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Narcissistic personality disorder

March 23, 2023

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, 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.[1][2] It is often comorbid with other mental disorders and associated with significant functional impairment and psychosocial disability.[1]

Narcissistic personality disorder
SpecialtyPsychiatry, Clinical psychology
SymptomsExaggerated feelings of self-importance, excessive craving for admiration, reduced levels of empathy[1][2]
Usual onsetEarly adulthood[2]
DurationLong term[2]
CausesUnknown[3]
Differential diagnosisBipolar Disorder, Antisocial Personality Disorder, Substance Abuse, Borderline Personality Disorder, Histrionic Personality Disorder[1]
TreatmentPsychotherapy, pharmaceuticals for comorbid disorders[1]
Frequency0.5%citations

Personality disorders are a class of mental disorders characterized by enduring and inflexible maladaptive 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.[4][5][6] Criteria for diagnosing personality disorders are listed in the sixth chapter of the International Classification of Diseases (ICD) and in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).

There is no standard treatment for NPD.[7][8] Its high comorbidity with other mental disorders influences treatment choice and outcomes.[7] Psychotherapeutic treatments generally fall into two categories: psychoanalytic/psychodynamic and cognitive behavioral therapy, with growing support for integration of both in therapy.[9][10] However, there is an almost complete lack of studies determining the effectiveness of treatments.[8]

Signs and symptoms

DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) describes NPD as possessing at least five of the following nine criteria.[2]

  • 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 (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.[2] Individuals with cluster B personality disorders often appear dramatic, emotional, or erratic.[2] 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.[1][2]

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.[1]

Narcissistic personality disorder usually develops either in youth or in early adulthood.[2] 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.[2]

ICD-11 and ICD-10

See also: Personality disorder § ICD-11

In the International Statistical Classification of Diseases and Related Health Problems, 11th Edition ICD-11 of the World Health Organization (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. Once a diagnosis has been made, the clinician then can draw upon five trait domains to describe the particular causes of dysfunction, as these have major implications for potential treatments.[11] NPD, as it currently conceptualised, would correspond more or less entirely to the ICD-11 trait of Dissociality, which includes self-centredness (grandiosity, attention-seeking, entitlement and egocentricity) and lack of empathy (callousness, ruthlessness, manipulativeness, interpersonal exploitativeness, and hostility).[11][12]

In the previous edition, the ICD-10, narcissistic personality disorder (NPD) is listed under the category of "other specific personality disorders", meaning 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.[13]

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[14] or to become impatient and disdainful when other persons talk about themselves.[2] This behavior correlates to an overall worse functioning in areas of life like work and intimate romantic relationships.[15][16][17][18]

People with NPD have been observed to use psychosocial 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.[19] Narcissistic personalities are more likely to respond with anger or aggressiveness when presented with rejection.[20][21][22] Some patients with NPD (see Subtypes) respond to (real or imagined) criticism or defeat with prone to feelings of shame, humiliation, and worthlessness,[14] and usually mask such feelings from people, by feigning humility, responding with outbursts of rage and defiance, or seeking revenge.[2][23]

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."[2] Given the high-function sociability associated with narcissism, some people with NPD might not view such a diagnosis as a functional impairment to their lives.[24] 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.[2][23] 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.[25]

Differential diagnosis

The occurrence of narcissistic personality disorder presents a high rate of comorbidity with other mental disorders.[26] People with a fragile variant of NPD (see Subtypes) are prone to bouts of psychological depression, often to the degree that meets the clinical criteria for a co-occurring depressive disorder.[27] NPD is associated with the occurrence of bipolar disorder and substance use disorders,[1][23] especially cocaine use disorder.[2] 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.[2] NPD should also be differentiated from mania and hypomania as these cases can also present with grandiosity, but present with different levels of functional impairment.[2] 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.[14]

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.[1][28][29] 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.[9][28] However, none of the subtypes of NPD are recognized in the DSM-5 or in the ICD-11.

Empirically-verified subtypes

Some research has indicated the existence of three subtypes of NPD,[30] which can be distinguished by symptom criteria, comorbidity and other clinical criteria. These are as follows:

Grandiose/Malignant: the group exhibits grandiosity, entitlement, interpersonal exploitativeness and manipulation, pursuit of power and control, lack of empathy and remorse, and marked irritability and hostility. This group was noted for high levels of comorbid antisocial and paranoid personality disorders, substance abuse, externalizing, unemployment and greater likelihood of violence.[30][31] Of note, Russ et al. observed that this group "do not appear to suffer from underlying feelings of inadequacy or to be prone to negative affect states other than anger", an observation corroborated by recent research which found this variant to show strong inverse associations with depressive, anxious-avoidant, and dependant/victimised features.[31]

Fragile/Covert: this variant is defined by feelings of shame, envy, resentment, and inferiority (which is occasionally "masked" by arrogance), entitlement, a belief that one is misunderstood or unappreciated, and excessive reactivity to slights or criticism. This variant is associated with elevated levels of psychological distress and comorbid depression, anxiety, and avoidant, borderline and dependent personality disorders.[30][31]

High-Functioning/Exhibitionistic: this variant has been described as "high functioning narcissists [who] were grandiose, competitive, attention-seeking, and sexually provocative; they tended to show adaptive functioning and utilize their narcissistic traits to succeed."[28] This group has been found to have relatively few psychological issues and high rates of obsessive-compulsive personality disorder, with excessive perfectionism posited as a potential cause for their impairment.[30]

Others

Communal Narcissism

A fourth 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.[32][33]

Millon's Taxonomy

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.[6]

Subtype Features
Unprincipled Narcissist Deficient conscience; unscrupulous, amoral, disloyal, fraudulent, deceptive, arrogant, exploitive; a con artist and charlatan; dominating, contemptuous, vindictive.
Amorous narcissist Sexually seductive, enticing, beguiling, tantalizing; glib and clever; disinclined to real intimacy; indulges hedonistic desires; bewitches and inveigles others; pathological lying and swindling. Tends to have many affairs, often with exotic partners.
Compensatory narcissist Seeks to counteract or cancel out deep feelings of inferiority and lack of self-esteem; offsets deficits by creating illusions of being superior, exceptional, admirable, noteworthy; self-worth results from self-enhancement.
Elitist narcissist Feels privileged and empowered by virtue of special childhood status and pseudo-achievements; entitled façade bears little relation to reality; seeks favored and good life; is upwardly mobile; cultivates special status and advantages by association.
Normal narcissist Least severe and most interpersonally concerned and empathetic, still entitled and deficient in reciprocity; bold in environments, self-confident, competitive, seeks high targets, feels unique; talent in leadership positions; expecting recognition from others.

Historical demarcation of grandiose and vulnerable types

Over the years, many clinicians and theorists have described two variants of NPD akin to the grandiose and vulnerable expressions of trait narcissism. Some examples include:[34]

Grandiose Phenotype Vulnerable Types
Kohut & Wolf (1978) Mirror-hungry Ideal-hungry
Broucek (1982) Egotistical Dissociative
Rosenfeld (1987) Thick-skinned Thin-skinned
Gabbard (1989, 1998, 2009) Oblivious Hypervigilent
Gersten (1991) Overly grandiose Overly vulnerable
Wink (1992) Willful Hypersensitive
Masterson (1993) Exhibitionist Closet
Fiscalini (1993) Special child Shamed child
Cooper and Maxwell (1995) Empowered Disempowered

Assessment and screening

Narcissistic Personality Inventory

Main article: Narcissistic Personality Inventory

Risk factors for NPD and grandiose/overt and vulnerable/covert subtypes are measured using the narcissistic personality inventory, an assessment tool originally developed in 1979, has undergone multiple iterations with new versions in 1984, 2006 and 2014. It captures principally grandiose narcissism, but also seems to capture elements of vulnerability. A popular three-factor model has it that grandiose narcissism is assessed via the Leadership/Authority and Grandiose/Exhibitionism facets, while a combination of grandiose and vulnerable traits are indexed by the Entitlement/Exploitativeness facet.[35]

Pathological Narcissism Inventory

The Pathological Narcissism Inventory (PNI) was designed to measure fluctuations in grandiose and vulnerable narcissistic states, similar to what is ostensibly observed by some clinicians (though empirical demonstration of this phenomenon is lacking). While having both "grandiosity" and vulnerability scales, empirically both seem to primarily capture vulnerable narcissism. [35][36]

The PNI scales show significant associations with parasuicidal behavior, suicide attempts, homicidal ideation, and several aspects of psychotherapy utilization.[37]

Five-Factor Narcissism Inventory

The Five-Factor Narcissism Inventory (FFNI) was defined as a comprehensive assay of grandiose and vulnerable expressions of trait narcissism. The scale measures 11 traits of grandiose narcissism and 4 traits of vulnerable narcissism, both of which correlate with clinical ratings of NPD (with grandiose features of arrogance, grandiose fantasies, manipulativeness, entitlement and exploitativeness showing stronger relations).[38] Later analysis revealed that the FFNI actually measures three factors:[39]

  1. Agentic Extraversion: an exaggerated sense of self-importance, grandiose fantasies, striving for greatness and acclaim, social dominance and authoritativeness, and exhibitionistic, charming interpersonal conduct.
  2. Self-Centred Antagonism: disdain for others, psychological entitlement, interpersonally exploitative and manipulative behaviour, lack of empathy, anger in response to criticism or rebuke, suspiciousness, and thrill-seeking.
  3. Narcissistic Neuroticism: shame-proneness, oversensitivity and negative emotionality to criticism and rebuke, and excessive need for admiration to maintain self-esteem.

Grandiose narcissism is a combination of agency and antagonism, and vulnerability is a combination of antagonism and neuroticism. The three factors show differential associations with clinically important variables. Agentic traits are associated with high self-esteem, positive view others and the future, autonomous and authentic living, commitment to personal growth, sense of purpose in life and life satisfaction. Neurotic traits show precisely the opposite correlation with all of these variables, while antagonistic traits show more complex associations; they are associated with negative view of others (but necessarily of the self), a sense of alienation from their 'true self', disinterest in personal growth, negative relationships with others, and all forms of aggression.[39][40]

Millon Clinical Multiaxial Inventory

Main article: 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.[41] 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.[42]

A 2020 study found that females scored significantly higher on vulnerable narcissism than males, but no gender differences were found for grandiose narcissism.[43]

Causes

Although there are no specific causes for NPD, it is described using the biopsychosocial model which describes a combination of risk factors from biological, psychological and socio-environmental factors.[7][44] This includes but is not limited to genetics, neurobiology, 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.[44][26][45][46] A number of twin studies historically suggested for the heritability of NPD, including personality disorders in general.[47][48][49]

Environment

Environmental and social factors also influence development of NPD.[26] In some people, vulnerable narcissism (or fragile/covert NPD) may develop from an impaired emotional attachment to primary caregivers (usually parents).[50] 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.[51] While very little is known about the origins of grandiose narcissism (or its concomitant subtypes of NPD), there it is often suggested that overindulgent, permissive parenting or insensitive and over-controlling parenting are risk factors towards the development of NPD in a child.[14][27]

In Gabbard's Treatments of Psychiatric Disorders (2014), the following factors are identified as promoting the development of narcissistic personality disorder:[52]

  • 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 or sexual abuse in childhood
  • Unpredictable or unreliable parental caregiving
  • Learning the behaviors of psychological manipulation from parents or peers[53]

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 societies.[26]

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 in the left, anterior insular cortex.[54][55] The results of a 2015 study associated the condition of NPD with a reduced volume of gray matter in the prefrontal cortex.[56] The regions of the brain identified and studied – the insular cortex and the prefrontal cortex – are associated with the human emotions of empathy 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.[57]

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.[9][58] Psychotherapeutic treatment falls into two general categories: psychoanalytic/psychodynamic 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.[10] The specific choice of treatment varies based on individual presentations.[59]

Management of narcissistic personality disorder has not been well studied, however many treatments tailored to NPD exist.[8][1] 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.[60][61][62][63][64] People with NPD often present with comorbid mental disorders, complicating diagnosis and treatment.[1] 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, a substance use disorder (drug addiction), or bipolar disorder.[23]

Prognosis

As of 2020, no treatment guidelines exist for NPD and no empirical studies have been conducted on specific NPD groups to determine efficacy for psychotherapies and pharmacology.[8][9]

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.[1]

Epidemiology

As of 2018, overall prevalence is estimated to range from 0.8% to 6.2%.[65][66] 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,[67] with a 2015 study confirming the gender difference.[68] In clinical settings, prevalence estimates range from 1% to 15%.[7][3] The occurrence of narcissistic personality disorder presents a high rate of comorbidity with other mental disorders.[26]

History

The term "narcissism" comes from a first century (written in the year 8 AD) book by the Roman poet Ovid. Metamorphoses Book III is a myth about two main characters, Narcissus and Echo. 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.[69]

The concept of excessive selfishness 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:[70]

  • Havelock Ellis (1898) was the first psychologist to use the term when he linked the myth to the condition in one of his patients.[70]
  • Sigmund Freud (1905-1953) used the terms "narcissistic libido" in his Three Essays on the Theory of Sexuality.[71][70]
  • Ernest Jones (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 sexually. 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.[72] The term narcissistic personality disorder (NPD) was coined by Heinz Kohut in 1968.[73][74] Waelder's initial study has been influential in the way narcissism and the clinical disorder Narcissistic personality disorder are defined today[75]

Freudianism and psychoanalysis

Much early history of narcissism and NPD originates from psychoanalysis. Regarding the adult neurotic's sense of omnipotence, Sigmund Freud said that "this belief is a frank acknowledgement of a relic of the old megalomania of infancy";[76] 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."[77]

Narcissistic injury and narcissistic scar are terms used by Freud in the 1920s. Narcissistic wound and narcissistic blow are other, almost interchangeable, terms.[78] 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;[14] but typically, the actions and responses of the NPD person are deliberate and calculated.[2] Despite occasional flare-ups of personal insecurity, the inflated self-concept of the NPD person is primarily stable.[2]

In The Psychology of Gambling (1957), Edmund Bergler considered megalomania to be a normal occurrence in the psychology of a child,[79] a condition later reactivated in adult life, if the individual takes up gambling.[80] 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.[81]

Narcissistic supply

Narcissistic supply was a concept introduced by Otto Fenichel in 1938, to describe a type of admiration, interpersonal support, or sustenance drawn by an individual from his or her environment and essential to their self-esteem.[82] 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.[83]

Narcissistic rage

The term narcissistic rage was a concept introduced by Heinz Kohut 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.[84]

Narcissistic rage reactions are not necessarily limited to narcissistic personality disorder. They may also be seen in catatonic, paranoid delusion, and depressive episodes.[84] 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.[85]

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.[86] This Kleinian therapeutic approach built upon Heinz Kohut's view of narcissistic megalomania as an aspect of normal mental development, by contrast with Otto Kernberg's consideration of such grandiosity as a pathological distortion of normal psychological development.[87]

To the extent that people are pathologically narcissistic, the person with NPD can be a self-absorbed individual who passes blame by psychological projection 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.[citation needed] 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.[88]

Comparison to other personality disorders

NPD shares properties with borderline personality disorder, including social stigma, 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."[89]

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.[90]

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, who led the DSM personality disorders committee for the 4th edition of the manual.[91]

The American Psychiatric Association'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.[24]

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.[92][93] 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.[94] 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.[95] 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."[96] 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.[97]

In popular culture

  • Suzanne Stone-Maretto, Nicole Kidman's character in the film To Die For (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".[98]
  • Jay Gatsby, the eponymous character of F. Scott Fitzgerald's novel The Great Gatsby (1925), "an archetype of self-made American men seeking to join high society", 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.[99]

See also

References

  1. ^ a b c d e f g h i j k l Caligor, Eve; Levy, Kenneth N.; Yeomans, Frank E. (May 2015). "Narcissistic personality disorder: diagnostic and clinical challenges". The American Journal of Psychiatry. 172 (5): 415–22. doi:10.1176/appi.ajp.2014.14060723. ISSN 1535-7228. PMID 25930131.
  2. ^ a b c d e f g h i j k l m n o p q r s Diagnostic and statistical manual of mental disorders : DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association. 2013. pp. 72–669. ISBN 978-0890425541. OCLC 830807378.
  3. ^ a b Sederer, Lloyd I. (2009). Blueprints Psychiatry (Fifth ed.). Philadelphia, Pennsylvania: Wolters Kluwer/Lippincott Williams & Wilkins. p. 29. ISBN 978-0781782531. from the original on 11 January 2017 – via Google Books.
  4. ^ Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, Virginia: American Psychiatric Association. 2013. pp. 646–49. ISBN 978-0-89042-555-8.
  5. ^ Berríos, Germán Elías (1993). "European views on personality disorders: a conceptual history". Comprehensive Psychiatry. Philadelphia, Pennsylvania: W.B. Saunders Ltd. 34 (1): 14–30. doi:10.1016/0010-440X(93)90031-X. PMID 8425387.
  6. ^ a b Theodore Millon; Roger D. Davis (1996). Disorders of Personality: DSM-IV and Beyond. New York City: John Wiley & Sons, Inc. p. 226. ISBN 978-0-471-01186-6.
  7. ^ a b c d Mitra, Paroma; Fluyau, Dimy (2022), "Narcissistic Personality Disorder", StatPearls, Treasure Island, Florida: StatPearls Publishing, PMID 32310461, retrieved 1 May 2022
  8. ^ a b c d King, Ross M.; Grenyer, Brin F.S.; Gurtman, Clint G.; Younan, Rita (1 March 2020). "A clinician's quick guide to evidence‐based approaches: Narcissistic personality disorder". Clinical Psychologist. Melbourne, Australia: Australian Psychological Society. 24 (1): 91–95. doi:10.1111/cp.12214. hdl:10536/DRO/DU:30136767. ISSN 1328-4207. S2CID 216198008.
  9. ^ a b c d Yakeley, Jessica (5 July 2018). "Current understanding of narcissism and narcissistic personality disorder". BJPsych Advances. 24 (5): 305–315. doi:10.1192/bja.2018.20. ISSN 2056-4678. S2CID 148566892.
  10. ^ a b Weinberg, Igor; Ronningstam, Elsa (March 2020). "Dos and Don'ts in Treatments of Patients With Narcissistic Personality Disorder". Journal of Personality Disorders. New York City: Guilford Press. 34 (Supplement): 122–142. doi:10.1521/pedi.2020.34.supp.122. ISSN 0885-579X. PMID 32186986. S2CID 214583609.
  11. ^ a b Bach, B., & First, M. B. (2018). Application of the ICD-11 classification of personality disorders. BMC psychiatry, 18, 1-14.
  12. ^ Bach, B., Kramer, U., Doering, S., di Giacomo, E., Hutsebaut, J., Kaera, A., ... & Renneberg, B. (2022). The ICD-11 classification of personality disorders: a European perspective on challenges and opportunities. Borderline Personality Disorder and Emotion Dysregulation, 9(1), 1-11.
  13. ^ WHO (2010) ICD-10: Specific Personality Disorders
  14. ^ a b c d e "Narcissistic personality disorder – Symptoms & causes". Mayo Clinic. Phoenix, Arizona: Mayo Foundation for Medical Education and Research. 18 November 2017. Retrieved 28 June 2018.
  15. ^ Gewirtz-Meydan, Ateret; Finzi-Dottan, Ricky (3 April 2018). "Narcissism and Relationship Satisfaction from a Dyadic Perspective: The Mediating Role of Psychological Aggression". Marriage & Family Review. 54 (3): 296–312. doi:10.1080/01494929.2017.1359814. ISSN 0149-4929. S2CID 148631814.
  16. ^ Cramer, Phebe (October 2010). "Narcissism through the ages: What happens when narcissists grow older?". Journal of Research in Personality. 45 (5): 479–92. doi:10.1016/j.jrp.2011.06.003.
  17. ^ Mathieu, Cynthia (October 2013). "Personality and job satisfaction: The role of narcissism". Personality and Individual Differences. 55 (6): 650–54. doi:10.1016/j.paid.2013.05.012.
  18. ^ Ellison, William D.; Acuff, M. Chase; Kealy, David; Joyce, Anthony S.; Ogrodniczuk, John S. (September 2020). "Narcissism and Quality of Life: The Mediating Role of Relationship Patterns". Journal of Nervous & Mental Disease. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins. 208 (8): 613–18. doi:10.1097/NMD.0000000000001170. ISSN 1539-736X. PMID 32229790. S2CID 213949270.
  19. ^ Ronningstam, Elsa (2005). Identifying and understanding the narcissistic personality. New York City: Oxford University Press. pp. 22–27. ISBN 978-0198033967. OCLC 61329826.
  20. ^ Ellison, William D.; Acuff, M. Chase; Kealy, David; Joyce, Anthony S.; Ogrodniczuk, John S. (31 March 2020). "Narcissism and Quality of Life". Journal of Nervous & Mental Disease. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins. 208 (8): 613–618. doi:10.1097/nmd.0000000000001170. ISSN 1539-736X. PMID 32229790. S2CID 213949270.
  21. ^ Gewirtz-Meydan A, Finzi-Dottan R (2018) "Narcissism and relationship satisfaction from a dyadic perspective: The mediating role of psychological aggression". Marriage Fam Rev. 54:296–312.
  22. ^ Barry CT, Kauten RL (2014) "Nonpathological and pathological narcissism: Which self-reported characteristics are most problematic in adolescents?" J Pers Assess. 96:212–19
  23. ^ a b c d Ronningstam, Elsa (2016). "New Insights into Narcissistic Personality Disorder". Psychiatric Times. New York City: MJH Associates. 33 (2): 11.
  24. ^ a b Ronningstam, Elsa (February 2010). "Narcissistic personality disorder: a current review". Current Psychiatry Reports. 12 (1): 68–75. doi:10.1007/s11920-009-0084-z. ISSN 1535-1645. PMID 20425313. S2CID 19473736.
  25. ^ Golomb, Elan (1992). Trapped in the Mirror: Adult Children of Narcissists in Their Struggle For Self (1st ed.). New York: W. W. Morrow. ISBN 0688094716. OCLC 23143624.[page needed]
  26. ^ a b c d e Paris, Joel (April 2014). "Modernity and narcissistic personality disorder". Personality Disorders. 5 (2): 220–26. doi:10.1037/a0028580. ISSN 1949-2723. PMID 22800179.
  27. ^ a b "Narcissistic personality disorder", MedlinePlus, U.S. National Library of Medicine, 8 July 2018
  28. ^ a b c Levy, Kenneth N (August 2012). "Subtypes, dimensions, levels, and mental states in narcissism and narcissistic personality disorder". Journal of Clinical Psychology. 68 (8): 886–97. doi:10.1002/jclp.21893. PMID 22740389.
  29. ^ Sedikides, Constantine (2021). "In Search of Narcissus". Trends in Cognitive Sciences. 25 (1): 67–80. doi:10.1016/j.tics.2020.10.010. PMID 33229145. S2CID 227063824.
  30. ^ a b c d Russ, Eric; Shedler, Jonathan; Bradley, Rebekah; Westen, Drew (November 2008). "Refining the Construct of Narcissistic Personality Disorder: Diagnostic Criteria and Subtypes". American Journal of Psychiatry. 165 (11): 1473–1481. doi:10.1176/appi.ajp.2008.07030376. ISSN 0002-953X. PMID 18708489.
  31. ^ a b c Tanzilli, Annalisa; Gualco, Ivan (March 2020). "Clinician Emotional Responses and Therapeutic Alliance When Treating Adolescent Patients With Narcissistic Personality Disorder Subtypes: A Clinically Meaningful Empirical Investigation". Journal of Personality Disorders. 34 (Supplement): 42–62. doi:10.1521/pedi.2020.34.supp.42. ISSN 0885-579X. PMID 32186983. S2CID 213186868.
  32. ^ Gebauer, J. E., Sedikides, C., Verplanken, B., & Maio, G. R. (2012). Communal narcissism. Journal of Personality and Social Psychology, 103, 854-878
  33. ^ Lancer, D. (March 6, 2021) "Know the Kind of Narcissist You're Dealing With and Symptoms," PsychologyToday.com
  34. ^ Pincus, A.L. & Roche, M.J. (2011). “Narcissistic Grandiosity and Narcissistic Vulnerability”. In Campbell, W.K. & Miller, J.D. (Ed.) The Handbook of Narcissism and Narcissistic Personality Disorder: Theoretical Approaches, Empirical Findings, and Treatments
  35. ^ a b Miller, J. D., Lynam, D. R., & Campbell, W. K. (2016). Measures of narcissism and their relations to DSM-5 pathological traits: A critical reappraisal. Assessment, 23(1), 3-9.
  36. ^ Miller, J. D., Lynam, D. R., & Campbell, W. K. (2016). Rejoinder: A construct validity approach to the assessment of narcissism. Assessment, 23(1), 18-22.
  37. ^ Pincus, AL; Ansell, EB; Pimentel, CA; Cain, NM; Wright, AGC; Levy, KN (September 2009). "Initial construction and validation of the Pathological Narcissism Inventory" (PDF). Psychological Assessment. Washington, D.C.: American Psychological Association. 21 (3): 365–79. doi:10.1037/a0016530. PMID 19719348. Retrieved 27 March 2020.
  38. ^ Miller, J. D., Few, L. R., Wilson, L., Gentile, B., Widiger, T. A., MacKillop, J., & Keith Campbell, W. (2013). The Five-Factor Narcissism Inventory (FFNI): a test of the convergent, discriminant, and incremental validity of FFNI scores in clinical and community samples. Psychological assessment, 25(3), 748.
  39. ^ a b Kaufman, S. B., Weiss, B., Miller, J. D., & Campbell, W. K. (2020). Clinical correlates of vulnerable and grandiose narcissism: a personality perspective. Journal of personality disorders, 34(1), 107-130.
  40. ^ Du, T. V., Miller, J. D., & Lynam, D. R. (2022). The relation between narcissism and aggression: A meta‐analysis. Journal of personality, 90(4), 574-594.
  41. ^ Auerbach JS (December 1984). "Validation of two scales for narcissistic personality disorder". Journal of Personality Assessment. Abingdon, England: Taylor & Francis. 48 (6): 649–53. doi:10.1207/s15327752jpa4806_13. PMID 6520692.
  42. ^ Foster, Joshua D.; Campbell, W. Keith (October 2007). "Are there such things as 'Narcissists'? A taxometric analysis of the Narcissistic Personality Inventory". Personality and Individual Differences. Amsterdam, Netherlands: Elsevier. 43 (6). doi:10.1016/j.paid.2007.04.003.
  43. ^ Green, Ava; MacLean, Rory; Charles, Kathy (1 December 2020). "Recollections of parenting styles in the development of narcissism: The role of gender". Personality and Individual Differences. Amsterdam, Netherlands: Elsevier. 167: 110246. doi:10.1016/j.paid.2020.110246. ISSN 0191-8869. S2CID 224958195.
  44. ^ a b Luo, Yu L. L.; Cai, Huajian (2018). "The Etiology of Narcissism: A Review of Behavioral Genetic Studies". Handbook of Trait Narcissism. New York City: Springer International Publishing. pp. 149–156. doi:10.1007/978-3-319-92171-6_16. ISBN 978-3-319-92170-9. Retrieved 2 May 2022.
  45. ^ Torgersen, Svenn; Myers, John; Reichborn-Kjennerud, Ted; Røysamb, Espen; Kubarych, Thomas S.; Kendler, Kenneth S. (17 September 2012). "The Heritability of Cluster B Personality Disorders Assessed Both by Personal Interview and Questionnaire". Journal of Personality Disorders. New York City: Guilford Press. 26 (6): 848–866. doi:10.1521/pedi_2012_26_060. ISSN 0885-579X. PMC 3606922. PMID 23281671.
  46. ^ Reichborn-Kjennerud, Ted (1 March 2010). "The Genetic Epidemiology of Personality Disorders". Dialogues in Clinical Neuroscience. Abingdon, England: Taylor & Francis. 12 (1): 103–14. doi:10.31887/DCNS.2010.12.1/trkjennerud. ISSN 1294-8322. PMC 3181941. PMID 20373672.
  47. ^ Livesley WJ, Jang KL, Jackson DN, Vernon PA (December 1993). "Genetic and environmental contributions to dimensions of personality disorder". Am J Psychiatry. 150 (12): 1826–31. doi:10.1176/ajp.150.12.1826. PMID 8238637.
  48. ^ Torgersen, S.; Lygren, S.; Oien, P. A.; Skre, I.; Onstad, S.; Edvardsen, J.; Tambs, K.; Kringlen, E. (November 2000). "A twin study of personality disorders". Comprehensive Psychiatry. 41 (6): 416–25. doi:10.1053/comp.2000.16560. ISSN 0010-440X. PMID 11086146.
  49. ^ Luo, Yu L. L.; Cai, Huajian; Song, Hairong (2 April 2014). García, Antonio Verdejo (ed.). "A Behavioral Genetic Study of Intrapersonal and Interpersonal Dimensions of Narcissism". PLOS ONE. 9 (4): e93403. doi:10.1371/journal.pone.0093403. ISSN 1932-6203. PMC 3973692. PMID 24695616.
  50. ^ Magid, Ken (1987). High Risk Children without a Conscience. New York City: Bantam Books. p. 67. ISBN 978-0553052909. Retrieved 17 November 2012.
  51. ^ Johnson, Stephen M. (1987). Humanizing the Narcissistic Style. New York City: W.W. Norton. p. 39. ISBN 978-0393700374. from the original on 4 July 2014. Retrieved 29 October 2013.
  52. ^ Gabbard, Glen O. (2014). Gabbard's treatments of psychiatric disorders (Fifth/DSM-5 ed.). Washington, D.C.: American Psychiatric Association. doi:10.1176/appi.books.9781585625048.gg72. ISBN 978-1585624423. OCLC 872383308.
  53. ^ Groopman, Leonard C.; Cooper, Arnold M. (2006). "Narcissistic Personality Disorder". Personality Disorders – Narcissistic Personality Disorder. Congers, New York: Armenian Medical Network. Retrieved 14 February 2007.
  54. ^ Schulze, Lars; Dziobek, Isabel; Vater, Aline; Heekeren, Hauke R.; Bajbouj, Malek; Renneberg, Babette; Heuser, Isabella; Roepke, Stefan (October 2013). "Gray matter abnormalities in patients with narcissistic personality disorder". Journal of Psychiatric Research. Amsterdam, Netherlands: Elsevier. 47 (10): 1363–69. doi:10.1016/j.jpsychires.2013.05.017. ISSN 1879-1379. PMID 23777939.
  55. ^ Pedersen, Traci (6 October 2015). "Narcissists' Lack of Empathy Tied to Less Gray Matter". PsychCentral. from the original on 24 April 2014. Retrieved 24 April 2014.
  56. ^ Nenadic, Igor; Güllmar, Daniel; Dietzek, Maren; Langbein, Kerstin; Steinke, Johanna; Gader, Christian (February 2015). "Brain Structure in Narcissistic Personality Disorder: A VBM and DTI Pilot Study". Psychiatry Research: Neuroimaging. Elsevier Ireland. 231 (2): 184–86. doi:10.1016/j.pscychresns.2014.11.001. PMID 25492857. S2CID 17073607.
  57. ^ Ronningstam, Elsa (19 January 2016). "Pathological Narcissism and Narcissistic Personality Disorder: Recent Research and Clinical Implications" (PDF). Current Behavioral Neuroscience Reports. 3 (1): 34–42. doi:10.1007/s40473-016-0060-y. S2CID 49575408. (PDF) from the original on 17 August 2018.
  58. ^ "Narcissistic personality disorder – Diagnosis and treatment". mayoclinic.org. 18 November 2017. Retrieved 28 June 2018.
  59. ^ Kramer, Ueli; Berthoud, Laurent; Keller, Sabine; Caspar, Franz (June 2014). "Motive-Oriented Psychotherapeutic Relationship Facing a Patient Presenting with Narcissistic Personality Disorder: A Case Study". Journal of Contemporary Psychotherapy. 44 (2): 71–82. doi:10.1007/s10879-013-9249-5. S2CID 9514109. Retrieved 25 April 2022.
  60. ^ Soyer, Renate B.; Rovenpor, Janet L.; Kopelman, Richard E.; Mullins, Lynn S.; Watson, P. J. (May 2001). "Further Assessment of the Construct Validity of Four Measures of Narcissism: Replication and Extension". The Journal of Psychology. 135 (3): 245–58. doi:10.1080/00223980109603695. ISSN 0022-3980. PMID 11577967. S2CID 31486515.
  61. ^ Morf, Carolyn C; Schürch, Eva; Küfner, Albrecht; Siegrist, Philip; Vater, Aline; Back, Mitja; Mestel, Robert; Schröder-Abé, Michela (2018). Expanding the nomological net of the pathological narcissism inventory German validation and extension in a clinical inpatient sample. OCLC 1236181501.
  62. ^ Egan, Vincent; Chan, Stephanie; Shorter, Gillian W. (September 2014). "The Dark Triad, happiness and subjective well-being". Personality and Individual Differences. 67: 17–22. doi:10.1016/j.paid.2014.01.004. S2CID 17277308.
  63. ^ Soeteman, Djøra I.; Verheul, Roel; Busschbach, Jan J.V. (June 2008). "The Burden of Disease in Personality Disorders: Diagnosis-Specific Quality of Life". Journal of Personality Disorders. 22 (3): 259–68. doi:10.1521/pedi.2008.22.3.259. ISSN 0885-579X. PMID 18540798.
  64. ^ Ellison, William D.; Acuff, M. Chase; Kealy, David; Joyce, Anthony S.; Ogrodniczuk, John S. (August 2020). "Narcissism and Quality of Life: The Mediating Role of Relationship Patterns". Journal of Nervous & Mental Disease. 208 (8): 613–18. doi:10.1097/NMD.0000000000001170. ISSN 1539-736X. PMID 32229790. S2CID 213949270.
  65. ^ Cailhol, Lionel; Pelletier, Éric; Rochette, Louis; Laporte, Lise; David, Pierre; Villeneuve, Évens; Paris, Joel; Lesage, Alain (12 April 2017). "Prevalence, Mortality, and Health Care Use among Patients with Cluster B Personality Disorders Clinically Diagnosed in Quebec: A Provincial Cohort Study, 2001-2012". The Canadian Journal of Psychiatry. 62 (5): 336–342. doi:10.1177/0706743717700818. ISSN 0706-7437. PMC 5459230. PMID 28403655.
  66. ^ Dhawan, Nikhil; Kunik, Mark E.; Oldham, John; Coverdale, John (July–August 2010). "Prevalence and Treatment of Narcissistic Personality Disorder in the Community: A Systematic Review". Comprehensive Psychiatry. 51 (4): 333–39. doi:10.1016/j.comppsych.2009.09.003. PMID 20579503.
  67. ^ Stinson, Frederick S.; Dawson, Deborah A.; Goldstein, Risë B.; Chou, S. Patricia; Huang, Boji; Smith, Sharon M.; Ruan, W. June; Pulay, Attila J.; Saha, Tulshi D.; Pickering, Roger P.; Grant, Bridget F. (July 2008). "Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions". The Journal of Clinical Psychiatry. 69 (7): 1033–1045. doi:10.4088/jcp.v69n0701. ISSN 1555-2101. PMC 2669224. PMID 18557663.
  68. ^ Grijalva, Emily; Newman, Daniel A.; Tay, Louis; Donnellan, M. Brent; Harms, Peter D. (2015). "Gender Differences in Narcissism: A Meta-analytic Review". Psychological Bulletin. 141 (2): 261–310. doi:10.1037/a0038231. PMID 25546498. from the original on 17 February 2017.
  69. ^ "Narcissus Greek mythology". britannica.com. Britanica. Retrieved 14 September 2021.
  70. ^ a b c Millon, Theodore; Grossman, Seth; Million, Carrie; Meagher, Sarah; Ramnath, Rowena (2004). Personality Disorders in Modern Life (PDF). Wiley. p. 343. ISBN 978-0471237341.
  71. ^ Zuern, John David (1998), "Freud: On Narcissism", CriticaLink, University of Hawaii.
  72. ^ Waelder, Robert (1925). "The psychoses: Their mechanisms and accessibility to influence". International Journal of Psycho-Analysis. 6: 259–281.
  73. ^ O'Donohue, William T.; Fowler, Katherine A.; Lilienfeld, Scott O. (2007). Personality disorders : toward the DSM-V. Los Angeles: Sage Publications. p. 235. ISBN 978-1412904223. OCLC 77716529.
  74. ^ Kohut, Heinz (1968). "The psychoanalytic treatment of narcissisticppersonality disorders. Outline of a systematic approach". The Psychoanalytic Study of the Child. Oxfordshire, England: Taylor & Francis. 23: 86–113. doi:10.1080/00797308.1968.11822951. ISSN 0079-7308. PMID 5759031.
  75. ^ Bergmann, Martin S. (1987). Anatomy of Loving; Man's Quest to Know what Love I. Ballantine Books. ISBN 978-0449905531.
  76. ^ Freud, Sigmund; Richards, Angela; Strachey, James (1990). Case Histories II. London, England: Penguin Books. p. 113. ISBN 978-0140137996. OCLC 490712192.
  77. ^ Freud, p. 203.
  78. ^ Akhtar, Salman (2018) [2009]. Comprehensive Dictionary of Psychoanalysis. Abingdon, England: Routledge. p. 182. ISBN 978-1-85575-471-3.
  79. ^ Bergler, Edmund (1974). Halliday, Jon; Fuller, Peter (eds.). The Psychology of Gambling. London, England: International Universities Press. pp. 176, 182. ISBN 978-1111916336.
  80. ^ Robert M. Lindner, "The Psychodynamics of Gambling", in Halliday/Fuller eds., p. 220.
  81. ^ Fenichel, Otto (2016). Psychoanalytic Theory of Neurosis. Abingdon, England: Taylor & Francis. p. 420. ISBN 978-1138147829. OCLC 960836519.
  82. ^ Fenichel, Otto (1938). "The Drive to Amass Wealth" (PDF). The Psychoanalytic Quarterly. 7 (1): 69–95. doi:10.1080/21674086.1938.11925342.
  83. ^ "StackPath". www.healthyplace.com. Retrieved 10 October 2019.[unreliable source?]
  84. ^ a b Malmquist, Carl P. (2006). Homicide: A Psychiatric Perspective. Washington, D.C.: American Psychiatric Association. pp. 181–82. ISBN 978-1585622047.
  85. ^ Vaknin, Sam (2003) [1999]. Malignant Self Love: Narcissism Revisited. p. 191. ISBN 8023833847.
  86. ^ Hughes, Judith M (2004). From obstacle to ally: the evolution of psychoanalytic practice. New York: Brunner-Routledge. p. 175. ISBN 978-1583918906. OCLC 57488252.
  87. ^ Hughes, Judith M (2004). From obstacle to ally: the evolution of psychoanalytic practice. New York: Brunner-Routledge. p. 149. ISBN 978-1583918906. OCLC 57488252.
  88. ^ Siegel, Judith P. (September 2006). "Dyadic splitting in partner relational disorders". Journal of Family Psychology. 20 (3): 418–22. doi:10.1037/0893-3200.20.3.418. ISSN 0893-3200. PMID 16937998.
  89. ^ Choi-Kain, Lois (March 2020). "Commentary on the Special Issue: Narcissistic Personality Disorder: A Coming of Age". Journal of Personality Disorders. 34 (Supplement): 210–213. doi:10.1521/pedi.2020.34.supp.210. ISSN 0885-579X. PMID 32186984. S2CID 214583509.
  90. ^ Wetzel, E; Brown, A; Hill, PL; Chung, JM; Robins, RW; Roberts, BW (December 2017). "The Narcissism Epidemic Is Dead; Long Live the Narcissism Epidemic" (PDF). Psychological Science. 28 (12): 1833–1847. doi:10.1177/0956797617724208. PMID 29065280. S2CID 10073811.
  91. ^ Zanor, Charles. "A Fate That Narcissists Will Hate: Being Ignored". The New York Times. Retrieved 9 November 2010.
  92. ^ "DSM-5: Proposed Revisions: Personality and Personality Disorders". American Psychiatric Association. 13 February 2010. from the original on 3 December 2010.
  93. ^ Holden, Constance (12 March 2010). "Psychiatry. APA seeks to overhaul personality disorder diagnoses". Science. 327 (5971): 1314. doi:10.1126/science.327.5971.1314. ISSN 1095-9203. PMID 20223959.
  94. ^ Shedler, Jonathan; Beck, Aaron; Fonagy, Peter; Gabbard, Glen O.; Gunderson, John; Kernberg, Otto; Michels, Robert; Westen, Drew (September 2010). "Personality disorders in DSM-5". The American Journal of Psychiatry. 167 (9): 1026–1028. doi:10.1176/appi.ajp.2010.10050746. ISSN 1535-7228. PMID 20826853.
  95. ^ Karterud, Sigmund; Øien, Maria; Pedersen, Geir (September 2011). "Validity aspects of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, narcissistic personality disorder construct". Comprehensive Psychiatry. 52 (5): 517–26. doi:10.1016/j.comppsych.2010.11.001. ISSN 1532-8384. PMID 21193181.
  96. ^ Alarcón, Renato D.; Sarabia, Silvana (January 2012). "Debates on the narcissism conundrum: trait, domain, dimension, type, or disorder?". The Journal of Nervous and Mental Disease. 200 (1): 16–25. doi:10.1097/NMD.0b013e31823e6795. ISSN 1539-736X. PMID 22210358. S2CID 24405066.
  97. ^ Aslinger, Elizabeth N.; Manuck, Stephen N.; Pilkonis, Paul A.; Simms, Leonard; Wright, Aidan G.C. (18 April 2018). "Narcissist or Narcissistic? Evaluation of the Latent Structure of Narcissistic Personality Disorder". Journal of Abnormal Psychology. 127 (5): 496–502. doi:10.31234/osf.io/tv7r9. PMC 6051431. PMID 30010367. Retrieved 1 May 2022.
  98. ^ Hesse, Morten; Schliewe S; Thomsen RR (2005). "Rating of personality disorder features in popular movie characters". BMC Psychiatry. 5 (1): 45. doi:10.1186/1471-244X-5-45. PMC 1325244. PMID 16336663.
  99. ^ Mitchell, Giles. "The Great Narcissist: A Study of Fitzgerald's Gatsby, by Giles Mitchell". fitzgerald.narod.ru. Retrieved 22 October 2017.

Further reading

  • Lowen, Alexander, Narcissism: Denial of the True Self (1984)
  • Malkin, Craig, Rethinking Narcissism, Harper Wave 2016
  • Masterson, James F. (1981). The Narcissistic and Borderline Disorders: An Integrated Developmental Approach. London: Routledge. doi:10.4324/9780203776148. ISBN 978-0876302927. LCCN 81038540.
  • 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)

March 23, 2023
narcissistic, personality, disorder, personality, disorder, characterized, life, long, pattern, exaggerated, feelings, self, importance, excessive, need, admiration, diminished, ability, unwillingness, empathize, with, others, feelings, interpersonally, exploi. 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 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 1 2 It is often comorbid with other mental disorders and associated with significant functional impairment and psychosocial disability 1 Narcissistic personality disorderSpecialtyPsychiatry Clinical psychologySymptomsExaggerated feelings of self importance excessive craving for admiration reduced levels of empathy 1 2 Usual onsetEarly adulthood 2 DurationLong term 2 CausesUnknown 3 Differential diagnosisBipolar Disorder Antisocial Personality Disorder Substance Abuse Borderline Personality Disorder Histrionic Personality Disorder 1 TreatmentPsychotherapy pharmaceuticals for comorbid disorders 1 Frequency0 5 citationsPersonality disorders are a class of mental disorders characterized by enduring and inflexible maladaptive 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 4 5 6 Criteria for diagnosing personality disorders are listed in the sixth chapter of the International Classification of Diseases ICD and in the American Psychiatric Association s Diagnostic and Statistical Manual of Mental Disorders DSM There is no standard treatment for NPD 7 8 Its high comorbidity with other mental disorders influences treatment choice and outcomes 7 Psychotherapeutic treatments generally fall into two categories psychoanalytic psychodynamic and cognitive behavioral therapy with growing support for integration of both in therapy 9 10 However there is an almost complete lack of studies determining the effectiveness of treatments 8 Contents 1 Signs and symptoms 1 1 DSM 5 1 2 ICD 11 and ICD 10 1 3 Associated features 1 4 Differential diagnosis 2 Subtypes 2 1 Empirically verified subtypes 2 2 Others 3 Assessment and screening 3 1 Narcissistic Personality Inventory 3 2 Pathological Narcissism Inventory 3 3 Five Factor Narcissism Inventory 3 4 Millon Clinical Multiaxial Inventory 4 Causes 4 1 Genetic 4 2 Environment 4 3 Pathophysiology 5 Management 6 Prognosis 7 Epidemiology 8 History 8 1 Freudianism and psychoanalysis 8 1 1 Narcissistic supply 8 1 2 Narcissistic rage 8 2 Object relations 8 3 Comparison to other personality disorders 9 Controversy 10 In popular culture 11 See also 12 References 13 Further readingSigns and symptoms EditDSM 5 Edit The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition DSM 5 describes NPD as possessing at least five of the following nine criteria 2 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 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 attitudesWithin the DSM 5 NPD is a cluster B personality disorder 2 Individuals with cluster B personality disorders often appear dramatic emotional or erratic 2 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 1 2 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 1 Narcissistic personality disorder usually develops either in youth or in early adulthood 2 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 2 ICD 11 and ICD 10 Edit See also Personality disorder ICD 11 In the International Statistical Classification of Diseases and Related Health Problems 11th Edition ICD 11 of the World Health Organization 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 Once a diagnosis has been made the clinician then can draw upon five trait domains to describe the particular causes of dysfunction as these have major implications for potential treatments 11 NPD as it currently conceptualised would correspond more or less entirely to the ICD 11 trait of Dissociality which includes self centredness grandiosity attention seeking entitlement and egocentricity and lack of empathy callousness ruthlessness manipulativeness interpersonal exploitativeness and hostility 11 12 In the previous edition the ICD 10 narcissistic personality disorder NPD is listed under the category of other specific personality disorders meaning 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 13 Associated features Edit 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 14 or to become impatient and disdainful when other persons talk about themselves 2 This behavior correlates to an overall worse functioning in areas of life like work and intimate romantic relationships 15 16 17 18 People with NPD have been observed to use psychosocial 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 19 Narcissistic personalities are more likely to respond with anger or aggressiveness when presented with rejection 20 21 22 Some patients with NPD see Subtypes respond to real or imagined criticism or defeat with prone to feelings of shame humiliation and worthlessness 14 and usually mask such feelings from people by feigning humility responding with outbursts of rage and defiance or seeking revenge 2 23 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 2 Given the high function sociability associated with narcissism some people with NPD might not view such a diagnosis as a functional impairment to their lives 24 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 2 23 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 25 Differential diagnosis Edit The occurrence of narcissistic personality disorder presents a high rate of comorbidity with other mental disorders 26 People with a fragile variant of NPD see Subtypes are prone to bouts of psychological depression often to the degree that meets the clinical criteria for a co occurring depressive disorder 27 NPD is associated with the occurrence of bipolar disorder and substance use disorders 1 23 especially cocaine use disorder 2 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 2 NPD should also be differentiated from mania and hypomania as these cases can also present with grandiosity but present with different levels of functional impairment 2 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 14 Subtypes EditAlthough the DSM 5 diagnostic criteria for NPD has been viewed as homogeneous there are a variety of subtypes used for classification of NPD 1 28 29 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 9 28 However none of the subtypes of NPD are recognized in the DSM 5 or in the ICD 11 Empirically verified subtypes Edit Some research has indicated the existence of three subtypes of NPD 30 which can be distinguished by symptom criteria comorbidity and other clinical criteria These are as follows Grandiose Malignant the group exhibits grandiosity entitlement interpersonal exploitativeness and manipulation pursuit of power and control lack of empathy and remorse and marked irritability and hostility This group was noted for high levels of comorbid antisocial and paranoid personality disorders substance abuse externalizing unemployment and greater likelihood of violence 30 31 Of note Russ et al observed that this group do not appear to suffer from underlying feelings of inadequacy or to be prone to negative affect states other than anger an observation corroborated by recent research which found this variant to show strong inverse associations with depressive anxious avoidant and dependant victimised features 31 Fragile Covert this variant is defined by feelings of shame envy resentment and inferiority which is occasionally masked by arrogance entitlement a belief that one is misunderstood or unappreciated and excessive reactivity to slights or criticism This variant is associated with elevated levels of psychological distress and comorbid depression anxiety and avoidant borderline and dependent personality disorders 30 31 High Functioning Exhibitionistic this variant has been described as high functioning narcissists who were grandiose competitive attention seeking and sexually provocative they tended to show adaptive functioning and utilize their narcissistic traits to succeed 28 This group has been found to have relatively few psychological issues and high rates of obsessive compulsive personality disorder with excessive perfectionism posited as a potential cause for their impairment 30 Others Edit Communal NarcissismA fourth 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 32 33 This section may be confusing or unclear to readers Please help clarify the section There is a discussion about this on talk page October 2021 Learn how and when to remove this template message Millon s TaxonomyIn 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 6 Subtype FeaturesUnprincipled Narcissist Deficient conscience unscrupulous amoral disloyal fraudulent deceptive arrogant exploitive a con artist and charlatan dominating contemptuous vindictive Amorous narcissist Sexually seductive enticing beguiling tantalizing glib and clever disinclined to real intimacy indulges hedonistic desires bewitches and inveigles others pathological lying and swindling Tends to have many affairs often with exotic partners Compensatory narcissist Seeks to counteract or cancel out deep feelings of inferiority and lack of self esteem offsets deficits by creating illusions of being superior exceptional admirable noteworthy self worth results from self enhancement Elitist narcissist Feels privileged and empowered by virtue of special childhood status and pseudo achievements entitled facade bears little relation to reality seeks favored and good life is upwardly mobile cultivates special status and advantages by association Normal narcissist Least severe and most interpersonally concerned and empathetic still entitled and deficient in reciprocity bold in environments self confident competitive seeks high targets feels unique talent in leadership positions expecting recognition from others Historical demarcation of grandiose and vulnerable typesOver the years many clinicians and theorists have described two variants of NPD akin to the grandiose and vulnerable expressions of trait narcissism Some examples include 34 Grandiose Phenotype Vulnerable TypesKohut amp Wolf 1978 Mirror hungry Ideal hungryBroucek 1982 Egotistical DissociativeRosenfeld 1987 Thick skinned Thin skinnedGabbard 1989 1998 2009 Oblivious HypervigilentGersten 1991 Overly grandiose Overly vulnerableWink 1992 Willful HypersensitiveMasterson 1993 Exhibitionist ClosetFiscalini 1993 Special child Shamed childCooper and Maxwell 1995 Empowered DisempoweredAssessment and screening EditNarcissistic Personality Inventory Edit Main article Narcissistic Personality Inventory Risk factors for NPD and grandiose overt and vulnerable covert subtypes are measured using the narcissistic personality inventory an assessment tool originally developed in 1979 has undergone multiple iterations with new versions in 1984 2006 and 2014 It captures principally grandiose narcissism but also seems to capture elements of vulnerability A popular three factor model has it that grandiose narcissism is assessed via the Leadership Authority and Grandiose Exhibitionism facets while a combination of grandiose and vulnerable traits are indexed by the Entitlement Exploitativeness facet 35 Pathological Narcissism Inventory Edit The Pathological Narcissism Inventory PNI was designed to measure fluctuations in grandiose and vulnerable narcissistic states similar to what is ostensibly observed by some clinicians though empirical demonstration of this phenomenon is lacking While having both grandiosity and vulnerability scales empirically both seem to primarily capture vulnerable narcissism 35 36 The PNI scales show significant associations with parasuicidal behavior suicide attempts homicidal ideation and several aspects of psychotherapy utilization 37 Five Factor Narcissism Inventory Edit The Five Factor Narcissism Inventory FFNI was defined as a comprehensive assay of grandiose and vulnerable expressions of trait narcissism The scale measures 11 traits of grandiose narcissism and 4 traits of vulnerable narcissism both of which correlate with clinical ratings of NPD with grandiose features of arrogance grandiose fantasies manipulativeness entitlement and exploitativeness showing stronger relations 38 Later analysis revealed that the FFNI actually measures three factors 39 Agentic Extraversion an exaggerated sense of self importance grandiose fantasies striving for greatness and acclaim social dominance and authoritativeness and exhibitionistic charming interpersonal conduct Self Centred Antagonism disdain for others psychological entitlement interpersonally exploitative and manipulative behaviour lack of empathy anger in response to criticism or rebuke suspiciousness and thrill seeking Narcissistic Neuroticism shame proneness oversensitivity and negative emotionality to criticism and rebuke and excessive need for admiration to maintain self esteem Grandiose narcissism is a combination of agency and antagonism and vulnerability is a combination of antagonism and neuroticism The three factors show differential associations with clinically important variables Agentic traits are associated with high self esteem positive view others and the future autonomous and authentic living commitment to personal growth sense of purpose in life and life satisfaction Neurotic traits show precisely the opposite correlation with all of these variables while antagonistic traits show more complex associations they are associated with negative view of others but necessarily of the self a sense of alienation from their true self disinterest in personal growth negative relationships with others and all forms of aggression 39 40 Millon Clinical Multiaxial Inventory Edit Main article 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 41 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 42 A 2020 study found that females scored significantly higher on vulnerable narcissism than males but no gender differences were found for grandiose narcissism 43 Causes EditAlthough there are no specific causes for NPD it is described using the biopsychosocial model which describes a combination of risk factors from biological psychological and socio environmental factors 7 44 This includes but is not limited to genetics neurobiology trauma abuse and parenting Genetic Edit Evidence suggests there is a high heritability of NPD with a number of genetic influences indicating varying rates of heritability based on subtype 44 26 45 46 A number of twin studies historically suggested for the heritability of NPD including personality disorders in general 47 48 49 Environment Edit Environmental and social factors also influence development of NPD 26 In some people vulnerable narcissism or fragile covert NPD may develop from an impaired emotional attachment to primary caregivers usually parents 50 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 51 While very little is known about the origins of grandiose narcissism or its concomitant subtypes of NPD there it is often suggested that overindulgent permissive parenting or insensitive and over controlling parenting are risk factors towards the development of NPD in a child 14 27 In Gabbard s Treatments of Psychiatric Disorders 2014 the following factors are identified as promoting the development of narcissistic personality disorder 52 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 or sexual abuse in childhood Unpredictable or unreliable parental caregiving Learning the behaviors of psychological manipulation from parents or peers 53 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 societies 26 Pathophysiology Edit 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 in the left anterior insular cortex 54 55 The results of a 2015 study associated the condition of NPD with a reduced volume of gray matter in the prefrontal cortex 56 The regions of the brain identified and studied the insular cortex and the prefrontal cortex are associated with the human emotions of empathy 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 57 Management EditTreatment 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 9 58 Psychotherapeutic treatment falls into two general categories psychoanalytic psychodynamic 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 10 The specific choice of treatment varies based on individual presentations 59 Management of narcissistic personality disorder has not been well studied however many treatments tailored to NPD exist 8 1 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 60 61 62 63 64 People with NPD often present with comorbid mental disorders complicating diagnosis and treatment 1 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 a substance use disorder drug addiction or bipolar disorder 23 Prognosis EditThis section needs to be updated Please help update this article to reflect recent events or newly available information October 2021 As of 2020 update no treatment guidelines exist for NPD and no empirical studies have been conducted on specific NPD groups to determine efficacy for psychotherapies and pharmacology 8 9 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 1 Epidemiology EditAs of 2018 update overall prevalence is estimated to range from 0 8 to 6 2 65 66 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 67 with a 2015 study confirming the gender difference 68 In clinical settings prevalence estimates range from 1 to 15 7 3 The occurrence of narcissistic personality disorder presents a high rate of comorbidity with other mental disorders 26 History EditThe term narcissism comes from a first century written in the year 8 AD book by the Roman poet Ovid Metamorphoses Book III is a myth about two main characters Narcissus and Echo 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 69 The concept of excessive selfishness 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 70 Havelock Ellis 1898 was the first psychologist to use the term when he linked the myth to the condition in one of his patients 70 Sigmund Freud 1905 1953 used the terms narcissistic libido in his Three Essays on the Theory of Sexuality 71 70 Ernest Jones 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 sexually 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 72 The term narcissistic personality disorder NPD was coined by Heinz Kohut in 1968 73 74 Waelder s initial study has been influential in the way narcissism and the clinical disorder Narcissistic personality disorder are defined today 75 Freudianism and psychoanalysis Edit Much early history of narcissism and NPD originates from psychoanalysis Regarding the adult neurotic s sense of omnipotence Sigmund Freud said that this belief is a frank acknowledgement of a relic of the old megalomania of infancy 76 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 77 Narcissistic injury and narcissistic scar are terms used by Freud in the 1920s Narcissistic wound and narcissistic blow are other almost interchangeable terms 78 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 14 but typically the actions and responses of the NPD person are deliberate and calculated 2 Despite occasional flare ups of personal insecurity the inflated self concept of the NPD person is primarily stable 2 In The Psychology of Gambling 1957 Edmund Bergler considered megalomania to be a normal occurrence in the psychology of a child 79 a condition later reactivated in adult life if the individual takes up gambling 80 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 81 Narcissistic supply Edit Narcissistic supply was a concept introduced by Otto Fenichel in 1938 to describe a type of admiration interpersonal support or sustenance drawn by an individual from his or her environment and essential to their self esteem 82 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 83 Narcissistic rage Edit The term narcissistic rage was a concept introduced by Heinz Kohut 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 84 Narcissistic rage reactions are not necessarily limited to narcissistic personality disorder They may also be seen in catatonic paranoid delusion and depressive episodes 84 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 85 Object relations Edit 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 86 This Kleinian therapeutic approach built upon Heinz Kohut s view of narcissistic megalomania as an aspect of normal mental development by contrast with Otto Kernberg s consideration of such grandiosity as a pathological distortion of normal psychological development 87 To the extent that people are pathologically narcissistic the person with NPD can be a self absorbed individual who passes blame by psychological projection 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 citation needed 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 88 Comparison to other personality disorders Edit NPD shares properties with borderline personality disorder including social stigma 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 89 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 90 Controversy EditThe 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 who led the DSM personality disorders committee for the 4th edition of the manual 91 The American Psychiatric Association 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 24 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 92 93 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 94 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 95 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 96 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 97 In popular culture EditSuzanne Stone Maretto Nicole Kidman s character in the film To Die For 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 98 Jay Gatsby the eponymous character of F Scott Fitzgerald s novel The Great Gatsby 1925 an archetype of self made American men seeking to join high society 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 99 See also Edit Psychology portal Psychiatry portalDark triad a concept in applied psychology associating personality traits of narcissism with Machiavellianism and psychopathy Narcissistic neurosisReferences Edit a b c d e f g h i j k l Caligor Eve Levy Kenneth N Yeomans Frank E May 2015 Narcissistic personality disorder diagnostic and clinical challenges The American Journal of Psychiatry 172 5 415 22 doi 10 1176 appi ajp 2014 14060723 ISSN 1535 7228 PMID 25930131 a b c d e f g h i j k l m n o p q r s Diagnostic and statistical manual of mental disorders DSM 5 5th ed Arlington VA American Psychiatric Association 2013 pp 72 669 ISBN 978 0890425541 OCLC 830807378 a b Sederer Lloyd I 2009 Blueprints Psychiatry Fifth ed Philadelphia Pennsylvania Wolters Kluwer Lippincott Williams amp Wilkins p 29 ISBN 978 0781782531 Archived from the original on 11 January 2017 via Google Books Diagnostic and Statistical Manual of Mental Disorders Fifth ed Arlington Virginia American Psychiatric Association 2013 pp 646 49 ISBN 978 0 89042 555 8 Berrios German Elias 1993 European views on personality disorders a conceptual history Comprehensive Psychiatry Philadelphia Pennsylvania W B Saunders Ltd 34 1 14 30 doi 10 1016 0010 440X 93 90031 X PMID 8425387 a b Theodore Millon Roger D Davis 1996 Disorders of Personality DSM IV and Beyond New York City John Wiley amp Sons Inc p 226 ISBN 978 0 471 01186 6 a b c d Mitra Paroma Fluyau Dimy 2022 Narcissistic Personality Disorder StatPearls Treasure Island Florida StatPearls Publishing PMID 32310461 retrieved 1 May 2022 a b c d King Ross M Grenyer Brin F S Gurtman Clint G Younan Rita 1 March 2020 A clinician s quick guide to evidence based approaches Narcissistic personality disorder Clinical Psychologist Melbourne Australia Australian Psychological Society 24 1 91 95 doi 10 1111 cp 12214 hdl 10536 DRO DU 30136767 ISSN 1328 4207 S2CID 216198008 a b c d Yakeley Jessica 5 July 2018 Current understanding of narcissism and narcissistic personality disorder BJPsych Advances 24 5 305 315 doi 10 1192 bja 2018 20 ISSN 2056 4678 S2CID 148566892 a b Weinberg Igor Ronningstam Elsa March 2020 Dos and Don ts in Treatments of Patients With Narcissistic Personality Disorder Journal of Personality Disorders New York City Guilford Press 34 Supplement 122 142 doi 10 1521 pedi 2020 34 supp 122 ISSN 0885 579X PMID 32186986 S2CID 214583609 a b Bach B amp First M B 2018 Application of the ICD 11 classification of personality disorders BMC psychiatry 18 1 14 Bach B Kramer U Doering S di Giacomo E Hutsebaut J Kaera A amp Renneberg B 2022 The ICD 11 classification of personality disorders a European perspective on challenges and opportunities Borderline Personality Disorder and Emotion Dysregulation 9 1 1 11 WHO 2010 ICD 10 Specific Personality Disorders a b c d e Narcissistic personality disorder Symptoms amp causes Mayo Clinic Phoenix Arizona Mayo Foundation for Medical Education and Research 18 November 2017 Retrieved 28 June 2018 Gewirtz Meydan Ateret Finzi Dottan Ricky 3 April 2018 Narcissism and Relationship Satisfaction from a Dyadic Perspective The Mediating Role of Psychological Aggression Marriage amp Family Review 54 3 296 312 doi 10 1080 01494929 2017 1359814 ISSN 0149 4929 S2CID 148631814 Cramer Phebe October 2010 Narcissism through the ages What happens when narcissists grow older Journal of Research in Personality 45 5 479 92 doi 10 1016 j jrp 2011 06 003 Mathieu Cynthia October 2013 Personality and job satisfaction The role of narcissism Personality and Individual Differences 55 6 650 54 doi 10 1016 j paid 2013 05 012 Ellison William D Acuff M Chase Kealy David Joyce Anthony S Ogrodniczuk John S September 2020 Narcissism and Quality of Life The Mediating Role of Relationship Patterns Journal of Nervous amp Mental Disease Philadelphia Pennsylvania Lippincott Williams amp Wilkins 208 8 613 18 doi 10 1097 NMD 0000000000001170 ISSN 1539 736X PMID 32229790 S2CID 213949270 Ronningstam Elsa 2005 Identifying and understanding the narcissistic personality New York City Oxford University Press pp 22 27 ISBN 978 0198033967 OCLC 61329826 Ellison William D Acuff M Chase Kealy David Joyce Anthony S Ogrodniczuk John S 31 March 2020 Narcissism and Quality of Life Journal of Nervous amp Mental Disease Philadelphia Pennsylvania Lippincott Williams amp Wilkins 208 8 613 618 doi 10 1097 nmd 0000000000001170 ISSN 1539 736X PMID 32229790 S2CID 213949270 Gewirtz Meydan A Finzi Dottan R 2018 Narcissism and relationship satisfaction from a dyadic perspective The mediating role of psychological aggression Marriage Fam Rev 54 296 312 Barry CT Kauten RL 2014 Nonpathological and pathological narcissism Which self reported characteristics are most problematic in adolescents J Pers Assess 96 212 19 a b c d Ronningstam Elsa 2016 New Insights into Narcissistic Personality Disorder Psychiatric Times New York City MJH Associates 33 2 11 a b Ronningstam Elsa February 2010 Narcissistic personality disorder a current review Current Psychiatry Reports 12 1 68 75 doi 10 1007 s11920 009 0084 z ISSN 1535 1645 PMID 20425313 S2CID 19473736 Golomb Elan 1992 Trapped in the Mirror Adult Children of Narcissists in Their Struggle For Self 1st ed New York W W Morrow ISBN 0688094716 OCLC 23143624 page needed a b c d e Paris Joel April 2014 Modernity and narcissistic personality disorder Personality Disorders 5 2 220 26 doi 10 1037 a0028580 ISSN 1949 2723 PMID 22800179 a b Narcissistic personality disorder MedlinePlus U S National Library of Medicine 8 July 2018 a b c Levy Kenneth N August 2012 Subtypes dimensions levels and mental states in narcissism and narcissistic personality disorder Journal of Clinical Psychology 68 8 886 97 doi 10 1002 jclp 21893 PMID 22740389 Sedikides Constantine 2021 In Search of Narcissus Trends in Cognitive Sciences 25 1 67 80 doi 10 1016 j tics 2020 10 010 PMID 33229145 S2CID 227063824 a b c d Russ Eric Shedler Jonathan Bradley Rebekah Westen Drew November 2008 Refining the Construct of Narcissistic Personality Disorder Diagnostic Criteria and Subtypes American Journal of Psychiatry 165 11 1473 1481 doi 10 1176 appi ajp 2008 07030376 ISSN 0002 953X PMID 18708489 a b c Tanzilli Annalisa Gualco Ivan March 2020 Clinician Emotional Responses and Therapeutic Alliance When Treating Adolescent Patients With Narcissistic Personality Disorder Subtypes A Clinically Meaningful Empirical Investigation Journal of Personality Disorders 34 Supplement 42 62 doi 10 1521 pedi 2020 34 supp 42 ISSN 0885 579X PMID 32186983 S2CID 213186868 Gebauer J E Sedikides C Verplanken B amp Maio G R 2012 Communal narcissism Journal of Personality and Social Psychology 103 854 878 Lancer D March 6 2021 Know the Kind of Narcissist You re Dealing With and Symptoms PsychologyToday com Pincus A L amp Roche M J 2011 Narcissistic Grandiosity and Narcissistic Vulnerability In Campbell W K amp Miller J D Ed The Handbook of Narcissism and Narcissistic Personality Disorder Theoretical Approaches Empirical Findings and Treatments a b Miller J D Lynam D R amp Campbell W K 2016 Measures of narcissism and their relations to DSM 5 pathological traits A critical reappraisal Assessment 23 1 3 9 Miller J D Lynam D R amp Campbell W K 2016 Rejoinder A construct validity approach to the assessment of narcissism Assessment 23 1 18 22 Pincus AL Ansell EB Pimentel CA Cain NM Wright AGC Levy KN September 2009 Initial construction and validation of the Pathological Narcissism Inventory PDF Psychological Assessment Washington D C American Psychological Association 21 3 365 79 doi 10 1037 a0016530 PMID 19719348 Retrieved 27 March 2020 Miller J D Few L R Wilson L Gentile B Widiger T A MacKillop J amp Keith Campbell W 2013 The Five Factor Narcissism Inventory FFNI a test of the convergent discriminant and incremental validity of FFNI scores in clinical and community samples Psychological assessment 25 3 748 a b Kaufman S B Weiss B Miller J D amp Campbell W K 2020 Clinical correlates of vulnerable and grandiose narcissism a personality perspective Journal of personality disorders 34 1 107 130 Du T V Miller J D amp Lynam D R 2022 The relation between narcissism and aggression A meta analysis Journal of personality 90 4 574 594 Auerbach JS December 1984 Validation of two scales for narcissistic personality disorder Journal of Personality Assessment Abingdon England Taylor amp Francis 48 6 649 53 doi 10 1207 s15327752jpa4806 13 PMID 6520692 Foster Joshua D Campbell W Keith October 2007 Are there such things as Narcissists A taxometric analysis of the Narcissistic Personality Inventory Personality and Individual Differences Amsterdam Netherlands Elsevier 43 6 doi 10 1016 j paid 2007 04 003 Green Ava MacLean Rory Charles Kathy 1 December 2020 Recollections of parenting styles in the development of narcissism The role of gender Personality and Individual Differences Amsterdam Netherlands Elsevier 167 110246 doi 10 1016 j paid 2020 110246 ISSN 0191 8869 S2CID 224958195 a b Luo Yu L L Cai Huajian 2018 The Etiology of Narcissism A Review of Behavioral Genetic Studies Handbook of Trait Narcissism New York City Springer International Publishing pp 149 156 doi 10 1007 978 3 319 92171 6 16 ISBN 978 3 319 92170 9 Retrieved 2 May 2022 Torgersen Svenn Myers John Reichborn Kjennerud Ted Roysamb Espen Kubarych Thomas S Kendler Kenneth S 17 September 2012 The Heritability of Cluster B Personality Disorders Assessed Both by Personal Interview and Questionnaire Journal of Personality Disorders New York City Guilford Press 26 6 848 866 doi 10 1521 pedi 2012 26 060 ISSN 0885 579X PMC 3606922 PMID 23281671 Reichborn Kjennerud Ted 1 March 2010 The Genetic Epidemiology of Personality Disorders Dialogues in Clinical Neuroscience Abingdon England Taylor amp Francis 12 1 103 14 doi 10 31887 DCNS 2010 12 1 trkjennerud ISSN 1294 8322 PMC 3181941 PMID 20373672 Livesley WJ Jang KL Jackson DN Vernon PA December 1993 Genetic and environmental contributions to dimensions of personality disorder Am J Psychiatry 150 12 1826 31 doi 10 1176 ajp 150 12 1826 PMID 8238637 Torgersen S Lygren S Oien P A Skre I Onstad S Edvardsen J Tambs K Kringlen E November 2000 A twin study of personality disorders Comprehensive Psychiatry 41 6 416 25 doi 10 1053 comp 2000 16560 ISSN 0010 440X PMID 11086146 Luo Yu L L Cai Huajian Song Hairong 2 April 2014 Garcia Antonio Verdejo ed A Behavioral Genetic Study of Intrapersonal and Interpersonal Dimensions of Narcissism PLOS ONE 9 4 e93403 doi 10 1371 journal pone 0093403 ISSN 1932 6203 PMC 3973692 PMID 24695616 Magid Ken 1987 High Risk Children without a Conscience New York City Bantam Books p 67 ISBN 978 0553052909 Retrieved 17 November 2012 Johnson Stephen M 1987 Humanizing the Narcissistic Style New York City W W Norton p 39 ISBN 978 0393700374 Archived from the original on 4 July 2014 Retrieved 29 October 2013 Gabbard Glen O 2014 Gabbard s treatments of psychiatric disorders Fifth DSM 5 ed Washington D C American Psychiatric Association doi 10 1176 appi books 9781585625048 gg72 ISBN 978 1585624423 OCLC 872383308 Groopman Leonard C Cooper Arnold M 2006 Narcissistic Personality Disorder Personality Disorders Narcissistic Personality Disorder Congers New York Armenian Medical Network Retrieved 14 February 2007 Schulze Lars Dziobek Isabel Vater Aline Heekeren Hauke R Bajbouj Malek Renneberg Babette Heuser Isabella Roepke Stefan October 2013 Gray matter abnormalities in patients with narcissistic personality disorder Journal of Psychiatric Research Amsterdam Netherlands Elsevier 47 10 1363 69 doi 10 1016 j jpsychires 2013 05 017 ISSN 1879 1379 PMID 23777939 Pedersen Traci 6 October 2015 Narcissists Lack of Empathy Tied to Less Gray Matter PsychCentral Archived from the original on 24 April 2014 Retrieved 24 April 2014 Nenadic Igor Gullmar Daniel Dietzek Maren Langbein Kerstin Steinke Johanna Gader Christian February 2015 Brain Structure in Narcissistic Personality Disorder A VBM and DTI Pilot Study Psychiatry Research Neuroimaging Elsevier Ireland 231 2 184 86 doi 10 1016 j pscychresns 2014 11 001 PMID 25492857 S2CID 17073607 Ronningstam Elsa 19 January 2016 Pathological Narcissism and Narcissistic Personality Disorder Recent Research and Clinical Implications PDF Current Behavioral Neuroscience Reports 3 1 34 42 doi 10 1007 s40473 016 0060 y S2CID 49575408 Archived PDF from the original on 17 August 2018 Narcissistic personality disorder Diagnosis and treatment mayoclinic org 18 November 2017 Retrieved 28 June 2018 Kramer Ueli Berthoud Laurent Keller Sabine Caspar Franz June 2014 Motive Oriented Psychotherapeutic Relationship Facing a Patient Presenting with Narcissistic Personality Disorder A Case Study Journal of Contemporary Psychotherapy 44 2 71 82 doi 10 1007 s10879 013 9249 5 S2CID 9514109 Retrieved 25 April 2022 Soyer Renate B Rovenpor Janet L Kopelman Richard E Mullins Lynn S Watson P J May 2001 Further Assessment of the Construct Validity of Four Measures of Narcissism Replication and Extension The Journal of Psychology 135 3 245 58 doi 10 1080 00223980109603695 ISSN 0022 3980 PMID 11577967 S2CID 31486515 Morf Carolyn C Schurch Eva Kufner Albrecht Siegrist Philip Vater Aline Back Mitja Mestel Robert Schroder Abe Michela 2018 Expanding the nomological net of the pathological narcissism inventory German validation and extension in a clinical inpatient sample OCLC 1236181501 Egan Vincent Chan Stephanie Shorter Gillian W September 2014 The Dark Triad happiness and subjective well being Personality and Individual Differences 67 17 22 doi 10 1016 j paid 2014 01 004 S2CID 17277308 Soeteman Djora I Verheul Roel Busschbach Jan J V June 2008 The Burden of Disease in Personality Disorders Diagnosis Specific Quality of Life Journal of Personality Disorders 22 3 259 68 doi 10 1521 pedi 2008 22 3 259 ISSN 0885 579X PMID 18540798 Ellison William D Acuff M Chase Kealy David Joyce Anthony S Ogrodniczuk John S August 2020 Narcissism and Quality of Life The Mediating Role of Relationship Patterns Journal of Nervous amp Mental Disease 208 8 613 18 doi 10 1097 NMD 0000000000001170 ISSN 1539 736X PMID 32229790 S2CID 213949270 Cailhol Lionel Pelletier Eric Rochette Louis Laporte Lise David Pierre Villeneuve Evens Paris Joel Lesage Alain 12 April 2017 Prevalence Mortality and Health Care Use among Patients with Cluster B Personality Disorders Clinically Diagnosed in Quebec A Provincial Cohort Study 2001 2012 The Canadian Journal of Psychiatry 62 5 336 342 doi 10 1177 0706743717700818 ISSN 0706 7437 PMC 5459230 PMID 28403655 Dhawan Nikhil Kunik Mark E Oldham John Coverdale John July August 2010 Prevalence and Treatment of Narcissistic Personality Disorder in the Community A Systematic Review Comprehensive Psychiatry 51 4 333 39 doi 10 1016 j comppsych 2009 09 003 PMID 20579503 Stinson Frederick S Dawson Deborah A Goldstein Rise B Chou S Patricia Huang Boji Smith Sharon M Ruan W June Pulay Attila J Saha Tulshi D Pickering Roger P Grant Bridget F July 2008 Prevalence correlates disability and comorbidity of DSM IV narcissistic personality disorder results from the wave 2 national epidemiologic survey on alcohol and related conditions The Journal of Clinical Psychiatry 69 7 1033 1045 doi 10 4088 jcp v69n0701 ISSN 1555 2101 PMC 2669224 PMID 18557663 Grijalva Emily Newman Daniel A Tay Louis Donnellan M Brent Harms Peter D 2015 Gender Differences in Narcissism A Meta analytic Review Psychological Bulletin 141 2 261 310 doi 10 1037 a0038231 PMID 25546498 Archived from the original on 17 February 2017 Narcissus Greek mythology britannica com Britanica Retrieved 14 September 2021 a b c Millon Theodore Grossman Seth Million Carrie Meagher Sarah Ramnath Rowena 2004 Personality Disorders in Modern Life PDF Wiley p 343 ISBN 978 0471237341 Zuern John David 1998 Freud On Narcissism CriticaLink University of Hawaii Waelder Robert 1925 The psychoses Their mechanisms and accessibility to influence International Journal of Psycho Analysis 6 259 281 O Donohue William T Fowler Katherine A Lilienfeld Scott O 2007 Personality disorders toward the DSM V Los Angeles Sage Publications p 235 ISBN 978 1412904223 OCLC 77716529 Kohut Heinz 1968 The psychoanalytic treatment of narcissisticppersonality disorders Outline of a systematic approach The Psychoanalytic Study of the Child Oxfordshire England Taylor amp Francis 23 86 113 doi 10 1080 00797308 1968 11822951 ISSN 0079 7308 PMID 5759031 Bergmann Martin S 1987 Anatomy of Loving Man s Quest to Know what LoveI Ballantine Books ISBN 978 0449905531 Freud Sigmund Richards Angela Strachey James 1990 Case Histories II London England Penguin Books p 113 ISBN 978 0140137996 OCLC 490712192 Freud p 203 Akhtar Salman 2018 2009 Comprehensive Dictionary of Psychoanalysis Abingdon England Routledge p 182 ISBN 978 1 85575 471 3 Bergler Edmund 1974 Halliday Jon Fuller Peter eds The Psychology of Gambling London England International Universities Press pp 176 182 ISBN 978 1111916336 Robert M Lindner The Psychodynamics of Gambling in Halliday Fuller eds p 220 Fenichel Otto 2016 Psychoanalytic Theory of Neurosis Abingdon England Taylor amp Francis p 420 ISBN 978 1138147829 OCLC 960836519 Fenichel Otto 1938 The Drive to Amass Wealth PDF The Psychoanalytic Quarterly 7 1 69 95 doi 10 1080 21674086 1938 11925342 StackPath www healthyplace com Retrieved 10 October 2019 unreliable source a b Malmquist Carl P 2006 Homicide A Psychiatric Perspective Washington D C American Psychiatric Association pp 181 82 ISBN 978 1585622047 Vaknin Sam 2003 1999 Malignant Self Love Narcissism Revisited p 191 ISBN 8023833847 Hughes Judith M 2004 From obstacle to ally the evolution of psychoanalytic practice New York Brunner Routledge p 175 ISBN 978 1583918906 OCLC 57488252 Hughes Judith M 2004 From obstacle to ally the evolution of psychoanalytic practice New York Brunner Routledge p 149 ISBN 978 1583918906 OCLC 57488252 Siegel Judith P September 2006 Dyadic splitting in partner relational disorders Journal of Family Psychology 20 3 418 22 doi 10 1037 0893 3200 20 3 418 ISSN 0893 3200 PMID 16937998 Choi Kain Lois March 2020 Commentary on the Special Issue Narcissistic Personality Disorder A Coming of Age Journal of Personality Disorders 34 Supplement 210 213 doi 10 1521 pedi 2020 34 supp 210 ISSN 0885 579X PMID 32186984 S2CID 214583509 Wetzel E Brown A Hill PL Chung JM Robins RW Roberts BW December 2017 The Narcissism Epidemic Is Dead Long Live the Narcissism Epidemic PDF Psychological Science 28 12 1833 1847 doi 10 1177 0956797617724208 PMID 29065280 S2CID 10073811 Zanor Charles A Fate That Narcissists Will Hate Being Ignored The New York Times Retrieved 9 November 2010 DSM 5 Proposed Revisions Personality and Personality Disorders American Psychiatric Association 13 February 2010 Archived from the original on 3 December 2010 Holden Constance 12 March 2010 Psychiatry APA seeks to overhaul personality disorder diagnoses Science 327 5971 1314 doi 10 1126 science 327 5971 1314 ISSN 1095 9203 PMID 20223959 Shedler Jonathan Beck Aaron Fonagy Peter Gabbard Glen O Gunderson John Kernberg Otto Michels Robert Westen Drew September 2010 Personality disorders in DSM 5 The American Journal of Psychiatry 167 9 1026 1028 doi 10 1176 appi ajp 2010 10050746 ISSN 1535 7228 PMID 20826853 Karterud Sigmund Oien Maria Pedersen Geir September 2011 Validity aspects of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition narcissistic personality disorder construct Comprehensive Psychiatry 52 5 517 26 doi 10 1016 j comppsych 2010 11 001 ISSN 1532 8384 PMID 21193181 Alarcon Renato D Sarabia Silvana January 2012 Debates on the narcissism conundrum trait domain dimension type or disorder The Journal of Nervous and Mental Disease 200 1 16 25 doi 10 1097 NMD 0b013e31823e6795 ISSN 1539 736X PMID 22210358 S2CID 24405066 Aslinger Elizabeth N Manuck Stephen N Pilkonis Paul A Simms Leonard Wright Aidan G C 18 April 2018 Narcissist or Narcissistic Evaluation of the Latent Structure of Narcissistic Personality Disorder Journal of Abnormal Psychology 127 5 496 502 doi 10 31234 osf io tv7r9 PMC 6051431 PMID 30010367 Retrieved 1 May 2022 Hesse Morten Schliewe S Thomsen RR 2005 Rating of personality disorder features in popular movie characters BMC Psychiatry 5 1 45 doi 10 1186 1471 244X 5 45 PMC 1325244 PMID 16336663 Mitchell Giles The Great Narcissist A Study of Fitzgerald s Gatsby by Giles Mitchell fitzgerald narod ru Retrieved 22 October 2017 Further reading EditLowen Alexander Narcissism Denial of the True Self 1984 Malkin Craig Rethinking Narcissism Harper Wave 2016 Masterson James F 1981 The Narcissistic and Borderline Disorders An Integrated Developmental Approach London Routledge doi 10 4324 9780203776148 ISBN 978 0876302927 LCCN 81038540 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 Retrieved from https en wikipedia org w index php title Narcissistic personality disorder amp oldid 1146112033, wikipedia, wiki, book, books, library,

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