A client of mine said he was involved in a relationship with a woman who was a Narcissist, a taker, and wanted to be a cougar so I wanted to do some research, and this is what I found.
Narcissists are often thought of as people who are in love with him or themselves, but this is not necessarily the case. Narcissists are in love with a made-up image of themselves that they attempt to project out into the world in lieu of their true selves. Most of the time, their true self is wounded and as such, they have an extraordinary feeling of inadequacy.
This is a terribly sad thing, however, it can also be dangerous and toxic. Narcissists are some of the most complicated individuals to associate with and particularly to have a relationship with. It can be troublesome because oftentimes narcissists are not easily identifiable. Many people find that they are deeply immersed in a relationship with a narcissist before they actually figure out that their partner is a narcissist.
Narcissists don’t generally carry on in the pompous or bragging way that one would suspect. As a rule, narcissists usually come across as pleasant, alluring, and even attractive. They are usually even quite fun to be with at first.
Over time, however, as this person’s true narcissistic nature is revealed, things can become increasingly difficult in the relationship. The narcissist can have a profound adverse impact on your well-being. It can feel as if there is never any balance and that you’re Walking on Eggshells. The energy consumed in this type of relationship is immense and draining.
If you suspect you are in a relationship with a narcissist or someone you know is a narcissist, be on the lookout for these 10 often hidden signs. (see more info) Remember that we all exhibit these behaviors from time to time. That doesn’t mean someone is a narcissist. Rather, true narcissists exhibit several of these behaviors on a chronic and habitual basis while being unaware of how their behavior is impacting those around him or them.
Narcissists lack compassion.
When it boils down to everyday living and circumstances, narcissists experience a considerable lack of compassion. Note that they very well may appear to be sympathetic. They are familiar with all the right things to say and do so as to appear to be an honorable individual.
They likewise might really act sympathetic towards their friends and family. They might likewise get involved in circumstances and appear to be benevolent and caring. After some time, however, you will discover that there is an absence of real compassion.
You can also see this in how they treat others in lesser positions or “below” them. For example, waiters and other people in service positions. Likewise, you can observe this in how critical they are to other people’s mistakes.
Overview. Narcissistic personality disorder — one of several types of personality disorders — is a mental condition in which people have an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others.
But behind this mask of extreme confidence lies a fragile self-esteem that’s vulnerable to the slightest criticism.
A narcissistic personality disorder causes problems in many areas of life, such as relationships, work, school, or financial affairs. People with a narcissistic personality disorder may be generally unhappy and disappointed when they’re not given the special favors or admiration they believe they deserve. They may find their relationships unfulfilling, and others may not enjoy being around them.
Treatment for narcissistic personality disorder centers around talk therapy (psychotherapy).
Researchers and experts typically work around five types of narcissism:
- overt narcissism.
- covert narcissism.
- antagonistic narcissism.
- communal narcissism.
- malignant narcissism.
Narcissists seek compliments.
As opposed to the given impression, narcissists deep down within do not believe in themselves. They are insecure and have low confidence in themselves – low self-esteem. Deep down, narcissists are exceptionally insecure and hard on themselves. This is the motivation behind why narcissists are so determined to prove their self-worth. Their low self-esteem pushes them to ascend and accomplish things.
You can sort through this by simply noticing whether this individual fishes for compliments. Some narcissists may even go as far as speaking poorly of themselves in order to get someone else to compliment them or contradict their comment.
Then again, it can also be commonplace for narcissists to outwardly praise themselves for their accomplishments or boast about their accomplishments.
She is often envious, even though she appears to be very confident. She looks for opportunities to undercut other people, and often buddies up with a friend to discuss how the two of them are superior to others in some way.
Signs and symptoms of narcissistic personality disorder and the severity of symptoms vary. People with the disorder can:
- Have an exaggerated sense of self-importance
- Have a sense of entitlement and require constant, excessive admiration
- Expect to be recognized as superior even without achievements that warrant it
- Exaggerate achievements and talents
- Be preoccupied with fantasies about success, power, brilliance, beauty, or the perfect mate
- Believe they are superior and can only associate with equally special people
- Monopolize conversations and belittle or look down on people they perceive as inferior
- Expect special favors and unquestioning compliance with their expectations
- Take advantage of others to get what they want
- Have an inability or unwillingness to recognize the needs and feelings of others
- Be envious of others and believe others envy them
- Behave in an arrogant or haughty manner, coming across as conceited, boastful, and pretentious
- Insist on having the best of everything — for instance, the best car or office
At the same time, people with narcissistic personality disorder have trouble handling anything they perceive as criticism, and they can:
- Become impatient or angry when they don’t receive special treatment
- Have significant interpersonal problems and easily feel slighted
- React with rage or contempt and try to belittle the other person to make themselves appear superior
- Have difficulty regulating emotions and behavior
- Experience major problems dealing with stress and adapting to change
- Feel depressed and moody because they fall short of perfection
- Have secret feelings of insecurity, shame, vulnerability, and humiliation
10 Signs of a Narcissist
- Monopoly on Conversation
- Flaunting Rules or Social Conventions
- Fixation with Appearance
- Unreasonable Expectations
- Disregard for Other People
- Praise, Praise, and More Praise
- It’s Everyone Else’s Fault
- They Fear Abandonment
- The Narcissist Lives in a Fantasy
- There Are Always Strings Attached
Narcissists have a prominent place in the popular imagination, and the label “narcissist” is widely deployed to refer to people who appear too full of themselves. There’s also a growing sense that narcissism is on the rise around the world, especially among young people, although most psychological research does not support that notion.
Narcissism is properly viewed on a spectrum. The trait is normally distributed in the population, with most people scoring near the middle, and a few at either extreme. The Narcissistic Personality Inventory (NPI), developed by Robert Raskin and Calvin S. Hall in 1979, is the most commonly used measure of the trait. Scores range from 0 to 40, with the average tending to fall in the low to mid-teens. Healthy individuals who score somewhat higher may be perceived as exceedingly charming, especially on the first encounter, but eventually, come across as vain. Such individuals may have awkward or stressful personal encounters but still, have a fundamentally healthy personality.
The Traits of Narcissism
It’s easy to describe someone who spends a bit too much time talking about her career or who never seems to doubt himself as a narcissist, but the trait is more complicated than that. Narcissism does not necessarily represent a surplus of self-esteem or of insecurity; more accurately, it encompasses a hunger for appreciation or admiration, a desire to be the center of attention, and an expectation of special treatment reflecting perceived higher status. Interestingly, research finds, many highly narcissistic people often readily admit to an awareness that they are more self-centered. A high level of narcissism, not surprisingly, can be damaging in romantic, familial, or professional relationships.
How do I spot a narcissist?
Narcissism is characterized by a grandiose sense of self-importance, a lack of empathy for others, a need for excessive admiration, and the belief that one is unique and deserving of special treatment. If you encounter someone who consistently exhibits these behaviors, you may be dealing with a highly narcissistic individual.
What’s the difference between narcissism and pathological narcissism?
Pathological narcissism, or narcissistic personality disorder, is rare: It affects an estimated 1 percent of the population, a prevalence that hasn’t changed since clinicians started measuring it. The disorder is suspected when narcissistic traits impair a person’s daily functioning. That dysfunction typically causes friction in relationships due to the pathological narcissist’s lack of empathy. It may also manifest as antagonism, fueled by grandiosity and attention-seeking. In seeing themselves as superior, pathological narcissist naturally views everyone else as inferior and may be intolerant of disagreement or questioning.
Do narcissists know that they are narcissists?
If you wonder whether someone is a narcissist, it might be best just to ask them. It’s generally assumed that people either don’t realize that they are narcissists, or deny it to avoid a challenge to their identity. But in research using the so-called Single-Item Narcissism Scale, people who answered affirmatively to the single question, “Are you a narcissist?” were far more likely than others to score highly on narcissism on the 40-question Narcissistic Personality Inventory.
Are there any benefits to being narcissistic?
Research has discovered some benefits in relatively high but subclinical narcissism, such as increased mental toughness (performing well in high-pressure situations) and higher achievement in school and on the job. A heightened sense of self-worth may also make a person more motivated and assertive than others. Other research has linked narcissism to a lower incidence of depression.
How to Handle a Narcissist
Navigating a relationship with a narcissist can be deeply frustrating and distressing. In their quest for control and admiration, narcissistic people may manipulate and exploit others, damaging their self-esteem and even aiming to alter their sense of reality. Arguing with a narcissist about their action often proves fruitless. A more successful solution is to establish boundaries and emotionally distance yourself. Recognize that you may not be able to control your feelings about a person, but you can control how you respond to them. Cutting ties with a narcissistic partner, family member, or boss may eventually be the best if not the only solution. In that process, it’s helpful to reflect on the characteristics of the individual to avoid finding oneself in similar scenarios in the future.
What are the strategies to handle a narcissist?
Acknowledging your frustration, appreciating where the behavior comes from, and refusing to lose your own sense of purpose when a narcissist takes center stage are key strategies, among others. Researchers who classify narcissists as either vulnerable or grandiose argue that specific approaches are warranted for each type.
Are narcissists successful leaders?
Narcissists tend to have an intense drive for power, attention, and affirmation, which may benefit them in campaigns for corporate management or political leadership. Once in charge, though, they may focus more on self-promotion and the suppression of opposition than advancing an organization’s goals and their lack of empathy fosters little loyalty.
Narcissism in Relationships
A narcissist’s desire to elicit admiration and praise, especially from potential romantic partners, often makes them charming and charismatic, traits that can rapidly ignite a romance. But their inherent deficit of empathy may prevent them from understanding a partner’s inner world and establishing a fulfilling long-term relationship.
It’s nearly impossible for people with a narcissistic personality disorder to truly fall in love and build a trusting, equal partnership. Such an individual may seek to establish strict rules in a relationship and attempt to isolate a new partner from friends and family, among other disturbing behaviors. So correct!
Why do narcissists make such a good first impression?
Research suggests that people may initially be drawn to narcissists because they seem to possess stronger self-esteem than they really do, a trait that people often appreciate.
Can narcissists fall in love?
Narcissists may show passion and charm in the early stages of dating. But for most narcissists, relationships are transactional. They provide positive attention and sexual satisfaction to bolster a narcissist’s ego and self-esteem. The objective is to enjoy uncommitted pleasure, and most narcissists lose interest in the relationship as the expectation for intimacy increases or they feel that they’ve conquered the challenge of securing a relationship. So correct!
Do narcissists have more hookups than other people?
From an evolutionary perspective, it has been theorized that, at least in the realm of mating, narcissism may serve an adaptive function: increased success in short-term mating. Cross-cultural research has found that narcissists tend to have higher levels of sociosexuality: They are more interested in short-term relationships or hookups, and more likely to pursue partners who are already in committed relationships.
What’s the difference between selfishness and narcissism in a relationship?
A narcissistic personality disorder is relatively rare—there are many more people who are simply selfish. The difference lies in whether the person is periodically mean and self-centered or whether they consistently lack empathy.
How Is Narcissistic Personality Disorder Diagnosed?
NPD is not the kind of condition that can be diagnosed with a blood test, MRI, or exact scale, and according to the DSM-5, a person needs to exhibit only 55% of the above traits, symptoms, and behaviors to be considered narcissistic. But nailing down NPD can be a little more complicated. Since narcissists tend to think there’s nothing wrong with them, they rarely enter treatment.
This in part may explain why we might feel we know and encounter many narcissists, but only an estimated 5% of people actually have NPD. (This is also why you can’t ask your therapist to diagnose your narcissistic husband with the disorder if he doesn’t think he has a problem.)
Narcissism hinges on personality traits alone—most of which are objectively negative (it’s pretty easy to label someone with these tendencies as, well, a jerk). But psychologists want to be extremely careful about pathologizing someone’s personality.
A clinical NPD diagnosis is given to someone who’s experiencing social and occupational impairment and subjective distress—which is a fancy way of saying that their narcissistic behavior is not only messing with their work and personal lives, but they’re actually aware that it’s destructive, and it’s making them uncomfortable.
In other words, if a self-entitled, grandiose, empathy-lacking person doesn’t see a problem with the way they live their life, they’re simply just a narcissist—full stop. A clinician usually won’t diagnose a narcissist with NPD until they’re struggling with their behavior and seeking help to change it.
“These individuals most frequently come to therapy to either a) get support for their perspective; or b) because a family member is insisting and it’s easier to comply,” says Dr. Hallett. Sometimes, it takes facing a serious ultimatum, failure, or loss for someone with this personality type to get help, and it’s not uncommon for them to seek treatment for another mental health problem altogether, like depression.
When to see a doctor
People with narcissistic personality disorder may not want to think that anything could be wrong, so they may be unlikely to seek treatment. If they do seek treatment, it’s more likely to be for symptoms of depression, drug or alcohol use, or another mental health problem. But perceived insults to self-esteem may make it difficult to accept and follow through with treatment.
If you recognize aspects of your personality that are common to narcissistic personality disorder or you’re feeling overwhelmed by sadness, consider reaching out to a trusted doctor or mental health provider. Getting the right treatment can help make your life more rewarding and enjoyable.
|Narcissistic personality disorder|
|Symptoms||Exaggerated feelings of self-importance, excessive craving for admiration, and reduced levels of empathy|
|Usual onset||Early adulthood|
|Differential diagnosis||Bipolar disorder, substance abuse, borderline personality disorder, and histrionic personality disorder|
|Treatment||Psychotherapy, pharmaceuticals for comorbid disorders|
|Cluster A (odd)|
|Cluster B (dramatic)|
|Cluster C (anxious)|
|Not otherwise specified|
Narcissistic personality disorder (NPD) is a mental disorder characterized by a life-long pattern of exaggerated feelings of self-importance, an excessive need for admiration, a diminished ability to empathize with others’ feelings, and interpersonally exploitative behavior. A narcissistic personality disorder is one of the subtypes of the broader category known as personality disorders. It is often comorbid with other mental disorders and associated with significant functional impairment and psychosocial disability.
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. Criteria for diagnosing personality disorders are listed in the fifth 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. Its high comorbidity with other mental disorders influences treatment choice and outcomes. Psychotherapeutic treatments generally fall into two categories: psychoanalytic/psychodynamic and cognitive behavioral therapy, with growing support for the integration of both in therapy. However, there is an almost complete lack of studies determining the effectiveness of treatments.
Signs and symptoms
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) describes NPD as possessing at least five of the following nine criteria.
- 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. Individuals with cluster B personality disorders often appear dramatic, emotional, or erratic. A 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.
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.
Narcissistic personality disorder usually develops either in youth or in early adulthood. 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.
ICD-11 and ICD-10
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 as opposed to attributing specific personality traits.
In the previous edition, the ICD-10, narcissistic personality disorder (NPD) is listed under the category of “other specific personality disorders”. This means similarly to the ICD-11, 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.
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, or become impatient and disdainful when other people talk about themselves. This behavior correlates to overall worse functioning in areas of life like work and intimate romantic relationships.
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. Narcissistic personalities are more likely to respond with anger or aggressiveness when presented with rejection. Because they are sensitive to perceived criticism or defeat, people with NPD are prone to feelings of shame, humiliation, and worthlessness over minor incidents of daily life and imagined, personal slights, and usually mask such feelings from people, by feigning humility, responding with outbursts of rage and defiance, or seeking revenge.
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.” 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. 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. 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.
The occurrence of narcissistic personality disorder presents a high rate of comorbidity with other mental disorders. People with NPD are prone to bouts of psychological depression, often to the degree that meets the clinical criteria for a co-occurring depressive disorder. NPD is associated with the occurrence of bipolar disorder and substance use disorders,, especially cocaine use disorder. NPD may also be comorbid or differentiated from the occurrence of other mental disorders, including histrionic personality disorder, borderline personality disorder, antisocial personality disorder, or paranoid personality disorder. 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. Narcissistic personality disorder differs from self-confidence which is associated with a strong sense of self. 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.
Although the DSM-5 diagnostic criteria for NPD have been viewed as homogeneous, there are a variety of subtypes used for the classification of NPD. 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. However, none of the subtypes of NPD are recognized in the DSM-5 or in the ICD-11.
Grandiose/overt and vulnerable/covert
Similar to the definition of NPD in the DSM-IV, Grandiose narcissism is defined by an inflated sense of self-worth and high self-esteem, interpersonal exploitativeness, social dominance and assertiveness, shamelessness, and a sense of entitlement derived from feelings of superiority or prestige.
Oblivious and hypervigilant
The psychiatrist and psychoanalyst Glen Gabbard described two subtypes of NPD in 1989, later referred to as equivalent to, the grandiose and vulnerable subtypes. The first was the “oblivious” subtype of narcissism, equivalent to the grandiose subtype. It was described as being grandiose, arrogant, and thick-skinned, while also exhibiting personality traits of helplessness and emotional emptiness, low self-esteem, and shame. These were observed in people with NPD to be expressed as socially avoidant behavior in situations where self-presentation is difficult or impossible, leading to withdrawal from situations where social approval is not given.
The second subtype Gabbard described was termed “hypervigilant”, equivalent to the vulnerable subtype. People with this subtype of NPD were described as having easily hurt feelings, an oversensitive temperament, and persistent feelings of shame.
High-functioning or exhibitionist
Those, competitive, attention-seeking, and sexually provocative; they tended to show adaptive functioning and utilize their narcissistic traits to succeed.”rd subtype for classifying people with NPD, also initially theorized by Gabbard, is termed high functioning or exhibitionistic.  It has been described as “high functioning narcissists [who] were grand.
This section may be confusing or unclear to readers. (October 2021)
|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, and 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.|
Masterson’s subtypes (exhibitionist and closet)
In 1993, James F. Masterson proposed two subtypes of pathological narcissism, exhibitionist and closet. Both fail to adequately develop an age- and phase-appropriate self because of defects in the quality of psychological nurturing provided, usually by the mother. A person with exhibitionist narcissism is similar to NPD described in the DSM-IV and differs from closet narcissism in several ways. A person with closet narcissism is more likely to be described as having a deflated, inadequate self-perception and greater awareness of emptiness within. A person with exhibitionist narcissism would be described as having an inflated, grandiose self-perception with little or no conscious awareness of feelings of emptiness. Such a person would assume that their condition was normal and that others were just like them. A person with closet narcissism is described to seek constant approval from others and appears similar to those with borderline personality disorder in the need to please others. A person with exhibitionist narcissism seeks perfect admiration all the time from others.
Malignant narcissism, a term first coined in Erich Fromm‘s 1964 book The Heart of Man: It’s Genius for Good and Evil, is a syndrome consisting of a combination of NPD, antisocial personality disorder, and paranoid traits. A person with malignant narcissism was described as deriving higher levels of psychological gratification from accomplishments over time, suspected to worsen the disorder. Because a person with malignant narcissism becomes more involved in psychological gratification, it was suspected to be a risk factor for developing antisocial, paranoid, and schizoid personality disorders. The term malignant is added to the term narcissist to indicate that individuals with this disorder have a severe form of the narcissistic disorder that is characterized also by features of paranoia, psychopathy (anti-social behaviors), aggression, and sadism.
Assessment and screening
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, which has undergone multiple iterations with new versions in 1984, 2006, and 2014. The subtype is also assessed with the pathological narcissism inventory (PNI). The PNI is a screening tool for antisocial, borderline, and narcissistic personality disorders. The PNI scales exhibited significant associations with parasuicidal behavior, suicide attempts, homicidal ideation, and several aspects of psychotherapy utilization. Pathological narcissism is a term for concurrent grandiose and vulnerable narcissism, which is linked to poor self-esteem, lack of empathy, feelings of shame, interpersonal distress, aggression, and significant impairments in personality functioning across both clinical and non-clinical samples. Despite the phenomenological and empirical distinction between vulnerable and grandiose narcissism, some theories suggest that grandiose narcissists also have fragile personality traits. There are a number of other assessment tools for narcissism and NPD subtypes.
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. 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.
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. This includes but is not limited to genetics, neurobiology, trauma, abuse, and parenting.
Evidence suggests there is a high heritability of NPD, with a number of genetic influences indicating varying rates of heritability based on subtype. A number of twin studies historically suggested the heritability of NPD, including personality disorders in general.
Environmental and social factors also influence the development of NPD. In some people, pathological narcissism may develop from an impaired emotional attachment to primary caregivers (usually parents). 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; overindulgent, permissive parenting or insensitive and over-controlling parenting are risk factors for the development of NPD in a child.
In Gabbard’s Treatments of Psychiatric Disorders (2014), the following factors are identified as promoting the development of narcissistic personality disorder:
- 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
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.
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. The results of a 2015 study associated the condition of NPD with a reduced volume of gray matter in the prefrontal cortex. 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.
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. 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. The specific choice of treatment varies based on individual presentations.
Management of narcissistic personality disorder has not been well studied, however many treatments tailored to NPD exist. 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 quality of life, irrespective of diagnosis. People with NPD often present with comorbid mental disorders, complicating diagnosis and treatment. 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.
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.
As of 2018, the overall prevalence is estimated to range from 0.8% to 6.2%. In 2008 under the DSM-IV, the lifetime prevalence of NPD was estimated to be 6.2%, with 7.7% for men and 4.8% for women, with a 2015 study confirming the gender difference. In clinical settings, prevalence estimates range from 1% to 15%. The occurrence of narcissistic personality disorder presents a high rate of comorbidity with other mental disorders.
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.
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:
- Havelock Ellis (1898) was the first psychologist to use the term when he linked the myth to the condition of one of his patients.
- Sigmund Freud (1905-1953) used the term “narcissistic libido” in his Three Essays on the Theory of Sexuality.
- 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 the inability to empathize with others’ situations, and was selfish sexuality. 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.
A narcissistic personality was first described by the psychoanalyst Robert Waelder in 1925. The term narcissistic personality disorder (NPD) was coined by Heinz Kohut in 1968. Waelder’s initial study has been influential in the way narcissism and the clinical disorder Narcissistic personality disorder are defined today
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 acknowledgment of a relic of the old megalomania of infancy“; and concluded that: “we can detect an element of megalomania in most other forms of the paranoic disorder. We are justified in assuming that this megalomania is essential of an infantile nature, and that, as development proceeds, it is sacrificed to social considerations.”
Narcissistic injury and narcissistic scar are terms used by Freud in the 1920s. Narcissistic wound and narcissistic blow are other, almost interchangeable, terms. When wounded in the ego, either by real or perceived criticism, a narcissistic person’s displays of anger can be disproportionate to the nature of the criticism suffered; but typically, the actions and responses of the NPD person are deliberate and calculated. Despite occasional flare-ups of personal insecurity, the inflated self-concept of the NPD person is primarily stable.
In The Psychology of Gambling (1957), Edmund Bergler considered megalomania to be a normal occurrence in the psychology of a child, a condition later reactivated in adult life if the individual takes up gambling. 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.
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. The term is typically used in a negative sense, describing a pathological or excessive need for attention or admiration in codependents and the orally fixated, that does not take into account the feelings, opinions, or preferences of other people.
The term narcissistic rage was a concept introduced by Heinz Kohut in 1972. Narcissistic rage was theorized 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.
Narcissistic rage reactions are not necessarily limited to NPD. They may also be seen in catatonic, paranoid delusion, and depressive episodes. It was later suggested that narcissistic people have two layers of rage; the first layer of rage is directed at constant anger toward someone else, with the second layer being self-deprecating.
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 defense mechanism. This Kleinian therapeutic approach is built upon Heinz Kohut‘s view of narcissistic megalomania as an aspect of normal mental development, in contrast with Otto Kernberg‘s consideration of such grandiosity as a pathological distortion of normal psychological development.
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. 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 defense mechanisms of idealization and devaluation, and of denial.
Comparison to borderline personality disorder
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.”
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.
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 criticized 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.
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. 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. 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 a personality dimension pertinent to the full range of personality disorders, rather than as a distinct diagnostic category. 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.” In a 2018 latent structure analysis, results suggested that the DSM-5 NPD criteria fail to distinguish some aspects of narcissism relevant to the diagnosis of NPD and subclinical narcissism.
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What makes someone a taker?
“We make a living by what we get; we make a life by what we give.” (Winston Churchill)
The Giver gives and forgives, and the Taker gets and forgets!
Takers are just that—takers. They usually treat people well only if and when those people can help them reach their goals. Interestingly, Grant points out, they often appear as the most charming and charismatic people—on the surface. They know how to work for the crowd and seduce, but their primary motivation is self-interest.
You can recognize a Taker by how poorly they treat people they believe are of no use to them. You know you’re in a relationship with a Taker when you feel they suck you dry for all you have—money, affection, time, etc. Once the Taker has everything they want, they may relegate you to the “unimportant” sphere of their life.
Givers, takers, and matches
What’s the difference between these types?
Takers are self-focused and put their own interests ahead of others’ needs. They try to gain as much as possible from their interactions while contributing as little as they can in return.
Matchers like to preserve an equal balance of giving and taking. Their mindset is: “If you take from me, I’ll take from you. If you give to me, I’ll give to you.”
Givers are others-focused and tend to provide support to others with no strings attached. They ask themselves, “How can I add value to this person? What can I contribute?”
- Make Sure the Person is Really a Taker. Sometimes takers aren’t that easy to spot. …
- Set Boundaries. Boundaries are healthy and save us from becoming bitter doormats or those who give so much that we never focus on our own needs or goals. …
- Stop Giving—But Not to Everyone. …
- Sever the Relationship. He did!
They’re constantly asking you to do favors for them
Sure, friends with healthy relationships will do favors for one another, but if it’s one-sided and the person is constantly asking you to go out of your way for them, they’re taking advantage of you — and wasting your time.
Givers are highly empathetic and caring individuals who put others’ needs above their own. They have intuitive abilities to anticipate the emotional gaps of others and support them. They find great joy in being available and are seen as a source of encouragement or a shoulder to cry on.
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
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