What is Narcissistic personality disorder?

Narcissism facts -infographic

Narcissistic personality disorder (NPD) is a mental disorder characterized by a lack of warmth and empathy, constant need for admiration, exaggerated feelings of self-importance, and the use of a variety of strategies to maintain the inflated self-views [1]. Someone may recognize all of the narcissistic personality disorder symptoms in themselves or just a few. A person with narcissistic traits may experience a NPD symptom much stronger than other symptoms; it varies per person. Depending on the severity and amount of narcissistic personality disorder symptoms one recognizes in themselves, the diagnosis of NPD could be made. According to study [4], there are a few subtypes of narcissism: the grandiose/malignant narcissist, the fragile narcissist, and the high-functioning/exhibitionistic narcissist, and each of them have different prognosis regarding treatment prognosis. Other studies, however, differentiate between the grandiose narcissist and the vulnerable narcissist [5], a distinction that explains their symptoms a lot better.
NOTE: Possessing just a few narcissistic personality disorder symptoms could be very beneficial in terms of maintaining a positive self-image [2]. As a matter of fact, people with some narcissistic traits tend to be ambitious, satisfied, and relatively successful [3],[4]. In other words, not every person with narcissistic traits should reach out to a professional.

This page focuses on the narcissistic personality disorder symptoms and diagnostic criteria according to the DSM V section III, and are accompanied by explanations and examples to clarify what is meant by each symptom. We prefer these diagnostic criteria, because the DSM IV (and V) definition has too many weaknesses (no acknowledgment for other NPD subtypes, but malignant narcissism). The DSM IV criteria for narcissistic personality disorder can be found at the bottom of the page.

For more information:

At Barends Psychology Practice, narcissistic personality disorder treatment is offered. Contact us to schedule a first, free of charge, appointment. (Depending on your health insurance, treatment may be reimbursed)

Narcissistic personality disorder symptoms

A. Significant impairments in personality functioning manifest by:

1. Impairments in self functioning (a or b):

2. Impairments in interpersonal functioning (a or b):

a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.

b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.

AND

a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.

b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others’ experiences and predominance of a need for personal gain.

a. Identity: there is a strong need to compare oneself with others, who perform worse on a certain aspect, to feel better about themselves. Praising oneself for their achievements is also important in terms of regulating self-esteem. Mood swings are dependent on their self-esteem at that moment: one moment they can be generous and friendly (for instance if they achieved something) and an hour later their mood can change and they can snap at others.
b. Self-direction: their motivation is to impress others and thus are their goals set up to achieve this. In a way they can identify themselves with that high goal. It is, however, also possible for them to set extremely low goals, because they feel they are too good to work hard/put in effort.

a. Empathy: the way they behave has one purpose: feeling good about themselves. This can mean that they completely disregard someone else’s emotions, feelings, needs, desires, norms and values. Often, they don’t even consider someone else’s point of view, either because they don’t care or because they simply cannot. This can make them come across rude, cruel, mean, and inconsiderate.
b. Intimacy: developing a deep connection with them is very difficult, because they don’t really care about someone else’s experiences, feelings, and thoughts. Relationships, therefore, serve one purpose: to maintain or boost their self-esteem. The moment they do not need you anymore, they are likely to drop you.

B. Pathological personality traits in the following domain:

1. Antagonism (also known as: hostility or opposition of a conflicting force), characterized by:

a. Grandiosity:
Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is
better than others; condescending toward others. This is one of the better known narcissistic personality disorder symptoms. These people behave and feel as if they are above the law, and often do not mind saying that. They often put other people down (also in public).

b. Attention seeking:
Excessive attempts to attract and be the focus of the attention of others; admiration seeking. These people like to be the center of attention and they use various strategies for it. A common strategy is playing the victim and guilt-tripping.

Other narcissistic personality disorder criteria

C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations. People with narcissistic personality disorder symptoms sooner or later reveal the real person. It is true that they can wear a mask in public, but as soon as someone gets to know the narcissist more intimately, the mask disappears.

D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment. In some cultures it is normal to come across confident and to let others know about their own achievements. In other cultures this is a no-go. Also, adolescents, as they develop, are more prone to developing narcissistic personality behaviour symptoms. These NPD symptoms usually reduce as the adolescent becomes an adult.

E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma). Some drugs and medications help produce feelings, emotions, thoughts, and behaviours common for people with NPD. However, these feelings and behaviours disappear when the medication or drugs leaves the body. In case of severe head trauma: it is possible that a part in the brain responsible for empathy is damaged, causing the person to show more selfish and self-centered behaviour.

Diagnostic criteria for narcissistic personality disorder according to the DSM IV

This is an overview of the often criticized diagnostic criteria for NPD according to the DSM IV and V. As will be clear, the symptoms mainly focus on identifying the malignant narcissist.

Has a grandiose sense of self-importance.
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 favorable 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 behaviors or attitudes.

Literature

[1] Campbell, W. K., & Baumeister, R. F. (2006). Narcissistic personality disorder. In Practitioner’s guide to evidence-based psychotherapy (pp. 423-431). Springer, Boston, MA.
[2] Pincus, A. L., & Lukowitsky, M. R. (2010). Pathological narcissism and narcissistic personality disorder. Annual review of clinical psychology, 6, 421-446.
[3] Ronningstam, E. (2005). Identifying and understanding the narcissistic personality. Oxford University Press.
[4] Russ, E., Shedler, J., Bradley, R., & Westen, D. (2008). Refining the construct of narcissistic personality disorder: Diagnostic criteria and subtypes. American Journal of Psychiatry, 165, 1473-1481.
[5] Pincus, A. L., Ansell, E. B., Pimentel, C. A., Cain, N. M., Wright, A. G., & Levy, K. N. (2009). Initial construction and validation of the Pathological Narcissism Inventory. Psychological assessment, 21, 365.