Diagnostic FeaturesIndividuals with Narcissistic Personality Disorder grow up feeling superior and needing to be admired. They have a longstanding pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy. The core feature of this disorder is antagonism(grandiosity, attention-seeking, callousness) which repeatedly puts the individual at odds with other people. This disorder is only diagnosed if: (1) it begins no later than early adulthood, (2) these behaviors occur at home, work, and in the community, and (3) these behaviors lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning. Narcissistic Personality Disorder should not be diagnosed if its symptoms can be better explained as due to another mental disorder, Substance Use Disorder, or another medical condition.
Interpersonal relations of individuals with Narcissistic Personality Disorder are typically impaired because of their feelings of entitlement, need for admiration, and callousness. Although these individuals are usually very ambitious and confident; vocational functioning often is impaired because of intolerance of criticism or defeat.
Like all personality disorders, Narcissistic Personality Disorder is a deeply ingrained and enduring behaviour pattern, manifesting as an inflexible response to a broad range of personal and social situations. This behavior represents an extreme or significant deviation from the way in which the average individual in a given culture relates to others. This behaviour pattern tends to be stable.
- Warning: Self-diagnosis of this disorder is usually inaccurate. Accurate diagnosis of this disorder requires assessment by a qualified practitioner trained in psychiatric diagnosis and evidence-based treatment. However, if no such professional is available, our free computerized diagnosis is usually accurate when completed by an informant who knows the patient well. Computerized diagnosis is less accurate when done by patients (because they often lack insight).
CourseNarcissistic traits are very common in adolescents, but most adolescents grow out of this behavior. Unfortunately, for some, this narcissistic behavior persists and intensifies into adulthood; thus they become diagnosed with this disorder.
ComplicationsIndividuals with Narcissistic Personality Disorder are intolerant of criticism or defeat. They usually respond with defiant counterattack or social withdrawal. Their feelings of entitlement, need for admiration, and disregard for the feelings of others usually significantly impair their social and occupational functioning.
Some other disorders frequently occur with this disorder:
Feeding and Eating Disorders:
- Persistent Depressive Disorder (Dysthmia); Major Depressive Disorder
Substance-Related and Addictive Disorders:
- Anorexia Nervosa
- Substance Use Disorders, especially cocaine
- Paranoid Personality Disorder
- Antisocial, Borderline and Histrionic Personality Disorders
Note: Antisocial, Narcissistic, Borderline, and Histrionic Personality Disorders are all closely related since they all share the same core feature ofantagonism. If an individual has one of these antagonistic personality disorders, they are very likely to have another.
Associated Laboratory FindingsNo laboratory test has been found to be diagnostic of this disorder.
PrevalenceThe prevalence of Narcissistic Personality Disorder is ranges from 0% to 6.2% in community samples, and 50% to 75% are males.
Effective TherapiesIndividuals with Narcissistic Personality Disorder are difficult to treat. They view themselves as being superior, and thus feel entitled to be callous, self-centered, and greedy. Their viewpoint is that life is the "survival of the fittest", and they are the "fittest". These individuals lust after fame, fortune and power. Many of these individuals achieve high positions in politics, religion and commerce. Most religious cult leaders have severe Narcissistic Personality Disorder.
The effectiveness of treatment for Narcissistic Personality Disorder is unknown because there are no randomized controlled trials. Individuals with this disorder seldom voluntarily present for treatment. However, individuals with this disorder may threaten suicide during a crisis (e.g., when discovering their spouse's infidelity). The individual may then use hospitalization as a manipulative ploy to win back their spouse, or to publicly expose their spouse's infidelity. Usually only brief hospitalization is required, with the goal being to de-escalate the crisis. Apart from such crisis intervention, most therapists believe that this disorder is very difficult to treat. However, with long-term therapy, some patients do gain insight into how they have become addicted to wealth, fame, or power, and how callous they have become. Admitting that they do have this addiction is the first step to recovery.
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