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Narcissistic personality disorder (NPD) is a personality disorder characterized by a life-long pattern of exaggerated feelings of self-importance, an excessive need for
admiration Admiration is a social emotion felt by observing people of competence, talent, or skill exceeding standards.Algoe, S. B., & Haidt, J. (2009). Witnessing excellence in action: The ‘other-praising’ emotions of elevation, gratitude, and admirati ...
, a diminished ability or unwillingness to empathize with others' feelings, and interpersonally exploitative behavior. Narcissistic personality disorder is one of the sub-types of the broader category known as personality disorders. It is often comorbid with other mental disorders and associated with significant functional impairment and
psychosocial The psychosocial approach looks at individuals in the context of the combined influence that psychological factors and the surrounding social environment have on their physical and mental wellness and their ability to function. This approach is ...
disability. Personality disorders are a class of
mental disorder A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitt ...
s characterized by enduring and inflexible
maladaptive In evolution, a maladaptation () is a trait that is (or has become) more harmful than helpful, in contrast with an adaptation, which is more helpful than harmful. All organisms, from bacteria to humans, display maladaptive and adaptive traits. I ...
patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by any culture. These patterns develop by early adulthood, and are associated with significant distress or impairment. Criteria for diagnosing personality disorders are listed in the fifth chapter of the ''
International Classification of Diseases The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating ...
'' (ICD) and in the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involv ...
's '' Diagnostic and Statistical Manual of Mental Disorders'' (DSM). There is no standard treatment for NPD. Its high comorbidity with other mental disorders influences treatment choice and outcomes. Psychotherapeutic treatments generally fall into two categories:
psychoanalytic PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might ...
/
psychodynamic Psychodynamics, also known as psychodynamic psychology, in its broadest sense, is an approach to psychology that emphasizes systematic study of the psychological forces underlying human behavior, feelings, and emotions and how they might relate t ...
and cognitive behavioral therapy, with growing support for integration of both in therapy. However, there is an almost complete lack of studies determining the effectiveness of treatments.


Signs and symptoms


DSM-5

The ''
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatric ...
'' (DSM-5) describes NPD as possessing at least five of the following nine criteria. * A grandiose sense of self-importance * Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love * Believing that they are "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions) * Requiring excessive admiration * A sense of entitlement (unreasonable expectations of especially favorable treatment or automatic compliance with their expectations) * Being interpersonally exploitative (taking advantage of others to achieve their own ends) * Lacking
empathy Empathy is the capacity to understand or feel what another person is experiencing from within their frame of reference, that is, the capacity to place oneself in another's position. Definitions of empathy encompass a broad range of social, co ...
(unwilling to recognize or identify with the feelings and needs of others) * Often being envious of others or believing that others are envious of them * Showing arrogant, haughty behaviors or attitudes Within the DSM-5, NPD is a cluster B personality disorder. Individuals with cluster B personality disorders often appear dramatic, emotional, or erratic. Narcissistic personality disorder is a mental disorder characterized by a life-long pattern of exaggerated feelings of self-importance, an excessive craving for admiration, and a diminished ability to empathize with others' feelings. A diagnosis of NPD, like other personality disorders, is made by a qualified healthcare professional in a clinical interview. The process of diagnosis often involves asking the client to describe people emotionally close to them, which can reveal extreme arrogance or a lack of empathy. Narcissistic personality disorder usually develops either in youth or in early adulthood. True symptoms of NPD are pervasive, apparent in varied social situations, and are rigidly consistent over time. Severe symptoms of NPD can significantly impair the person's mental capabilities to develop meaningful human relationships, such as friendship, kinship, and marriage. Generally, the symptoms of NPD also impair the person's psychological abilities to function socially, either at work or at school, or within important societal settings. The DSM-5 indicates that, in order to qualify as symptomatic of NPD, the person's manifested personality traits must substantially differ from social norms.


ICD-11 and ICD-10

In the ''International Statistical Classification of Diseases and Related Health Problems'', 11th Edition ICD-11 of the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...
(WHO), all personality disorders are diagnosed under a single title called "personality disorder". The criteria for diagnosis are mainly concerned with assessing dysfunction, distress and maladaptive behavior as opposed to attributing specific personality traits. In the previous edition, the ICD-10, narcissistic personality disorder (NPD) is listed under the category of "other specific personality disorders". This means similarly to the ICD-11, the ICD-10 required that cases otherwise described as NPD in the DSM-5 would only need to meet a general set of diagnostic criteria.


Associated features

People with NPD exaggerate their skills, accomplishments, and their degree of intimacy with people they consider high-status. A sense of personal superiority may lead them to monopolize conversations, look down on others or to become impatient and disdainful when other persons talk about themselves. This behavior correlates to an overall worse functioning in areas of life like work and intimate romantic relationships. People with NPD have been observed to use
psychosocial The psychosocial approach looks at individuals in the context of the combined influence that psychological factors and the surrounding social environment have on their physical and mental wellness and their ability to function. This approach is ...
strategies, such as the tendency to devalue and derogate and to insult and blame other people, usually with anger and hostility towards people's responses to their anti-social behavior. Narcissistic personalities are more likely to respond with anger or aggressiveness when presented with rejection. Because they are sensitive to perceived criticism or defeat, people with NPD are prone to feelings of shame, humiliation, and worthlessness over minor incidents of daily life and imagined, personal slights, and usually mask such feelings from people, by feigning humility, responding with outbursts of rage and defiance, or seeking revenge. The DSM-5 indicates that: "Many highly successful individuals display personality traits that might be considered narcissistic. Only when these traits are inflexible, maladaptive, and persisting, and cause significant functional impairment or subjective distress, do they constitute narcissistic personality disorder." Given the high-function sociability associated with
narcissism Narcissism is a self-centered personality style characterized as having an excessive interest in one's physical appearance or image and an excessive preoccupation with one's own needs, often at the expense of others. Narcissism exists on a co ...
, some people with NPD might not view such a diagnosis as a functional impairment to their lives. Although overconfidence tends to make people with NPD very ambitious, such a mindset does not necessarily lead to professional high achievement and success, because they refuse to take risks, in order to avoid failure or the appearance of failure. Moreover, the psychological inability to tolerate disagreement, contradiction, and criticism, makes it difficult for persons with NPD to work cooperatively or to maintain long-term, professional relationships with superiors and colleagues.


Differential diagnosis

The occurrence of narcissistic personality disorder presents a high rate of
comorbidity In medicine, comorbidity - from Latin morbus ("sickness"), co ("together"), -ity (as if - several sicknesses together) - is the presence of one or more additional conditions often co-occurring (that is, concomitant or concurrent) with a primary ...
with other mental disorders. People with NPD are prone to bouts of
psychological depression Depression is a mental state of low mood and aversion to activity, which affects more than 280 million people of all ages (about 3.5% of the global population). Classified medically as a mental and behavioral disorder, the experience of ...
, often to the degree that meets the clinical criteria for a co-occurring
depressive disorder A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where a disturbance in the person's mood is the main underlying feature. The classification is in the ''Diagnostic and Stat ...
. NPD is associated with the occurrence of
bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
and substance use disorders, especially
cocaine use disorder Cocaine dependence is a neurological disorder that is characterized by withdrawal symptoms upon cessation from cocaine use. It also often coincides with cocaine addiction which is a biopsychosocial disorder characterized by persistent use of c ...
. NPD may also be comorbid or differentiated with the occurrence of other mental disorders, including histrionic personality disorder, borderline personality disorder, antisocial personality disorder, or
paranoid personality disorder Paranoid personality disorder (PPD) is a mental illness characterized by paranoid delusions, and a pervasive, long-standing suspiciousness and generalized mistrust of others. People with this personality disorder may be hypersensitive, easily i ...
. NPD should also be differentiated from mania and
hypomania Hypomania (literally "under mania" or "less than mania") is a mental and behavioural disorder, characterised essentially by an apparently non-contextual elevation of mood ( euphoria) that contributes to persistently disinhibited behaviour. Th ...
as these cases can also present with grandiosity, but present with different levels of functional impairment. Narcissistic personality disorder differs from self-confidence which is associated with a strong sense of self. It is common for children and adolescents to display personality traits that resemble NPD, but such occurrences are usually transient, and register below the clinical criteria for a formal diagnosis of NPD.


Subtypes

Although the DSM-5 diagnostic criteria for NPD has been viewed as homogeneous, there are a variety of subtypes used for classification of NPD. There is poor consensus on how many subtypes exist, but there is broad acceptance that there are at least two: grandiose or overt narcissism, and vulnerable or covert narcissism. However, none of the subtypes of NPD are recognized in the DSM-5 or in the ICD-11.


Grandiose/overt and vulnerable/covert

Similar to the definition of NPD in the
DSM-IV The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langu ...
, Grandiose narcissism is defined by an inflated sense of self-worth and high self-esteem, interpersonal exploitativeness, social dominance and assertiveness, shamelessness and a sense of entitlement derived from feelings of superiority or prestige. The counterpart to grandiose narcissism is vulnerable narcissism, characterized by the personality traits of defensiveness, fragility, social withdrawal, and sensitivity to criticism.


Oblivious and hypervigilant

The psychiatrist and psychoanalyst
Glen Gabbard Glen Owens Gabbard (born 1949) is an American psychiatrist known for authoring professional teaching texts for the field. He is Clinical Professor of Psychiatry at Baylor College of Medicine in Houston, Texas, and is also training and supervising ...
described two subtypes of NPD in 1989, later referred to as equivalent to, the grandiose and vulnerable subtypes. The first was the "oblivious" subtype of narcissist, equivalent to the grandiose subtype. It was described as being grandiose, arrogant and thick-skinned, while also exhibiting personality traits of helplessness and emotional emptiness, low self-esteem and shame. These were observed in people with NPD to be expressed as socially avoidant behavior in situations where self-presentation is difficult or impossible, leading to withdrawal from situations where social approval is not given. The second subtype Gabbard described was termed "hypervigilant", equivalent to the vulnerable subtype. People with this subtype of NPD were described as having easily hurt feelings, an oversensitive temperament, and persistent feelings of shame.


High functioning or exhibitionist

A third subtype for classifying people with NPD, also initially theorised by Gabbard, is termed high functioning or exhibitionistic. It has been described as "high functioning narcissists howere grandiose, competitive, attention-seeking, and sexually provocative; they tended to show adaptive functioning and utilize their narcissistic traits to succeed."


Communal Narcissist

A third type is the communal narcissist, who shares the same arrogance and self-motives, and sense of entitlement and grandiosity as the grandiose narcissist but seeks power and admiration in the communal realm. They see themselves as altruistic, saintly, caring, helpful, and warm.


Millon's subtypes

In the study ''Disorders of Personality: DSM-IV-TM and Beyond'' (1996), Theodore Millon suggested five subtypes of NPD, although they did not identify specific treatments per subtype.


Masterson's subtypes (exhibitionist and closet)

In 1993, James F. Masterson proposed two subtypes for pathological narcissism, exhibitionist and closet. Both fail to adequately develop an age- and phase- appropriate self because of defects in the quality of psychological nurturing provided, usually by the mother. A person with exhibitionist narcissism is similar to NPD described in the
DSM-IV The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langu ...
and differs from closet narcissism in several ways. A person with closet narcissism is more likely to be described as having a deflated, inadequate self-perception and greater awareness of emptiness within. A person with exhibitionist narcissism would be described as having an inflated, grandiose self-perception with little or no conscious awareness of feelings of emptiness. Such a person would assume that their condition was normal and that others were just like them. A person with closet narcissism is described to seek constant approval from others and appears similar to those with borderline personality disorder in the need to please others. A person with exhibitionist narcissism seeks perfect admiration all the time from others.


Malignant narcissism

Malignant narcissism, a term first coined in Erich Fromm's 1964 book ''The Heart of Man: Its Genius for Good and Evil'', is a
syndrome A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. The word derives from the Greek language, Greek σύνδρομον, meaning "concurrence". When a sy ...
consisting of a combination of NPD, antisocial personality disorder, and
paranoid Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy c ...
traits. A person with malignant narcissism was described as deriving higher levels of psychological
gratification Gratification is the pleasurable emotional reaction of happiness in response to a fulfillment of a desire or goal. It is also identified as a response stemming from the fulfillment of social needs such as affiliation, socializing, social approva ...
from accomplishments over time, suspected to worsen the disorder. Because a person with malignant narcissism becomes more involved in psychological gratification, it was suspected to be a risk factor for developing antisocial,
paranoid Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy c ...
, and
schizoid Schizoid personality disorder (, often abbreviated as SzPD or ScPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency toward a solitary or sheltered lifestyle, secretiveness, emotional coldness ...
personality disorders. The term ''
malignant Malignancy () is the tendency of a medical condition to become progressively worse. Malignancy is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous ''benign'' tumor in that a malignancy is not s ...
'' is added to the term ''narcissist'' to indicate that individuals with this disorder have a severe form of narcissistic disorder that is characterized also by features of paranoia, psychopathy ( anti-social behaviors), aggression, and
sadism Sadism may refer to: * Sadomasochism, the giving or receiving of pleasure from acts involving the receipt or infliction of pain or humiliation * Sadistic personality disorder, an obsolete term proposed for individuals who derive pleasure from the s ...
.


Assessment and screening


Narcissistic Personality Inventory

Risk factors for NPD and grandiose/overt and vulnerable/covert subtypes are measured using the
narcissistic personality inventory The Narcissistic Personality Inventory (NPI) was developed in 1979 by Raskin and Hall, and since then, has become one of the most widely utilized personality measures for non-clinical levels of the trait narcissism. Since its initial development, t ...
, an assessment tool originally developed in 1979, has undergone multiple iterations with new versions in 1984, 2006 and 2014. The subtype is also assessed with the pathological narcissism inventory (PNI). The PNI is a screening tool for antisocial, borderline, narcissistic personality disorders. The PNI scales exhibited significant associations with parasuicidal behavior, suicide attempts, homicidal ideation, and several aspects of psychotherapy utilization. Pathological narcissism is a term for concurrent grandiose and vulnerable narcissism, which is linked to poor self-esteem, lack of empathy, feelings of shame, interpersonal distress, aggression, and significant impairments in personality functioning across both clinical and non-clinical samples. Despite the phenomenological and empirical distinction between vulnerable and grandiose narcissism, some theories suggest that grandiose narcissists also have fragile personality traits. There are a number of other assessment tools for narcissism and NPD subtypes.


Millon Clinical Multiaxial Inventory

The Millon Clinical Multiaxial Inventory (MCMI) is another diagnostic test developed by Theodore Millon. The MCMI includes a scale for narcissism. The NPI and MCMI have been found to be well correlated. Whereas the MCMI measures narcissistic personality disorder (NPD), the NPI measures narcissism as it occurs in the general population; the MCMI is a screening tool. In other words, the NPI measures "normal" narcissism; i.e., most people who score very high on the NPI do not have NPD. Indeed, the NPI does not capture any sort of narcissism taxon as would be expected if it measured NPD. A 2020 study found that females scored significantly higher on vulnerable narcissism than males, but no gender differences were found for grandiose narcissism.


Causes

Although there are no specific causes for NPD, it is described using the biopsychosocial model which describes a combination of
risk factor In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection. Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often ...
s from biological, psychological and socio-environmental factors. This includes but is not limited to genetics,
neurobiology Neuroscience is the scientific study of the nervous system (the brain, spinal cord, and peripheral nervous system), its functions and disorders. It is a multidisciplinary science that combines physiology, anatomy, molecular biology, developme ...
, trauma, abuse and parenting.


Genetic

Evidence suggests there is a high heritability of NPD, with a number of genetic influences indicating varying rates of heritability based on subtype. A number of twin studies historically suggested for the heritability of NPD, including personality disorders in general.


Environment

Environmental and social factors also influence development of NPD. In some people, pathological narcissism may develop from an impaired emotional attachment to primary caregivers (usually parents). That lack of psychological and emotional attachment to a parental figure can result in the child's perception of themselves as unimportant and unconnected to other people, usually, family, community and society. Typically, the child comes to believe that they have a personality defect that makes them unvalued and unwanted; overindulgent, permissive parenting or insensitive and over-controlling parenting are risk factors towards the development of NPD in a child. In ''Gabbard's Treatments of Psychiatric Disorders'' (2014), the following factors are identified as promoting the development of narcissistic personality disorder: * An oversensitive temperament (individual differences of behavior) at birth * Excessive admiration that is never balanced with realistic criticism * Excessive praise for good behaviors, or excessive criticism for bad behaviors in childhood * Overindulgence and overvaluation by family or peers * Being praised by adults for perceived exceptional physical appearance or abilities * Trauma caused by psychological abuse,
physical abuse Physical abuse is any intentional act causing injury or trauma to another person or animal by way of bodily contact. In most cases, children are the victims of physical abuse, but adults can also be victims, as in cases of domestic violence or wo ...
or
sexual abuse Sexual abuse or sex abuse, also referred to as molestation, is abusive sexual behavior by one person upon another. It is often perpetrated using force or by taking advantage of another. Molestation often refers to an instance of sexual assa ...
in childhood * Unpredictable or unreliable parental caregiving * Learning the behaviors of
psychological manipulation Manipulation in psychology is a behavior designed to exploit, control, or otherwise influence others to one’s advantage. Definitions for the term vary in which behavior is specifically included, influenced by both culture and whether referring t ...
from parents or peers Moreover, the research reported in "Modernity and Narcissistic Personality Disorders" (2014) indicates that cultural elements also influence the prevalence of NPD, because narcissistic personality traits more commonly occur in modern societies than in
traditionalist conservative Traditionalist conservatism, often known as classical conservatism, is a political and social philosophy that emphasizes the importance of transcendent moral principles, manifested through certain natural laws to which society should adhere ...
societies.


Pathophysiology

Studies of the occurrence of narcissistic personality disorder identified structural abnormalities in the brains of people with NPD, specifically, a lesser volume of
gray matter Grey matter is a major component of the central nervous system, consisting of neuronal cell bodies, neuropil (dendrites and unmyelinated axons), glial cells (astrocytes and oligodendrocytes), synapses, and capillaries. Grey matter is distingui ...
in the left, anterior
insular cortex The insular cortex (also insula and insular lobe) is a portion of the cerebral cortex folded deep within the lateral sulcus (the fissure separating the temporal lobe from the parietal and frontal lobes) within each hemisphere of the mammalian b ...
. The results of a 2015 study associated the condition of NPD with a reduced volume of gray matter in the
prefrontal cortex In mammalian brain anatomy, the prefrontal cortex (PFC) covers the front part of the frontal lobe of the cerebral cortex. The PFC contains the Brodmann areas BA8, BA9, BA10, BA11, BA12, BA13, BA14, BA24, BA25, BA32, BA44, BA45, BA46 ...
. The regions of the brain identified and studied – the insular cortex and the prefrontal cortex – are associated with the human emotions of
empathy Empathy is the capacity to understand or feel what another person is experiencing from within their frame of reference, that is, the capacity to place oneself in another's position. Definitions of empathy encompass a broad range of social, co ...
and compassion, and with the mental functions of cognition and emotional regulation. The neurologic findings of the studies suggest that NPD may be related to a compromised (damaged) capacity for emotional empathy and emotional regulation.


Management

Treatment for NPD is primarily psychotherapeutic; there is no clear evidence that psychopharmacological treatment is effective for NPD, although it can prove useful for treating comorbid disorders. Psychotherapeutic treatment falls into two general categories:
psychoanalytic PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might ...
/
psychodynamic Psychodynamics, also known as psychodynamic psychology, in its broadest sense, is an approach to psychology that emphasizes systematic study of the psychological forces underlying human behavior, feelings, and emotions and how they might relate t ...
and cognitive behavioral. Psychoanalytic therapies include schema therapy, transference focused psychotherapy, mentalization-based treatment and metacognitive psychotherapy. Cognitive behavioral therapies include cognitive behavioral therapy and dialectical behavior therapy. Formats also include group therapy and couples therapy. The specific choice of treatment varies based on individual presentations. Management of narcissistic personality disorder has not been well studied, however many treatments tailored to NPD exist. Therapy is complicated by the lack of treatment-seeking behavior in people with NPD, despite mental distress. Additionally, people with narcissistic personality disorders have decreased life satisfaction and lower qualities of life, irrespective of diagnosis. People with NPD often present with comorbid mental disorders, complicating diagnosis and treatment. NPD is rarely the primary reason for which people seek mental health treatment. When people with NPD enter treatment (psychologic or psychiatric), they often express seeking relief from a comorbid mental disorder, including
major depressive disorder Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Intro ...
, a substance use disorder (drug addiction), or
bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
.


Prognosis

, no treatment guidelines exist for NPD and no empirical studies have been conducted on specific NPD groups to determine efficacy for
psychotherapies Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome prob ...
and pharmacology. The presence of NPD in patients undergoing psychotherapy for the treatment of other mental disorders is associated with slower treatment progress and higher dropout rates.


Epidemiology

, overall prevalence is estimated to range from 0.8% to 6.2%. In 2008 under the DSM-IV, lifetime prevalence of NPD was estimated to be 6.2%, with 7.7% for men and 4.8% for women, with a 2015 study confirming the gender difference. In clinical settings, prevalence estimates range from 1% to 15%. The occurrence of narcissistic personality disorder presents a high rate of
comorbidity In medicine, comorbidity - from Latin morbus ("sickness"), co ("together"), -ity (as if - several sicknesses together) - is the presence of one or more additional conditions often co-occurring (that is, concomitant or concurrent) with a primary ...
with other mental disorders.


History

The term "narcissism" comes from a first century (written in the year 8 AD) book by the Roman poet
Ovid Pūblius Ovidius Nāsō (; 20 March 43 BC – 17/18 AD), known in English as Ovid ( ), was a Roman poet who lived during the reign of Augustus. He was a contemporary of the older Virgil and Horace, with whom he is often ranked as one of the th ...
.
Metamorphoses The ''Metamorphoses'' ( la, Metamorphōsēs, from grc, μεταμορφώσεις: "Transformations") is a Latin narrative poem from 8 CE by the Roman poet Ovid. It is considered his ''magnum opus''. The poem chronicles the history of the ...
Book III is a myth about two main characters, Narcissus and
Echo In audio signal processing and acoustics, an echo is a reflection of sound that arrives at the listener with a delay after the direct sound. The delay is directly proportional to the distance of the reflecting surface from the source and the lis ...
. Narcissus is a handsome young man who spurns the advances of many potential lovers. When Narcissus rejects the nymph Echo, named this way because she was cursed to only echo the sounds that others made, the gods punish him by making him fall in love with his own reflection in a pool of water. When Narcissus discovers that the object of his love cannot love him back, he slowly pines away and dies. The concept of excessive
selfishness Selfishness is being concerned excessively or exclusively, for oneself or one's own advantage, pleasure, or welfare, regardless of others. Selfishness is the opposite of altruism or selflessness; and has also been contrasted (as by C. S. Lewis) w ...
has been recognized throughout history. In ancient Greece, the concept was understood as hubris. It is only since the late 1800s that narcissism has been defined in psychological terms: *
Havelock Ellis Henry Havelock Ellis (2 February 1859 – 8 July 1939) was an English physician, eugenicist, writer, progressive intellectual and social reformer who studied human sexuality. He co-wrote the first medical textbook in English on homosexuality i ...
(1898) was the first psychologist to use the term when he linked the myth to the condition in one of his patients. *
Sigmund Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating pathologies explained as originating in conflicts ...
(1905-1953) used the terms "narcissistic libido" in his
Three Essays on the Theory of Sexuality ''Three Essays on the Theory of Sexuality'' (german: Drei Abhandlungen zur Sexualtheorie), sometimes titled ''Three Contributions to the Theory of Sex'', is a 1905 work by Sigmund Freud, the founder of psychoanalysis, in which the author advance ...
.. *
Ernest Jones Alfred Ernest Jones (1 January 1879 – 11 February 1958) was a Welsh neurologist and psychoanalyst. A lifelong friend and colleague of Sigmund Freud from their first meeting in 1908, he became his official biographer. Jones was the first En ...
(1913/1951) was the first to construe extreme narcissism as a character flaw. * Robert Waelder (1925) published the first case study of narcissism. His patient was a successful scientist with an attitude of superiority, an obsession with fostering self-respect, and a lack of normal feelings of guilt. The patient was aloof and independent from others and had an inability to empathize with others situations, and was selfish sexuality. Waelder's patient was also overly logical and analytical and valued abstract intellectual thought (thinking for thinking's sake) over the practical application of scientific knowledge. Narcissistic personality was first described by the psychoanalyst Robert Waelder in 1925. The term ''narcissistic personality disorder'' (NPD) was coined by
Heinz Kohut Heinz Kohut (3 May 1913 – 8 October 1981) was an Austrian-born American psychoanalyst best known for his development of self psychology, an influential school of thought within psychodynamic/ psychoanalytic theory which helped transform the mod ...
in 1968. Waelder's initial study has been influential in the way narcissism and the clinical disorder Narcissistic personality disorder are defined today


Freudianism and psychoanalysis

Much early history of narcissism and NPD originates from
psychoanalysis PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might b ...
. Regarding the adult neurotic's sense of omnipotence,
Sigmund Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating pathologies explained as originating in conflicts ...
said that "this belief is a frank acknowledgement of a relic of the old megalomania of infancy"; and concluded that: "we can detect an element of megalomania in most other forms of paranoic disorder. We are justified in assuming that this megalomania is essentially of an infantile nature, and that, as development proceeds, it is sacrificed to social considerations." ''
Narcissistic injury Narcissistic injury, also known as "narcissistic wound" or "wounded ego" are emotional traumas that overwhelm an individual's defense mechanisms and devastate their pride and self worth. In some cases the shame or disgrace is so significant that t ...
'' and ''narcissistic scar'' are terms used by Freud in the 1920s. ''Narcissistic wound'' and ''narcissistic blow'' are other, almost interchangeable, terms. When wounded in the ego, either by a real or a perceived criticism, a narcissistic person's displays of anger can be disproportionate to the nature of the criticism suffered; but typically, the actions and responses of the NPD person are deliberate and calculated. Despite occasional flare-ups of personal insecurity, the inflated self-concept of the NPD person is primarily stable. In ''The Psychology of Gambling'' (1957),
Edmund Bergler Edmund Bergler ( , ; July 20, 1899 – February 6, 1962) was an Austrian-born American psychoanalyst whose books covered such topics as childhood development, mid-life crises, loveless marriages, gambling, self-defeating behaviors, and homosexualit ...
considered megalomania to be a normal occurrence in the psychology of a child, a condition later reactivated in adult life, if the individual takes up gambling. In ''The Psychoanalytic Theory of Neurosis'' (1946), Otto Fenichel said that people who, in their later lives, respond with denial to their own narcissistic injury usually undergo a similar regression to the megalomania of childhood.


Narcissistic supply

Narcissistic supply In psychoanalytic theory, narcissistic supply is a pathological or excessive need for attention or admiration from codependents, or such a need in the orally fixated, that does not take into account the feelings, opinions or preferences of othe ...
was a concept introduced by Otto Fenichel in 1938, to describe a type of
admiration Admiration is a social emotion felt by observing people of competence, talent, or skill exceeding standards.Algoe, S. B., & Haidt, J. (2009). Witnessing excellence in action: The ‘other-praising’ emotions of elevation, gratitude, and admirati ...
, interpersonal support, or sustenance drawn by an individual from his or her environment and essential to their self-esteem. The term is typically used in a negative sense, describing a pathological or excessive need for attention or admiration that does not take into account the feelings, opinions, or preferences of other people.


Narcissistic rage

The term ''narcissistic rage'' was a concept introduced by
Heinz Kohut Heinz Kohut (3 May 1913 – 8 October 1981) was an Austrian-born American psychoanalyst best known for his development of self psychology, an influential school of thought within psychodynamic/ psychoanalytic theory which helped transform the mod ...
in 1972. Narcissistic rage was theorised as a reaction to a perceived threat to a narcissist's self-esteem or self-worth. Narcissistic rage occurs on a continuum from aloofness, to expressions of mild irritation or annoyance, to serious outbursts, including violent attacks. Narcissistic rage reactions are not necessarily limited to NPD. They may also be seen in catatonic,
paranoid delusion Delusional disorder is a mental illness in which a person has delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect.American Psychiatric Association. (2013). ''Diagnost ...
, and depressive episodes. It was later suggested that narcissistic people have two layers of rage; the first layer of rage being directed constant anger towards someone else, with the second layer being
self-deprecating Self-deprecation is the act of reprimanding oneself by belittling, undervaluing, disparaging oneself, or being excessively modest. It can be used as a way to make complaints, express modesty, invoke optimal reactions or add humour. It may also be u ...
.


Object relations

In the second half of the 20th century, in contrast to Freud's perspective of megalomania as an obstacle to psychoanalysis, in the US and UK Kleinian psychologists used the object relations theory to re-evaluate megalomania as a
defence mechanism In psychoanalytic theory, a defence mechanism (American English: defense mechanism), is an unconscious psychological operation that functions to protect a person from anxiety-producing thoughts and feelings related to internal conflicts and o ...
. This Kleinian therapeutic approach built upon
Heinz Kohut Heinz Kohut (3 May 1913 – 8 October 1981) was an Austrian-born American psychoanalyst best known for his development of self psychology, an influential school of thought within psychodynamic/ psychoanalytic theory which helped transform the mod ...
's view of narcissistic megalomania as an aspect of normal mental development, by contrast with
Otto Kernberg Otto Friedmann Kernberg (born 10 September 1928) is a psychoanalyst and professor of psychiatry at Weill Cornell Medicine. He is most widely known for his psychoanalytic theories on borderline personality organization and narcissistic pathology. I ...
's consideration of such grandiosity as a pathological distortion of normal psychological development. To the extent that people are pathologically narcissistic, the person with NPD can be a self-absorbed individual who passes blame by
psychological projection Psychological projection is the process of misinterpreting what is "inside" as coming from "outside". It forms the basis of empathy by the projection of personal experiences to understand someone else's subjective world. In its malignant forms, i ...
and is intolerant of contradictory views and opinions; is apathetic towards the emotional, mental, and psychological needs of other people; and is indifferent to the negative effects of their behaviors, whilst insisting that people should see them as an ideal person. The merging of the terms "inflated self-concept" and "actual self''"'' is evident in later research on the grandiosity component of narcissistic personality disorder, along with incorporating the defence mechanisms of idealization and devaluation and of
denial Denial, in ordinary English usage, has at least three meanings: asserting that any particular statement or allegation is not true (which might be accurate or inaccurate); the refusal of a request; and asserting that a true statement is not true. ...
.


Comparison to other personality disorders

NPD shares properties with borderline personality disorder, including
social stigma Social stigma is the disapproval of, or discrimination against, an individual or group based on perceived characteristics that serve to distinguish them from other members of a society. Social stigmas are commonly related to culture, gender, ra ...
, unclear causes and prevalence rates. In a 2020 study, it was argued that NPD is following a similar historical trend to borderline personality disorder: "In the past three decades, enormous progress has been made to elucidate the psychopathology, longitudinal course, and effective treatment for BPD. NPD, which remains as similarly stigmatized and poorly understood as BPD once was, now carries the potential for a new wave of investigation and treatment development." However, NPD also shares some commonality with the now discredited "multiple personality disorder" (MPD) personality constellation in popular culture and clinical lore. MPD received a high level of mainstream media attention the 1980s, followed by a nearly complete removal from public discourse within the following two decades; this was in part due to thorough debunking many of its propositions and the evident societal harm created by its entry into the legal defence realm. Similar to MPD, NPD has been the subject of high levels of preoccupation in social and popular media forums, without a firm empirical basis despite over a century of description in clinical lore. The NPD label may be misused colloquially and clinically to disparage a target for the purpose of buttressing one's own self-esteem, or other motives that are detrimental for the person receiving the label. Finally, the rise in popular interest in NPD is not accompanied by hypothesized increases in narcissism among recent generations despite widespread assumptions to the contrary.


Controversy

The extent of controversy about narcissism was on display when the committee on personality disorders for the 5th Edition (2013) of the Diagnostic and Statistical Manual of Mental Disorders recommended the removal of Narcissistic Personality from the manual. A contentious three-year debate unfolded in the clinical community with one of the sharpest critics being
John Gunderson John Edward Gunderson (born May 1, 1980) is a retired American mixed martial artist. He used to fight with the UFC and SCC also numerous other organizations being a champion or fighting for the championship in many of them. Once he was a top ...
, who led the DSM personality disorders committee for the 4th edition of the manual. The
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involv ...
's (APA) formulation, description, and definition of narcissistic personality disorder, as published in the ''Diagnostic and Statistical Manual of Mental Disorders'', Fourth Ed., Text Revision (DSM-IV-TR, 2000), was criticised by clinicians as inadequately describing the range and complexity of the personality disorder that is NPD. That it is excessively focused upon "the narcissistic individual's external, symptomatic, or social interpersonal patterns – at the expense of ... internal complexity and individual suffering", which reduced the clinical utility of the NPD definition in the DSM-IV-TR. In revising the diagnostic criteria for personality disorders, the work group for the list of "Personality and Personality Disorders" proposed the elimination of narcissistic personality disorder (NPD) as a distinct entry in the DSM-5, and thus replaced a categorical approach to NPD with a dimensional approach, which is based upon the severity of the dysfunctional-personality-trait domains. Clinicians critical of the DSM-5 revision characterized the new diagnostic system as an "unwieldy conglomeration of disparate models that cannot happily coexist", which is of limited usefulness in clinical practice. Despite the reintroduction of the NPD entry, the APA's re-formulation, re-description, and re-definition of NPD, towards a dimensional view based upon personality traits, remains in the list of personality disorders of the DSM-5. A 2011 study concluded that narcissism should be conceived as personality dimensions pertinent to the full range of personality disorders, rather than as a distinct diagnostic category. In a 2012 literature review about NPD, the researchers concluded that narcissistic personality disorder "shows nosological inconsistency, and that its consideration as a trait domain needed further research would be strongly beneficial to the field." In a 2018 latent structure analysis, results suggested that the DSM-5 NPD criteria fail to distinguish some aspects of narcissism relevant to diagnosis of NPD and subclinical narcissism.


In popular culture

* '' Game of Thrones'' series and television adaptation of
George R. R. Martin George Raymond Richard Martin (born George Raymond Martin; September 20, 1948), also known as GRRM, is an American novelist, screenwriter, television producer and short story writer. He is the author of the series of epic fantasy novels ''A Song ...
's '' A Song of Ice and Fire'': ** The
Lannister George R. R. Martin's ''A Song of Ice and Fire'' saga features a large cast of characters. The series follows three interwoven plotlines: a dynastic war for control of Westeros by several families; the rising threat of the superhuman Others beyo ...
s have been deemed a "family of narcissists". Licensed Mental Health Counselor (LMHC) Colleen Jordan has said the incestuous twins Cersei and Jaime have a combination of borderline personality disorder and narcissistic personality disorder, and their younger brother Tyrion is an alcoholic narcissist. Additionally, a clinical psychologist posted as Redditor Rain12913: "People seem to be falling into the trap of thinking that Cersei really does genuinely love her brother and her (late) children. While she certainly says that she does quite a bit, and while her behaviour may seem to suggest that she does, it is highly unlikely that such a narcissistic character is capable of true love." About the family's patriarch, Jordan observes that "
Tywin Lannister Tywin Lannister is a fictional character in the fantasy series ''A Song of Ice and Fire'' by American novelist George R. R. Martin, and its television adaptation ''Game of Thrones''. He is introduced in ''A Game of Thrones'' (1996) and subsequent ...
is actually the worst of them". ** Of Lord
Petyr Baelish Petyr Baelish, nicknamed Littlefinger, is a fictional character in the ''A Song of Ice and Fire'' series of fantasy novels by American author George R. R. Martin, and its television adaptation ''Game of Thrones''. Introduced in 1996's ''A Game ...
(nicknamed "Littlefinger") Jordan observes: "If you look at Littlefinger, we know he's not remotely personally interested in Lysa, but he likes the attention. And he needs her. Narcissists use people for functions, which he does." * Suzanne Stone-Maretto,
Nicole Kidman Nicole Mary Kidman (born 20 June 1967) is an American and Australian actress and producer. Known for her work across various film and television productions from several genres, she has consistently ranked among the world's highest-paid act ...
's character in the film ''
To Die For ''To Die For'' is a 1995 satirical black comedy film directed by Gus Van Sant, and written by Buck Henry based on the novel of the same name by Joyce Maynard, which in turn was inspired by the story of Pamela Smart. It stars Nicole Kidman, Joa ...
'' (1995), wants to appear on television at all costs, even if this involves murdering her husband. A psychiatric assessment of her character noted that she "was seen as a prototypical narcissistic person by the raters: on average, she satisfied 8 of 9 criteria for narcissistic personality disorder... had she been evaluated for personality disorders, she would receive a diagnosis of narcissistic personality disorder". *
Jay Gatsby Jay Gatsby (originally named James Gatz) is the titular fictional character of F. Scott Fitzgerald's 1925 novel ''The Great Gatsby''. The character is an enigmatic ''nouveau riche'' millionaire who lives in a luxurious mansion on Long Island whe ...
, the eponymous character of
F. Scott Fitzgerald Francis Scott Key Fitzgerald (September 24, 1896 – December 21, 1940) was an American novelist, essayist, and short story writer. He is best known for his novels depicting the flamboyance and excess of the Jazz Age—a term he popularize ...
's novel ''
The Great Gatsby ''The Great Gatsby'' is a 1925 novel by American writer F. Scott Fitzgerald. Set in the Jazz Age on Long Island, near New York City, the novel depicts first-person narrator Nick Carraway's interactions with mysterious millionaire Jay Gatsby ...
'' (1925), "an archetype of self-made American men seeking to join
high society High society, sometimes simply society, is the behavior and lifestyle of people with the highest levels of wealth and social status. It includes their related affiliations, social events and practices. Upscale social clubs were open to men based ...
", has been described as a "pathological narcissist" for whom the " ego-ideal" has become "inflated and destructive" and whose "grandiose lies, poor sense of reality, sense of entitlement, and exploitive treatment of others" conspire toward his own demise.


See also

*
Dark triad The dark triad is a psychological theory of personality, first published by Delroy L. Paulhus and Kevin M. Williams in 2002, that describes three notably offensive, but non-pathological personality types: Machiavellianism, sub-clinical narcissism ...
, a concept in applied psychology associating personality traits of narcissism with
Machiavellianism Machiavellianism or Machiavellian may refer to: Politics *Machiavellianism (politics), the supposed political philosophy of Niccolò Machiavelli *Political realism Psychology *Machiavellianism (psychology), a personality trait centered on cold an ...
and psychopathy.


References


Further reading

* Lowen, Alexander, ''Narcissism: Denial of the True Self'' (1984) * Malkin, Craig, ''Rethinking Narcissism'', Harper Wave 2016 * * Morrison, Andrew P., ''Essential Papers on Narcissism'' (Essential Papers in Psychoanalysis) (1986) * Morrison, Andrew P., ''Shame: The Underside of Narcissism'' (1997) * Shaw, Daniel, ''Traumatic Narcissism: Relational Systems of Subjugation'' (2013) * Thomas David, ''Narcissism: Behind the Mask'' (2010) {{Authority control Dark triad * * Psychoanalytic terminology Wikipedia medicine articles ready to translate Wikipedia neurology articles ready to translate