Narcissistic personality diso... Health Article

Symptoms

Most observers regard grandiosity as the most important single trait of a narcissistic personality. It is important to note that grandiosity implies more than boasting or prideful display as such—it signifies self-aggrandizement that is not borne out by reality. For example, a person who claims that he or she was the most valuable player on a college athletic team may be telling the truth about their undergraduate sports record. Their claim may be bad manners but is not grandiosity. On the other hand, someone who makes the same claim but had an undistinguished record or never even made the team is being grandiose. Grandiosity in NPD is related to some of the diagnostic criteria listed by DSM-IV-TR, such as demanding special favors from others or choosing friends and associates on the basis of prestige and high status rather than personal qualities. In addition, grandiosity complicates diagnostic assessment of narcissists because it frequently leads to lying and misrepresentation of one's past history and present accomplishments.

Other symptoms of NPD include:

• a history of intense but short-term relationships with others; inability to make or sustain genuinely intimate relationships
• a tendency to be attracted to leadership or high-profile positions or occupations
• a pattern of alternating between unrealistic idealization of others and equally unrealistic devaluation of them
• assessment of others in terms of usefulness
• a need to be the center of attention or admiration in a working group or social situation
• hypersensitivity to criticism, however mild, or rejection from others
• an unstable view of the self that fluctuates between extremes of self-praise and self-contempt
• preoccupation with outward appearance, "image," or public opinion rather than inner reality
• painful emotions based on shame (dislike of who one is) rather than guilt (regret for what one has done)

People diagnosed with NPD represent a range of levels of functioning. Otto Kernberg has described three levels of narcissistic impairment. At the top are those who are talented or gifted enough to attract all the admiration and attention that they want; these people may never enter therapy because they don't feel the need. On the second level are those who function satisfactorily in their jobs but seek professional help because they cannot form healthy relationships or because they feel generally bored and aimless. Narcissists on the lowest level have frequently been diagnosed with another mental disorder and/or have gotten into trouble with the law. They often have severe difficulties with anxiety and with controlling their impulses.

Demographics

DSM-IV-TRstates that 2% to 16% of the clinical population and slightly less than 1% of the general population of the United States suffers from NPD. Between 50% and 75% of those diagnosed with NPD are males. Little is known about the prevalence of NPD across racial and ethnic groups.

Gender issues

The high preponderance of male patients in studies of narcissism has prompted researchers to explore the effects of gender roles on this particular personality disorder. Some have speculated that the gender imbalance in NPD results from society's disapproval of self-centered and exploitative behavior in women, who are typically socialized to nurture, please, and generally focus their attention on others. Others have remarked that the imbalance is more apparent than real, and that it reflects a basically sexist definition of narcissism. These researchers suggest that definitions of the disorder should be rewritten in future editions of DSMto account for ways in which narcissistic personality traits manifest differently in men and in women.

Professional and leadership positions

One important aspect of NPD that should be noted is that it does not prevent people from occupying, as well as aspiring to, positions of power, wealth, and prestige. Many people with NPD, as Kernberg's classification makes clear, are sufficiently talented to secure the credentials of success. In addition, narcissists' preoccupation with a well-packaged exterior means that they often develop an attractive and persuasive social manner. Many high-functioning narcissists are well liked by casual acquaintances and business associates who never get close enough to notice the emptiness or anger underneath the polished surface.

Unfortunately, narcissists in positions of high visibility or power—particularly in the so-called helping professions (medicine, education, and the ministry)—often do great harm to others. In recent years a number of books and articles have been published within the religious, medical, and business communities regarding the problems caused by professionals with NPD. One psychiatristnoted in a lecture on substance abuse among physicians that NPD is one of the three most common psychiatric diagnoses among physicians in court-mandated substance abuse programs. A psychologist who serves as a consultant in the evaluation of seminary students and ordained clergy has remarked that the proportion of narcissists in the clergy has risen dramatically since the 1960s. Researchers in the field of business organization and management styles have compiled data on the human and economic costs of executives with undiagnosed NPD.