dChan - Q Origins Project Archive

Introduction

Narcissistic personality disorder (NPD), a cluster B personality disorder, is considered to be one of the least identified personality disorders (Pies, 2011). On the other hand, a good number of patients with narcissistic traits present at the psychiatrist's office with other types of issues such as anxiety or depression. A common finding in clinical practice, NPD frequently coexists with other psychiatric disorders. NPD is a relatively recent diagnostic category. Its origins stem from a great effort between psychoanalysts and psychoanalytic psychotherapists to recognize a cluster of predominantly difficult patients who could not be classified as psychotic, not typically neurotic and overall not responsive to conventional psycho therapeutic treatment options (Gildersleeve, 2012).

NPD appears to be more widespread in males than females for unknown reasons. In the past there has been some speculation that the limited spotlight on grandiosity likely adds to the extensive discrepancy that is seen with small NPD prevalence rates in epidemiological research and elevated occurrences of NPD seen in clinical practice (Campbell, Miller, & Widiger, 2010).

The most important characteristics of NPD are grandiosity, seeking excessive admiration, and a lack of empathy (Ronningstam & Weinberg, 2013). These identifying features can result in a negative impact on an individual’s interpersonal affairs and life general. In most cases, on the exterior, these patients act with an air of right and control, dismissing others, and frequently showcasing condescending or denigrating attitudes. Nevertheless, internally, these patients battle with strong feelings of low self esteem issues and inadequacy. Even though the typical NPD patient may achieve great achievements, ultimately their functioning in society can be affected as these characteristics interfere with both personal and professional relationships. A large part of this is as result of the NPD patient being incapable of receiving disapproval or rebuff of any kind, in addition to the fact that the NPD patient typically exhibits lack of empathy and overall disrespect for others.

Symptoms of Narcissistic Personality Disorder

The definition of NPD states that it comprises of a persistent manner of grandiosity, a continuous desire for admiration, along with a lack of empathy. It starts by early adulthood and occurs in a range of situations, as signified by the existence of any 5 of the next 9 standards (American Psychiatric Association, 2013):

A grandiose logic of self-importance

A fixation with fantasies of infinite success, control, brilliance, beauty, or idyllic love

A credence that he or she is extraordinary and exceptional and can only be understood by, or should connect with, other extraordinary or important people or institutions

A desire for unwarranted admiration

A sense of entitlement

Interpersonally oppressive behavior

No form of empathy

Resentment of others or a conviction that others are resentful of him or her

A display of egotistical and conceited behaviors or attitudes

Another model, characterizes NPD as having fair or superior impairment in personality functioning, apparent by characteristic troubles in at least 2 of the following 4 areas (American Psychiatric Association, 2013):

Individuality

Self-direction

Empathy

Closeness

No actual physical characteristics are seen with NPD, but patients may have concurrent substance abuse, which may be seen in the clinical examination.

Epidemiology

Narcissistic Personality Disorder is more prevalent in males, with about 18 percent of males presenting with NPD, compared to six percent of females (Ronningstam & Weinberg, 2013). Within the general population, the prevalence rate is less than one percent, yet within the clinical population, this number rises to about 2 to 16 percent.

Differential Diagnosis

NPD has similar characteristics with the other 3 cluster B personality disorders, and thus should be differentiated accordingly. These are Antisocial personality disorder (ASPD), Borderline personality disorder (BPD) and Histrionic personality disorder (HPD). Additionally individuals with NPD may also meet the definition for also having axis I disorder, or exhibits features that similar to axis I disorders (CITE).

While no particular laboratory tests help with the diagnosis of NPD, a urine toxicology screen may be important to exclude substance abuse such as alcohol and drugs as likely reasons of the pathology.