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.