Personality Disorders 102: Narcissistic PD

The term “Narcissism” originally derives from the Greek myth of Narkissos, a demigod with renowned beauty. While everybody noticed him because of his beauty, he was scornful and rejecting of everyone who loved him . Eventually Nemesis, the goddess of revenge, led him to a pool of water. Narkissos fell in love with the image in the water, not realising it was himself. When he realised this, and understood that he can never truly love another person in the same way, he died.

Narcissism is a widely-(though often wrongly-) used term: people often call someone who is arrogant or over-confident a narcissist. However, the disorder itself covers far more areas than just confidence. The DSM criteria are as follows:

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  • 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 he or she is “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 favourable treatment or automatic compliance with his or her expectations
  • is interpersonally exploitative, i.e.., takes advantage of others to achieve his or her 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 him or her
  • shows arrogant, haughty behaviours or attitudes

One theory is that NPD is linked to a lack of boundaries between the “self” and the “world”. For a typical person, something that’s done wrong or small imperfections in the self can usually be shrugged off. However, for someone with NPD, anything that’s not quite right in the world is an intense threat to the self, while anything they are associated with which has not gone completely right is not just a failure but their failure, a destruction of the self.

Someone with NPD can be described as someone in a house of sand. Because they do not have, and don’t know how to build, any stable foundation/boundaries, they live in fear of other people finding this out. Therefore, they counteract their weakness with excessive projected strength, fighting every moment to knock other people’s foundations away, and to keep building their own walls higher.

A recent theory of NPD is that a narcissist develops, in childhood, a view of themselves as  being flawed and unlovable. This belief is not conscious, so the person wouldn’t say they believe anything like that, if asked. However, this belief gets buried in the mind, which then activated defence mechanisms against this feeling, and fights to overcome this negative difference by virtue of retelling it as a positive difference. So, for example, if someone with NPD grew up feeling like they weren’t loved, they might unconsciously retell that as believing they were loved like they should be because people didn’t understand their greatness enough to love them, and were put off. This belief may also not be fully conscious, but would be a driving force behind their later, adult behaviour of seeing themselves as better than, or deserving different treatment to, others.

Similar to people with ASPD, Narcissists can have a very cynical view on the world…. to many, exploiting other people isn’t unfair, as people would all exploit others anyway so they were simply making sure they would get there first. To them, everything is survival of the quickest; manipulate or be manipulated.

NPD is another disorder often given a very negative media characterisation: that of arrogance, shallowness and cruelty. These elements are also incorporated into negative characters- for example, many fictional supervillians will be written with and display elements of NPD. However, there are also positive portrayals, such as Iron Man, who is shown as being irresponsible, reckless, entitled and self-important, yet channels his narcissism into doing the right thing on his own terms.

Psychological Criticisms of NPD

A major controversy over NPD is the gender disparity in diagnosis: 75% of people diagnosed with it are male, despite there being no gender-specific diagnostic criteria. Traits of NPD will come across similarly to some traits of Borderline Personality Disorder (BPD), of which <75% of people diagnosed are females. Furthermore, in studies using vignettes (small descriptive paragraphs) of fictional patients, psychiatrists who could easily point out female patients with BPD symptoms, but couldn’t identify male patients with the same BPD symptoms. This gender imbalance suggests the presence of gender-based diagnostic biases amongst practitioners, added to the already-existing cultural biases present in the system.

NPD is also one of the disorders with the most limited options for treatment- people with NPD will generally not see any reason why they need to have any treatment, or see anything wrong with them. Also, if someone with NPD was to go to a therapist, they would most likely leave at the first disagreement, interpreting it as the therapist not understanding them.

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