What is #Narcissistic Personality Disorder?
Narcissistic Personality Disorder is a set of personality characteristics, behaviors & core beliefs that manifest themselves in multiple life-areas, across a broad set of circumstances, and over a long period of time.
In order to really understand what Narcissistic Personality Disorder is it’s good to know what qualifies as a personality disorder, in the first place. The DSM [Diagnostic and Statistical Manual], the go-to guide for what defines mental health (or the absence of it), lays out the diagnostic criteria for personality disorder, as follows:
Criteria for diagnosing Personality Disorder
An enduring pattern of inner experience and behavior the deviates markedly from the expectations of the individual’s culture.
B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.
The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder.
The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug abuse, a medication) or a general medical condition (e.g., head trauma).
Basically, what that means is in order to be considered for a personality disorder diagnosis, you have to be acting wonky almost all the time, regardless of the situation. No fair kick-dropping someone in the stomach and, then, calling them personality disordered when they get mad and retaliate.
In the latest version of the DSM, there are 10 listed personality disorders. Of the 10, only 4 are considered to be “cluster b”. The cluster b disorders are those largely characterized by poor impulse control and a lack of emotional regulation. Made up of a motley crew of Histrionics, Borderlines, Narcissists, and Antisocials, these ‘cluster b’ personalities are society’s wild cards- the unpredictable group.
As you might guess, each personality disorder has its own specific diagnostic criteria. In order to be eligible for the Narcissistic Personality Disorder (#NPD) label, that same DSM IV says that you must meet the following criteria:
- A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
- Is preoccupied with fantasies of unlimited success, power,brilliance, beauty, or ideal love.
- Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
- Requires excessive admiration.
- Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations.
- Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends.
- Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
- Is often envious of others or believes that others are envious of him or her.
- Shows arrogant, haughty behaviors or attitudes.
Now, keep in mind that lots of people exhibit a good number of these behavior, BUT that doesn’t make them narcissists. For example, let’s say that a person is a mostly kind, and generous person. Yet, one day, he completely lost his cool, with the cashier at a grocery store. Would you say that he is a narcissist? No, absolutely not. You might say that he acted like a jack-ass but, being a jack-ass is nowhere near the level of NPD.
Remember, at least 5 of these shitty behaviors and attitudes have to be present in a variety of circumstances, and over a long period of time. In other words, the person would have to exhibit NPD symptoms at home, and with friends/at work, and behave in narcissistic ways regardless of the particular circumstance (i.e. regardless of whether he was in a bad or good mood, whether he’s stressed or not, etc.). The behaviors have to be pathological.
What constitutes pathological narcissistic behavior?
Basically, how can you tell the difference between someone who is acting like a douche-bag, and a person whose behavior is straight up pathological? First, let’s define “pathological”.
1. of or relating to pathology. “the interpretation of pathological studies”
2. involving, caused by, or of the nature of a physical or mental disease. “pathological changes associated with senile dementia.
3. compulsive; obsessive.
“a pathological gambler”, “A PATHOLOGICAL LIAr.”
Of the above, #3 is the most commonly used definition of pathological behavior. It’s behaviors, attitudes, thoughts, feelings, and/or actions, that a person can’t seem to stop themselves from exhibiting. A person with pathological behavior will act the same, self-destructive ways, regardless of the situation, and with a care for any possible negative consequences. Even if those consequences are potentially irreparable.
Pathological liars will lie. Even when they don’t have to. Even when they can trust the person they’re lying to. Even if it gets them landed in serious trouble. None of that matters. A pathological liar will lie…because that’s who he is. Nothing more. He doesn’t even acknowledge any other option, but lying.
In a way, pathological behavior is a lot like being an addict. Only, instead of a certain chemical, it’s self-and-other-destructive choices, the person is addicted to. And, mostly, the person isn’t even fully conscious of what their patterns are.
This is not to say that narcissists don’t know what they’re doing (because they DO), but they truly can’t see a problem with how they are acting. They simply DO NOT have the ability to walk a mile, in someone’s shoes, nor can they cope with having to be responsible for themselves- especially when they are infinitely more comfortable playing their favorite part-“the victim/martyr”. After all, it gets them everything they want.
What’ s missing?
I had some beef with the above diagnostic criteria seeing as, (1) the list is severely limited and excludes some MAJOR aspects of the narcissistic personality, and (2) nothing in the above criteria suggests an underlying cause for the narcissist’s behavior. In my opinion, these are major problems for two reasons.
Firstly, the listing of vague, overarching behaviors, could easily lead mental health professionals to diagnose NPD in individuals who are NOT narcissists. The disturbing lack of detail, and/or discussion, regarding the underlying problems/trauma that causes the narcissistic behavior is conspicuously absent. That seems to be a MASSIVE oversight because, if no one is looking at what causes a behavior then, as is the current belief, no one can research/test ways in which the problem might be solved.
It is my belief that Narcissistic Personality Disorder is believed to be “incurable” only because no one has spent sufficient time, or energy, looking into the REAL underlying causes of the disorder. And, perhaps, that is simply the naïve and wishful thinking of the wife of a narcissist but… I really don’t think it is. I’ve done my homework (for years now) and it is my belief that NPD is absolutely curable. But that’s a topic for a separate article and, so, I digress.
The latest version of the DSM (5- Released May 2012), hits closer to the mark. It lists the criteria for NPD as follows:
The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose narcissistic personality disorder, the following criteria must be met:
Significant impairments in personality functioning manifest by:
Impairments in self functioning (a or b):
Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.
Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.
Impairments in interpersonal functioning (a or b):
Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.
Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others‟ experiences and predominance of a need for personal gain.
Pathological personality traits in the following domain:
Antagonism, characterized by:
Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others.
Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.
The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.
The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.
The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).
They hit on some major characteristics here and, definitely gave a more thorough description. Yet, there is still no real mention of root causes, or whys, or viable treatment options. And by treatment options, I mean ones that actually WORK.
#Narcissism, or Narcissistic Personality Disorder, is one sticky wicket. The ways in which a narcissist can present (can be identified) are many… and confusing. But, I believe there is hope. I know that, DSM or not, we will find a way to alleviate the harm, strain, stress, damage, and destruction that this disorder causes the people who unhappily enough, fall in love with a narcissist.