Narcissistic Personality Disorder (NPD)

Narcissistic Personality Disorder (NPD)

Narcissism is the excessive interest and admiration of oneself or one’s physical appearance. The word in English comes from a Greek myth in which a handsome young man named Narcissus sees his reflection in a pool of water and falls in love with it. He pines away for the love of that reflection and is eventually turned into an eponymous flower.

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Definition

Narcissistic personality disorder (NPD) is a mental health condition in which people have an exceptionally high sense of self-importance. It is defined by DSM-5 in terms of attention-seeking and grandiose personality traits. It is also defined through significant personality impairments like looking for external validation of self-esteem and thinking of self as outstanding.

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This translates to the need for admiration and a distorted understanding of caring about and feeling for others. Broken empathy and shallow relationships are thus an eventuality, there is also lesser tolerance for criticism and masked doubt on self-worth. As a result, their interpersonal relationships are generally not satisfying and they seem snobbish, deflecting socially. Note that this is different from having a narcissistic personality type. It is a less extreme form of narcissism while displaying all of the characteristics. Such people are in the normal personality range, i.e. a majority of people fall in the same range.

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Symptoms

Narcissistic personality disorders are shown through varied outlets. People with the disorder:

• Are highly judgemental and negatively critical of others and make that visible.

• Show an inflated sense of self but are very unsure of it internally.
• Envy others but expect only similarly exceptional people to “get them”.
• Require admiration and validation, from others intensely and constantly.

• Are arrogant, repulsive, and are either incapable or uninterested in recognizing others’ wants and emotions.
• Feel entitled to favours and pedestal treatment, because of an unquestionable superiority established without backing or any achievements.

• Fantasise and think about the perfect looks, love life, control, intelligence etc. Their needs are similar as they would ask for the best of everything.

• Can be impulsive and engage in gambling, substance abuse or certain sexual activities.

They thus harbour and hide feelings of humiliation and insecurity. They fear failing and being shown to the external world as a failure. This leads to
withdrawing from such possibilities in advance and isolating themselves. If this is disproved somehow, they would react in contempt and belittle others or exaggerate their skills, to elevate self superiority. This can sometimes be confused with healthy confidence, but people with healthy self-esteem display humbleness which is absent in this disorder. They can turn to displays of impatience and anger if this is not recognised. Thus they can experience discomfort in dealing with inferior quality and in being forced to adapt, which can cause stress, depression, or moodiness.

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Types

Overt and Covert are two types of NPD. They share a lot of the same traits and symptoms with the core idea being that of promotion of self, the idea that the self stands out exceptionally because of intelligence, beauty etc. What differs between the two types is how they surface. Overt is generally more grandiose and covert is more reflective of a vulnerable person. This difference generally originates from different childhood experiences and also controls how future interpersonal relationships play out.

1. Overt (grandiose) narcissism:

It is characterised by dominance, control-asserting behaviour, extroversion, aggressive actions, not being sensitive, elitism, exaggerated self-confidence, bragging and seeking attention visibly. This mostly stems from being treated as superior since their childhood, which becomes an expectation as an adult.

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2. Covert (vulnerable) narcissism:

It is characterised by the need to feel special, anxiety, extra sensitivity but for self-promotion, getting offended at not being recognised, feeling inadequate, need for constant reassurance, negative emotions towards others shown as introversion etc. This mostly stems from years of abuse or neglect as a child.

Diagnosis

As there are no tests to diagnose this mental disorder, professionals either use the Narcissistic Personality Inventory (NPI) or DSM-5 defined criteria set. The NPI is a questionnaire that approximates how much attention and power someone craves by presenting respondents with a set of 40 items in which they decide which of two statements is most relatable to them. Statements are generally structured like “being an authority doesn’t mean that much to me”.

On the other hand, the DSM-5 diagnostic criteria to diagnose include the following:

• Inflated sense of self-importance, entitlement, achievements, and talents
• Need for constant admiration, praise, and special treatment due to perceived superiority
• Behaving arrogantly, reacting negatively to criticism, and in general, being poorly emphatically skilled or unwilling to understand others’ needs and feelings.
• Taking advantage of others for self-promotion and ignoring consequences.
• Not liking inferiority and being preoccupied with fantasies about power, success, and beauty.

Causes

Causes for NPD remain elusive to research and are likely complex. It may be related to neurobiology, genetics, or parent-child relationships where the criticism or adoration doesn’t equate to the level of real skills or accolades. Studies have found the last case to be more probable as being put on a pedestal as a child can lead to narcissistic expectations as an adult which ignorance or abuse can develop NPD as an unhealthy coping mechanism for survival, where through narcissism, they are looking out for themselves. In terms of statistics and demographics, teens and young adults display it more and males show the same more than females.

Treatments

Therapy is a great tool to counter NPD. As early as possible, talking can help one learn to appreciate and relate to others. Social connections and appreciation are an important first step that can be obtained through talk therapy to make interpersonal relationships more fun, strengthen the bonds in them, and make them feel worth pursuing. Positive interactions with others can start breaking through self-centrism and show one how to maintain relationships.

Therapy through talking can take various positive forms like collaboration which can improve one’s skills & desire to work with colleagues. It can help with self-esteem and managing feelings. Finally, it can also help one understand their actual strengths and estimate their potential more accurately to be able to tolerate criticisms and set realistic goals for oneself.

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Conclusion

A therapist needs to pull out the vain, grandiose narcissist who is masking the possibly abused and excessively self-critical, depressed, and shame-faced child, to help people with NPD. They need to set this child on a journey of finding self-acceptance without either going back to inflating themselves or belittling others. It is tricky, difficult, and requires a lot of patience to understand these complex personalities.

A good system of support positive interactions, and appreciation of the other, are friends of the therapist here. There is a need for a better understanding of NPD. It is tricky as someone who is snobbish may have a deep sense of insecurity below the mask of superiority and need your help in identifying this disorder and helping them out of it. On the other hand, detailed awareness of NPD can help one tease apart people with NPD and people who are just mildly self-absorbed and hypercompetitive, which is not to the extent that disrupts their mental health and relationships around them.