental status examination, behavioral observation, family and patient interview, psychological tests, DSM 5 checklist, baselines, and daily observations to give a diagnosis of NPD. The professional is the one to decide if the person met the criteria of personality disorder.
Narcissistic Personality Disorder: Treatment
There are no set treatments for all the personality disorders because they are complex and with the passage of time, they become permanent patterns of personality. However, with the help of psychotherapy, a narcissist may know about his symptoms and how he can handle it.
Following treatments can help to manage a narcissistic personality disorder:
Cognitive Behavior Therapy (CBT)
It helps the narcissist to identify his negative beliefs, behaviors, persistent patterns, and undesirable habits. After identifying it, the therapy helps him to replace them with positive, healthful, and constructive ones.
Many therapists will, as an everyday matter, treat their serious narcissistic patients for apparent symptoms related to catastrophe and comparatively external diagnosis. They overlook the personality disorder itself. Individual therapy is very helpful for such patients.
The therapist must know the significance of NPD to the contiguity of the patient’s mind, abstain from opposing the need for self-glorification, and support the patient practice his/her narcissism to restructure an undamaged self-image. Therapeutic alliance and positive transference should not be allowed, as the patient may not accept the genuine humanness of the therapist but see him/her as either devalued or exceptional.
After getting help for NDP, many narcissist patients continue the therapy to treat their other problems such as depression and interpersonal issues.
Goals of the individual therapy must be set at 60 to 80%. The patient of NPD does not usually follow the complete psychotherapy. They need consistent reminders to follow up with the treatment.
Group therapy is a very constructive way of treatment for NPD patients. The goal of the therapy is to support the patient in developing a healthy individuality. Instead of remaining a narcissist, therapy allows him to accept others as separate individuals. It also promotes the concept of mutual understanding instead of self-admiration. The person learns to reduce coping mechanisms in order to protect its broken self.
The chief component of group therapy is the patient’s involvement in a working alliance with others. He learns to show empathy to others and confront his manipulative behaviors in the group. This therapy aims to work on the external structuring of the personality of the narcissist patient. This will result in less destructive and manipulative behaviors.
The therapist’s role is less authoritative in group therapy. He will not deny or confront the patients, rather promote less emotionality, controlled regression, clarification, and confrontation.
There are chances of NPD patients to be hospitalized on exhibiting severe issues. This is a recommended treatment for some patients, such as self-destructive or impulsive ones. The hospitalization deal with specific symptoms at hand. There are specific wards for NPD patients in psychiatric sections. The trained staff will look after for initial symptoms and the patient is a little stable, they ask for psychological help.
Initially, medicines are used for NPD hospitalized patients. Then the session with psychologists and psychiatrists help the individual to handle his situation. Psychologist gets benefits from psychotherapy techniques. Every individual is unique so it is possible that one treatment may not be fit for all the patients. With individual psychotherapy, one can take advantage of family involvement.
The indoor treatment is just like a “holding” environment where patients are appreciated to share their problems. The treatment may include daily assignments, following specific positive behaviors, social involvement, recreational activities, and ways to channelize impulses.
The aim of the treatment is to construct better-integrated individuals, having a positive and modulated self-representation, and a self-image less prone to narcissistic damage.
When a condition of narcissist deteriorates severely, medications are recommended.
Narcissistic Personality Disorder: Benefits of Psychotherapy
The therapy may bring a positive change in a narcissist’s personality.
A change in attitudes can result in optimistic constructive behavior.
A person may find therapy helpful in building positive self-image and confident self-esteem.
A narcissist may acquire realistic prospects and beliefs of themselves and others.
Narcissistic Personality Disorder: Tips to Deal with Narcissistic Person
Below are some practical ways to handle an NPD:
- Accept The Real Them: Do not get irritated by NPD. Accept the real them as ignore their manipulative behaviors.
- Do Not Attend Them: One thing that NPD wants in abundance is attention. The simplest trick is to avoid them and stop giving them excessive attention.
- Speak For Yourself: Tell them how bad and manipulated you feel when they suppress you.
- Ask For Immediate Answers: People with NPD are good at promises and bad at taking actions. In order to handle them, ask for immediate action.
- Ask Them To Take Professional Help: This could be the easiest and appropriate way to tell them how they can manage their problem.
Narcissistic Personality Disorder:Chances of Long-term Recovery
NPD patients are in denial about the nature and depth of their narcissism related problems. They continue this state of denial even after they have agreed to seek help. With such patients, therapy may not work in the short term. In order to manage a personality disorder, a therapist must make long term goals.
After initial resistance towards treatment, they may show a sign of positivity by listening to their therapists. After getting an idea about their problems, they might consider that they have some issues that can disturb themselves and others. They will start analyzing themselves more accurately. When they will start confronting their past problems and thinking about a positive better future, you can expect a change in thinking and living.
All the personality disorders are persistent patterns of personality and it will take time to improve such conditions. NPD is also a stable condition that may not evolve or change overnight. It will require proper treatment with a follow-up. Those NPD patients, who are willing to give it a try, have great hope of recovery.