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More about narcissistic personality disorder

The MetroWest Daily News
Feb 20, 2017

Q: My friend says there is a psychiatric diagnosis for being a narcissist. Is that true?

A: There are no specific blood or imaging tests to diagnose psychiatric disorders, although research is being done on this (for example studying specialized MRI imaging tests). However, it is very important to have a set of criteria to identify psychiatric disorders in a reproducible and objective way in order to make the correct diagnosis and to help guide treatment. To accomplish this the American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders (the DSM, now in its fifth edition).

The DSM defines Narcissistic Personality Disorder as a condition of “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:

Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements) Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love believes that he or she is “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, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations Is interpersonally exploitative, i.e., takes 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 him or her Shows arrogant, haughty behaviors or attitudes.”

It is important to understand how these criteria may manifest is a given patient. NPD patients: Do more than exaggerate their achievements or brag; for them everything is “huge,” “fantastic” and other such extreme descriptions. They will say this even in the face of substantial evidence to the contrary, for example saying “I got the best grade ever,” even though they actually scored an average grade. Will ignore facts and try to manipulate others to believe something that is not true in order to control a situation or dialogue, whether by utilizing “alternative facts” or simply by repeating a lie often enough to get others to accept it as true. Typically do not show remorse for their actions. They have a very difficult time admitting they are wrong and/or apologizing. Have an excessive need for admiration, overly basking in any recognition and inflating it (for example saying they won an award by “a landslide” even if this is not consistent with the facts). Usually believe they are superior to everyone else, and may make statements like “I am the only one who can fix this problem.” Typically lack empathy since they often have difficulty sharing, or even understanding, someone else’s feelings. Hence they may treat others, even whole groups of people, in a negative way, callously making decisions or statements that may hurt them. Typically cannot accept criticism or questioning of their self-proclaimed superiority, aggressively pushing back even at perceived challenge to their self-view of perfection. May be abusers, although the specifics of their abusive behavior may manifest differently depending on their status in their social circle and community. For example, they may insult or mock other people (even to the point of being sexist, racist, etc.) to demonstrate their superiority. Some NPD patients are verbally, physically and/or emotionally abusive to their significant other, family or social network, using fear, guilt, or other threatening and/or bullying behavior (such as name-calling).

People with NPD are thought to be trying to mask their insecurity and underlying true lack of self-esteem. It is this fragile aspect of their personality that motivates much of their behavior (for example their inability to admit error or their misrepresentation of facts).

Although there are many egotistical people of varying degrees, having a true NPD is not very common; it affects about one in every 200 people. Males account for about three quarters of NPD cases. Having NPD does not necessarily prevent someone from becoming successful in their pursuits or professions; for example, it is estimated that over 10 percent of medical students have some aspects of NPD.

There are no specific medications to help people with NPD. Instead intensive, and typically long duration, psychotherapy is required. The results of these treatments vary quite a bit from patient to patient, but overall are usually quite limited.

It may not be possible to convince someone with NPD to seek help, and most do not seek treatment on their own (because of their inability to admit any flaws. If their behavior adversely affects your life, you need to put your own health and well-being first. You may benefit from counseling to help guide you as to what is best for you, even if that means severing your relationship with this person.

—Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com

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