A pattern of traits and behaviors that signify infatuation and obsession with oneself to the exclusion of all others and the selfish and ruthless pursuit of one’s own gratification, dominance and ambition.
The majority of narcissists (50-75%, according to DSM IV-TR) are men.
Narcissistic Personality Disorder (NPD) is one of a “family” of personality disorders (known as “Cluster B”). Other members of Group B are borderline PD, antisocial PD, and histrionic PD.
NPD is often diagnosed with other mental health disorders (“comorbidity”), or with substance abuse and impulsive and reckless behaviors (“dual diagnosis”).
NPD is a new mental health category (1980) in the Diagnostic and Statistical Manual (DSM).
There is little research on narcissism. But what there is has not shown any ethnic, social, cultural, economic, genetic or professional predilection for the NPD.
It is estimated that 0.7-1% of the general population suffers from NPD.
Pathological narcissism was first described in detail by Freud. Other important contributors are: Klein, Horney, Kohut, Kernberg, Millon, Roningstam, Gunderson, Hare.
The onset of narcissism is in infancy, childhood, and early adolescence. It is commonly attributed to childhood abuse and trauma inflicted by parents, authority figures, or even peers.
There is a whole range of narcissistic reactions, from mild, reactive and transient to permanent personality disorder.
The narcissistic supply is external attention, usually positive (adulation, affirmation, fame, celebrity), used by the narcissist to regulate his labile sense of self-worth.
Narcissists are either “cerebral” (they derive their narcissistic supply from their intelligence or academic achievement) or “somatic” (they derive their narcissistic supply from their physique, exercise, physical or sexual prowess, and romantic or physical “conquests”).
Narcissists are either “classical” (see definition below) or they are “compensatory” or “inverted” (see definitions here: “The Inverted Narcissist”).
The classic narcissist is self-confident, the compensatory narcissist masks a deep-seated deficit in self-esteem in his haughty behavior, and the inverted type is a codependent who meets the emotional needs of a classic narcissist.
NPD is treated in talk therapy (psychodynamic or cognitive-behavioral). The prognosis for an adult narcissist is poor, although his adjustment to life and to others may improve with treatment. Medication is applied to side effects and behaviors (such as mood or affective disorders and obsession-compulsion), usually with some success.
The American Psychiatric Association, based in Washington DC, USA, publishes the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), 2000.
Click here to read the DSM-IV-TR diagnostic criteria for Narcissistic Personality Disorder.
The international equivalent of the DSM is the ICD-10, Classification of Mental and Behavioral Disorders, published by the World Health Organization in Geneva (1992).
Click here to read the ICD-10 diagnostic criteria for Narcissistic Personality Disorder.
The DSM defines NPD as “a pervasive pattern of grandiosity (in fantasy or behavior), a need for admiration or flattery, and a lack of empathy, usually beginning in early adulthood and present in various contexts.”
The ICD considers NPD to be “a personality disorder that does not fit any of the specific rubrics.” It relegates it to the “Other Specific Personality Disorders” category along with eccentric, “haltlose,” immature, passive-aggressive, and psychoneurotic personality types and disorders.
The DSM specifies nine diagnostic criteria. For NPD to be diagnosed, five (or more) of these criteria must be met.
(In the text that follows, I have proposed modifications to the language of these criteria to incorporate current knowledge about this disorder. My modifications appear in bold italics.)
(My amendments do not constitute part of the text of DSM-IV-TR, nor is the American Psychiatric Association (APA) associated with them in any way.)
Click here to download a bibliography of Narcissistic Personality Disorder (NPD) studies and research on which I based my review proposals.
Proposed Modified Criteria for Narcissistic Personality Disorder
Feels grandiose and conceited (eg, exaggerates achievements, talents, skills, contacts, and personality traits to the point of lying, demands to be recognized as superior without commensurate achievements);
He is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unmatched brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, eternal, all-conquering love or passion;
Firmly convinced that he or she is unique and, being special, can only be understood, should only be treated or associated with other special or unique people (or institutions) or of high status;
Requires excessive admiration, adulation, attention, and affirmation, or alternatively wishes to be feared and conspicuous (narcissistic supply);
It feels entitled. It demands the full and automatic fulfillment of its unreasonable expectations of special and favorable priority treatment;
He is “interpersonally exploitative”, that is, he uses others to achieve his own ends;
Devoid of empathy. Unable or unwilling to identify with, acknowledge, or accept the feelings, needs, preferences, priorities, and choices of others;
Constantly envious of others and seeks to hurt or destroy the objects of his frustration. He suffers from persecutory (paranoid) delusions because he believes that he feels the same way about him or her and is likely to act similarly;
Behave with arrogance and haughtiness. Feels superior, omnipotent, omniscient, invincible, immune, “above the law” and omnipresent (magical thinking). He becomes enraged when frustrated, contradicted, or confronted by people he or she considers inferior to him or her and unworthy.
