Narcissistic Personality Traits

Narcissistic Personality Disorder

What is a personality disorder?

We are all individuals and we do not always think, feel, and act exactly the way that others do or others expect us to. There are many factors that go into how we behave including who we are with and the environment that we are in. Yet, if a person finds that they are, pretty much, always having the same significant and serious problems, across the board, and these same patterns have been there since childhood or adolescence, and if these issues have plagued them for years and makes day to day life extremely difficult, it is important to seek mental health evaluation to discern whether a personality disorder might be the cause.

What does a personality disorder look like?

A personality disorder is “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture,” according to the Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5-TR), published by the American Psychiatric Association. This behavioral pattern is expressed across various domains of life and causes impaired functioning, distress, or suffering for both the individual and those around them.

The manner in which the individual thinks, feels, and behaves causes them significant problems in daily life. These problems are experienced across significant areas of the personal’s life. These problems started in childhood or adolescence and continue into adulthood. These issues are not caused by alcohol or substance abuse or another medical or psychiatric condition. However, it is not uncommon for the personality disorder to be present in tandem with another mental health condition or conditions.

It is important to remember that having a personality disorder makes life very difficult for, not only the individual, but those around them, as well. The term, “personality disorder,” is not an easy one to grasp, but, however an individual understands the term, they are deserving of understanding and high quality mental health care.

What does narcissistic personality disorder (NPD) look like?

The term “narcissist” comes from the story of Narcissus, a character in Greek mythology. Narcissus was a handsome young man, well known for his beauty. One day, he saw his reflection in a pool of water and fell in love with his own image. According to the story, Narcissus rejected all suitors and, instead, gazed, admiringly, at his own reflection. Narcissus’ life came to a tragic end, when, upon reaching into the pool to embrace himself, he fell into the water and drowned. This exaggerated sense of self love has come to represent a core feature of narcissism.

Narcissistic personality disorder (NPD) is one of ten personality disorders described in the DSM-5. Narcissism is a term that is, sometimes, casually tossed into daily conversation to describe a person who appears to value his or her own importance, wants, and needs above all else. Yet, having these characteristics may not, in themselves, imply an actual diagnosis of NPD.

NPD is one of the most stigmatized, misunderstood, and under-diagnosed mental health conditions. The term is frequently misused as an accusation or put down, having little to do with the clinical sense of the word. However, NPD is not a term to throw around in frustration or anger, but an actual psychiatric condition that affects millions of people.

It may be difficult to muster empathy for someone who appears completely devoid of empathy for others. Yet those with NPD do suffer from the losses and loneliness that come as a result of their actions. Yet the human cost of suffering and disruption these behaviors cause to others is impossible to calculate.

Narcissistic personality disorder vs. narcissistic traits

As with most characteristics, narcissism exists on a spectrum. Having an appropriate level of healthy self interest can be a functional attribute, when it is balanced with concern for the interests and welfare of others. However, when excessive self interest impinges on the legitimate rights, needs and feelings of others, its unhealthy counterpart, narcissistic personality disorder, becomes a clinical concern.

It is possible to have some traits of narcissism and still function within normal limits. Moreover, just because a person exhibits some narcissistic tendencies does not mean that they have full-fledged NPD. In fact, having just a few narcissistic tendencies can be more amenable to therapy, whereas, having NPD is more ingrained.

Symptoms of Narcissistic Personality Disorder

Narcissistic personality disorder is a complex set of beliefs and behaviors that creates distress and dysfunction in both social and occupational areas of life for the individual and those around them.

Having a narcissistic parent or caretaker can be particularly challenging for developing children and can cause psychological problems for them down the road. All children need a parent who can control their own emotions and who is capable of setting their personal wishes aside in favor of the child’s best interests. This is, most often, not the case with a parent who has severe NPD, and may react explosively to the normal demands of parenting.

It is not uncommon for children, who are affected by a parent who has NPD, to see a therapist for acting out behavior and become the identified psychiatric patient in an unhealthy family system. All the while, the therapist may have no clue as to what is really going on at home.

These behaviors can create turmoil and suffering for other members of the family, as well. Partners may experience various forms of abuse and control by their NPD spouse, who may exhibit angry outbursts and feel entitled to make demands, berate, or bully them. This ongoing stress can wreak havoc with the partner’s day to day functioning and self esteem, sometimes resulting in severe mental health and substance abuse conditions of their own.

Likewise, the co-workers of individuals with NPD may suffer from the unpredictable moods of a demanding NPD co-worker or boss, for whom their best efforts are seldom good enough. Interestingly, it is not uncommon for those who have NPD to rise to the top of the organizational ladder, as a result of their self-serving schemes.

A person who has NPD may tire of hearing such statements as “you only care about yourself and what you want,” “you can never take responsibility for your part in the problem,” “you blow up whenever I try to talk to you.” They may have varying levels of self awareness as to whether these statements actually apply to them. These characteristics make it difficult to relate to and connect with others. Others may see them as arrogant or vain, even though, inside, that person may feel insecure, inadequate, and empty, and all too frequently, misunderstood and lonely. It has been speculated that some individuals with NPD may have suffered profoundly from a painful early rejection or injury to their self esteem, and struggle to feel good enough, themselves.

Symptoms of narcissistic personality disorder can vary in severity, number of traits, and intensity. It is possible to have several features of narcissistic personality disorder, without meeting the criteria for having full-fledged NPD. In any case, if a person identifies with a number of the traits that follow, they are advised to obtain mental health services:

• A sense of entitlement and seeking excessive admiration, attention, and praise
• A sense of superiority, despite lacking achievements to merit it
• An exaggerated sense of self importance; exhibiting selfishness and putting themselves first
• A tendency to exaggerate their abilities and accomplishments
• A preoccupation with fantasies of success, beauty, power, or perfection
• A pattern of seeking to associate with very wealthy, talented, beautiful, or powerful people; to emphasize their own sense of being special
• An expectation of special treatment and unquestioning loyalty and compliance with their demands or wishes
• A pattern of monopolizing conversations, with talk about themselves, and belittling others
• A pattern of taking advantage or coercing others to accomplish their goals; using manipulation, coercion, and flattery for personal gain
• An inability to recognize the needs of others or feel empathy for their pain
• Preoccupation with envying others and the perception that others envy them
• Displaying arrogance; prone to bragging and conceit
• An exaggerated need to have the best of everything
• A heightened sensitivity to criticism or anything they perceive as criticism
• Inability to control their emotions and behavior; overreacting; easily hurt; exhibiting rage when confronted
• A pattern of relationship problems when they feel slighted
• Seeking perfection and falling into depression when they cannot achieve their goals
• Expressing rage and demeaning behavior in order to feel superior to someone else; an inability to take no for an answer
• Experiencing feelings of insecurity and shame; an exaggerated fear of humiliation

How is Narcissistic Personality Disorder diagnosed?

Although there are no laboratory tests for NPD, a complete physical examination is helpful to make sure that a medical condition is not in play. Then, a thorough psychiatric evaluation should be taken by a qualified clinician including a detailed history and diagnostic testing. This is the point in the process when showing the MindMetrix report to the treatment provider can be a real asset.

A diagnosis is made if the individual’s symptoms match the criteria for NPD, as defined in the Diagnostic Statistical Manual (DSM-5). It can be helpful for the therapist to request the input of a close friend or family member, with permission, in order to construct a fuller clinical picture.

NPD often accompanies other conditions

This pairing or clustering of conditions is often referred to as, “dual diagnosis,” or “co-occurring disorders.” NPD and alcoholism or substance abuse are seen together 40% of the time. Among individuals who have a diagnosis of narcissism, 40% also have an anxiety disorder and 29% have a mood disorder such as depression or bipolar disorder.

It is important to remember that, although there is currently no authoritative guidance on evidence-based treatment for NPD, there are effective treatments for anxiety, depression, ADHD, bipolar depression, alcohol and substance use disorders. Treating these conditions in tandem with psychotherapy and medication management can improve an individual’s relationships and quality of life.

Outlook

The outlook for improving symptoms of NPD is considered to be challenging. Few individuals with NPD seek treatment for their actual symptoms of narcissism. Individuals may lack the insight and self awareness to acknowledge the role they themselves play in their troubles. Individuals who do get treatment often have to contend with the urge to drop out of therapy. Nonetheless, some do persevere and obtain gains in their relationships and quality of life.

The current thinking on what causes Narcissistic Personality Disorder

Although NPD has been widely studied, there is no conclusive theory as to its cause. Likely, the origin is a complex interplay of factors including neurobiology, genetics, and environment.

Some research suggests a strong genetic component for personality disorders. Having family members with a personality disorder, Bipolar Disorder, Major Depressive Disorder, Generalized Anxiety, ADHD, or alcohol and substance abuse are additional risk factors. Having experienced trauma, abandonment, an addicted parent, emotional, physical, or sexual abuse, or a chaotic, unsafe home atmosphere are additional risk factors. Since the cause of narcissistic personality disorder is unknown, there is no effective method of preventing it, at this time.