Narcissism

When talking about narcissism in everyday life, we often imagine a person who is selfish, self-absorbed and has no empathy for others, this colloquial term originates from the serious personality disorder called narcissistic personality disorder.

Like with many mental disorders, it is necessary to make a difference between different manifestations of some personality traits or moods, and pathological problems which damage the person and their surroundings. It’s easy to call someone narcissistic in a moment of frustration or anger, but people who suffer from narcissistic personality disorder don’t do the things they do out of malice.

What is narcissistic personality disorder?

The DSM 5 (diagnostic and statistical manual of mental disorder) diagnostic criteria define this disorder as a pattern which is ever-present and characterized by grandiosity (in fantasy and behavior), lack of empathy and a need for constant praise and adoration. It most often begins in early adulthood and seeps into many aspects of one’s life.

For diagnosing, the DSM 5 requires the presence of at least 5 of the 9 symptoms listed here:

1. A grandiose feeling of one’s own importance
2. Occupation with fantasies of incredible success, power, intellect, beauty or love
3. Beliefs that they are special and unique, and can only be understood, and should only connect, with other special and high-status people or institutions
4. Need for excessive adoration
5. Feelings of entitlement to special treatment and obedience
6. Tendencies to exploit others in interpersonal relationships
7. Lack of empathy
8. Feelings of envy towards others or beliefs that others are envious of them
9. Arrogance and superiority in behavior and beliefs

With personality disorders, it’s often difficult to differentiate between a normal style of behavior which resembles a personality disorder and real pathology.

While normality would mean something like healthy self-confidence, belief in oneself, preferring certain surroundings; pathology could mean a grandiose feeling of self-confidence, omnipotence, appreciating only those who are perceived as equally special. Narcissistic personality disorders are also defined by their lack of empathy and humility, unhealthy feelings of envy instead of a normal ability to praise others, and inability to show compassion or true altruism.

Persons with this disorder can be perceived by others as boastful, arrogant and unpleasant. Narcissistic personality disorder is a personality pattern which persists in the life of the individual for a long time and in different situations and contexts, it can lead to significant interpersonal and professional difficulties in the functioning of the person.

Narcissistic personality disorder is often associated with other mental disorders, which can worsen functioning even more. It most often appears with other personality disorders, but can also be accompanied by disorders such as depression, anxiety disorders, dysthymia and bipolar disorder. It is also often associated with substance abuse problems.

As for personality disorders its comorbidity is highest with histrionic, antisocial and borderline personality disorders, it is necessary to precisely diagnose and differentiate between these disorders.

Causes of narcissism

Research suggests that narcissistic personality disorder has a strong genetic component, on the other hand, certain experiences in early and key formative periods of childhood can play a significant role in developing this disorder. Negative developmental experiences such as abandonment or avoidance can lead to a “fragile ego” which can contribute to the development of a narcissistic personality disorder later in life. In contrast to that, intense praise and the elevation of the child's accomplishments and beliefs that it possesses special capabilities can lead to a later pattern of expecting constant praise.

It could be said that contemporary western capitalistic culture of individuality breeds narcissism by emphasizing the importance of the individual and rewarding “stepping over others” to achieve one's goals. Still, there isn’t any evidence that these surroundings cause narcissism, they allow narcissistic people to look for social status and attention, for example through social media.

Types of narcissism

As with all personality disorders, it is difficult to measure personality and understand what makes it pathological. Every personality is specific and conditioned by a multitude of factors, so there are also many different clinical representations of narcissistic personality disorder.

The two types of this disorder that stand out are the grandiose and the vulnerable subtypes.

The grandiose subtype includes open grandiosity, aggression, a clear lack of empathy, exploitation of others and self-confidence. They have a clear belief in their own superiority, they exploit others for their personal gain and show aggression when someone confronts them. They often seek out positions of power and authority in society and organizations, but research shows that their tendencies to go after their own goals despite the good of the collective can often pose a problem for the organization they lead or their position in it.

The vulnerable subtype presents itself as sensitive and defensive, it can often be disregarded or misunderstood. These individuals tend to be more susceptible to mood disorders, anxiety and a fragile concept of self with low self-esteem. This form of narcissism accentuates the defensive style of presenting oneself, being deeply hurt when others don’t perceive them as special or criticize them, because of their self-esteem and introversion. They also don’t have the capacity for empathy, when they show it, it is always for elevating their own image. Unlike the grandiose narcissist who will clearly exploit others, vulnerable narcissists will more often be manipulative in their attempts to control others.

Treating narcissistic personality disorder

People who suffer from narcissistic personality disorder often can’t recognize that there is something wrong with their behavior. They are most often brought in by family members or close people in their lives after the amount of stress they are experiencing because of the narcissist becomes unbearable or culminates in an event. This can be a good opportunity to create therapy goals focused on a specific thing in the life of the patient. Chances of the narcissistic personality disorder disappearing are low, with or without therapy. The most effect is provided by psychotherapy; pharmacotherapy hasn’t proven significant other than in the cases of treating comorbidities.

Psychotherapy can have significant effects in helping people with this disorder better understand their condition, better their interpersonal relationships, better evaluate their abilities, help better understanding and communication of emotions, alleviate confidence problems and learn to set realistic goals.

Psychotherapy can have a short-term function helping in stressful periods of time, but also a long-term function in which it can help the person live a more fulfilled and easier life.

Written by: Bachelor of Psychology, Aleksa Holcer.

Narcissistic personality disorder. (2024, September 9). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9742-narcissistic-personality-disorder

Mitra, P., Torrico, T. J., & Fluyau, D. (2024, March 1). Narcissistic personality disorder. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK556001/

*This text is intended for informational purposes only. If you experience any symptoms, it is recommended that you seek advice from your doctor or a qualified healthcare professional.*

*Image taken from the site: https://pixabay.com/photos/people-girl-face-lips-mirror-2604159/*