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Mental illness narcissistic personality disorder


Narcissistic Personality Disorder - HelpGuide.org

What is narcissistic personality disorder (NPD)?

The word narcissism gets tossed around a lot in our selfie-obsessed, celebrity-driven culture, often to describe someone who seems excessively vain or full of themselves. But in psychological terms, narcissism doesn't mean self-love—at least not of a genuine sort. It's more accurate to say that people with narcissistic personality disorder (NPD) are in love with an idealized, grandiose image of themselves. And they're in love with this inflated self-image precisely because it allows them to avoid deep feelings of insecurity. But propping up their delusions of grandeur takes a lot of work—and that's where the dysfunctional attitudes and behaviors come in.

Narcissistic personality disorder involves a pattern of self-centered, arrogant thinking and behavior, a lack of empathy and consideration for other people, and an excessive need for admiration. Others often describe people with NPD as cocky, manipulative, selfish, patronizing, and demanding. This way of thinking and behaving surfaces in every area of the narcissist's life: from work and friendships to family and love relationships.

People with narcissistic personality disorder are extremely resistant to changing their behavior, even when it's causing them problems. Their tendency is to turn the blame on to others. What's more, they are extremely sensitive and react badly to even the slightest criticisms, disagreements, or perceived slights, which they view as personal attacks. For the people in the narcissist's life, it's often easier just to go along with their demands to avoid the coldness and rages. However, by understanding more about narcissistic personality disorder, you can spot the narcissists in your life, protect yourself from their power plays, and establish healthier boundaries.

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Signs and symptoms of narcissistic personality disorder

Grandiose sense of self-importance

Grandiosity is the defining characteristic of narcissism. More than just arrogance or vanity, grandiosity is an unrealistic sense of superiority. Narcissists believe they are unique or “special” and can only be understood by other special people. What's more, they are too good for anything average or ordinary. They only want to associate and be associated with other high-status people, places, and things.

Narcissists also believe that they're better than everyone else and expect recognition as such—even when they've done nothing to earn it. They will often exaggerate or outright lie about their achievements and talents. And when they talk about work or relationships, all you'll hear is how much they contribute, how great they are, and how lucky the people in their lives are to have them. They are the undisputed star and everyone else is at best a bit player.

Lives in a fantasy world that supports their delusions of grandeur

Since reality doesn't support their grandiose view of themselves, narcissists live in a fantasy world propped up by distortion, self-deception, and magical thinking. They spin self-glorifying fantasies of unlimited success, power, brilliance, attractiveness, and ideal love that make them feel special and in control. These fantasies protect them from feelings of inner emptiness and shame, so facts and opinions that contradict them are ignored or rationalized away. Anything that threatens to burst the fantasy bubble is met with extreme defensiveness and even rage, so those around the narcissist learn to tread carefully around their denial of reality.

Needs constant praise and admiration

A narcissist's sense of superiority is like a balloon that gradually loses air without a steady stream of applause and recognition to keep it inflated. The occasional compliment is not enough. Narcissists need constant food for their ego, so they surround themselves with people who are willing to cater to their obsessive craving for affirmation. These relationships are very one-sided. It's all about what the admirer can do for the narcissist, never the other way around. And if there is ever an interruption or diminishment in the admirer's attention and praise, the narcissist treats it as a betrayal.

Sense of entitlement

Because they consider themselves special, narcissists expect favorable treatment as their due. They truly believe that whatever they want, they should get. They also expect the people around them to automatically comply with their every wish and whim. That is their only value. If you don't anticipate and meet their every need, then you're useless. And if you have the nerve to defy their will or “selfishly” ask for something in return, prepare yourself for aggression, outrage, or the cold shoulder.

Exploits others without guilt or shame

Narcissists never develop the ability to identify with the feelings of others—to put themselves in other people's shoes. In other words, they lack empathy. In many ways, they view the people in their lives as objects—there to serve their needs. As a consequence, they don't think twice about taking advantage of others to achieve their own ends. Sometimes this interpersonal exploitation is malicious, but often it is simply oblivious. Narcissists simply don't think about how their behavior affects others. And if you point it out, they still won't truly get it. The only thing they understand is their own needs.

Frequently demeans, intimidates, bullies, or belittles others

Narcissists feel threatened whenever they encounter someone who appears to have something they lack—especially those who are confident and popular. They're also threatened by people who don't kowtow to them or who challenge them in any way. Their defense mechanism is contempt. The only way to neutralize the threat and prop up their own sagging ego is to put those people down. They may do it in a patronizing or dismissive way as if to demonstrate how little the other person means to them. Or they may go on the attack with insults, name-calling, bullying, and threats to force the other person back into line.

Different types of narcissist

Narcissism comes in several forms. Adaptive narcissism is when a person with this disorder leans into positive traits—such as self-sufficiency and confidence—that can actually be healthy. They may help someone set high ambitions at work, for example, or enjoy satisfying relationships without being overdependent on a partner.

Maladaptive narcissism, on the other hand, is characterized by the toxic traits, such as a sense of entitlement and willingness to exploit others. The different forms of maladaptive narcissism include:

Overt or grandiose narcissism. Overt narcissists tend to be extroverted but also uncooperative, selfish, and overbearing. Their exaggerated self-image and high self-esteem allow them to be confident and assertive. However, they’re also likely to overestimate their own emotional intelligence.

Covert or vulnerable narcissism. It's common to imagine all narcissists as dominant and overwhelming in social situations. However, covert narcissists are introverted. They tend to be extremely sensitive to criticism and suffer from low self-esteem. They can be defensive and passive-aggressive, but they are less likely to overestimate their emotional abilities than overt narcissists.  

Communal narcissism. Communal narcissists tend to view themselves as altruistic and claim to care deeply about fairness. They present themselves to others as supportive and selfless. However, their behavior is motivated by a desire for social power and a sense of superiority or entitlement. Because of this, their actions don’t always match their beliefs.

Antagonistic narcissism. In contrast with communal narcissists, antagonistic narcissists take a highly competitive approach to social interactions. They often exhibit zero-sum thinking, believing that every situation has a “loser” and “winner. ” This view of the world leads them to be aggressive and hostile. They may be quick to disparage others and slow or unwilling to forgive.

Malignant narcissism. Malignant narcissism can be a more destructive form of the personality disorder. In addition to the typical signs of narcissism, a malignant narcissist might be aggressive, paranoid, or sadistic—taking joy in other people’s pain. They tend to display antisocial behavior, disregarding the rights or safety of others.

Dealing with a narcissist: Don't fall for the fantasy

Narcissists can be very magnetic and charming. They are very good at creating a fantastical, flattering self-image that draw us in. We're attracted to their apparent confidence and lofty dreams—and the shakier our own self-esteem, the more seductive the allure. It's easy to get caught up in their web, thinking that they will fulfill our longing to feel more important, more alive. But it's just a fantasy, and a costly one at that.

Your needs won't be fulfilled (or even recognized). It's important to remember that narcissists aren't looking for partners; they're looking for obedient admirers. Your sole value to the narcissist is as someone who can tell them how great they are to prop up their insatiable ego. Your desires and feelings don't count.

Look at the way the narcissist treats others. If the narcissist lies, manipulates, hurts, and disrespects others, he or she will eventually treat you the same way. Don't fall for the fantasy that you're different and will be spared.

Take off the rose-colored glasses. It's important to see the narcissist in your life for who they really are, not who you want them to be. Stop making excuses for bad behavior or minimizing the hurt it's causing you. Denial will not make it go away. The reality is that narcissists are very resistant to change, so the true question you must ask yourself is whether you can live like this indefinitely.

Focus on your own dreams. Instead of losing yourself in the narcissist's delusions, focus on the things you want for yourself. What do you want to change in your life? What gifts would you like to develop? What fantasies do you need to give up in order to create a more fulfilling reality?

Set healthy boundaries

Healthy relationships are based on mutual respect and caring. But narcissists aren't capable of true reciprocity in their relationships. It isn't just that they're not willing; they truly aren't able. They don't see you. They don't hear you. They don't recognize you as someone who exists outside of their own needs. Because of this, narcissists regularly violate the boundaries of others. What's more, they do so with an absolute sense of entitlement.

Narcissists think nothing of going through or borrowing your possessions without asking, snooping through your mail and personal correspondence, eavesdropping on conversations, barging in without an invitation, stealing your ideas, and giving you unwanted opinions and advice. They may even tell you what to think and feel. It's important to recognize these violations for what they are, so you can begin to create healthier boundaries where your needs are respected.

Make a plan. If you have a long-standing pattern of letting others violate your boundaries, it's not easy to take back control. Set yourself up for success by carefully considering your goals and the potential obstacles. What are the most important changes you hope to achieve? Is there anything you've tried in the past with the narcissist that worked? Anything that hasn't? What is the balance of power between you and how will that impact your plan? How will you enforce your new boundaries? Answering these questions will help you evaluate your options and develop a realistic plan.

Consider a gentle approach. If preserving your relationship with the narcissist is important to you, you will have to tread softly. By pointing out their hurtful or dysfunctional behavior, you are damaging their self-image of perfection. Try to deliver your message calmly, respectfully, and as gently as possible. Focus on how their behavior makes you feel, rather than on their motivations and intentions. If they respond with anger and defensiveness, try to remain calm. Walk away if need be and revisit the conversation later.

Don't set a boundary unless you're willing to keep it. You can count on the narcissist to rebel against new boundaries and test your limits, so be prepared. Follow up with any consequences specified. If you back down, you're sending the message that you don't need to be taken seriously.

Be prepared for other changes in the relationship. The narcissist will feel threatened and upset by your attempts to take control of your life. They are used to calling the shots. To compensate, they may step up their demands in other aspects of the relationship, distance themselves to punish you, or attempt to manipulate or charm you into giving up the new boundaries. It's up to you to stand firm.

Don't take things personally

To protect themselves from feelings of inferiority and shame, narcissists must always deny their shortcomings, cruelties, and mistakes. Often, they will do so by projecting their own faults on to others. It's very upsetting to get blamed for something that's not your fault or be characterized with negative traits you don't possess. But as difficult as it may be, try not to take it personally. It really isn't about you.

Don't buy into the narcissist's version of who you are. Narcissists don't live in reality, and that includes their views of other people. Don't let their shame and blame game undermine your self-esteem. Refuse to accept undeserved responsibility, blame, or criticism. That negativity is the narcissist's to keep.

Don't argue with a narcissist. When attacked, the natural instinct is to defend yourself and prove the narcissist wrong. But no matter how rational you are or how sound your argument, they are unlikely to hear you. And arguing the point may escalate the situation in a very unpleasant way. Don't waste your breath. Simply tell the narcissist you disagree with their assessment, then move on.

Know yourself. The best defense against the insults and projections of the narcissist is a strong sense of self. When you know your own strengths and weaknesses, it's easier to reject any unfair criticisms leveled against you.

Let go of the need for approval. It's important to detach from the narcissist's opinion and any desire to please or appease them at the expense of yourself. You need to be okay with knowing the truth about yourself, even if the narcissist sees the situation differently.

Look for support and purpose elsewhere

If you're going to stay in a relationship with a narcissist, be honest with yourself about what you can—and can't—expect. A narcissist isn't going to change into someone who truly values you, so you'll need to look elsewhere for emotional support and personal fulfillment.

Learn what healthy relationships look and feel like. If you come from a narcissistic family, you may not have a very good sense of what a healthy give-and-take relationship is. The narcissistic pattern of dysfunction may feel comfortable to you. Just remind yourself that as familiar as it feels, it also makes you feel bad. In a reciprocal relationship, you will feel respected, listened to, and free to be yourself.

Spend time with people who give you an honest reflection of who you are. In order to maintain perspective and avoid buying into the narcissist's distortions, it's important to spend time with people who know you as you really are and validate your thoughts and feelings.

Make new friendships, if necessary, outside the narcissist's orbit. Some narcissists isolate the people in their lives in order to better control them. If this is your situation, you'll need to invest time into rebuilding lapsed friendships or cultivating new relationships.

Look for meaning and purpose in work, volunteering, and hobbies. Instead of looking to the narcissist to make you feel good about yourself, pursue meaningful activities that make use of your talents and allow you to contribute.

How to leave a narcissist

Ending an abusive relationship is never easy. Ending one with a narcissist can be especially difficult as they can be so charming and charismatic—at least at the start of the relationship or if you threaten to leave. It’s easy to become disoriented by the narcissist’s manipulative behavior, caught up in the need to seek their approval, or even to feel “gaslighted” and doubt your own judgement. If you’re codependent, your desire to be loyal may trump even your need to preserve your safety and sense of self. But it’s important to remember that no one deserves to be bullied, threatened, or verbally and emotionally abused in a relationship. There are ways to escape the narcissist—and the guilt and self-blame—and begin the process of healing.

Educate yourself about narcissistic personality disorder. The more you understand, the better you’ll be able to recognize the techniques a narcissist may use to keep you in the relationship. When you threaten to leave, a narcissist will often resurrect the flattery and adoration (“love bombing”) that caused you to be interested in them in the first place. Or they’ll make grand promises about changing their behavior that they have no intention of keeping.

Write down the reasons why you’re leaving. Being clear on why you need to end the relationship can help prevent you from being sucked back in. Keep your list somewhere handy, such as on your phone, and refer to it when you’re starting to have self-doubts or the narcissist is laying on the charm or making outlandish promises.

Seek support. During your time together, the narcissist may have damaged your relationships with friends and family or limited your social life. But whatever your circumstances, you’re not alone. Even if you can’t reach out to old friends, you can find help from support groups or domestic violence helplines and shelters.

Don’t make empty threats. It’s a better tactic to accept that the narcissist won’t change and when you’re ready, simply leave. Making threats or pronouncements will only forewarn the narcissist and enable them to make it more difficult for you to get away.

Seek immediate help if you’re physically threatened or abused. Call 911 in the U.S. or your country’s local emergency service.

For more tips on leaving, read How to Get Out of an Abusive Relationship.

After you’ve left

Leaving a narcissist can be a huge blow to their sense of entitlement and self-importance. Their huge ego still needs to be fed, so they’ll often continue trying to exert control over you. If charm and “love bombing” doesn’t work, they may resort to threats, denigrating you to mutual friends and acquaintances, or stalking you, on social media or in person.

Cut off all contact with the narcissist. The more contact you have with them, the more hope you’ll give them that they can reel you back in. It’s safer to block their calls, texts, and emails, and disconnect from them on social media. If you have children together, have others with you for any scheduled custody handovers.  

Allow yourself to grieve. Breakups can be extremely painful, whatever the circumstances. Even ending a toxic relationship can leave you feeling sad, angry, confused, and grieving the loss of shared dreams and commitments. Healing can take time, so go easy on yourself and turn to family and friends for support.

Don’t expect the narcissist to share your grief. Once the message sinks in that you will no longer be feeding their ego, the narcissist will likely soon move on to exploit someone else. They won’t feel loss or guilt, just that never-ending need for praise and admiration. This is no reflection on you, but rather an illustration of how very one-sided their relationships always are.

If you need help for narcissistic personality disorder

Due to the very nature of the disorder, most people with NPD are reluctant to admit they have a problem—and even more reluctant to seek help. Even when they do, narcissistic personality disorder can be very challenging to treat. But that doesn’t mean there’s no hope or that changes aren’t possible. Mood stabilizers, antidepressants, and antipsychotic drugs are sometimes prescribed in severe cases or if your NPD co-occurs with another disorder. However, in most cases psychotherapy is the primary form of treatment.

Working with a skilled therapist, you can learn to accept responsibility for your actions, develop a better sense of proportion, and build healthier relationships. You can also work on developing your emotional intelligence (EQ). EQ is the ability to understand, use, and manage your emotions in positive ways to empathize with others, communicate effectively, and builder strong relationships.  Importantly, the skills that make up emotional intelligence can be learned at any time.

Last updated or reviewed on March 28, 2023

Narcissistic Personality Disorder - StatPearls

Continuing Education Activity

Narcissistic personality disorder (NPD) is a complex personality disorder often detected with other affective and personality disorders. This activity outlines the evaluation of narcissistic personality disorder and discusses a multi-modal approach to treatment. This article also outlines complications related to personality disorder and discusses interprofessional approaches to the same.

Objectives:

  • Identify the etiology of narcissistic personality disorder.

  • Summarize the evaluation of narcissistic personality disorder.

  • Review management options available for narcissistic personality disorder.

  • Describe the complications of narcissistic personality disorder, including comorbid diagnosis and relation to suicidal behavior.

Access free multiple choice questions on this topic.

Introduction

Narcissistic personality disorder (NPD) is a pattern of grandiosity, need for admiration, and lack of empathy per the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). The disorder is classified in the dimensional model of "Personality Disorders."NPD is highly comorbid with other disorders in mental health. Persons with NPD can often present with impairment in maintaining work and relationships.[1] NPD is highly prevalent in society; however, there has been limited research on the same. Given the limited research on the same and differences in the diagnosis of the disease, it was initially going to be discontinued from the DSM.NPD is under the umbrella of Cluster B personality disorders, which include antisocial personality disorder, histrionic personality disorder, and borderline personality disorder. Cluster B typically presents with overtly emotional and unpredictable behavior. [2] 

NPD has been associated with the concept of " development." "Development" has been central to studies that have been done to understand the psychopathology and etiology of NPD. Experts such as Otto Kernberg and Eve Caligor have introduced more standardized evaluation tools to understand the disorder. Due to NPD comorbidity with other mental disorders and its elevated medical, social, and psychiatric complications, and a gap of knowledge about the disorder, understanding NPD is warranted. This paper aims to cover the gap and incite more research on NPD.

Etiology

The etiology of narcissistic personality disorder is multifaceted. Some studies have suggested a genetic predisposition toward the disorder.[3] Traits such as aggression, reduced tolerance to distress, and dysfunctional affect regulation is prominent in persons with NPD.[4] Developmental experiences, negative in nature, being rejected as a child, and a fragile ego during early childhood may have contributed to the occurrence of NPD in adulthood. [5][6] In contrast, excessive praise, including the belief that a child may have extraordinary abilities, may also lead to NPD.

Epidemiology

Given the challenges of diagnosing narcissistic personality disorder, there have been varying reports of prevalence in the United States of America( USA). Prevalence rates from community samples have been from 0.5% to 5% of the US population.[7] However, in clinical settings, NPD appears to be more prevalent. Prevalence rates can be from 1% to 15% of the United States population. NPD may coexist with other mental disorders rendering its diagnosis challenging. Substance use disorders are among the most comorbid conditions.[8] Other personality disorders such as antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and schizotypal personality disorder are also common in people with NPD.[9] 

Comorbid antisocial personality disorder is said to have the most negative effect. There is much contention around the diagnosis of NPD. There are two basic subtypes, including grandiose and vulnerable narcissistic personality disorder. The grandiose subtype includes overt grandiosity, presence of aggression, and boldness. The vulnerable subtype presents with hypersensitivity and defensiveness and is often easy to miss.[10] There has been some research on the grandiose subtype, which includes evidence of behavior such as overt aggression, lack of empathy, and exploitation of the other.[11][12] Interviews of 34,653 adults who participated in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions revealed a lifetime prevalence of NPD of 6.2%: 7.7% greater in men and 4.8% in women. A high prevalence of NPD was found among Black men and women and Hispanic women.[1] 

Pathophysiology

There has been limited work done on neuroimaging in persons diagnosed with narcissistic personality disorder. A voxel-based morphometry (VBM) study done in Germany with a small sample size showed gray matter abnormalities in the prefrontal and insular regions. [13] Another voxel-based morphometry and diffuse tensor imaging study(DTI) done in Germany showed grey matter abnormalities in the right prefrontal and anterior cingulate cortices. There were abnormalities detected in the white matter of the frontal lobe as well.[14]

History and Physical

Obtaining an accurate history can be somewhat challenging for persons with narcissistic personality disorder, given the variability of the presentation. In the outpatient setting, individuals can be well related and high functioning, while in the inpatient setting, they can be some of the most aggressive and challenging patients. Most of the time, NPD patients come into contact with clinicians during emergencies were more often than not, they are noted to behave aggressively.[15]

The aggression indicates the severity of the personality disorder, i.e., the more aggression detected, the personality disorder is considered more severe. Otto Kernberg cited extensive cases correlating aggression with the severity of personality disorders. [16]

Per the DSM, NPD includes:

A pervasive pattern of grandiosity (fantasy or behavior), need for admiration, and with lack of empathy, beginning by early adulthood, as indicated by at least five of the following:

  • Has a grandiose sense of self-importance (e.g., exaggerates achievements, expects to be recognized as superior without actually completing the achievements)

  • Is preoccupied with fantasies of success, power, brilliance, beauty, or perfect love.

  • Believes that they are "special" and can only be understood by or should only associate with other special people (or institutions).

  • Requires excessive admiration.

  • Has a sense of entitlement, such as an unreasonable expectation of favorable treatment or compliance with his or her expectations).

  • Is exploitative and takes advantage of others to achieve their own ends.

  • Lacks empathy and is unwilling to identify with the needs of others.

  • Is often envious of others or believes that others are envious of them.

  • Shows arrogant, haughty behaviors and attitudes

The diagnosis of NPD as other personality disorders requires evaluation of long-term patterns of functioning. One needs to be cautious not to jump to hasty conclusions because NPD can trigger countertransference. A careful evaluation of the different aspects of a person's life and an understanding of the person's childhood development can assist in the evaluation and diagnosis of NPD.

Evaluation

A standard psychiatric interview is often used to make a diagnosis of personality disorders. Otto Kernberg's structured clinical interview, which was created in 1981, has continued to undergo revisions and restructuring as a structured clinical interview for personality disorders. The current version is a semi-structured diagnostic interview with questions focused on personality organization, defenses, object relations, and coping skills. This interview focuses on interpersonal relationships. The current version is copyrighted by the Personality Institute at The Weill Cornell Institute. The interview is based on psychodynamic principles and is expected to be used by persons who had have had previous training in psychoanalytical work.[17]

Other instruments may measure the severity of narcissistic personality disorder, such as the five-factor narcissism inventory that looks at the five aspects of general personality. There are about 148 questions that are asked on the measure.[18] Another measure that may be useful is the Narcissistic Personality Inventory.[19]

The instruments above are mostly used in research settings. In the clinical world, the clinical interview is of most value. An excellent clinical interview focuses on interpersonal relationships as persons with an NPD often present with conflicts with others in inpatient or outpatient settings. In outpatient settings, referrals are often made at the behest of a loved one. In inpatient or emergency room settings, symptoms often come into play when there is interaction with other personnel, especially others in authority. Persons with NPD often describe themselves in relation to others with themes of comparison.[10]

Often a clinician's countertransference may help with forming a diagnosis. Often, persons with NPD create feelings of either feeling flattered or admired, or on the other extreme, having feelings of inadequacy and low self-worth.[20][21] Glen Gabbard is another analyst who has done extensive work in understanding these feelings described as "countertransference" in the therapist. As a clinician, it is always important to pay attention to the feelings evoked by a patient in themselves as this is often diagnostic.

Treatment / Management

No standardized pharmacological or psychological treatment has been established for persons with narcissistic personality disorder.[10] More often than not, NPD is present, along with other mood disorders. Once a diagnosis is established, it is essential to discuss the diagnosis because of several challenges that will mostly be present in the future. It is equally important to treat ongoing symptoms of co-occurring affective disorders.[22]

Kohut and Kernberg have focused on long-term therapy and exploring the relationship between a therapist and patient, which continues to be an established treatment for persons with a narcissistic personality disorder.[23] Psychodynamic psychotherapy focuses on defenses present during therapy sessions.[24] Many therapists have advocated for ongoing therapy for patients with an established diagnosis of NPD. NPD may significantly reduce emergency department visits and lower the incidence of self-harm. Of note, studies are more focused on borderline personality disorder; however, borderline personality disorder's findings may be generalizable to other disorders as well.

Transference-focused therapy is structured twice a week psychoanalytic therapy that focuses on personal expression of emotions toward a therapist. Given that persons with NPD can often be provoked by their perception of being treated by another, their own emotions towards other people are essential.[25]

Schema-focused therapy is relatively new and focuses on alternate forms of cognitive-behavioral therapy, including activating emotional senses.[26]

There are no FDA-approved medications for the treatment of NPD, but many patients may benefit from the treatment of symptoms, including anxiety, depression, mood lability, transient psychosis, and impulse control issues. Antidepressants, including selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, have been used. Risperidone, an antipsychotic, has shown benefit in some patients. Some patients are given mood stabilizers like lamotrigine.

Differential Diagnosis

The differential diagnosis often includes prevailing mood or anxiety disorders. Often persons with grandiose narcissism can present with heightened mood and more energy when excited by a new idea, which may initially point to a hypomanic/manic presentation; however, the personality aspect would be prominent in their interaction with others. On the other extreme, persons with vulnerable narcissism may present with salient features of dysthymia, depression, and anhedonia. However, the grandiosity and need for admiration would be prominent despite the affective symptoms, which would differentiate it from a major depressive disorder.

The closest differentials continue to remain other cluster B personality disorders, including antisocial personality disorder, histrionic personality disorder, and borderline personality disorder. It bears mention that persons with NPD do not show overt signs of impulsivity and self-destructiveness associated with borderline personality disorder. Similarly, apparent emotional responses are associated with histrionic personality disorder. NPD is most similar to antisocial personality disorder with a lack of empathy and superficial charm. However, persons with an antisocial personality disorder would show a lack of morals compared to persons with NPD and have a past diagnosis of conduct disorder.

  • Antisocial personality disorder

  • Borderline personality disorder

  • Histrionic personality disorder

  • Major depressive disorder

  • Obsessive-compulsive disorder

  • Substance-induced mood disorder

Prognosis

The prognosis, as discussed above, depends on the presence of comorbid disorders and the level of functioning of the patient. Aggression is often directly related to the severity of the disease; rather, the more aggressive the patient appears, the more severe is the personality disorders.

Complications

The complications essentially involve the presence of comorbid conditions, including mood and substance use disorders. The presence of other personality disorders is also common. However, narcissistic personality disorder is associated with a higher risk of death by suicide compared to other personality disorders.[27] In contrast, there is mixed evidence of suicide attempts and persons with narcissistic personality disorder since NPD is associated with factors such as “self-love” and “grandiosity” and comparatively less impulsivity. [28] Substance use disorder is also related to NPD, and when there is an association of substance use disorder with NPD, there is significantly more hostility, and aggression is also present. This makes treatment even more challenging than usual. There are several theories related to both biology and trauma regarding the same.[29][30]

Deterrence and Patient Education

As detailed above, it is necessary to discuss the diagnosis with the patient as soon as possible. It is equally important to discuss the process of arriving at this conclusion, including clinical information gathered and observed behaviors. Discussion of other comorbid disorders, including mood and substance use disorders, if present, needs to be addressed. Often family members also require education about personality disorders, their behaviors, and complications.

Pearls and Other Issues

  1. Obtaining a detailed history is vital. A primary psychiatric interview focuses on symptoms; however, longitudinal assessments focusing on interpersonal relations are helpful to point toward a diagnosis of NPD.

  2. Given that there are two subtypes established, it is essential to focus on identifying both grandiose and vulnerable forms, given that the latter is missed in place of other diagnoses.

  3. It is essential to be mindful of other comorbid diagnoses given the high levels of comorbidity with affective and other cluster B personality disorders.

  4. Literature has shown that most persons with narcissistic personality disorder are difficult to engage; hence, being empathetic is necessary when beginning treatment.

  5. Once a diagnosis is established, it is important to share the same with the patient. Lack of sharing may lead to further complications during care.

  6. It is equally important to treat comorbid mood and substance use disorders.

  7. It is crucial for treating clinicians to be aware that there are high rates of drop-outs and increased rates of therapeutic disruption with persons with a narcissistic personality disorder.

  8. It is essential to recognize that most clinicians experience negative countertransference when treating persons with NPD. Clinicians are advised to be aware of the same and process emotions that arise in treatment.

Enhancing Healthcare Team Outcomes

Often collaborative work is required in the medical setting when patients with NPD work with non-mental health professionals such as surgeons, medical nursing, nutritionists, etc. These patients are often described as "difficult and demanding," and importantly, their medical needs remain untreated. Often mental health professionals may be consulted for a mood disorder on the inpatient floor for a patient with underlying NPD and have to liaison with the primary medical team in charge of the patient. Other medical professionals must be educated about personality disorder and their countertransference towards the patient so that it does not impact clinical care. Mental health professionals in the consult-liaison service may provide support and education to the first medical teams as well.

In the outpatient setting, patients are asked to discuss their diagnosis as they feel relevant to their medical providers. A partnership among medical professionals and other ancillaries may ensure optimal care. Pharmacists need to have input into the medication process, ensuring proper dosing and the absence of interactions. Nurses function as the glue that holds the team together and are often the primary point of patient contact. The education of both patients and their providers is also helpful. All these disciplines functioning as an interprofessional team are vital to achieving optimal patient outcomes. [Level 5]

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References

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Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, Ruan WJ, Pulay AJ, Saha TD, Pickering RP, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2008 Jul;69(7):1033-45. [PMC free article: PMC2669224] [PubMed: 18557663]

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Otway LJ, Vignoles VL. Narcissism and childhood recollections: a quantitative test of psychoanalytic predictions. Pers Soc Psychol Bull. 2006 Jan;32(1):104-16. [PubMed: 16317192]

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Ronningstam E. An update on narcissistic personality disorder. Curr Opin Psychiatry. 2013 Jan;26(1):102-6. [PubMed: 23187086]

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Ronningstam E. Narcissistic personality disorder: a current review. Curr Psychiatry Rep. 2010 Feb;12(1):68-75. [PubMed: 20425313]

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Caligor E, Levy KN, Yeomans FE. Narcissistic personality disorder: diagnostic and clinical challenges. Am J Psychiatry. 2015 May;172(5):415-22. [PubMed: 25930131]

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Pincus AL, Ansell EB, Pimentel CA, Cain NM, Wright AGC, Levy KN. Initial construction and validation of the Pathological Narcissism Inventory. Psychol Assess. 2009 Sep;21(3):365-379. [PubMed: 19719348]

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Dickinson KA, Pincus AL. Interpersonal analysis of grandiose and vulnerable narcissism. J Pers Disord. 2003 Jun;17(3):188-207. [PubMed: 12839099]

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Schulze L, Dziobek I, Vater A, Heekeren HR, Bajbouj M, Renneberg B, Heuser I, Roepke S. Gray matter abnormalities in patients with narcissistic personality disorder. J Psychiatr Res. 2013 Oct;47(10):1363-9. [PubMed: 23777939]

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Nenadic I, Güllmar D, Dietzek M, Langbein K, Steinke J, Gaser C. Brain structure in narcissistic personality disorder: a VBM and DTI pilot study. Psychiatry Res. 2015 Feb 28;231(2):184-6. [PubMed: 25492857]

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Gunderson JG, Ronningstam E. Differentiating narcissistic and antisocial personality disorders. J Pers Disord. 2001 Apr;15(2):103-9. [PubMed: 11345846]

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Hörz-Sagstetter S, Caligor E, Preti E, Stern BL, De Panfilis C, Clarkin JF. Clinician-Guided Assessment of Personality Using the Structural Interview and the Structured Interview of Personality Organization (STIPO). J Pers Assess. 2018 Jan-Feb;100(1):30-42. [PubMed: 28388222]

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Vater A, Schröder-Abé M, Ritter K, Renneberg B, Schulze L, Bosson JK, Roepke S. The Narcissistic Personality Inventory: a useful tool for assessing pathological narcissism? Evidence from patients with Narcissistic Personality Disorder. J Pers Assess. 2013;95(3):301-8. [PubMed: 23101721]

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Narcissism - what it is, signs and causes of narcissistic personality disorder

About who people with narcissism are, where it comes from and whether it is always necessary to break off relations with narcissists, says Anna Krymskaya, a clinical psychologist and co-founder of the online psychological help service YouTalk

Surely among your acquaintances there is someone about whom you thought “yes, he is a typical narcissist”. Most likely, the description of this person will look like this: self-confident, ambitious, somewhat selfish. Possibly manipulative.

The term "narcissism" is heard everywhere: in psychological blogs, movies, Tiktok. There are articles and studies about him. But often in them this phenomenon is simplified and stigmatized. Who are narcissists, should they be avoided, and when can one speak of a narcissistic disorder? What is Narcissism? This is not a monolithic concept, but a whole spectrum. To some extent, its features are present in many of us, this is normal and even useful in some ways. For example, people with a narcissistic temperament are often ambitious, take care of themselves and achieve great success in their careers.

Depending on how pronounced the narcissistic tendencies are and whether they interfere with life, the spectrum of narcissism can be divided into four parts:

Character and accentuation are variants of a healthy manifestation of narcissism, and a personality disorder is already a psychiatric diagnosis.

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The extreme degree of the norm is the narcissistic accentuation of the personality. This means that the narcissistic qualities of character are so pronounced that in some cases they begin to interfere with a person's life. They can affect his relationships with others or the professional sphere. However, their influence is not so serious as to diagnose a personality disorder. For example, they can lead to conflicts with superiors or prevent a person from sincerely opening up to another, removing the mask of ideality.

What qualities are considered narcissistic

Based on the Narcissistic Personality Inventory, one of the most popular tools for identifying non-clinical cases of narcissism, the following qualities can be considered narcissistic:

  • Demonstration. It is expressed in the idea of ​​one's own unusualness, uniqueness, physical attractiveness and ability to influence others
  • Authority. Confidence in possessing leadership qualities, the ability to influence others, power over people, the ability to succeed.
  • Chosenness. The feeling of one's own peculiarity, the expectation of an exceptionally good attitude, respect, recognition of one's merits, submission to one's requirements and desires.
  • Vanity. The desire to look good in the eyes of others, the need to confirm one's superiority, the desire to hear flattery from other people.
  • Self-sufficiency. Confidence in one's independence from people in achieving results, competence, responsibility for making decisions, confidence in the correctness of one's actions, the ability to live in accordance with one's desires, the ability to become a great person.
  • Excellence. Conviction in the extraordinary and uniqueness of one's personality, the presence of special achievements and talents, the deserving of appropriate recognition from others.
  • Operation. Confidence in one's ability to use other people, the ease of manipulating others to achieve one's own goals, the ability to understand others well, influence their behavior, and convince of something.

Along with these traits, there are often such characteristics as increased sensitivity to shame, perfectionism, a feeling of inner emptiness and loneliness.

People with a narcissistic psychotype are demonized, attributing to them aggressiveness, lack of empathy, a tendency to violence

The traits listed above are manifestations of narcissism as a personality trait, that is, a norm. To be diagnosed with Narcissistic Personality Disorder, according to the DSM-5 American Classification of Diseases, a person must exhibit five or more of the following characteristics of narcissism in early adulthood:

  • Preoccupation with fantasies of unlimited achievement, influence, power, intelligence, beauty, or ideal love.
  • Belief in one's individuality and uniqueness, accompanied by the need to communicate only with people of the highest level.
  • The need for unconditional admiration.
  • Feeling the right to a reward.
  • Exploitation of others to achieve one's own goals.
  • Lack of empathy.
  • Envy of others and belief that others envy them.
  • Arrogance and haughtiness.

    • In Russia, however, since January 2022, it has become impossible to get a diagnosis of Narcissistic Personality Disorder, because our doctors do not follow the DSM-5, but the International Classification of Diseases from the World Health Organization. In the latest edition, the division into individual personality disorders was removed: now they look at whether a person has general signs of a personality disorder, the degree of their severity and specific manifestations. This will make the approach more comprehensive and personalized.

    Is it worth labeling a person as a narcissist

    There are two sides to using such labels. They can be a guide, explain individual patterns in their own and others' behavior, feelings and thinking; can help you get the big picture. But they can also become a stigmatizing stigma, if you do not pay attention to the individual characteristics of a person. Unfortunately, in modern culture, this often happens and any people with a narcissistic psychotype are demonized, attributing to them aggressiveness, lack of empathy, a tendency to violence, and offering to avoid any contact with them. But this will not be true for every person with narcissistic traits. Because of such generalizations, even the expression "narcissist" itself has acquired a negative connotation, and its use is considered not entirely ethical.

    In addition, in psychology there are many different classifications of narcissism that better convey the shades of this phenomenon than one term.

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    What types of narcissism are distinguished by psychologists

    Most often they talk about two types:

    Grandiose. Such a person wants to be the best. Faster, higher, stronger than all. Career, appearance, relationships - everything should be perfect. This characteristic fits well with the modern philosophy of success and achievement, so often this type achieves a lot in life. Grandiose narcissists can embellish reality to fit their ideal image if reality falls short. The self-esteem of such people is unstable: from the outside it may seem high or even inflated, but inside they often feel empty and dissatisfied.

    Vulnerable. He is also hidden or thin-skinned. Clinical psychologist Paul Wink in his work "The Two Faces of Narcissism" described the mental portrait of representatives of this type as prone to introversion, submission, anxiety, vulnerability and always being on the defensive. However, like the grandiose type, they are vain, interested in others, impulsive, and often take risks.

    While grandiose narcissists tend to exalt themselves in the eyes of others, vulnerable narcissists may appear to hate themselves. In fact, this is the same idealization, but turned inside out. While grandiose narcissists tend to see themselves as the best, covert narcissists tend to see themselves as the worst, stupidest, most miserable. Keyword: most.

    From the grandiose pole, a person with narcissism can fall into the other extreme: to feel like a partner unworthy of love in principle

    Some researchers believe that these types are not mutually exclusive, but can change depending on the circumstances of a person's life. For example, there was a successful period at work: a person exceeded KPI and received praise from his superiors. At this point, he will be inclined to idealize himself, to feel his own exclusivity and superiority, life will seem beautiful. A week later, the partner shares that some aspect of the relationship does not suit him. From the grandiose pole, a person with narcissism can fall into the other extreme: to feel like a disgusting partner, unworthy of love in principle. And at the same time devalue all previous achievements. In this state, a person may impulsively propose a breakup or show aggression, trying to avoid corrosive shame.

    And if the narcissistic disorder is accompanied by features of sociopathy (indifference, aggressiveness, disregard for social norms), one can speak of perverse narcissism. It is this type that is prone to emotional violence and even crime due to a lack of empathy. Perverted narcissists are people who prove their worth and value through the humiliation of others. It is extremely difficult for them to build a healthy relationship, as they are not able to empathize, lie, manipulate and overly control their partner. This type rarely turns to a psychotherapist, and it is difficult for him to stay in therapy.

    Narcissism in men and women

    Scientists at the Buffalo Institute reviewed studies of narcissistic personality disorder published over the past 30 years and found that it is more common in men and manifests itself somewhat differently than in women.

    First, men are more likely to exploit others and feel entitled to have privileges. Secondly, they show more desire for power and leadership. But in the manifestations of vanity and egocentrism, there was no particular difference. Scientists suggest that such results may be the result of a certain gender socialization - that is, the attitudes broadcast by society about what men and women can and cannot be.

    Because women are often criticized for being aggressive and authoritarian, they can suppress these narcissistic traits while men do not have to. But the authors note that this topic requires further study.

    Causes of narcissism

    There are different concepts as to why people develop narcissism. The conducted studies have not proved an unambiguous connection with genetics, so the sociocultural concept remains the main one.

    Representatives of psychoanalysis paid a lot of attention to the nature of narcissism. For example, Sigmund Freud and Heinz Kohut were of the opinion that at a certain stage in the development of a child, the emergence of narcissism is a natural and healthy phenomenon - this is called primary narcissism. In infancy, the child has no other needs than his own, and he does not have to make any effort to satisfy them. In fact, he is the center of his own universe. This is a normal developmental stage that everyone goes through.

    However, certain circumstances can lead to secondary narcissism - that is, its unhealthy form. Such a circumstance could be a lack of parental love and acceptance. Moreover, the child did not necessarily encounter excessive severity, cruelty or indifference. It is quite possible that his parents, on the contrary, praised him for any reason and did not forbid anything. Child idealization and permissiveness can also be perceived as dislike and cause secondary narcissism, according to Karen Horney. When only the positive side is seen in a child, ignoring the existence of negative traits, he feels unseen. As if they love not him, but some other person, an image. In both cases, the defensive reaction is the creation of an imaginary ideal "I", designed to deserve the love and attention of others.

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    Psychoanalyst Andre Green considers another reason in his article "Dead Mother". He talks about a situation in which the mother was physically alive, but was emotionally unavailable and absent due to depression. For this reason, the child did not receive love, care, support in the proper amount. The researcher believed that the mother's depression becomes a trauma for the child, since the baby, up to a certain age, sees in himself the cause of everything that happens around him and, among other things, blames himself for his mother's condition.

    Lack of communication and warmth leads to the fact that the child tries to "bring the mother back to life", changing behavior, attracting attention. Failures give rise to tremendous anxiety and a feeling of a bottomless hole inside. Over time, the baby begins to feel the emptiness, which he will later try to fill: with achievements, attention, other people. In this case, those around him can become his narcissistic extension - like an extension of his personality, an attribute to maintain status and high self-esteem. Other consequences are the replacement of emotions with reasoning, a tendency to depression, aggressiveness, the inability to let someone in, to accept and experience love, to build warm trusting relationships.

    Narcissistic trauma

    Trauma associated with the narcissistic part of the personality can occur not only in childhood. According to Freud, a narcissistic injury is a situation in which the narcissist feels that his hidden true self has been discovered. Its imperfection is revealed. For example, if he faced failure or his authority was called into question. Narcissistic trauma can lead to depression or what is known as narcissistic rage, an attempt to regain control and avenge the pain.

    Treatment of narcissism

    Both narcissistic personality disorder and narcissism in the broadest sense are generally amenable to psychotherapy. It's not exactly a "treatment" in the medical sense of the word. Rather, the process of knowing, accepting and adapting to the characteristics of one's personality.

    For therapy to be effective, the person must be interested in it. In many cases, the benefits of narcissistic character traits and the difficulty in recognizing one's own imperfection lead to the fact that a person is not too willing to change something in his life and turn to a psychotherapist. And in a situation where we are talking simply about character traits that do not interfere with the person himself and do not harm others, the therapy of narcissism is, in principle, not needed.

    If you feel bad in a relationship, then whether the person is a narcissist or not, it makes sense to think about parting. Working with the deep structures of personality requires a lot of effort and time. But at the same time, the very arrival of psychotherapy already has a positive effect. The therapeutic relationship is built on trust, acceptance, and recognition of the person in all of his manifestations, and this is exactly the kind of experience that people with narcissistic disorder or pronounced narcissism practically do not have.

    Together with the client, the therapist looks for points of support and support. The psychologist is able to endure regular cycles of idealization and devaluation, which allows the relationship to last. Teaches the client to see himself, not to fall into one of the poles of adoration and hatred, to endure his fears, doubts, vulnerability, envy and a constant sense of shame. See the value of other people in isolation from himself and, if necessary, control his aggression.

    Having received the experience of warm acceptance of different aspects of his personality in therapy, a person with narcissism learns to apply this experience in everyday life, to build relationships with the world and himself in a new way.

    How to communicate with a person if you suspect narcissism or NPD

    There are two main principles to follow: focus on how you feel in contact with this person, and not try to save him. In general, these rules can be applied to any relationship, regardless of the type of person.

    It is not so important to recognize how pronounced narcissism is, but to pay attention to the quality of your relationship:

    • whether there is disrespect, manipulation, aggression or violence
    • Does your self-esteem suffer? No, it makes sense to think about parting. In the case of an abusive relationship without outside support, this can be very difficult. Psychotherapy can help you find a resource for ending a relationship, as well as understanding the reasons why you ended up and stayed in it so that the scenario does not repeat itself in the future.

      If it seems to you that a person has strong narcissistic inclinations, but at the same time the relationships themselves are built on mutual respect, warmth and sincerity, there is no violence in them in any form, then you should not break off contact just because the person is a “narcissist”.

      Narcissistic Personality Disorder | NRL

      Introduction

      Narcissism is a character trait characterized by an excessive sense of self-importance and self-esteem. Narcissistic personality disorder is a serious illness.

      It is commonly believed that narcissists are narcissists and self-satisfied people. That they have an inflated conceit, they think only of themselves and live for their own pleasure. In fact, the life of a narcissist can be deeply unhappy.

      picture from vk.com

      Ordinary narcissism

      Narcissism one way or another exists in each of us. This is the property of character that is responsible for ambition, competitiveness and the desire to be successful. For people with healthy narcissism, high goals and self-respect are important, which they protect in every possible way.

      Diagnosing yourself by articles is a bad idea. It is better to go to psychotherapy and just solve the disturbing problems. If you are interested, but for some reason it breaks making an appointment with a psychologist, check out this free onboarding course. There are answers to all questions and useful additional materials.

      Healthy narcissistic people often take leadership positions and create ambitious projects. They seek positive feedback, so they often check in on their goals and progress with others. Such people are adapted to modern life no worse, and even better than many.

      Narcissistic Personality Disorder (NPD)

      When a person is unable to control his need for admiration, we can talk about Narcissistic Personality Disorder . There are difficulties at work, in relationships with other people and with oneself. Painful narcissism makes it difficult to adequately evaluate yourself and your achievements. The narcissist pathologically needs the approval of others.

      NRL manifests itself in different ways. In its mild form, it creates difficulties only in some areas of life and does not affect others. In a more complex case, the number of problem areas increases. Here, a clear symptom would be narcissistic depression caused by a lack of positive feedback. Not getting the approval they want, the narcissist begins to feel miserable, unworthy, and vulnerable.

      When narcissistic disorder is severe, it seriously affects the quality of life. Relationships with people turn into endless scandals, it is impossible to stay at work. Also characteristic signs will be aggression directed not only at others, but also at oneself.

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      Posted by Your Personal Psychologist Online (@zigmund.online)

      Signs of Narcissistic Disorder

      In Russia, there is no such diagnosis as narcissistic personality disorder. However, it is in the American DSM-5 mental disorder rating system.

      Here are its key features:

      1. Grandiose conceit;
      2. Preoccupation with fantasies of unlimited success, power, splendor, beauty, or ideal love;
      3. Belief in one's "exclusivity", belief that one should be friends and can be understood only by one's own kind - "exceptional" or high-ranking people;
      4. In need of excessive praise;
      5. Feels that he has some special rights;
      6. Uses others to achieve own goals;
      7. Does not know how to sympathize;
      8. Often jealous of others and believes that others envy him;
      9. Demonstrates arrogant, haughty behavior or attitude.

      It is common for a person with NPD to either idealize or devalue people. Today you are the best person in the world for them, and tomorrow, apart from shortcomings, there is nothing in you. All conversations the narcissist tries to translate into himself. You start a story about your situation, which is interrupted by the phrase: "Yeah, but I have ..."

      1359

      Everyone needs to feel sincere sympathy and good attitude towards oneself. But with those who have too much attention to themselves, who constantly demand it from us, absolutely not interested in our affairs and feelings, it is very difficult to communicate. Take the test and find out if you can be called a narcissist.

      1 / 11

      Do you think you can influence other people?

      Extremely rare

      Sometimes

      Yes, I can be charismatic when I need it

      Yes, it's hard for me to refuse

      2 / 11

      Are you a modest person who is not used to showing off his achievements?

      Yes, absolutely possible

      Yes, possible, but not always

      Not possible. But I'm not exaggerating

      No, I don't think that modesty is good

      3 / 11

      Do compliments addressed to you bother you?

      Yes, always

      Sometimes

      No, I'm pleased

      What's the matter! I ask for them myself

      4 / 11

      Would you make a good leader?

      Hardly: even the very prospect frightens me

      I would not say

      I think so

      Of course

      5 / 11

      Do you consider yourself better than others?

      No, I'm just like everyone else

      When it's better when it's not

      In general, I'm better

      I'm special

      6 / 11

      You get annoyed when you go out in public and almost no attention is paid to you ?

      No, on the contrary

      Sometimes

      Yes, annoying

      How! I'm used to having everyone's attention on me

      7 / 11

      Do you feel like a respected person?

      Just a little

      Enough

      Yes, almost always

      Of course, I am highly appreciated

      8 / 11

      How does it feel to be the center of attention?

      Desire to sink into the ground

      Most often, awkwardness. Although it depends on the situation

      Feel at ease

      Finally!

      9 / 11

      Do you consider yourself a charismatic person?

      No

      Rarely

      Often

      Of course I am charismatic

      10 / 11

      Would you be able to manipulate others to achieve your own goals?

      No, I couldn't

      Unlikely

      Yes, but only if there is no other way

      Of course. I don't see anything wrong with this

      11 / 11

      Are you satisfied with your appearance?

      No

      when, like

      as a whole yes

      Yes, so I like to spin at the mirror

      Your rating

      How they become narcissists

      NARCISS grow in families where parents show love for the child only if it corresponds to them only if it corresponds to them expectations. Measuring his personality by external merit is a sure way to grow a narcissist. Moreover, the demands of parents can be based on their own neuroses. Trying to live up to expectations, the child will learn to constantly strain and forbid himself everything that, as it seems to him, will not lead to approval.

      There is another parenting model that makes people narcissists. This is a situation in which the needs of the child are met instantly in the family. Then, as an adult, he will continue to demand this from those around him. Such children are sure that everyone owes them, and the word "no" does not exist. They have not developed the skill of orienting themselves in their own desires. These narcissists want everything at once, so they can never be completely satisfied.

      Relationship with a narcissist

      It is impossible to build an emotional and respectful relationship with a narcissist in severe NPD. For these people, a partner will be just another way to achieve universal admiration.

      picture from vk.com

      Narcissists tend to idealize just as much as they tend to devalue. They are masters of manipulation. At first, in order to drag you into their networks, the narcissist will praise and exalt you in every possible way. This is done so that you, succumbing to the spell, take on the responsibility of serving his life.

      If you don't live up to the narcissist's expectations, don't devote yourself to meeting his needs, he will explode. All your merits will be subject to total depreciation. The narcissist will begin to shame and humiliate you so that you understand "where you belong". In relationships with such people, you will often feel shame, contrary to your own sense of self.

      Psychotherapy for narcissistic disorder

      Most people with narcissistic disorder do not want to go to psychotherapy. They are sure that they have no problems with the perception of reality. Problems may be with other people who do not understand how lucky they are to meet a narcissist.

      If narcissists do get into psychotherapy, it is only after a serious external crisis. There must be a blow in their life like a painful divorce or a layoff. In order to make the decision to enter psychotherapy, the narcissist must clearly understand that his usual methods of living among people no longer work.

      The American psychoanalyst Heinz Kohut believed that the only way to help the narcissist was to show empathy. Some narcissists, when treated with attention and care, slowly begin to open up and respond to empathy with gratitude.

      In general, practice shows that psychotherapy can greatly improve the life of the narcissist and his environment. It will affect his habits, for example, the habit of devaluing a partner. It will help the narcissist learn to track their states and reactions, deal with them in an environmentally friendly way. Can psychotherapy completely rid a person of narcissistic personality disorder? For now, it remains questionable.

      These films will help you understand the topic

      Dorian Gray

      Dorian Gray

      Young and incredibly handsome Dorian Gray arrives in London and falls under the influence of the adventurer Lord Wotton. He inspired the young man that the secret of Dorian's success and happiness is in his beauty, because it will help to get all the pleasures of the world. Dorian makes a deal with the Devil. A young man commissions his portrait, and now all the dirt of his life, full of debauchery and criminal passions, will stain and spoil the canvas, while his own face will remain forever young and beautiful.

      Kinopoisk 6.8
      IMDb 6.3


      The story told by Wilde goes back to the old legends about selling the soul to the devil. In it, two ideas can be distinguished that are closely intertwined: the idea of ​​beauty and youth as the main value and the idea of ​​finding pleasure as the meaning of life. Dorian wants to be forever young, not only because he is in love with his face, like Narcissus, but also because beauty opens the way for him to any pleasure.

      Still from the film "Dorian Gray" kinopoisk.ru

      Both ideas are still relevant more than a hundred years after the novel was written. People all over the world spend millions of dollars to look younger, and plastic surgery to eliminate wrinkles is done not only by movie stars and fashion models, but also by politicians. We live in a consumer society obsessed with the cult of beauty, and this makes the story of Dorian Gray very modern. That is why Parker turned to her, making his additions to the plot.

      Learn more