Narcissism – When High Self Esteem isn’t Healthy

We all know the story of Narcissus, the vain hunter who fell so deeply in love with his own reflection he died, pining away looking at himself. Narcissism refers to that self love that is so overwhelming and all encompassing it becomes harmful.

Narcissism: A Disorder?

Not just an annoying quirk, narcissistic personality disorder is a “Cluster B” personality disorder, understood by clinicians to be categorized as antisocial, histrionic, and borderline personality disorders. This means that those diagnosed with narcissistic personality disorder share some basic commonalities with people diagnosed with those other personality disorders.

As with all personality disorders, in order to meet diagnostic criteria, the symptoms must be severe enough to cause real functional impairment (for example, loss of job or divorce), and the patient must experience significant distress. As with other disorders, the symptoms must also be present in a number of settings – not just at work or exclusively in intimate relationships, for example. In addition, other mental illnesses must be ruled out as potential causes of the symptomatic behaviors. This is important in narcissistic personality disorder, because the grandiosity present in a manic episode could be mistaken for narcissistic behavior. The diagnostician’s careful attention to details will help tease out which disorder is at work.

What are the symptoms of this personality disorder?

The typical narcissist requires constant flattery, admiration, and attention. In order to be diagnosed, at least five of the following symptoms must be present.

  • A belief that he or she is the best at whatever skill or achievement is under discussion, despite a lack of evidence to support such a belief. This is grandiosity and is common to manic episodes as well as narcissistic personality disorder.
  • A focus on fantasies of success in all arenas, again, despite evidence to suggest otherwise.
  • Snobbishness: A belief that status is of the utmost importance, and a resistance to interact with people or institutions that are deemed “low-status.”
  • A need to be admired.
  • A pervasive attitude and sense of entitlement in all arenas. The expectation that he or she must be catered to.
  • A willingness to exploit others for personal gain.
  • A lack of empathy and the inability and/or unwillingness to meet others’ needs.
  • patient feels they deserve. Also holds the belief that others are jealous of him/her.
  • Moves through the world with an arrogant, self-aggrandizing manner.

Unlike a person with histrionic personality disorder who may become despondent or desperate when s/he does not receive the attention and admiration they believe they deserve, a narcissistic person will often become angry and then dismissive. Similar to those suffering from borderline personality disorder, those with narcissistic personality disorder can have rapid shifts in their belief system such that a person could go from high status and desirable to low status and unworthy in an instant.

Treatment? I Think Not!

People with Narcissistic Personality Disorder are often very rigid and inflexible in their thinking, and a core aspect of this is the inability to admit that they have any flaws or imperfections. This would make it very difficult for them to seek treatment, but sadly many patients with NPD do end up in psychiatric facilities because as life hands them situations in which they must face normal human flaws, they react with much violence and intensity. People with NPD may be at risk for suicide if they receive what is called a “narcissistic injury” – basically a reality check in which their own beliefs about their invincibility are challenged.

If someone with NPD enters outpatient treatment, it might be under duress (e.g. a boss might remand them into treatment) or it might be to seek assistance in managing a loved one’s problem or illness. Medications are not recommended for this disorder, but helping someone with NPD would involve some sophisticated techniques by a well-trained psychotherapist, who might be able to forge a therapeutic alliance by joining with the client, earning and maintaining their respect and trust, while slowly helping them to grow and develop a more flexible and realistic outlook.

Rather than seeking to get help for someone with NPD, it might be more useful for loved ones and family member s of such clients to learn coping skills and techniques for dealing with them.

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