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In this section you will find a clear summary of all important information about narcissistic personality disorder.
For a classification of narcissistic personality disorder in the overall concept of narcissism as well as further information on characteristics, causes, manifestations, severity and treatment options of narcissism as well as the origin of the term, see the article Narcissism.
In colloquial language, a "narcissist" is understood to mean a person who displays pronounced egotism, arrogance and selfishness and behaves ruthlessly towards others.
Narcissistic personality disorder, on the other hand, is a profound personality disorder in which there is a lack of self-esteem and a strong sensitivity to criticism. These characteristics alternate with a conspicuous self-admiration and exaggerated vanity and an exaggerated self-confidence outwardly. The latter serves those affected to compensate for their low self-esteem. In addition, they have a poor ability to empathize with others.
Those affected tend to present themselves as great to the outside world. For example, they emphasize their professional achievements, appear very status-conscious, or have a tendency to engage in exclusive activities. Often they overestimate their own abilities or make them out to be better than they really are. They also have a tendency to lie- with the aim to get attention and recognition or to get their own way. Because of their low empathy, they often behave toward others as they would not like to be treated themselves: They exploit others or destroy their achievements out of envy.
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Michael was convinced that he was a special person: he thought of himself as intelligent and good-looking, and as someone who excelled professionally, had a large circle of friends and acquaintances, and always had an intense relationship with an attractive woman. Even as a child and adolescent, he had believed that he was actually entitled to more than he got.
He applied for a job as editor of a newspaper with the words: "I am extraordinarily talented. I am sure that I will do great things in this position and will soon create a new standard in this region.“ In his new job, he was performing well – but not as outstanding as he believed himself to be. In addition, after a short time he was extremely unpopular among his colleagues and employees. They thought he was arrogant, conceited and self-centered. He often bragged about grandiose plans, manipulated others, had choleric emotional outbursts, and refused to take responsibility when something went wrong. If someone criticized him only slightly, he became angry and was convinced that the others were only envious of him.
At first glance, Michael was indeed charming and socially successful. However, he only used his charm to take advantage of other people. His relationships were also superficial: he often had enough of his partners after a short time, then treated them dismissively and broke up with them rather callously. He himself was not sad about the separations- and other people meant nothing to him, except when they were useful to his goals. (according to Comer, 2008)
Symptoms and frequency of narcissistic personality disorder
The affected persons have according to DSM An exaggerated idea of how important they themselves are. They demand and expect to be constantly admired and praised by others. At the same time, they can only take other people’s perspectives to a limited extent. The disorder begins in adolescence or early adulthood. At least five of the following criteria must be met:
- Those affected have a grandiose understanding of their own importance. For example, they exaggerate their accomplishments and talents or expect to be recognized as superior by others without corresponding accomplishments.
- They are strongly taken in by fantasies of boundless success, power, brilliance, beauty, or ideal love.
- They believe themselves to be "special and being unique. Therefore, they are convinced that they are only "special" to others or to be understood by highly placed people or only to have to maintain contact with them.
- They need excessive admiration.
- They display a high sense of entitlement. This means that they have an exaggerated expectation that expectations will automatically be met or that they will be treated especially favorably.
- They behave exploitatively in interpersonal relationships, that is, they take advantage of others to achieve their own goals.
- They show a lack of empathy, meaning they are unwilling to recognize, accept, or empathize with the feelings or needs of others.
- They are often envious of others or believe others are envious of them.
- They exhibit arrogant, haughty behaviors or views.
In contrast to the DSM, the narcissistic personality disorder in the ICD-10 only in the case of "other specific personality disorders" listed, but not described in detail there.
How common is narcissistic personality disorder?? What other disorders often occur at the same time?
Probably less than one percent of the population is affected by the disorder. In this case, 75 percent are men and 25 percent are women. The disorder is often observed together with borderline personality disorder.
Causes of narcissistic personality disorder
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This disorder is also thought to involve a combination of biological, psychological and environmental factors. Genetic factors are thought to play a role in its development. In addition, the disorder may be fueled by parents who show little appreciation for their child, lack empathy, and may also overtax the child. In order to nevertheless receive recognition, those affected then develop behavior in which they constantly emphasize their own abilities and present themselves as particularly good to the outside world.
Psychoanalytic theory assumes that people with narcissistic personality disorder received too little love and recognition from their parents in childhood. However, it could also be that parents have focused on their child and their child’s desires and have admired them excessively for their talents.
Sufferers constantly vacillate between an overly positive self-image and a fear of not meeting the standards of others. They are convinced that they will only be loved if they do a lot for it and constantly show their talents and specialties, and need constant affirmation from others.
The constant feelings of envy and the lack of empathy can be explained, from the point of view of psychoanalysis, by the fact that those affected have an unconscious anger towards others. Their tendency to exploit and manipulate others also means that they cannot develop satisfying interpersonal relationships.
Cognitive behavioral therapy is based on the assumption that sufferers were treated too positively in their early years- they were, for example, idolatrously loved, admired or idealized by their parents. As a result, they develop the self-image of being special and overestimate their own abilities.
Treatment of narcissistic personality disorders
Narcissistic personality disorder is primarily treated with psychotherapy. However, those affected rarely come to therapy of their own accord. Reasons for therapy are usually other mental disorders, especially depression.
Possible problems in psychotherapy and possible solutions
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Because sufferers see themselves as special and are reluctant to challenge this image, the disorder is considered relatively difficult to treat. In therapy, it is therefore helpful to understand this view as a kind of self-protection that gives patients at least superficial self-esteem and protects them from psychological crises.
Another problem in therapy is often that the patients believe they are entitled to a very special treatment. In addition, they tend to admire and idealize the therapist on the one hand, but then react with feelings of envy or devaluation again. Characteristically, they also try to manipulate the therapist into behaving in a certain way. It is therefore important to recognize the central personal needs of the patient and to respond to them- but also to establish clear rules and set boundaries.
Psychoanalytic and depth psychology-based therapy
In the context of psychoanalytic therapy, different approaches have been developed to treat narcissistic personality disorder. Transfer-focused psychotherapy according to Otto Kernberg and John Clarkin assumes that therapy should work with interpretations and that patients should be confronted with the fact that their overestimation of themselves is a defense mechanism against anger, aggression and feelings of envy. In practice, however, it has been shown that this approach often leads to premature discontinuation of therapy.
Other psychoanalysts, such as Heinz Kohut, also consider a confrontational approach to be of little use because it only leads to defensive reactions on the part of the patient. Instead, Kohut and his followers see a supportive, empathetic, and caring approach as clearly more appropriate. They emphasize that the therapist should treat the affected person respectfully and empathetically even if they either extremely idealize or devalue him or her. In this way, the patient can experience being accepted and valued as a person, and gradually develop a more positive self-image in which he or she is not constantly dependent on the admiration of others.
Cognitive behavioral therapy
Again, the establishment of a sustainable, appreciative therapeutic relationship is an essential element of therapy. The patient’s idiosyncrasies should not be judged morally. Instead, very concrete experiences and problems are addressed. Characteristic difficulties of the patient in relationships can be worked out from them and gradually changed.
In addition, attempts are made to change unfavorable thinking patterns- for example, the idea of having to be good all the time in order to be accepted and valued by others. Patients may learn to stop basing their self-esteem so much on other people’s opinions and to handle criticism better. The patients’ black-and-white thinking (i.e., the tendency to view themselves or others as grandiose at times, but then again as worthless) is questioned and gradually replaced by a more graded viewpoint.
To help them develop more empathy, role-playing with video feedback can be used. Here they can experience how their own behavior affects others and then change it accordingly.
Therapy with psychotropic drugs
As a rule, psychotropic drugs are not considered helpful in narcissistic personality disorder. They are mainly used when other mental disorders are present at the same time, for example depression.
The narcissistic personality style according to Kuhl& Kazen
People with a narcissistic personality style- which resembles a narcissistic personality disorder, but is less pronounced- place value on the special. For example, they are particularly achievement-oriented, prefer fancy clothes and display a status-conscious demeanor. They are often ambitious and have a high attitude of entitlement. But this can also lead them to be quickly offended or envious of others.