Mental Health & Psychology Guide

A pattern of traits and behaviours which signify infatuation and obsession with one’s self to the exclusion of all others and the egotistic and ruthless pursuit of one’s gratification, dominance and ambition.

Most narcissists (50-75%, according to the DSM IV-TR) are men.

The Narcissistic Personality Disorder (NPD) is one of a “family” of personality disorders (known as “Cluster B”). Other members of Cluster B are Borderline PD, Antisocial PD and Histrionic PD.

NPD is often diagnosed with other mental health disorders (”co-morbidity”) - or with substance abuse and impulsive and reckless behaviors (”dual diagnosis”).

NPD is new (1980) mental health category in the Diagnostic and Statistics Manual (DSM).

There is only scant research regarding narcissism. But what there is has not demonstrated any ethnic, social, cultural, economic, genetic, or professional predilection to NPD.

It is estimated that 0.7-1% of the general population suffer from NPD.

Pathological narcissism was first described in detail by Freud. Other major contributors are: Klein, Horney, Kohut, Kernberg, Millon, Roningstam, Gunderson, Hare.

The onset of narcissism is in infancy, childhood and early adolescence. It is commonly attributed to childhood abuse and trauma inflicted by parents, authority figures, or even peers.

There is a whole range of narcissistic reactions - from the mild, reactive and transient to the permanent personality disorder.

Narcissistic Supply is outside attention - usually positive (adulation, affirmation, fame, celebrity) - used by the narcissist to regulate his labile sense of self-worth.

Narcissists are either “cerebral” (derive their narcissistic supply from their intelligence or academic achievements) - or “somatic” (derive their narcissistic supply from their physique, exercise, physical or sexual prowess and romantic or physical “conquests”).

Narcissists are either “classic” - see definition below - or they are “compensatory”, or “inverted” - see definitions here: “The Inverted Narcissist”.

The classic narcissist is self-confident, the compensatory narcissist covers up in his haughty behaviour for a deep-seated deficit in self-esteem, and the inverted type is a co-dependent who caters to the emotional needs of a classic narcissist.

NPD is treated in talk therapy (psychodynamic or cognitive-behavioural). The prognosis for an adult narcissist is poor, though his adaptation to life and to others can improve with treatment. Medication is applied to side-effects and behaviours (such as mood or affect disorders and obsession-compulsion) - usually with some success.

The American Psychiatric Association, based in Washington D.C., USA, publishes the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM-IV-TR), 2000.

Click here to read the DSM-IV-TR diagnostic criteria for the Narcissistic Personality Disorder.

The international equivalent of the DSM is the ICD-10, Classification of Mental and Behavioural Disorders, published by the World Health Organization in Geneva (1992).

Click here to read the ICD-10 diagnostic criteria for the Narcissistic Personality Disorder.

The DSM defines NPD as “an all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts.”

The ICD regards NPD as “a personality disorder that fits none of the specific rubrics.” It relegates it to the category “Other Specific Personality Disorders” together with the eccentric, “haltlose”, immature, passive-aggressive, and psychoneurotic personality disorders and types.

The DSM specifies nine diagnostic criteria. For NPD to be diagnosed, five (or more) of these criteria must be met.

(In the text below, I have proposed modifications to the language of these criteria to incorporate current knowledge about this disorder. My modifications appear in bold italics.)

(My amendments do not constitute a part of the text of the DSM-IV-TR, nor is the American Psychiatric Association (APA) associated with them in any way.)

Click here to download a bibliography of the studies and research regarding the Narcissistic Personality Disorder (NPD) on which I based my proposed revisions.

Proposed Amended Criteria for the Narcissistic Personality Disorder

Feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to the point of lying, demands to be recognized as superior without commensurate achievements);

Is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion;

Firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions);

Requires excessive admiration, adulation, attention and affirmation - or, failing that, wishes to be feared and to be notorious (Narcissistic Supply);

Feels entitled. Demands automatic and full compliance with his or her unreasonable expectations for special and favourable priority treatment;

Is “interpersonally exploitative”, i.e., uses others to achieve his or her own ends;

Devoid of empathy. Is unable or unwilling to identify with, acknowledge, or accept the feelings, needs, preferences, priorities, and choices of others;

Constantly envious of others and seeks to hurt or destroy the objects of his or her frustration. Suffers from persecutory (paranoid) delusions as he or she believes that they feel the same about him or her and are likely to act similarly;

Behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient, invincible, immune, “above the law”, and omnipresent (magical thinking). Rages when frustrated, contradicted, or confronted by people he or she considers inferior to him or her and unworthy.

About The Author

Sam Vaknin is the author of Malignant Self Love - Narcissism Revisited and After the Rain - How the West Lost the East. He is a columnist for Central Europe Review, PopMatters, and eBookWeb , a United Press International (UPI) Senior Business Correspondent, and the editor of mental health and Central East Europe categories in The Open Directory Bellaonline, and Suite101 .

Until recently, he served as the Economic Advisor to the Government of Macedonia.

Visit Sam’s Web site at http://samvak.tripod.com; palma@unet.com.mk

Tags: extremists, interpersonal, mind, Narcissism, NPD, psychology, self absorbed, self center, self improvementextremists, interpersonal, mind, Narcissism, NPD, psychology, self absorbed, self center, self improvement

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How often do you hear a parental voice in your head that says things like, “You’ve got to lose weight,” or “You should get up earlier every morning and exercise,” or “Today I should get caught up on the bills,” or “I’ve got to get rid of this clutter.” Let’s explore what happens in response to this voice.

We have a very good reason for judging ourselves: the judgmental part of us believes that by judging, criticizing, “shoulding” ourselves, we will motivate ourselves to take action and therefore protect against failure or rejection. We may have been judging ourselves to get ourselves to do things “right” since we were kids, hoping to keep ourselves in line. And we keep on doing it because we believe it works.

Let’s take the example of Karl, who is a high-powered executive in a large accounting firm. Karl has had a heart attack and is supposed to watch his diet. Right after his heart attack, he did well avoiding sugar, fats, and overeating, but after six months or so, he found himself struggling with his food plan. In our counseling session, Karl told me he was upset with himself for having a big desert as well as a big meal the night before. I asked Karl to put himself back into the situation and recreate what he had been feeling.

“Well, I was out to dinner with one of our biggest clients. He asked me a question and I didn’t remember the facts, so I couldn’t answer him. As soon as this happened, that voice came into my head telling me that I’m stupid, that I should have remembered it and ‘What’s the matter with me anyway?’”

“What did you feel as soon as you judged yourself?” I asked.

“Well, looking back, I think I felt that sad, sort of dark empty hollow feeling I often get inside. And you know what - that’s when I started to eat a lot of bread with tons of butter and ordered the desert! I didn’t realize it was in response to that empty feeling that I hate!”

“So the sad empty feeling is what you feel when you judge yourself. Judging yourself is an inner abandonment, so your Inner Child then feels alone, sad and empty. You are telling your Child that he is not good enough. I know that you don’t do this with your actual children, but you do it a lot with yourself, don’t you?”

“Yeah, I think it do it all the time. After I judged myself for not knowing the answer, then I judged myself for eating too much and having desert. And then I felt even worse.”

“So what did you hope for by judging yourself?

“I guess I hoped that I could control my eating and also get myself to work harder so I wouldn’t forget things.”

“It doesn’t seem to be working.”

“No, it just makes me feel terrible. In fact, I can see that judging myself for not knowing the answer made me feel so badly that then I wanted to eat more. Instead of giving me more control, it gave me less!”

“So you are trying to have control over yourself through your self-judgments, but what actually happens is that you feel awful and behave in addictive ways to avoid the pain. I think what also happens is that some part of you goes into resistance to being judged and told what to do, so you end up doing the opposite of what you tell yourself you should do.”

“Right. As soon as I tell myself not to eat so much and judge myself for eating, that’s when I really want to eat. So I’m eating to not be controlled and also because in judging myself I’m abandoning myself, which makes me feel sad and empty, and I’ve always used food to fill up that emptiness. Whew! How do I stop this cycle?”

“You can’t stop it until you are conscious of it. As long as you are doing it unconsciously - on automatic pilot - you have no choice over it. So the first thing you can do is not try to change it but just notice it. As you become very aware of this pattern, you will have the choice to change it. You will have the choice to be loving and caring toward yourself instead of judgmental once you become aware of what you are doing. You can start by noticing every time you feel that empty sad feeling, and then exploring what you were telling yourself that led to the painful feeling.”

Karl did start to notice and over time was able to stop judging himself. Not only did the sad empty feeling that he had experienced so often in his life go away, but he was able to keep to his medical nutrition plan for his heart. When his Inner Child felt loved instead of judged, he didn’t need to eat to take away the pain.

About The Author

Margaret Paul, Ph.D. is the best-selling author and co-author of eight books, including “Do I Have To Give Up Me To Be Loved By You?” She is the co-creator of the powerful Inner Bonding healing process. Learn Inner Bonding now! Visit her web site for a FREE Inner Bonding course: http://www.innerbonding.com or mailto:margaret@innerbonding.com. Phone sessions available.

Tags: coaching, goals, psychology, self discipline, self improvementcoaching, goals, psychology, self discipline, self improvement

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