Psychology Group Project Draft

Topic: Narcissistic Personality Disorder (NPD)

Requirements: Power Point + Poster

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Deadline: 31/1/23 UPLOAD TO MOODLE!

My Research Part

 Symptoms
Symptoms are pervasive!!!
 Have an unreasonably high sense of self-importance and require constant,
excessive admiration.
 Feel that they deserve privileges and special treatment.
 Expect to be recognized as superior even without achievements.
 Make achievements and talents seem bigger than they are.
 Be preoccupied with fantasies about success, power, brilliance, beauty or the
perfect mate.
 Believe they are superior to others and can only spend time with or be
understood by equally special people.
 Be critical of and look down on people they feel are not important.
 Expect special favours and expect other people to do what they want without
questioning them.
 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 way, brag a lot and come across as conceited.
 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 view as criticism. They can:
 Become impatient or angry when they don't receive special recognition or
treatment.
 Have major problems interacting with others and easily feel slighted.
 React with rage or contempt and try to belittle other people to make
themselves appear superior.
 Have difficulty managing their emotions and behaviour.
 Experience major problems dealing with stress and adapting to change.
 Withdraw from or avoid situations in which they might fail.
 Feel depressed and moody because they fall short of perfection.
 Have secret feelings of insecurity, shame, humiliation and fear of being exposed
as a failure.
 Having an inflated sense of self-importance and entitlement. Deep down, you
feel like you’re the best, most successful, competent, [insert praise here] in any
situation.
 Needing constant admiration. Your self-esteem is like a balloon without a
knot, requiring a steady stream of attention, approval, and recognition to keep it
inflated. No matter how much someone tells you that they love or look up to you,
it feels like it's never enough.
 Expecting special treatment. Whether it’s favors or apologies, whatever you
want, you believe you deserve to have it—because you’re superior to everyone
around you, and they know it and should comply.
 Exaggerating achievements and talents. You have no problem embellishing
the facts—or even outright lying—about your life, resume, and experiences.
 Reacting negatively to criticism. Even though you crave control and take full
credit when things are going well, you’re quick to blame others whenever a
situation doesn’t go as planned. It’s extremely hard to accept criticism or admit
to mistakes because, naturally, it’s always someone else’s fault, not yours.
 Being preoccupied with fantasies about power, success, and beauty. You
tend to create and believe exaggerated, unrealistic narratives around your
success, relationships, even how good you look to help you feel special and in
control. Anything that threatens the fantasy is rationalized away or simply
ignored. You also want people to feel envious of you, and you feel pretty envious
of people who have what you want.
 Taking advantage of others. You often don’t think twice about using or
exploiting other people to achieve your own ends—whether maliciously or
obliviously. You care about your relationships and the people in your life on a
superficial level—if they elevate your social status, or make you look or feel
good, for instance—and you don’t really think about how your behavior might
affect them.
 Having an inability or unwillingness to recognize the needs and feelings of
others. You’re super sensitive to how people treat you and react to your needs
and feelings, but on the flip side, you can’t put yourself in other people’s shoes
and empathize with their experiences. You might belittle others or even bully
people to feel better about yourself. You never really “go deep” in any of your
relationships, either—and, frankly, it doesn’t bother you all that much.
 Behaving in an arrogant manner. With an inflated ego and sense of superiority
and entitlement, you probably insist on having the best everything—the best car,
office, designer clothes—monopolize conversations, look down on people you
perceive as “inferior,” and only associate with those you think are equally
special, successful, and talented.
https://www.psycom.net/personality-disorders/narcissistic
 More specifically, in people with NPD, exploitative behavior may be unconsciously
motivated and emanate from feeling superior or entitled, which serves to enhance
self-image by gaining attention, admiration, and status. Exploitativeness can also
stem from the narcissistic individual having compromised empathic ability and being
unable to identify the boundaries and feelings of others

 Overtly, people with NPD demonstrate extreme confidence,

crave attention, and show little empathy for other people.
However, underneath this facade of confidence, they
 typically suffer from vulnerable self-esteem that requires
constant validation, accompanied by feelings of sadness or
inadequacy and an inability to form lasting relationships.
“The clinical manifestation of narcissism is narcissistic
personality disorder,” says Ramani Durvasula, PhD, a professor
emerita of psychology at California State University in Los
Angeles. “This is a persistent and pathological pattern and
causes the person distress and dysfunction.”

Someone diagnosed with narcissism tends to exhibit certain of

the following traits in a way that suggests they think they are
superior:
 Considering themselves very important
 Not taking criticism well
 Having an outsized sense of their own potential success
 Having a need to be admired
NPD is closely related to other types of personality disorders,
including:

 Histrionic personality disorder (patients with this disorder act

provocatively to gain attention)
 Borderline personality disorder
 Antisocial personality disorder.

Narcissism is a personality trait that is characterized by grandiosity, an inflated sense

of self-importance, and overestimations of uniqueness [1]. For instance, narcissism
is positively correlated with self-references [2], self-focused attention [3], and the
need for uniqueness [4]. Additionally, research has shown that non-clinical
narcissists overestimate their intellectual abilities (e.g. final course grades: [5,6]),
their attractiveness [5,7], and their positive personality traits [8].

The most important characteristics of Narcissistic Personality Disorder (NPD)

as listed by the DSM 5 are “grandiosity, seeking excessive admiration, and a
lack of empathy.” To pinpoint how narcissism manifests itself a little further, I
recently wrote about the fact that there are actually two main types of
narcissism. Grandiose narcissists display an inflated sense of self and often
appear arrogant and entitled. Vulnerable narcissists also have a heightened
focus on themselves but are more needing of reassurance and are envious of
others. Both types of narcissist have something in common, and that is their
 strong propensity to compare themselves to others. While a grandiose
narcissist may feel the need to put others down in relation to themselves or
consider themselves more deserving, a vulnerable narcissist may use
comparisons to feel victimized, jealous, or desperate to have what someone
else possesses.
 Distribution (Age, Race and Gender)

 The disorder affects anywhere from 0.5 to 5% ¹of the general US population with
a greater prevalence in men than women. ² The percentage is low because, in
order to be diagnosed, someone with NPD has to admit they have issues—which
they often don’t. “The real problem with a narcissistic personality disorder is that
the individual lacks good insight into what’s going on,” says Moody. “They
think that the problem is all about everyone else, not them.”

And it can manifest differently in men versus women. According to research, compared
to males, a narcissistic female personality is more likely to include deep insecurity,
martyrdom, jealousy, and competitiveness with other women, often seeing them as a
“threat” (think the overbearing mother-in-law).³ Men on the other hand are more likely
than women to exploit others and feel entitled to certain privileges. They’re also more
apt to exhibit qualities of assertiveness or power hunger.

However, this is not to say these traits are exclusive to either sex. When it comes to
vanity and self-absorption, both sexes rate equally. https://www.psycom.net/personality-
disorders/narcissistic

 0.5-5%: The estimated percentage of people with NPD in the US population-

based on community samples.
 50-75%: The percentage of people with NPD who are men.
 40%: The percentage of people with NPD who also have an anxiety disorder

 50-75%: The percentage of people with NPD who are men.

 0.5-5%: The estimated percentage of people with NPD in the US population-

based on community samples.

 https://www.psycom.net/personality-disorders/narcissistic
 It is notable that the most recent epidemiological study of NPD (Stinson et al.
2008) found a higher lifetime prevalence rate than did many prior studies (men,
7.7%; women, 4.8%).

A 2009 study found that 6.2 percent of people were likely to have
NPD. The disorder is more common in men (7.7 percent) than
women (4.8 percent). The study found that NPD is much more
common among younger people, as well as in people who never
married or are widowed, separated, or divorced. According to
research published in 2018, narcissism decreases with age. The
study also reported that narcissism overall is increasing in
modern Western societies, in what it terms a “narcissism
epidemic.”

Narcissistic personality disorder, on the other hand, is much less common. Approximately
0.5% of the United States population, or one 1 in 200 people, has the disorder. There are
significant gender differences when it comes to the prevalence of the disorder; about 75% of
people with narcissistic personality disorder are men. The prevalence of narcissistic
personality disorder is higher in certain demographics, including:

2–6% of those seeking help from mental health clinics

6% of forensic analysts

20% of people in the military

17% of first-year medical students

Signs of Narcissistic Personality Disorder (NPD) Statistics | Learn More

(therecoveryvillage.com)

A study by J Clin Psychiatry published in the National Library of Medicine ,

collected data from 34,653 adults who participated in face-to-face
interviews. Narcissist statistics results showed that prevalence of
lifetime NPD was 6.2%. The rates show that NPD characteristics were
7.7% more prevalent in men. Out of the total number of
participants 4.8% women showed NPD traits and characteristics.

Throughout this study, results show that NPD was significantly more
common among Afro-Americans at 12,5%, followed by Hispanics at 7.5%,
and Caucasians at 5.0%.

Despite narcissism being higher in Afro-Americans and Hispanics , 87% of

people diagnosed with NPD are Caucasian. This could be a result of
easier access to therapy and treatment among Caucasians.

Research suggests that narcissism is more common among young

adults between the age of 20 to 34. The data shows that narcissistic
traits are less present in adults aged 50 years old or older.

This could be related to the fact that as people grow older, they start
reflecting more about what really matters in life. Young adults see to be
more pre-occupied with materialism, career goals, success, fame, beauty,
control and power.

Another study suggests that NPD declines with age. Wilson and Sibley
showed that in New Zealand, young adults in their twenties showed
symptoms of NPD at a rate of 9.4%, while older adults at the age of
65+ scored less at 3.2%. Narcissistic Personality Disorder Statistics
| 2022 (grace-being.com)

 Research Paper mention/Experiment

Expensive Egos: Narcissistic Males Have Higher Cortisol- David A. Reinhard1, Sara
H. Konrath2,3*, William D. Lopez4, Heather G. Cameron2
When splitting by sex, we found that healthy narcissism was not related to the log of
cortisol in either males, b= 2.30, p= .26, or females, b = 2.13, p= .36. Unhealthy
narcissism, on the other hand, was associated with marginally higher cortisol in
females, b = .27, p= .055, and significantly higher cortisol in males, b = .72, p = .011.
In fact, unhealthy narcissism was more than twice as large a predictor of cortisol in
males as in females.
The present study examined the relationship between narcissism and basal cortisol
concentrations in male versus female participants. Previous experiments have
studied the role of narcissism and reactivity to acute stressful events, and we sought
to determine whether narcissists have higher basal cortisol concentrations even
without an explicit experimentally induced stressor. Participants gave two saliva
samples (one directly after consent and the second after 25 minutes) to determine a
baseline concentration of salivary cortisol. We found that narcissism predicted
higher basal cortisol concentrations overall, and especially in males, even when
controlling for mood, general stress, social support, and relationship status.
A novel aspect to the current study was our analysis of healthy versus unhealthy
types of narcissism. We found that higher unhealthy narcissism predicted higher
salivary cortisol concentrations in males but there was no relationship between
healthy narcissism and cortisol in males. This pattern remains when adding
important controls. This is consistent with prior work showing that unhealthy
narcissism might be the most important aspect of narcissism to examine with
respect to cortisol [48]. In females, there is a marginal tendency for women with
high unhealthy narcissism to have higher cortisol concentrations, however, the
effect size is over 2.5 times smaller in females (b = .27) compared to males (b= .72).
Overall, the relationship between narcissism and cortisol in females is less clear, and
warrants further research.
However, one advantage to measuring a baseline without a relaxation period is that
it captures a more realistic account of how people typically respond to everyday
situations. We found that regardless of whether we examined the Time 1, Time 2, or
average cortisol concentrations, our results were similar (See Tables 1 and 2).
larger increases in cortisol concentrations after stressors [46,47]. Our findings
suggest that the HPA axis may be chronically activated in males high in unhealthy
narcissism, even without an explicit stressor. Given societal definitions of masculinity
that overlap with narcissism (i.e. they include arrogance and dominance), we
hypothesize that these difficulties in maintaining an inflated sense of the self are at
least in part related to the extent to which males endorse stereotypically male
gender roles.
Why do unhealthy aspects of narcissism influence males and females differently?
Perhaps females can escape more severe physiological consequences of narcissism
because there are different expectations for their roles in society. Female gender
roles promote behaviours that encourage women to value relationships and to seek
 and gain social support [67–69], which may lower their risks for chronic activation of
the HPA axis.

 Side Effects (Anxiety, Depression, Anorexia, suicidal thoughts,

drug/alcohol, physical health problems)
Estimates of the prevalence of NPD range from 1% to 17% in the clinical population
and up to 20% in outpatient private practice [4••]. The Wave 2 National
Epidemiologic Survey on Alcohol and Related Conditions found a lifetime prevalence
rate of 6% (7.7% for men, 4.8% for women) in the general population, with
considerable psychosocial disability, especially among men, and co-occurring mood
disorders (depression, bipolar spectrum disorder), anxiety disorders, personality
disorders, and substance use disorders [13••]. However, NPD has also been
diagnosed in private practice and clinics, as well as in non-psychiatric professional
settings such as the military and in medical schools, indicating that people with NPD
can be high functioning and professionally, creatively, or socially successful. In other
words, narcissistic traits and NPD do not necessarily cause or are they necessarily
accompanied by impairment in ability to work or in social or daily functioning. This
was acknowledged in the study by Russ and colleagues [2••], which proposed a third
subtype of narcissistic personalities: the high-functioning exhibitionistic subtype. A
study by Miller et al. [14••] confirmed that depression and anxiety may not be
endemic to narcissistic functioning but rather develop as a result of encountering
failures and limitations, especially in vocational, social, and romantic areas.
Narcissistic Personality Disorder: A Current Review.
Secret feelings of insecurity, shame, vulnerability, and
humiliation
Difficulty dealing with stress and handling change
Feeling depressed if they fall short of their own expectations
What Is Narcissism? Symptoms, Causes, Diagnosis, Treatment, and Prevention |
Everyday Health

 40%: The percentage of people with NPD who also have an anxiety disorder.
https://www.psycom.net/personality-disorders/narcissistic
 Trauma-associated narcissistic symptoms are usually triggered by specific
personally significant interpersonal events that in one or another way affect or
intrude upon the protective narcissistic shield (ie, the individual’s self-esteem,
internal control, and self-regulatory functioning). Although such events can vary
in intensity and duration, the significance is that they are experienced by the
individual as a humiliating or traumatizing attack. Narcissistic Personality
Disorder: A Current Review
 Closely related to internal control is self-esteem dysregulation and the
associated states ranging from experience of grandeur perfectionism to those
of inferiority, insecurity, and worthlessness. Grandiosity (ie, enhanced or
unrealistic sense of superiority, uniqueness, or capability) is expressed in
unwarranted expectations, exceptionally high aspirations, and self-
centeredness, as well as in fantasies of unfulfilled ambitions or unlimited
success, power, brilliance, beauty, or ideal relationships. As one of the key
features of narcissism, grandiosity is now the most distinguishing and
 discriminating evidence-based criterion for NPD. Nevertheless, grandiosity
has also been proven changeable, with variable degrees of overtness or
distinguishability [31]. Vulnerability and fluctuations in self-esteem
regulations cause changeability in grandiosity. Several studies support the
shifts in self-esteem-related internal experiences and their overt expressions
[32, 33]. Vulnerability and insecurity usually have been assigned to the range
of NPD that also includes the shy, covert, shame-ridden phenotype. However,
such shifts may be easily bypassed in people within the arrogant aggressive
phenotypic range or covered up by their surface presentation. Alternatively,
indications of vulnerability may only become overtly noticeable in the context
of ultimatums or failures or when individuals feel trapped, with no way out.
They are then expressed in rage attacks, retaliation, or suicidal behaviour.
Narcissistic Personality Disorder: A Current Review
 Perfectionism can relate to self-presentation (ie, to appear to others as if one is
perfect). This aspect of perfectionism is more interpersonally enacted and
problematic, as it is tied into concealing something that is not perfect. In other
words, this represents an interpersonal relational style or self-presentation
strategies that promote the individual’s supposed perfection to others and
conceal his/her perceived imperfections from others. As such, this is a
significant aspect of narcissistic self-enhancing behaviour that can be actively
self-promoting or self-protective via the non-displaying (not concealing) or
non-disclosing (not admitting) of imperfections. Applied to the narcissistic
personality, perfectionism can be present in conjunction with one or all of the
following: ego ideals, serving as a goal, motivation, or standards; selfesteem
regulation (ie, “I am good/better/superior because I am perfect” or “I have
higher or more perfect standards than others”), indicating self-esteem-related
perfectionism or perfectionism-based self-esteem; or internal control, to which
perfectionism may be crucial for affect regulation and serve as protection
against a delusional state of powerlessness or incompetence and potential
suicidality. Developmental injuries that are perpetuated in entitled attitudes
can become the target of self-criticism and self-depravation, which can operate
effectively 72 Curr Psychiatry Rep (2010) 12:68–75 or unconsciously or be
externalized. Kris [38] also suggested that failure in self-control causes
punitive unconscious or even conscious self-criticism or depressed affect.
 Ritter and colleagues [43•] assessed cognitive and emotional empathy in
patients diagnosed with NPD. They concluded that although NPD involves
deficits in emotional empathy, the cognitive empathy is unaffected and intact.
This challenges the previous notion that people with pathological narcissism
or NPD “lack” empathy. In circumstances in which their self-esteem is less
challenged or they feel more in control of their emotions, people with
disordered narcissism can appropriately empathize. Some can empathize more
with others’ positive experiences than with negative, whereas others are able
to empathize in specific contexts (eg, a friend having difficulties with work or
marriage, but not when co-workers or spouses have difficulties) [4••]
Empathic impairment can be a source of vulnerability to loss of internal
control. The perception of others’ feeling states can cause overwhelming
helplessness, disgust, shame, or envy, triggering hostile reactions or
withdrawal (emotional and/or physical). Note that empathy is not only related
to others’ distress, but for narcissistic people, others’ happiness and joy can be
equally or even more challenging with which to empathize. Empathic
 dysfunction and compromised capability for empathic processing also work
the other way (ie, the narcissistic patient may be unable to accurately perceive
and experience empathy from another person). This is very important to
remember in treating narcissistic patients, who can easily misinterpret genuine
efforts to help [44]. Narcissistic Personality Disorder: A Current Review

 In public, someone with narcissism displays confidence and

a strong sense of self. However, people with NPD may
suffer from depression and anxiety, suicidal thoughts or
behaviour, drug or alcohol misuse, and physical health
problems.
 A 2012 study found that for men, levels of the stress
hormone cortisol were higher among those with higher
scores on a narcissism scale.
 High levels of cortisol can have serious health implications,
including increased risk of high blood pressure and heart
disease.
 Research has also found “high co-occurrence rates” of
substance use and mood, anxiety, and other personality
disorders in people with NPD. What Is Narcissism? Symptoms, Causes,
Diagnosis, Treatment, and Prevention | Everyday Health
 Narcissists score low in empathy [14] and high in hostility,
with a tendency toward aggression, especially after a threat
to their positive self-images [15–18].
 Despite these negative interpersonal outcomes, narcissism is associated with a
number of positive intrapersonal outcomes. For example, narcissists report high self-
esteem [3,4,19–21], and low levels of depression, anxiety, and loneliness [22,23].
They also tend to report more happiness and subjective well-being compared to
those who score lower in narcissism [22]. Researchers have attempted to address
this incongruity by positing that narcissism is multidimensional, namely, that it can
be broken down into adaptive and maladaptive components. Several researchers
have theorized that the most interpersonally toxic elements of narcissism are its
subfactors of Exploitativeness and Entitlement [3,4,24–26], which (1) are typically
uncorrelated with self-esteem, (2) are associated with increased anxiety and
depression [23,27], and (3) are the strongest predictors of poor interpersonal
outcomes such as low forgiveness and increased aggression [17,28]. Some positive
intrapersonal correlates of narcissism, like high self-esteem, seem to exist only for
the adaptive aspects of narcissism (Leadership/Authority, Superiority/Arrogance,
Self-Absorption/Self-Admiration: [21,23]). Overall, the most intrapersonally and
interpersonally toxic aspects of narcissism appear to be limited to Exploitativeness
and Entitlement.
 Despite grandiose self-perceptions, many researchers find that narcissists
simultaneously possess fragile self-views grounded in a sense of inferiority and
worthlessness. For example, Horvath and Morf demonstrate that a threat to the ego
activates concepts of worthlessness in those scoring high in narcissism, but has no
effect on low scorers. To cope with these feelings of inferiority, narcissists use
defensive strategies following threats to the self. For instance, narcissists are more
likely that non-narcissists to believe that an evaluation technique is less diagnostic,
and the evaluator is less competent and likeable, following negative evaluations.
Additionally, narcissists behave more aggressively when insulted and exhibit
displaced aggression when there is a perceived threat to their perceptions of
superiority. To bolster their sense of greatness, narcissists favour companions who
enhance their self-image over caring partners.

 Diagnosis
Nailing down NPD can be a little more complicated since narcissists
tend to think there's nothing wrong with them, they rarely enter
treatment. 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 behaviour 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 behaviour and seek 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 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.
https://www.psycom.net/personality-disorders/narcissistic
 Depression and Anxiety. Subtypes of patients who are vulnerable to
criticism from themselves or others have a higher risk of having
symptoms of depression or anxiety. About 15% of people with
 narcissistic personality disorder also have depression, 13.5% have
anxiety and around 17% have another mood disorder.
 Bipolar Disorder. Bipolar disorder is also fairly common among people
with narcissistic personality disorder. About 17% of people with
pathological narcissism also have either bipolar I or bipolar II.
 Eating Disorders In some cases, people with narcissistic personality
disorder obsess over their appearance. These individuals have a higher
risk of developing an eating disorder because of their obsession with
staying thin and meeting idealized beauty standards.
 Other Personality Disorders. Different personality
disorders commonly co-occur with narcissistic personality disorder.
People with the condition, especially those who have a grandiose
persona, may also have paranoid personality disorder and antisocial
personality disorder. Histrionic, borderline and schizotypal personality
disorders also sometimes co-occur with NPD.
 Substance Use Disorders. People with narcissistic personality disorder
frequently have a substance use disorder as well. They may use drugs
or alcohol to self-medicate and cope with the frustration and anxiety
that comes with the condition. About 14% of people with narcissistic
personality disorder also have an alcohol use disorder,
while 24% misuse other types of drugs.
Signs of Narcissistic Personality Disorder (NPD) Statistics | Learn More
(therecoveryvillage.com)

It’s quite common that individuals who suffer from NPD end up having
problems with substance abuse. Narcissists often use drugs or alcohol to
cope with their overwhelming emotions, frustration, and anxiety that
comes with this mental health issue.

Statistics show that 14% of people with NPD end up developing an

alcohol disorder, and 24% of people with NPD abuse from other
types of drugs. Researchers also analysed people with NPD and
investigated the correlation between narcissism and other disorders.

 Around 40% of people with NPD develop a substance abuse disorder

 40% of people with NPD also suffer from an anxiety disorder
 28.6% of people with NPD suffer from a mood disorder.

Diagnosis
Some features of narcissistic personality disorder are like those of other personality
disorders. Also, it's possible to be diagnosed with more than one personality disorder
at the same time. This can make diagnosis more challenging.

Diagnosis of narcissistic personality disorder usually is based on:

 Your symptoms and how they impact your life.

 A physical exam to make sure you don't have a physical problem

causing your symptoms. 2

 A thorough psychological evaluation that may include filling out

questionnaires. 1

 Guidelines in the Diagnostic and Statistical Manual of Mental Disorders

(DSM-5), published by the American Psychiatric Association.3
https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-
disorder/diagnosis-treatment/drc-20366690
The vast majority of empirical research on normal narcissism has been conducted by
social/personality psychologists measuring narcissistic personality traits in
nonclinical (often student) samples. This research is dominated by the use of the
Narcissistic Personality Inventory (NPI; Raskin & Hall 1979, 1981) as the main self-
report measure of narcissism. Although originally developed with reference to the
introduction of NPD criteria in DSM-III, factor analytic studies of the NPI have
demonstrated an unstable factor structure with two- (Corry et al. 2008), three-
(Kubarych et al. 2004), four- (Emmons 1987), and seven- (Raskin & Terry 1988)
factor solutions reported. Of these, only Raskin & Terry (1988) felt their seven
factors reflected DSM NPD criteria. Unfortunately, no NPI subscales based on these
factor solutions exhibit acceptable levels of internal consistency (del Rosario &
White 2005), and thus most recent studies employ only the NPI total score or the
recent shortened version (NPI-16; Ames et al. 2006). ‘Pathological Narcissism and
Narcissistic Personality Disorder’.
 Internal control is a psychological function that serves to maintain an inner sense of
mastery, cohesiveness, power, separateness, and self-sufficiency. Related to the
concept of self-cohesiveness, which Kohut considered central to narcissistic
functioning, internal control includes the efforts to maintain a sense of control and
an underlying fear of loss of control. Capability of and flexibility in internal control
are central to self-esteem regulation but also to tolerance of affects and the ability
to manage interpersonal relations. Recent efforts to understand narcissistic patients’
consistent rejection of therapeutic intentions highlight their fear of loss of self-
sufficiency, internal control, and ultimately of self-disintegration in response to such
interventions. Narcissistic Personality Disorder: A Current Review
A personality disorder affects the way a person thinks,
behaves, and relates to others. According to the American
 Psychiatric Association, the essential features of a
personality disorder are impairments in personality (self
and interpersonal) functioning and the presence of
pathological personality traits.

Holly Crisp-Han, MD, a psychiatrist and clinical associate

professor at Baylor College of Medicine in Houston and the co-
author of Narcissism and Its Discontents, says everyone has
narcissistic tendencies from time to time.

However, those tendencies become a personality disorder when a

person’s ability to function and engage with others is affected.

Diagnosis is usually made based on several factors:

 An in-depth psychological evaluation

 An assessment of criteria for diagnosis based on the latest
version of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5), published by the American Psychiatric
Association

A diagnosis of NPD in the DSM-5 includes these criteria, according

to PsychDB:4

 Has a grandiose sense of self-importance?

 Is preoccupied with fantasies of unlimited success, power,
brilliance, beauty, or ideal love
 Believes that they are 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?
 Is interpersonally exploitative (such as taking 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
them
 Shows arrogant, haughty behaviours or attitudes

A diagnosis of narcissism requires that these personality traits

continue over time, are consistent in different situations, are not
normal based on the person’s stage of development or their
social or cultural environment, and are not the result of drug or
alcohol use or a medication the person is taking.

As the name implies, mental health professionals characterize narcissistic

personality disorder as a type of personality disorder. The characteristics of people
with narcissistic personality disorder are fairly diverse. However, there is a core set
of features common to most people with this condition. The American Psychological
Association has a set of guidelines on how to diagnose narcissistic personality
disorder that psychologists refer to when they interview a patient. These symptoms
are listed in their official book Diagnosis and Statistics of Mental Disorders (DSM 5):

A pervasive pattern of grandiosity (making themselves appear impressive)

Need for admiration
Fantasies about power, success, beauty or an idealized vision of love
Sense of entitlement
Belief of being special, unique or high-status
Lack of empathy for others
Tendency to exploit others
Arrogant behaviour

 Types of Narcissistic Behaviours

https://youtu.be/nwoHeRvgx_Q
https://youtu.be/_uJs0iGQN0M
The 10 Types of Narcissists, Causes & Warning Signs - Pathways Family
Coaching

#1. The Covert Narcissist (or vulnerable narcissist)

Basically the exact opposite of the stereotype, instead of craving the spotlight and constant
admiration, covert narcissists tend to be shy, self-effacing, hypersensitive to how others perceive
them, and chronically envious. They often think their pain or suffering is worse than everyone
else’s—and may even believe they’re the ugliest person in the room.

#2. The Cerebral Narcissist

They derive their self-importance from their intellect, believing they’re smarter than everyone
else.

#3. The Somatic Narcissist

Somatic narcissists get their self-worth from their bodies. They tend to obsess over physical
appearance, including weight, and criticize others based on their appearance.

#4. The Spiritual Narcissist

They use religion or spirituality to intimidate or justify harmful behaviours to others that can
creep in when an individual takes a "holier than thou" stance, overemphasizing their level of
spirituality or closeness to God. Harmful behaviours can happen when, as an example, a church
leader claims they had a vision from God about someone else, or that they're in a "higher"
position to use Biblical passages to control, hurt, or shame someone.

Other types mentioned in NPD research include grandiose, or "overt"—that stereotypical over-
the-top, attention-seeking type—and high-functioning, meaning those who may use traits such as
competitiveness and exploitation to succeed in a profession or endeavour.

However, it should be noted that there is a broad spectrum of presentable traits with NPD, each
with varying levels of severity, so subtypes should be used as guides rather than hard-and-fast
rules. https://www.psycom.net/personality-disorders/narcissistic

Check out: Phenotypic and taxonomic inconsistencies in conceptualizations of narcissism. On

‘Pathological Narcissism and Narcissistic Personality Disorder’.

Although the validity of the narcissistic personality disorder (NPD) diagnosis has been
confirmed, the present criteria set and diagnostic approach to NPD in the DSM-IV have been
criticized for their overlap with those of other personality disorders, the foremost being
borderline personality disorder, antisocial personality disorder, histrionic personality
disorder, and obsessive-compulsive disorder...Narcissistic Personality Disorder: A Current
Review.

Classic
Classic narcissists are the typical narcissists that most people
think of when they hear the term “narcissist”, also described as
high-functioning, exhibitionistic, or grandiose narcissists. They
exhibit attention seeking behaviour, tend to brag about their
accomplishments, feel entitled to special treatment and expect
others to bow down and kiss their feet. They really aren’t
interested in anyone but themselves, and get easily bored when
the conversation turns away from them. They tend to perceive
themselves to be superior to most people, but ironically are
desperate to feel important.

Vulnerable
The second major type of narcissist is the vulnerable narcissist,
also sometimes called fragile, compensatory or closet narcissists.
Like the classic narcissists, they also feel superior to most people
they meet; however, they are more introverted and despise being
the centre of attention. They prefer to attach themselves to special
people instead of seeking the special treatment themselves. They
are more likely to seek out pity from others or flatter and suck up to
others, sometimes through excessive generosity, just to receive
the attention and admiration they desire to boost their sense of
self-worth.

Communal
The third major type of narcissist is the communal narcissist. This
type is a little trickier to spot at first glance because they focus on
promoting themselves through their commitment to others,
communal goals, and their self-proclaimed super-ability to listen
and connect with others. They will often give to charities (or brag
about how little they spend on themselves) and volunteer their time
“helping” others. They may talk about their “life’s mission” in
grandiose terms or commit themselves to a cause that will “change
the world”. Although they appear selfless on the surface, dig a little
deeper and you may find that they are hugely territorial of the
charity they serve and much more concerned with receiving a pat
on the back for their contribution rather than the communal goal
they are supposedly working toward. The truth of the matter is that
they are only involved in community to validate their sorely lacking
sense of self.

Malignant
The fourth and final major type of narcissist is the malignant, or
toxic, narcissist. They are highly manipulative and exploit others
(typically for pleasure). These narcissists tend to display paranoia
and antisocial traits not present in classic, vulnerable, or
communal narcissists. They can be ruthless in their primary goal
to control and dominate others. They are deceitful and
aggressive. Worse yet, they lack remorse for their actions.

Sub-Type 1: Overt vs. Covert

As I mentioned earlier, each of these major types of narcissists
include sub-types that characterize how the traits may appear to
others. The first sub-type describes the methods the narcissist
uses to get his or her needs met…Are they overt and use methods
that are obvious and out in the open for all to see? Or are they
covert and use methods that are stealthier and more secretive?
For example, we all know that narcissists like to deliver insults and
put people down. An overt narcissist will do so in obvious and
unmistakable ways, while a covert narcissist will do so in more
passive-aggressive ways. A covert narcissist can manipulate
others without them knowing they were manipulated, or their
tactics allow them to deny what happened.

Classic and communal narcissists are always overt, and

vulnerable narcissists are always covert; however, when it comes
to malignant narcissists…they can be either.

Sub-Type 2: Somatic vs. Cerebral

The second sub-type defines what the narcissist values most in
him or herself and others. No narcissist wants to be out-shined by
their partner. Their partner is viewed more like a shiny object they
can show off to raise their own social status. This sub-type
includes somatic narcissists, who are obsessed with their bodies
and their external appearance, and cerebral narcissists who come
across as know-it-alls. They view themselves as the most
intelligent ones in the room, and like to try to impress people with
their accomplishments. Any of the four major types of narcissists –
classic, vulnerable, communal or malignant – can be either
somatic or cerebral.

Sub-Type 3: Inverted vs. Sadistic

The last and final sub-type includes a couple of special types of
narcissists. The first special sub-type is the inverted narcissist,
which only applies to vulnerable, covert narcissists. This group of
narcissists are co-dependent and tend to attach themselves to
other narcissists to feel special. They tend to have a victim mind
set and suffer from child abandonment issues.

The second special sub-type is the sadistic narcissist…a special

type of malignant narcissist. This group is comparable to
sociopaths and psychopaths in that they take great pleasure in
others’ pain. They like humiliating and hurting people, and
sometimes have bizarre sexual fetishes. There are two sides to narcissistic
functioning: the external (ie, being self-enhanced and self-preoccupied, controlling,
insensitive, critical, aggressive, condescending, or provocative, which may serve as
protective armor) and the internal (ie, the low self-esteem, harsh self-criticism, insecurity,
inferiority, and loneliness/isolation, with hypersensitivity, fear, rage, shame, and pain
indicating vulnerability, dysregulation, and compromised abilities). Narcissistic Personality
Disorder: A Current Review