NARCISSISTIC PERSONALITY DISORDER

To refer to the contemporary understanding of the narcissistic personality, it can be said that narcissists are those who have almost no relationship with anyone other than themselves, or who live together with other people whom they cannot imagine existing without them. These are the narcissists whom others experience as such. They do not interact with others and tend toward an antisocial personality style. They have great difficulty recognizing another person’s emotional side. This concerns their difficulty being around others who feel something. They are called thick-skinned, insensitive, ruthless, and cool. Such people do not know how others respond to them. They do not feel what they do to others. They can be arrogant and aggressive, self-centered. They need to be the center of attention, to have something that gives them a sense of dominance, influence, and control over others. They seem immune to pain caused by others. On the other hand, there are narcissists whom other people do not immediately see as narcissistic. They are more likely to be seen as helpful, willing, dependent, and anxious. They always have relationships with other people or work or spend their lives in an institution without which they cannot imagine their lives. This type of narcissistic personality is similar to the avoidant personality.

Causes

Theoretical work has suggested that narcissism in the broad sense may develop as a result of either an overly cold, critical, and strict parenting style, or an overly compliant one—in relation to the child’s individual vulnerability. According to Paris, who accepts the existence of many forms of this character structure, an indulgent parenting style may be a risk factor for the development of grandiose narcissism, and a strict and controlling style for the development of hypersensitive narcissism. Preliminary studies suggest that indicators associated with later symptoms of narcissism are revealed as early as preschool age, both in the behavior of children and that of their caregivers. The higher prevalence of these traits in men has led some authors to speculate about the importance of cultural gender roles and the significance of genetic mechanisms. Studies based on different criteria and methodologies estimate the heritability of NPD at 40%, 77%, or 79% in twin studies, and dimensional narcissism at 24%. This does not necessarily mean direct inheritance of the disorder or its traits.

Diagnosis

The American system of psychiatric classification (DSM) defines the narcissistic personality as a persistent pattern of grandiosity (visible in fantasies or behavior), a need for admiration from others, and a lack of empathy that appears in early adulthood and manifests in various contexts, as indicated by at least five of the following:

• The individual has an exaggerated sense of self-importance (they exaggerate their achievements and talents, expect recognition of their own superiority, disproportionate to their actual accomplishments);
• They are consumed by fantasies of unlimited success, power, exceptional abilities, beauty, or ideal love;
• They are convinced of their own uniqueness, which can only be understood by or associated with other exceptional or high-status people or institutions;
• They require excessive admiration;
• They have a sense of entitlement, i.e. they unreasonably expect especially favorable treatment or automatic compliance with their expectations;
• They exploit other people, i.e. they use them to achieve their own goals;
• They lack empathy, are unwilling to recognize the feelings and needs of other people, and are not willing to identify with them;
• They are often envious of others or feel that others are envious of them;
• Through their attitude and behavior, they display arrogance and haughtiness.

Treatment

Treatment for people with an abnormal narcissistic personality is primarily based on psychodynamic psychotherapy. Pharmacotherapy can play a supportive and symptomatic role (that is, it is used during periods of worsening well-being, an increase in symptoms, for example depression, anxiety, and others). Its use can relieve the suffering associated with mental health crises, but it does not offer solutions to fundamental personality problems. Optimal therapy results are often ensured by teamwork (psychotherapist and psychiatrist), making it possible to combine psychotherapeutic methods and pharmacotherapy, with an exchange of information between specialists.