NARCISSISTIC

PERSONALITY
DISORDER
MADE BY: Yashika (63), Priyal (11), Sakshi
YASHIKA CONTRIBUTION

INTRODUCTION AND DEFINITION

DSM-5 CRITERIA OF NPD
COMMORBIDITY
DEVELOPEMT AND DISCOURSE
ONSET
PREVALENCE
 INTRODUCTION
 Individuals with narcissistic personality disorder show an exaggerated sense of self-importance, a preoccupation
with being admired, and a lack of empathy for the feelings of others (Pincus & Lukowitsky, 2010; Ronningstam,
2005, 2009, 2012).
 Numerous studies support the notion of two subtypes of narcissism: grandiose and vulnerable narcissism (Cain et
al., 2008; Ronningstam, 2005, 2012).
a) The grandiose presentation of narcissistic patients, highlighted in the DSM-5 criteria, is manifested by traits
related to grandiosity, aggression, and dominance. These are reflected in a strong tendency to overestimate their
abilities and accomplishments while underestimating the abilities and accomplishments of others. Their sense of
entitlement is frequently a source of astonishment to others, although they themselves seem to regard their lavish
expectations as merely what they deserve. They behave in stereotypical ways (e.g., with constant self-references
and bragging) to gain the acclaim and recognition they crave. Because they believe they are so special, they often
think they can be understood only by other high-status people or that they should associate only with such
people, as was the case with Bob at the beginning of the chapter. Finally, their sense of entitlement is also
associated with their unwillingness to forgive others for perceived slights, and they easily take offense (Exline et
al., 2004).
b) The vulnerable presentation of narcissism is not as clearly reflected in the DSM criteria but nevertheless
represents a subtype long observed by researchers and clinicians. Vulnerable narcissists have a very fragile and
unstable sense of self-esteem, and for these individuals, arrogance and condescension is merely a façade for
intense shame and hypersensitivity to rejection and criticism (Cain et al., 2008; Miller et al., 2010; Pincus &
Lukowitsky, 2010; Ronningstam, 2005, 2012). Vulnerable narcissists may become completely absorbed and
preoccupied with fantasies of outstanding achievement but at the same time experience profound shame about
their ambitions. They may avoid interpersonal relationships due to fear of rejection or criticism.

 Narcissistic personalities also share another central trait— they are unwilling or unable to take the perspective
of others, to see things other than “through their own eyes.” Moreover, if they do not receive the validation or
assistance they desire, they are inclined to be hypercritical and retaliatory (P. S. Rasmussen, 2005). Indeed, one
study of male students with high levels of narcissistic traits showed that they had greater tendencies toward
sexual coercion when they were rejected by the target of their sexual desires than did men with lower levels of
narcissistic traits. They also rated filmed depictions of rape less unfavorably and as more enjoyable and
sexually arousing than did the men with low levels of narcissistic traits (Bushman et al., 2003).
 CASE STUDY (from butcher)
A 25-year-old, single graduate student complains to his psychoanalyst of difficulty completing his Ph.D. in English literature
and expresses concerns about his relationships with women. He believes that his thesis topic may profoundly increase the
level of understanding in his discipline and make him famous, but so far he has not been able to get past the third chapter. His
mentor does not seem sufficiently impressed with his ideas, and the patient is furious at him but also self-doubting and
ashamed. He blames his mentor for his lack of progress and thinks that he deserves more help with his grand idea, that his
mentor should help with some of the research.
The patient brags about his creativity and complains that other people are “jealous” of his insight. He is very envious of
students who are moving along faster than he and regards them as “dull drones and ass-kissers.” He prides himself on the
brilliance of his class participation and imagines someday becoming a great professor. He becomes rapidly infatuated with
women and has powerful and persistent fantasies about each new woman he meets, but after several experiences of sexual
intercourse feels disappointed and finds them dumb, clinging, and physically repugnant. He has many “friends,” but they turn
over quickly, and no one relationship lasts very long. People get tired of his continual self-promotion and lack of
consideration of them. For example, he was lonely at Christmas and insisted that his best friend stay in town rather than visit
his family. The friend refused, criticizing the patient’s self-centeredness; and the patient, enraged, decided never to see this
friend again.
 DSM-5 CRITERIA OF
NPD
A pervasive pattern of grandiosity (in fantasy or behavior),
need for admiration, and lack of empathy, beginning by
early adulthood and present in a variety of contexts, as
indicated by five (or more) of the following:
1. Has a grandiose sense of self-importance (e.g.,
exaggerates achievements and talents, expects to be
recognized as superior without commensurate
achievements).
2. Is preoccupied with fantasies of unlimited success,
power, brilliance, beauty, or ideal love.
3. Believes that he or she is “special” and unique and can
only be understood by, or should associate with, other
special or highstatus people (or institutions)
5. Has a sense of entitlement (i.e., unreasonable
expectations of especially favorable treatment or
automatic compliance with his or her expectations).
6. Is interpersonally exploitative (i.e., takes advantage
of others to achieve his or her own ends).
7. Lacks empathy: is unwilling to recognize or
identify with the feelings and needs of others.
8. Is often envious of others or believes that others are
envious of him or her.
9. Shows arrogant, haughty behaviors or attitudes.
 CLINICAL PICTURE
COMORBIDITY:
Narcissistic personality disorder is
frequently comorbid with- substance use
disorders, bipolar disorder, and other
personality disorders. Narcissistic
personality disorder most commonly co-
occurs with antisocial, histrionic,
borderline, schizotypal, and passive-
aggressive personality disorders;
comorbidity with antisocial personality
disorder
SIGNS & SYMPTOMS:
oHave an exaggerated sense of self-importance
oHave a sense of entitlement and require
constant, excessive admiration
oExpect to be recognized as superior even
without achievements that warrant it
oExaggerate achievements and talents
oBe preoccupied with fantasies about success,
power, brilliance, beauty or the perfect mate
oBelieve they are superior and can only associate
with equally special people
SIGNS & SYMPTOMS:
o Monopolize conversations and belittle or look
down on people they perceive as inferior
o Expect special favors and unquestioning
compliance with their expectations
o Take advantage of others to get what they want
o Have an inability or unwillingness to recognize
the needs and feelings of others
o Behave in an arrogant or haughty manner,
coming across as conceited, boastful and
pretentious
 SIGNS & SYMPTOMS:
o Become impatient or angry when they don't
receive special treatment
o React with rage or contempt and try to belittle the
other person to make themselves appear superior
o Have difficulty regulating emotions and behavior
o Experience major problems dealing with stress and
adapting to change
o Have secret feelings of insecurity, shame,
vulnerability and humiliation
DIFFERENTIAL DIAGNOSIS:

The differential diagnosis for narcissistic personality disorder

includes bipolar illness, substance abuse, depressive
disorders, especially treatment refractory depression, and
anxiety disorders, as well as other personality disorders. All
are frequently comorbid with narcissistic personality disorder,
complicating diagnostic and clinical decision making. While
manic states can mimic many of the features of grandiose
narcissism, the admiration seeking and devaluation of others
characteristic of narcissistic personality disorder are typically
absent in manic individuals. Symptoms associated with major
depression, dysthymia, social anxiety, and generalized anxiety
disorder overlap with features of vulnerable narcissism.
ONSET:
Often, NPD begins in the teenage years or early adulthood (18 years or older).
Psychologists believe that the full onset of NPD may occur when interpersonal
development is compromised, for example:
o Being born with an oversensitive temperament
o Learning manipulative behavior from parents or peers
o Being excessively praised for good behaviors and excessively criticized for
bad behaviors
o Suffering from severe childhood abuse or neglect
o Inconsistent or unpredictable parental caregiving
o Growing up with unrealistic expectations from parents
o Being excessively pampered or overindulged by parents, peers, or family
members
o Being excessively admired with no realistic feedback to ground you with
reality
o Receiving excessive praise from parents or others focused on your looks or
abilities
 DEVELOPMENT & COURSE
Narcissistic traits may be particularly common
in adolescents and do not necessarily indicate
that the individual will go on to have narcissistic
personality disorder. Individuals with
narcissistic personality disorder may have
special difficulties adjusting to the onset of
physical and occupational limitations that are
inherent in the aging process.

 PREVALENCE
Prevalence estimates for narcissistic personality
disorder, based on DSM-IV definitions, range
from 0% to 6.2% in community samples. Of
those diagnosed with narcissistic personality
disorder, 50%-75% are male
 CASE STUDY
David was an attorney in his early 40s when he sought treatment for a depressed mood. He appeared to be an outgoing man
who paid meticulous attention to his appearance. He made a point of asking for the therapist’s admiration of his new designer
suit, his winter tan, and his new foreign convertible. He also asked the therapist what car he drove and how many VIP clients
he dealt with. David wanted to make sure he was dealing with someone who was the best in the business. David spoke of
being an “ace” student and a “super” athlete, but could not provide any details that would validate a superior performance in
these areas. During law school, David became a workaholic, fuelled by fantasies of brilliant work and international
recognition. He spent minimal time with his wife, and after his son was born, even less time with either of them. He waited
until he felt reasonably secure in his first job so that he could let go of her financial support, and then sought a divorce.
After his divorce, David decided he was totally free to just please himself. He loved spending all his money on himself, and
lavishly decorated his condominium and bough an attention getting wardrobe. He constantly sought the companionship of
different, attractive women.
David felt better when someone flattered him; when he was in a social situation where he could easily grab the centre of
attention; and when he could fantasize about obtaining a high ‐level position, being honoured for his great talent, or just being
fabulously wealthy