NARCISSISTIC PERSONALITY DISORDER

Introduction

Narcissistic personality disorder is a condition in which a person has an inflated sense of self-importance, need to be admired, and extreme self-involvement.

Alternative Names:

God complex

Causes & Risk Factors

How narcissistic personality develops in an individual is not known.

However, possible factors that have been proposed as causes include:

• Genetics
• Disturbed childhood e.g. extremely high expectations, neglect

Classification & Types

• Paranoid narcissists
• Craving narcissists
• Manipulative narcissists
• Phallic narcissists

Symptoms & Signs
Persons with narcissistic personality disorder usually have the following traits:

• Are self-obsessed
• Consider themselves better than others
• Seek constant admiration
• Like to be the centre of attraction
• Fantasize about unlimited power, success, love etc.
• Are often arrogant to others
• Lack empathy for others’ feelings

Diagnosis of Narcissistic Personality Disorder
The Diagnostic and Statistic Manual (DSM) for mental disorders has listed the following criteria for diagnosis of narcissistic personality disorder, at least 5 of which should be met:

1. Grandiose sense of self-importance and exaggeration of own skills and achievements.
   
2. Fantasy expectations towards improbable things like unlimited power, ideal beauty etc.
   
3. Expectation of admiration or praise for every small deed.
   
4. Considering that one is extraordinary.
   
5. Try to take advantage of others for achieving their own goals.
   
6. Lack empathy towards others.
   
7. Expect favorable treatment for themselves.
   
8. Are jealous of others’ achievements.
   
9. Are rude and arrogant.
   

References and Internet Links

1. Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA. Personality and personality disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Clinical Psychiatry. 1st ed. Philadellphia, Pa: Mosby Elsevier;2008:chap 39.
   
2. http://psychological-disorders.org/npd/classification-of-narcissistic-personality-disorder/
   
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.
   
4. Coid, J.W. Aetiological Risk Factors for Personality Disorders. British Journal of Psychiatry 174, June 1999: 530-538.
   

Treatment of Narcissistic Personality Disorder
No medications have been recommended for the treatment of narcissistic personality disorder. Treatment is mainly based on psychotherapy. 
The types of psychotherapy include the following:

1. Behavioural therapy
   
2. Group therapy
   
3. Family therapy
   

Prognosis of Narcissistic Personality Disorder
Prognosis of narcissistic personality disorder is not too bright. It is often not possible to change the personality traits, although, with prolonged psychotherapy, a few patients may develop empathy for others and lowered expectations from others 

Complication of Disease

• Behind an overconfident exterior, narcissistic persons often hide a personality which is extremely vulnerable to any form of criticism. Such individuals may either hide their feelings or respond with rage and anger.
• Such patients are also prone to substance or alcohol abuse.
• The disease may also be complicated by other psychiatric problems such as eating disorders, depression and suicidal thoughts.

Representative Case Study
A 32 year old man presented with history of threatening his family with suicide. The incident was sparked when he was rebuked by his parents for not being able to hold on to a job. Further questioning revealed that the patient believed that no job was good enough for him. He was confirmed as a case of narcissistic personality disorder when he was seen to satisfy 7 of the 9 DSM criteria. The patient was started on psychotherapy. After prolonged psychotherapy, the patient’s family reported improvement in some though not all of his traits.