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Narcissistic Personality Disorder

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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.

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Tips & Comments
  1. patobrien

    hello,I am not too sure if my ex boyfriend hs ncp but after reading joannas description of her ex he sounds very much like mine.I have known J for over 20 years now 7 of them he just up and left and went to another country!Only for the fact that I am a very strong person thanks to him,I would of cracked up a long time ago.In fact thinking about it I probably had a breakdown the first time he decided to leave me.I love this man very much even though he has tried to destroy me with his lies,manipulation and abuse,but thankfully now,aged 56 I am beginning to love myself more!Even as I write J has not rang me even though I had planned to spend a few days with him.Thats what I do now see him for a few days then go back to normality.I have a very loving family around me who have all tried to understand why J behaves the way he does,even my 4 year old grand daughter.My 3 sons have felt like killing him in the past,but deep down we all care very much about him.He still breaks my heart now but being a little older and wiser I can get on with things and concentrate on people who love me .Thankyou for your message Joanna it has helped ease the pain knowing that someone else knows how it feels to love someone even though it hurts like hell.J has been described with a personality disorder,has been to prison many times for conning people,and is presently wanted for fraud.The only time my mind is at rest is when he is in prison because I know where he is,but as I said before slowly I am getting there.I will always love him because he has a lovely side to him,is very funny,very caring,sensitive,but there is a part of me that hates him as well.I feel a lot better for writing this,thankyou so much

  2. thePersonDirectlyBelowIsAnIdiot

    I should really heed my own advise and just ignore you... If you really want to find some answers for yourself, ask yourself why a few harsh criticisms over the internet cause you to go into a rage. Anyhow, I only jumped in because you had nothing to offer other than criticism yourself.

  3. reyrepairs

    Thanks to " thePersonDirectlyBelowIsAnIdiot". I'm actually a sufferer looking for answers, instead I find the usual subnormal comments posted by a rude and ignorant individual who obviously lacks the capacity to empathise, understand or even care what it may actually be like for the sufferer. Wait a minute isn't that a trait of NPD. Wow there's the answer.

  4. joannag73

    this is for angelica - i read your message and I must say that reading that your husband 'just runs out to the garage & hides' has really helped me understand what my now-ex did. He wouldn't run to the garage and hide, he'd do his vanishing act, where he'd leave not reply to any texts and phonecalls. He just doesn't want to accept that his behaviour is so destructive. I have tried for three years, three painful years to understand. I used to think it was me. I can't tell you how many sleepless nights I've had, how long I've cried. He lies and lies and lies. I used to think, if I do more to understand then things would be fine. NO. That doesn't work as he just changes, we could be having fun one minute and then the next he'd shut-off and be rather cold/distant to me. I've been almost going crazy trying to understand, thinking maybe it's me. I think this last attempt at 'trying again' is the last. I listened to him and yet again believed his words only to be told something strange/different less than ten days after him saying 'he was a fool, and how sorry he is, and if i could just forgive him....' then less than ten days after a wonderful weekend he says that he needs to think. (wow). I ask for some type of explanation between the phone call and now and he shuts off. He becomes angry with me, tells me, "you wouldn't like me when I'm angry", and basically he's now not responding to anything, no message, no phone call, no text - nothing. I've endured this for three years as I thought perhaps he just needs to see that I'm for real. I gave everything. I've never known anyone prior to him to simply vanish/ignore/hide rather than discuss things. He goes on and on about how difficult life is - and at the same time, there's no attempt to try and make things better. He's made promises in the past to me that never came to fruition. He's asked me to hold off on certain things so we can do them together - none of these happened either. It is so painful. So utterly painful. I'm at the point now where even the mention of his name makes me want to throw up. It's extraordinary. I truly damaged soul. NPD. all of my friends/relatives told me this about him about two years ago - yet I just persisted thinking 'oh no, we shouldn't label people'. now i'm thinking to heck with not labelling, if it saves one's own sanity/soul..label away. Wow. He goes on about his employed by her majesty the queen to protect the UK...it's quite incredible, in the beginning I thought he was being funny/cute - but NO he actually believes that he's an honourable person. WOW. Thank you all.

  5. thePersonDirectlyBelowIsAnIdiot

    Just ignore the post DIRECTLY below mine. Whoever posted doesn't know what they are talking about. And if they have decided to post above, ignore that too.

  6. reyrepairs

    If you want to read the typical mind numbingly ignorant and standard reactions to sufferers of NPD read the comments below! Spare a thought for the sufferers of this isolatting and life altering condition. By definition the problems displayed are SYMPTOMS of a Mental Illness and as such deserve a little understanding!

  7. angelicaa

    I am after many many years of living with a man who has NPD I have finally found somewhere where I can see others problems...I have tried to leave my husband many times, he always gets me back by pathetic excuses now, but at first by my love for him thinking I could change him!! that was in the 60s so as you can see I have been in this torturous relationship for a long while, How I haven't gone mad I dont know..my children have all been affected even grandchildren, just want to say here & now that anyone discovering through all the info now known, who gets involved with a NPD ..DONT they never alter & it will be you who is hurt.He is now 73 & cant see anything is wrong with the way he is, that is if he stands to listen mine just runs out to the garage & hides !!

  8. kelli92829

    My mother has NPD and of course I am the one in counseling for it not her! She left me to take care of my father when I was 13, because he had epilepsy and could not make enough money to satisfy her. She insisted that he have an experimental brain surgury to separate the hemispheres of his brain in hopes of stopping the seizures medication could not stop. When he refused, she left saying "I am only going to date men with Mercedes". Needless to say I have hated her from that moment on (I am now 45). I am only now beginning to learn how to deal with her. It is so painful. She has devalued me my entire life. She has stolen money from her own sister. She has been fired from jobs because she devalued her own bosses. It is hell dealing with someone like this.

  9. fastbyk

    I would stay as far a way from these people as possible. My mother has this illness and degrades people to the point of being responsible for the suicide of my step father and brother, as well as the mental illness of my sister and her suicide attempts. It's a matter of your survival over their trying to feel better to fight their insecurity.

  10. criz

    sadly my mother has this.