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Narcissistic Personality Disorder

Narcissistic Personality Disorder

Rhoda Hahn (Psychiatrist) gives expert video advice on: What are the signs of narcissistic personality disorder?; What are the causes of narcissistic personality disorder?; What are the treatments for narcissistic personality disorder? and more...

What is "narcissistic personality disorder"?

Narcissistic personality disorder is characterized by patients with, who display grandiosity, envy and an inability to have empathy or, you know, put themselves in another person's shoes. You know, be able to imagine what another person might feel like. Despite all of their crowing about themselves and always tooting their own horn, the underlying dynamic of narcissistic personality disorder is someone with very poor self-esteem. So the person that the narcissist is trying to convince how wonderful they are isn't necessarily all the rest of us. It's them.

What are the signs of narcissistic personality disorder?

A person with narcissistic personality disorder is an individual who will display an over-inflated sense of themselves, and their accomplishments, and they will be completely floored when other people don't see them in that same light. They have a constant need for admiration. Now, I mentioned when we were talking about histrionic personality disorder that they need constant attention. However, unlike the person with histrionic personality disorder, the person with narcissistic personality disorder has to have entirely positive attention. Histrionics have attention at any cost; they don't care if it's good or bad. People with narcissistic personality disorder, on the other hand, need constant admiration; it all needs to be positive, all the time. They will feel that they are incredibly special and they can only interact with other people who are equally special. People with narcissistic personality disorder will only get into social settings if they feel like they will gain from them. Now, unlike the antisocial, who will only enter into social interactions if they're going to get something now, for positive primary gain; money, drugs, or whatever, for the narcissist the gain can be a little bit more abstract, let's put it that way. It could be power. It could be tickets to a private concert; prestige. It could be money, too, but I'm just saying that people with narcissistic personality disorder are a little bit more abstract, in terms of their interaction with others and what they hope to gain from it. Now, while people with narcissistic personality disorder are off and running around tooting their own horn, I think one of the reasons that they have so much social dysfunction, and why other people tend to dislike them intensely, is not so much because they're constantly bragging about themselves (although in fact it is irritating), but because I think implied in all of that bragging about themselves is a very thinly veiled devaluation of whatever it is you're doing. So, it's not only, 'I'm so great,' but there is an implied 'and you're not' which tends to upset people, and make you not very popular. The other thing is that like the borderlines, people with narcissistic personality disorder would also devalue people, but the dynamic is a little different. Envy is an incredible part of any narcissist's experience. So, if you possess something materially or psychologically that a person with narcissistic personality disorder doesn't have, they will become envious. Now, you're not going to hear them say, "Oh, I'm so jealous of you." What you'll actually see, the manifestation of that envy, will be a devaluation, "Oh well, that's because she's a brown-noser; that's why she got that promotion." So, anytime they feel that envy coming up, they will immediately have to devalue it.

What are the causes of narcissistic personality disorder?

Like borderline personality disorder there has been a lot written about narcissisicm and the developementle deficiancies. In other words, parenting flaws are problems. Narcissiisicm is a normal part of child hood developement. So each one of us starts out with a healthy narcissisicm, that gradiosity that small children often have. One way of looking at it is almost as if you have this narcisisicm that is considered a normal developemental phase and over time as you get older, and the reality of the world sets in and you realize that you are not the most special person in the world and you can't leap tall buildings with a single bound or whatever. That narcessicicm gets chipped away, that grandiose arcaic narcessicimcn gets chipped away hopefully leaving a kernal of self esteem.

What are the dangers of narcissistic personality disorder?

The danger of narcissistic personality disorder is basically having everyone that you come into contact with hate your guts. It's very difficult to like these individuals. As I mentioned before, one of the problems is that despite the fact they are always tooting their own horn, which gets tiresome in and of itself, is that there is a very thinly veiled evaluation of you. It's "I'm so great and you're not," which people get pretty angry about. I think that people with narcissistic personality disorder are often very exploitive and will take advantage of you if they think they can get something out of it. Also, from an occupational standpoint, it's very difficult to be the instructor, supervisor, or boss of someone with narcissistic personality disorder because they will become envious, and mean to devalue you.

Who is at risk for narcissistic personality disorder?

It appears to be more common in men than women. The more flagrant aspects of the disorder tend to deteriorate with age. Age is accompanied by a series of narcissistic hits. I think aging is very difficult for the patient with narcissistic personality disorder. While the more flagrant aspects of narcissistic personality disorder may diminish with age, I think that the aging process itself can actually enhance the disorder because inherent to that aging process are a variety of narcissistic injuries.

What are the treatments for narcissistic personality disorder?

Like so many other personality disorders in this cluster, in Cluster B: anti-social, borderline, histrionic and now narcissistic, a lot has been written about the psychotheraputic treatment of patients with narcissistic personality disorder. You know by virtue of the theraputic relationship, i.e. "You're the therapist and they're the patient", inherent in that relationship will be a lot of envy. So these patients will have difficulty in that theraputic relationship. They'll tend to de-value the therapist because of the envy involved in this situation and keeping them in treatment can be an issue and can be rather challenging. So, inside oriented psychotherapy, probably the treatment of choice. If the person meets criteria for a mood disorder, then you would treat that in the standard fashion as well.