NARCISSISTIC PERSONALITY DISORDER
This disorder is characterized by a pattern of grandiosity (in
fantasy or behavior), need for admiration, and lack of empathy,
beginning by early adulthood and present in a variety of contexts.
The term comes from the ancient Greek legend of Narcissus, who
according to the legend, fell in love with himself, after gazing
into a pool of water, and seeing his own reflection. While a
degree of Narcissism, or self love, is a vital aspect of healthy
psychological growth and development, the narcissistic personalty
is preoccupied with the self, without the accompanying self-
knowledge, and self-worth, and without the ability to develop close
loving relationships with others. The narcissist fails to see
beyond his or her own needs, and lacks emotional depth and the
capacity to care for others. Let's look at an example: Denise was
angry when she learned that her friend Bob had to cancel their
dinner date. Bob, obviously upset, tried to explain that his dog
had been hit by a car and might have to be put to sleep, but Denise
was unmoved. To her the inconvenience of having to break a date is
far more important to her than Bob's emotional distress over his
dog. Another key feature of individuals diagnosed as Narcissistic
is that they unrealistically expect special treatment from others.
Let's look at another example. Jim had gone out with Shelly for
several months before he decided to call it quits. Although
dissatisfied with the relationship, he liked the way Shelly took
care of his everyday needs. On the same day that Jim broke up with
her he asked her if she would wash a load of his clothes. Her
angry refusal came as a complete shock.
Dr. Otto Kernberg, M.D. Medical Director of the N.Y. Hospital-
Cornell Medical Center, and a leading authority on narcissism,
believes that the narcissist's difficulty in feeling love and
empathy for others stems directly from early experiences in infancy
and childhood - the time when the concept of self is first
developed. A mother who is both over-involved with the child, and
at the same time, in strange ways is callous, indifferent, and
aggressive, contributes very strongly to the development of this
disorder. These parents have difficulty understanding the internal
life of the child. They have difficulty enjoying the child in
terms of the child's own needs, and tend to use the child for their
own self gratification. These parents may admire certain aspects of
the child but not love the child. This lack of genuine love in
childhood forms the basis of the narcissist's desperate search for
admiration throughout life. The young narcissist is so involved in
achieving admiration, the he or she fails to recognize that there
is a problem at all until much later in life. In childhood, and
adolescence, many narcissistic personalities tend to do very well.
They strive, seem ambitious, friendly, and get a good deal of
attention from others. Very often, they only become aware that
something is wrong with them, after years of difficult
interpersonal relations with others. They don't understand why
people don't like them; why they resent their selfishness. Only
later in life, when the external glitter wears off, do they begin
to understand that you either have mutual loving relationships, or
your life is very empty. At this point they are much more
treatable, since they have already experienced the failure of their
This diagnosis is usually made if 5 or more of the following are
1. A grandiose sense of self importance (e.g. exaggerates
achievements and talents, expects to be recognized as
superior without commensurate achievements).
2. Preoccupation with fantasies of unlimited success, power,
brilliance, beauty or ideal love.
3. A belief that he or she is "special" and unique and can
only be understood by, or should associate with, other
special or high status people.
4. Requires excessive admiration.
5. Has a sense of entitlement. For example her or she may Have
unreasonable expectations of especially favorable treatment,
or automatic compliance with his or her expectations.
6. Is personally exploitative. For example, he or she may take
advantage of others to achieve his or her own needs.
7. A lack of empathy. An unwillingness to recognize or identify
with the feelings and needs of others.
8. Often envious of others, or believes that others are envious
of him or her.
9. Shows arrogant, haughty behaviors or attitudes.
As with most character disorders treatment is often difficult.
The clients own personal motivation for treatment most often
determines the degree of success with psychotherapy. Individual
therapy that helps the client focus on an understanding and empathy
of how his or her behavior affects other is sometimes at least
partially successful. Group therapy, and sensitivity training,
have also been used to treat these individuals. The prognosis is
usually guarded, at best, and is very poor when the individual is
not self referred. Medications are seldom used to treat this Axis
II personality disorder.