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Narcissistic personality disorder is diagnosed when at least five of the following symptoms are present and the individual is at least 18 years old (DSM-IV). The individual has an overwhelming and excessive need for attention and respect from his surroundings. There is grandiose sense of self-importance. The individual believes in own superiority and uniqueness and expects to be recognized as such. There is preoccupation with fantasies of success, power, brilliance and beauty. A narcissist embraces a sense of entitlement and a need to be admired. Others need to comply with the individuals’ wishes, wants, thoughts and desires. Lack thereof will often lead to outrageous and enraged outbursts. Others are being arrogantly, mercilessly and exploitatively used as pawns to achieve the individuals’ goals.  The narcissistic individual is arrogant, condescending, egotistical and will want to only be associated with others who are of a same status and level of self-perceived worthiness. Those who are not special enough are believed to be envious of the individual’s grandiosity.

According to Dhawan et al., (2010) narcissistic personality disorder is found among 6.2% of the population and is present in at least 35.7% of clinical populations. It is commonly found more among men than woman. There is a common co-morbidity of narcissistic personality disorder with depressive mood disorder, substance abuse and bipolar disorder (Gabbard,1989). It is also highly correlated with histrionic, borderline and antisocial dysfunctional personality traits (Beck et al., 2001).  

It has been proposed that there are 2 subtypes of pathological narcissism (Levy et al., 2009) which could co-occur or get alternated. The grandiose type corresponds to the description above of the entitled, arrogant, manipulative, attention seeking narcissist who lacks empathy and is in continuous pursuit of interpersonal power and control. The basic assumption is that if one will achieve one’s entitlement then that implies that one is special. The second type is named the covert or vulnerable narcissist. It is described as an individual who is very sensitive to others’ reactions, anxious and inhibited in social situations. The vulnerable narcissist has a tendency of harshly use self- criticism and feels more guilt.   Such an individual has extreme high and unrealistic internal standards, expectations and ideals but also the realization of personal failure to reach that ideal. The perfectionism, which is demanded from the self and others, typically leads to disappointment and defeat. It is done in a pathological attempt to strengthen and stabilize the self-esteem (Dimaggio & Attina, 2012). The fragile self-esteem leads to the constant need to seek reassurances from others in order boost the self-image. This subtype comes over as more shy and will mostly try to avoid being the centre of attention as it increases the risk of exposure to criticisms (Gabbard,1989).  The switch between the contradictory views of the self could lead, in times of loss or failure, to deep feelings of inferiority and depression.  

The pretentiousness and over self-enhancement behaviour is used as a defence from the outer world that masks feelings of vulnerability, inferiority and inadequacies (Pincus & Lukowitsky, 2010). The core belief about the self is “I am inferior” but the manifest compensatory belief is ” I am superior”. In the same manner the core belief about others is often that” others are superior” but the compensatory belief is that” others are inferior”.  The false-self helps the individual to receive admiration, respect and love, which otherwise it is believed if the truth is known, one will not receive. In an attempt to protect the positive external image the narcissist will take credit for successes, but will blame others for all failures. There is also a tendency to prefer short term goals that will supply immediate pleasure and gratification such as shopping, gambling, various sexual encounters etc.

Initially the narcissist can be charming, charismatic and display confidence which can be very appealing. However, the narcissist has little interest in true intimacy because it might lead to the exposure of his insecurities and vulnerabilities. If the individual’s needs are not being fulfilled then the behaviour can change into insults, belittling, sulking, neglect and even humiliating and being hurtful towards others. Game playing and infidelity might also occur. A narcissistic individual will take all measures in order to ensure that others will not see the true imperfect self and at the same time will try to increase gratification and strengthen the facade which one attempts to cultivate.  

Beck, A.T., Butler, A.C., Brown, G.K., Dahlsgaard, K.K., & Beck, J. S.(2001). Dysfunctional beliefs discriminate personality disorders. Behaviour Research and Therapy, 39, 10,1213-1225.

Dimaggio, G., & Attinà G. (2012). Metacognitive interpersonal therapy for narcissistic personality disorder and associated perfectionism. Journal of clinical psychology, 68, 8, 922-34.

 Gabbard, G. (1989). Comorbidity can be examined two subtypes of narcissistic personality disorder. Bulletin of the Menninger Clinic, 53, 6,527-532.

 Levy, K. N., Chauhan, P., Clarkin, J. F., Wasserman, R. H. T.,& Reynoso, J. S. (2009). Narcissistic Pathology: Empirical Approaches. Psychiatric Annals, 39, 4.

Pincus, A. L., & Lukowitsky, M. R. (2010). Pathological Narcissism and Narcissistic Personality Disorder. The Annual Review of Clinical Psychology, 6, 8.1–8.26.

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