Narcissistic Personality Disorder
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Narcissistic Personality Disorder (NPD) At a
by: Sam Vaknin, Ph.D.
Most narcissists (75%) are men.
NPD is one of a "family" of personality disorders (formerly known as "Cluster
Other members: Borderline PD, Antisocial PD and Histrionic PD.
NPD is often diagnosed with other mental health disorders ("co-morbidity") - or
with substance abuse, or impulsive and reckless behaviours ("dual diagnosis").
NPD is new (1980) mental health category in the Diagnostic and Statistics Manual
There is only scant research regarding narcissism. But what there is has not
demonstrated any ethnic, social, cultural, economic, genetic, or professional predilection to NPD.
It is estimated that 0.7-1% of the general population suffer from NPD.
Pathological narcissism was first described in detail by Freud. Other major
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
There is a whole range of narcissistic reactions - from the mild, reactive and
transient to the permanent personality disorder.
Narcissists are either "Cerebral" (derive their narcissistic supply from their
intelligence or academic achievements) - or "Somatic" (derive their narcissistic supply from their physique,
exercise, physical or sexual prowess and "conquests").
Narcissists are either "Classic" - see definition below - or they are
"Compensatory", or "Inverted" - see definitions here: "The Inverted Narcissist".
NPD is treated in talk therapy (psychodynamic or cognitive-behavioural). The
prognosis for an adult narcissist is poor, though his adaptation to life and to others can improve with treatment.
Medication is applied to side-effects and behaviours (such as mood or affect disorders and obsession-compulsion) -
usually with some success.
Please read CAREFULLY!
The text in italics is NOT based on the Diagnostics and Statistics Manual, Fourth
The text in italics IS based on "Malignant Self Love - Narcissism Revisited",
second, revised, printing (2001)
An all-pervasive pattern of grandiosity (in fantasy or behaviour), need for
admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts.
Five (or more) of the following criteria must be met:
- Feels grandiose and self-importance (e.g., exaggerates
achievements and talents to the point of lying, demands to be recognized as superior without commensurate
- Is obsessed with fantasies of unlimited success, fame,
fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual
performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion
- Firmaly convinced that he or she is unique and, being
special, can only be understood by, should only be treated by, or associate with, other special or unique,
or high-status people (or institutions)
- Requires excessive admiration, adulation, attention and
affirmation - or, failing that, wishes to be feared and to be notorious (narcissistic supply)
- Feels entitled. Expects unreasonable or special and
favourable priority treatment. Demands automatic and full compliance with his or her
- Is "interpersonally exploitative", i.e., uses others to
achieve his or her own ends
- Devoid of empathy. Is unable or unwilling to identify with
or acknowledge the feelings and needs of others
- Constantly envious of others or believes that they feel the
same about him or her
- Arrogant, haughty behaviours or attitudes coupled with rage
when frustrated, contradicted, or confronted
Some of the language in the criteria above is based on or summarized
American Psychiatric Association. (1994). Diagnostic and statistical manual of
mental disorders, fourth edition (DSM IV). Washington, DC: American Psychiatric Association.
The text in italics is based on:
Sam Vaknin. (2001). Malignant Self Love - Narcissism Revisited, second, revised,
printing. Prague and Skopje: Narcissus Publication.
For the exact language of the DSM IV criteria - please refer to the manual itself
About The Author
Sam Vaknin is the author of "Malignant Self Love - Narcissism
Revisited" and the editor of mental health categories in The Open Directory, Suite101, and
Shery is the director of ACRS and is a licensed clinical
psychologist. He has practiced clinical psychology for
approximately 24 years and is affiliated with almost all
health plans, including: ValueOptions, Medicare, Cigna,
Cigna Behavioral Health, United Health Care,
Aetna, First Health,
Healthstar, Blue Cross Blue Shield of Illinois, ComPsych,
Magellan Health, HFN, Tricare, Humana, most union local
school district plans, Unicare, ChoiceCare, CAPP, Multiplan,
Mental Health Network, Managed Health Network, PHCS,
PPONext, Tricare, Humana
Military-Tricare, United Behavioral Health and Beech
He is board
certified as a specialist in professional
counseling by the International Academy of Behavioral
Psychotherapy. He a member of the American Counseling
The office is
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northern Kane County and in southern McHenry
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