Diagnostic criteria for Narcissistic Personality Disorder (NPD) revisted
August 29, 2005
What is Narcissism?
A pattern of traits and behaviours which signify infatuation and obsession with
one's self to the exclusion of all others and the egotistic and ruthless pursuit
of one's gratification, dominance and ambition.
• Most narcissists (50-75%, according to the DSM-IV-TR) are men.
• The Narcissistic Personality Disorder (NPD) is one of a "family"
of personality disorders (known as "Cluster B"). Other members of
Cluster B are Borderline PD, Antisocial PD and Histrionic PD.
• NPD is often diagnosed with other mental health disorders
("co-morbidity") - or with substance abuse and impulsive and reckless
behaviours ("dual diagnosis").
• NPD is new (1980) mental health category in the Diagnostic and Statistics
Manual (DSM).
• There is only scant research regarding narcissism. But what there is has not
demonstrated any ethnic, social, cultural, economic, genetic, or professional
predilection to NPD.
• It is estimated that 0.7-1% of the general population suffer from NPD.
The lifetime prevalence rate of NPD is approximately 0.5-1 percent; however,
the estimated prevalence in clinical settings is approximately 2-16 percent.
Almost 75 percent of individuals diagnosed with NPD are male (APA, DSM IV-TR
2000).
From the Abstract of Psychotherapeutic Assessment and Treatment of Narcissistic
Personality Disorder By Robert C. Schwartz,Ph.D., DAPA and Shannon D. Smith,
Ph.D., DAPA (American Psychotherapy Association, Article #3004 Annals
July/August 2002)
• Pathological narcissism was first described in detail by Freud. Other major
contributors are: Klein, Horney, Kohut, Kernberg, Millon, Roningstam, Gunderson,
Hare.
• The onset of narcissism is in infancy, childhood and early adolescence. It
is commonly attributed to childhood abuse and trauma inflicted by parents,
authority figures, or even peers.
• There is a whole range of narcissistic reactions - from the mild, reactive
and transient to the permanent personality disorder.
• Narcissistic Supply is outside attention - usually positive (adulation,
affirmation, fame, celebrity) - used by the narcissist to regulate his labile
sense of self-worth.
• Narcissists are either "cerebral" (derive their Narcissistic
Supply from their intelligence or academic achievements) or "somatic"
(derive their Narcissistic Supply from their physique, exercise, physical or
sexual prowess and romantic or physical "conquests").
• Narcissists are either "classic" [see definition below] or they
are "compensatory", or "inverted" [see definitions here:
"The Inverted Narcissist"].
• The classic narcissist is self-confident, the compensatory narcissist covers
up in his haughty behaviour for a deep-seated deficit in self-esteem, and the
inverted type is a co-dependent who caters to the emotional needs of a classic
narcissist.
• NPD is treated in talk therapy (psychodynamic or cognitive-behavioural). The
prognosis for an adult narcissist is poor, though his adaptation to life and to
others can improve with treatment. Medication is applied to side-effects and
behaviours (such as mood or affect disorders and obsession-compulsion) - usually
with some success.
The ICD-10, the International Classification of Mental and Behavioural
Disorders, published by the World Health Organisation in Geneva [1992] regards
Narcissistic Personality Disorder (NPD) as "a personality disorder that
fits none of the specific rubrics". It relegates it to the category
"Other Specific Personality Disorders" together with the eccentric,
"haltlose", immature, passive-aggressive, and psychoneurotic
personality disorders and types.
The American Psychiatric Association, based in Washington D.C., USA, publishes
the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text
Revision (DSM-IV-TR) [2000] where it provides the diagnostic criteria for the
Narcissistic Personality Disorder.
The DSM defines NPD as "an all-pervasive pattern of grandiosity (in
fantasy or behaviour), need for admiration or adulation and lack of empathy,
usually beginning by early adulthood and present in various contexts."
The DSM specifies nine diagnostic criteria. For NPD to be diagnosed, five (or
more) of these criteria must be met.
[In the text below, I have proposed modifications to the language of these
criteria to incorporate current knowledge about this disorder.]
[My amendments do not constitute a part of the text of the DSM-IV-TR, nor is
the American Psychiatric Association (APA) associated with them in any way.]
[Click here
to download a bibliography of the studies and research regarding the
Narcissistic Personality Disorder (NPD) on which I based my proposed revisions.]
Proposed Amended Criteria for the Narcissistic Personality Disorder
• Feels grandiose and self-important (e.g., exaggerates accomplishments,
talents, skills, contacts, and personality traits to the point of lying, demands
to be recognised as superior without commensurate achievements);
• Is obsessed with fantasies of unlimited success, fame, fearsome power or
omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or
sexual performance (the somatic narcissist), or ideal, everlasting,
all-conquering love or passion;
• Firmly convinced that he or she is unique and, being special, can only be
understood by, should only be treated by, or associate with, other special or
unique, or high-status people (or institutions);
• Requires excessive admiration, adulation, attention and affirmation - or,
failing that, wishes to be feared and to be notorious (Narcissistic Supply);
• Feels entitled. Demands automatic and full compliance with his or her
unreasonable expectations for special and favourable priority treatment; • Is
"interpersonally exploitative", i.e., uses others to achieve his or
her own ends;
• Devoid of empathy. Is unable or unwilling to identify with, acknowledge, or
accept the feelings, needs, preferences, priorities, and choices of others;
• Constantly envious of others and seeks to hurt or destroy the objects of his
or her frustration. Suffers from persecutory (paranoid) delusions as he or she
believes that they feel the same about him or her and are likely to act
similarly;
• Behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient,
invincible, immune, "above the law", and omnipresent (magical
thinking). Rages when frustrated, contradicted, or confronted by people he or
she considers inferior to him or her and unworthy.
By Sam Vaknin
Author of "Malignant Self Love - Narcissism Revisited"
AUTHOR BIO
Sam Vaknin ( http://samvak.tripod.com
) is the author of Malignant Self Love - Narcissism Revisited and After the Rain
- How the West Lost the East. He served as a columnist for Global Politician,
Central Europe Review, PopMatters, Bellaonline, and eBookWeb, a United Press
International (UPI) Senior Business Correspondent, and the editor of mental
health and Central East Europe categories in The Open Directory and Suite101.
Until recently, he served as the Economic Advisor to the Government of Macedonia.