How To Deal With A Narcissist

Stop Narcissists from messing up your life

This is a comprehensive guide that contains every information you need to deal with narcissistic personality. The program offers valuable intuition into how this condition is formed, the effects they have on developmental experiences, and how this personality affects the brain and eventually the information that can help you deal with narcissists. This program is wished-for for people that are fed up with the frustrations of dealing with narcissists. If you are fed up and don't want to put up with them or give up on them, then this program is perfectly for you. This program is not all about solving problems. It helps people who are fed up with frustrations of dealing with Narcissists giving them a better method of solving all the problems from home. You don't have to put up with their frustrations or even give up because there's a reliable solution. The main program is available in downloadable PDF formats. This means you can download the program from wherever you are without any issues.

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Narcissistic Personality Disorder

The narcissistic personality is characterized by an exaggerated or grandiose sense of self-importance and an illusion of being unique or special that lead to feelings of entitlement. Such persons overestimate their abilities, popularity, and power, frequently coming across as self-centered, conceited, and boastful. They are typically preoccupied with themselves and their self-affirming fantasies of unlimited success, fame, intellectual sophistication, power, and beauty. Sadly, their excessive self-regard is equaled only by their cavernous misperception they think and expect that others should recognize their superiority, special talents, and uniqueness. Underneath, it is presumed that the narcissist feels inadequate and dependent, with fragile self-esteem (Kernberg, 1975). The narcissistic type often responds to negative feedback with intense rage and attempts to degrade those who were critical, presumably in an attempt to bolster fragile self-esteem. Another feature is that the...

Application to Antisocial Histrionic Narcissistic Dependent and Avoidant Personality Disorders

People with features of Narcissistic Personality Disorder are perhaps, on the surface, more clearly related to ancestral status hierarchies than the other disorders in this group. Narcissistic persons are attracted to power, have a high need for admiration, and lack empathy. They often abuse people whom they feel are beneath them, especially if these attacks also build up the narcissist. They often exaggerate their own successes while they denigrate or greatly envy the successes of others. The basis of the Narcissistic Personality Disorder is one of status and its maintenance. They are also seen as cheaters by evolutionary psychologists because their self-centeredness and lack of empathy means that they will take advantage of others and be poor reciprocators.

Narcissistic personality disorder DLT

Narcissistic personality disorder is characterized by an exaggerated sense of self-importance with a lack of sustained positive regard for others. Grandiosity (in fantasy or behaviour) and constant craving for admiration and external gratification are additional features of this disorder. They are present in a variety of contexts and begin by early adulthood. The term narcissism originates from the Greek myth of Narcissus who was infatuated with his own reflection in the mirror-lake. Its contemporary usage has many meanings and implications, from its colloquial usage denoting self-centred persons, often with pejorative connotations, to a pathological clinical syndrome. Despite the popularity of the construct, there is still considerable disagreement on the aetiology and phenomenology of narcissistic personality disorder. There is little empirical evidence regarding its description, clinical utility, and validity.

Variations of the Narcissistic Personality

Compensatory Narcissist

Few individuals in real life exist as the incarnation of an abstract psychological ideal. Instead, most persons combine aspects of two or more personality styles, though some combinations are more common than others. Whereas the previous section sharpened the contrast between various prototypes for explanatory purposes, in this section we portray narcissistic variants that are found as the disorder begins to shade toward other personalities (see Figure 10.2 for a summary). Actual cases may or may not fall into one of these combinations. The Unprincipled Narcissist Unprincipled narcissists combine the self-confidence of the narcissist with the recurrent aberrant behavior of antisocial personality patterns. Many of these individuals achieve success in society by exploiting legal boundaries to the verge of unlawfulness. Others may inhabit drug rehabilitation programs, centers for youth offenders, and jails and prisons. Still others are opportunists and con men, who take advantage of...

The Misunderstood Narcissist Personality and the Therapeutic Relationship

A local university student scheduled an appointment with a psychologist in private practice, complaining that his instructors rarely understood his ideas. When asked why he did not present this to the counseling center, he explained that ordinary counselors would be unable to understand his problems. During the first session, he was confident but congenial. By the second session, however, a condescending attitude of superiority had broken through. During the third session, he appeared to regard the psychologist with contempt. When a clarifying question was asked, he responded, I would think you would have enough information to understand everything that you need to know by now. Arrogant and exploitive interpersonal conduct is often associated with the narcissistic personality.

Variations of the Antisocial Personality

Antisocial Personality Disorder

Not all antisocials covet material possessions or power. Those who share traits with the narcissistic personality are motivated by the desire to defend and extend a reputation of bravery and toughness. Antisocial acts are designed to ensure that others notice them and accord them the respect that they deserve. As such, they are perpetually on guard against the possibility of belittlement. Society should know that the reputation-defending antisocial is someone significant, not to be easily dismissed, treated with

Interpersonal relationships

Interpersonal relationships are frequently parasitic, manipulative, and exploitative. They idealize people whom they expect to feed their narcissism, but deprecate and treat with contempt others (often former idols) from whom they do not expect to receive anything. They lack empathy and concern for others, who are welcome only as an applauding crowd and as mirrors of success. Typical defence mechanisms (omnipotence, omniscience, intellectualization, rationalization, idealization, and devaluation) are derived from splitting. The Narcissistic Personality Inventory(91 and the semistructured Diagnostic Interview for Narcissism (92 assess characteristics imputed to pathological narcissism. Narcissistic personality disorder is often comorbid with major depression, dysthymic disorder, substance abuse, and anorexia nervosa. Patients meeting criteria for narcissistic disorder have a high overlap with histrionic, borderline, and antisocial personality disorders, and also with schizotypal,...

Variations of the Compulsive Personality

Much larger force and becoming an indispensable part of this important structure. As such, they often share hallmarks with the narcissistic personality, although these more inflated qualities are but skin-deep. Like the conscientious compulsive, the bureaucratic compulsive often shades gently into normality, but individual differences run the spectrum from nearly normal to wholly forceful. At a moderately disordered level, their rigid adherence to policies and rules makes them seem officious, high-handed, close-minded, and petty. At a severely disordered level, they may use their knowledge of the rules, effectiveness with red tape, and ingratiating attitude with superiors to terrorize subordinates or anyone else who crosses their path without paying them the proper dues and respect. Donald has some traits of the bureaucratic compulsive in that he is obviously a company man, but he doesn't derive pleasure from control. As a middle-level manager, he could potentially exert a great...

Early Historical Forerunners

In spite of an apparent dearth of reported clinical cases of narcissistic personality disorder across the globe, this potential for excessive self-regard leading to involuntary self-destructiveness is apparently well recognized across culture and time. Ancient Greek mythology teaches us the perils of excessive hubris (roughly translated as lack of humility ) in the myth of Narcissus, a beautiful young man who, though loved by everyone, will not love anyone in return. His refusal eventually catches the ire of the goddess Aphrodite, who curses him. Ironically, he gazes into a pool and falls desperately in love with his own reflection. Each day is spent alone with his reflection, pining after what he cannot possess. Not knowing that it is his own image that he loves, he proceeds to seek oneness with his self-glorified image, and he promptly drowns himself in the pool. The myth thus seems to say that narcissists are unaware both of the intensity of their own self-love and how it affects...

For Designing a Treatment Plan

The purposes of treatment include the relief of symptoms, the accommodation of necessary change, the tolerance of interdependence, and the support of healthy narcissism. To conclude this chapter, we offer several guiding questions for psychother-apeutic work. Kernberg, O. F. (1975). Borderline conditions and pathological narcissism. New York Aronson.

The ego and its defences Anna Freud Hartmann and Lacan

Reaction formation describes the ways in which the ego counteracts unconscious desires or impulses that threaten its equilibrium by consciously held views directly contrary to these the militant pacifist who is out of touch with any feelings of aggression for example, or the self-effacing secret narcissist. Identification with the aggressor, first described by Anna Freud, is frequently invoked in discussions of the psychological effects of childhood abuse. One way of dealing with the horror of abuse is to 'dis-identify' with oneself (a form of dissociation), and to put oneself in the place of the person who is attacking, thereby reducing feelings of pain and helplessness. This idea helps to explain how those who have been abused in childhood may become abusers themselves in adult life. A frequent experience in working with severely disturbed patients, many of whom are abuse survivors, is that healthcare workers may themselves feel attacked or symbolically 'abused' by these patients...

Personality change due to a general medical condition JLC

The narcissistic personality disorder and the differential diagnosis of antisocial behaviour. Psychiatric Clinics of North America, 12, 553-70. 41. Kernberg, O.F. (1975). Borderline conditions and pathological narcissism. Aronson, New York. 45. Quality Assurance Project (1991). Treatment outlines for borderlines, narcissistic and histrionic personality disorders. Australian and New Zealand Journal of Psychiatry, 25, 392-403. 83. Freud, S. (1914). On narcissism an introduction. In Standard edition of the complete psychological works of Sigmund Freud, Vol. 14 (ed. J. Strachey), pp. 67-103. Hogarth Press, London, 1957. 89. Lasch, C. (1978). The culture of narcissism American life in an age of diminishing expectations. Norton, New York. 90. Akhtar, S. (1989). Narcissistic personality disorder. Descriptive features and differential diagnosis. Psychiatric Clinics of North America, 12, 505-29. 91. Raskin, R. and Hall, C.S. (1981). The Narcissistic Personality...

Indications and contraindications for psychoanalysis and derived psychotherapies

Standard psychoanalysis is the treatment of choice for patients with neurotic personality organization, i.e. with good identity integration and a repertoire of defences centring on repression along with sufficient severity of illness to warrant such a major therapeutic intervention. Psychoanalysis has also expanded its scope to some of the severe personality disorders, particularly a broad spectrum of patients with narcissistic personality disorders, patients with mixed hysterical-histrionic features, and selected cases of patients with severe paranoid, schizoid, and sado-masochistic features.

The Evolutionary Neurodevelopmental Perspective

According to the biopsychosocial-evolutionary theory (Millon, 1990 Millon & Davis, 1996), the narcissistic personality is passively self-oriented. Such individuals turn primarily to themselves for gratification and do not perceive a need to engage in the requisite give and take necessary to live in a community. The developmental pathway to this strategy is often relatively straightforward, as portrayed in the interpersonal tradition. Here, caretakers overvalue the self-worth of the future narcissist by providing noncontingent praise, attention, and tribute. Narcissists fail to develop the motivation and skills ordinarily necessary to elicit these rewards. Merely being who they are is sufficient thus, narcissists come to value themselves regardless of their real attainments. Nothing should be required to elicit admiration or performance from others. Instead, narcissists feel nothing more is needed than to just be themselves. Indeed, parental overvaluation through the stages of...

The Debate about Stability versus Change for the Personality Disorders

In another early cross-sectional study, Coolidge et al. (1992) examined age differences in personality disorders between a sample of community-dwelling older adults (age range 61 to 78 years) and younger adults (age range 16 to 58 years) with the self-report form of the CATI (Coolidge & Mer-win, 1992). Results showed that the older adults were significantly higher on the schizoid and obsessive-compulsive scales than the younger adults there were no age differences on the dependent and avoidant scales and younger adults were higher on the remaining scales (antisocial, borderline, histrionic, narcissistic, paranoid, passive-aggressive, schizotypal, sadistic, and self-defeating). These results of age-related elevations for obsessive-compulsive and schizoid scales were replicated with larger samples (Segal et al., 2001). In a similar cross-sectional study using the self-report Millon Clinical Multiaxial Inventory (MCMI Millon, 1981b), Molinari et al. (1999) also reported a higher rate of...

Cluster A personality disorders Paranoid personality disorder JLC

Personailty Disorder Table

Individuals with this personality disorder may be at increased risk for agoraphobia, obsessive-compulsive disorder, and substance abuse or dependence. This personality disorder is often codiagnosed with schizoid, schizotypal, narcissistic, and avoidant personality disorders. People with schizotypal personality disorder are suspicious, have paranoid ideas, and keep their distance from others. However, they also experience perceptual distortions and magical thinking, and are usually odd and eccentric. Schizoid personality disorder is characterized by aloofness, coldness, and eccentricity, but these individuals usually lack prominent suspiciousness or paranoid ideation. Individuals with avoidant personality disorder are hypersensitive and do not confide in others. However, their lack of confidence is based on fear of being embarrassed or found inadequate rather than fear of other people's malicious intentions. Some antisocial behaviour by paranoid individuals originates in a wish for...

The Psychodynamic Perspective

Although the results of this particular study referred to histrionic women, there is no reason to believe that histrionic men are any more sexually competent. In fact, a similar pattern of high sexual self-esteem and difficulties has been identified for males and labeled sexual narcissism by the same authors (Hurlbert & Apt, 1991).

Carl G Jung Jungs Contribution to Personality Theory

Histronie Wut

In contrast to denial and repression, other defense mechanisms seem more complex or convoluted. Rationalization, for example, is often used to justify a particular action after the fact. In effect, ego looks at both its own behavior and the situation as it might be perceived by others and asks, How can what I've done be made to seem reasonable This defense is a favorite of narcissists, whose self-centeredness often leads them to act without thinking through in advance the consequences for others or how their own actions might be viewed. Other defense mechanisms seem convoluted. In projection, for example, unacceptable motives are transferred from the self and attributed to others. Paranoids use projection to rid themselves of guilt about their own aggressive impulses by attributing such threats to others, it is the paranoid who becomes the persecuted, endangered, sympathetic victim. A list of defense mechanisms is given in Table 1.3. As Freud and his associates viewed it, personality...

The relationship between offending behaviour and mental disorder

Perhaps most complex of all is the relationship between the disordered state of mind and disordered behaviour to be found in psychopathy, or its virtual equivalents antisocial personality disorder and severe personality disorder. These disorders are often characterized by varying mixtures of affective instability, impulsivity, suspiciousness, narcissism, difficulties with intimacy, and ready resort to anger. The psychopathic disorders arguably often have their roots in large part in an interaction between a pre-existing vulnerability and developmental disadvantages such as inadequate parenting, child abuse, educational failure, and social disruption. Similarly antisocial behaviour emerges most frequently against the same background of family and social deprivation. The problems of the definition and management of personality disorders are dealt with elsewhere suffice it to say that the offending behaviour and disturbances of mental state which often accompany such conditions are...

Comparison of the brief psychodynamic psychotherapies

Brief psychodynamic psychotherapy for depression, narcissistic disturbances, panic disorder, substance abuse, and post-traumatic stress disorder have been described 2 26) Horowitz et a .(27) have described brief psychotherapy focused on the stress responses evidenced by various personality styles. He emphasizes that this psychotherapy is directed towards dealing with the process of the stress response and not character change. However, his outcomes indicate that selected character changes are possible in some areas. The distinction between recovery from a disruption in homoeostatic balance, reconstitution of self-esteem and self-concept, and changes in character structure require further exploration.

The Cognitive Perspective

Writing in the same volume, Beck et al. (1990) paint a similar picture. Histrionics see themselves, according to Beck, as glamorous and impressive. As such, they feel justified in being the center of attention and form strong bonds with others who indulge them and play the part of the admiring audience. Whereas the same is true of narcissists, histrionics do not remain aloof and superior to others, but instead engage them directly in ways that solicit a continuous flow of praise and appreciation. Like most personality disorders, the core beliefs of histrionics are intensely negative. In fact, those schemas lead to compensatory beliefs, which literally insulate individuals from what they believe to be the dismal truth. Histrionic core beliefs are variants of, I am basically unattractive, and I need others to admire me in order to be happy compensatory beliefs include, I am very lovable, entertaining, and interesting, and People are there to admire me and do my bidding (p. 50)....

The DSM Multiaxial Model

Axis Psychological Disorderrs

The disorders in the DSM are grouped in terms of a multiaxial model. Multiaxial literally means multiple axes. Each axis represents a different kind or source of information. Later, we concentrate on exactly what these sources are now, we just explain their purpose. The multiaxial model exists because some means is required whereby the various symptoms and personality characteristics of a given patient can be brought together to paint a picture that reflects the functioning of the whole person. For example, depression in a narcissistic personality is different from depression in a dependent personality. Because narcissists consider themselves superior to everyone else, they usually become depressed when confronted with objective evidence of failure or inadequacy too profound to ignore. Their usually puffed-up self-esteem deflates, leaving feelings of depression in its wake. In contrast, dependent personalities seek powerful others to take care of them, instrumental surrogates who...

Gender Bias in the Diagnosis of Personality Disorders Do Clinicians Have Gender Expectations

Cloninger Model

Nevertheless, certain personality disorders do seem weighted toward a particular gender. For some researchers (Kaplan, 1983 Pantony & Caplan, 1991), these discrepancies in diagnostic frequency, particularly in the larger number of females diagnosed borderline, dependent, and histrionic, are inherently sexist. However, although the DSM-IV agrees that these three are more frequently diagnosed in women, it also states that the paranoid, schizoid, schizotypal, antisocial, narcissistic, and obsessive-compulsive are more frequently diagnosed in men. If there is a bias, then, it would appear to go against the males. Livesley, Jang, Jackson, and Vernon (1993) sought to examine the heritability of 18 dimensions associated with personality disorder pathology, as assessed by the Dimensional Assessment of Personality Pathology (Livesley, Jackson, & Schroeder, 1992). They found that the dimensions of anxiousness, callousness, cognitive distortion, compulsiv-ity, identity problems, oppositionality,...

Characteristics of the subchapters of Chapter V F

Specific personality disorders are coded in this subchapter. Cyclothymic personality is not included, but an equivalent appears in F3 as cyclothymia. Also, schizotypal disorders could have been assigned to this subchapter but appears instead in F2 (as F21). As in DSM-IV, the emotionally unstable personality disorder is found in this subchapter, where it is subdivided into an impulsive type (F60.30) and a borderline type (F60.31). A new entity is the factitious disorder, i.e. the intentional production or feigning of symptoms or disabilities, either physical or psychological (F68.1). If desired, narcissistic personality disorder and passive-aggressive personality disorder may be coded by using the criteria in Annex 1 of DCR.

Looking at Significant Stressors What Else Can Account for Somatic Symptomatology

They present themselves in a socially acceptable light, maximizing impressions of health and minimizing or even omitting negative characteristics, behaviors, and symptoms that might become an important focus of treatment, if only they were known. Compulsive interviewers sometimes overestimate pathology when confronted with subjects who appear overly frivolous or grandiose, such as the histrionic and narcissistic personalities. In contrast to the compulsive, the masochistic personality is invested in bringing harsh punishment on the self masochists may, therefore, overadmit to problems. Sometimes, distortions of reality are corroborated by two or more individuals because of the personality dynamics of their relationship. A narcissistic member of a couple may damn his masochistic counterpart for her failings, while the masochist sits in agreement. To an interviewer focused only on verbal report, the masochist is the problem and, therefore, the proper focus of treatment. Functionally,...

Sadistic personality disorder DLT

The major distinction for the diagnosis of sadistic personality disorder is from antisocial personality disorder. Widiger et al.(U2) note that the sadistic person may simply represent an aggressive (antagonistic) subtype of psychopathy. Intimidation and sadistic control of others, as well as a fascination with weapons, martial arts, and torture, may be manifested by both antisocial and sadistic individuals. Moreover, both disorders may display 'malignant narcissism', (3 with an admixture of narcissistic, antisocial, sadistic, and paranoid features. Such a characterological constellation is frequent among murderers and therefore is considered to be of great forensic significance. (H8) Widiger et al.(UD state that making a distinction between antisocial personality disorder and the sadistic personality disorder may be as meaningless as trying to determine whether a person is psychopathic or antisocial. Existing data(H9) suggest that sadistic personality disorder is relatively uncommon,...

Maximizing Supervision Finding the Most Suitable Therapeutic Approach

Having learned much from her first supervisor, a psychodynamic sage, Jenna was eager to begin studying with her second supervisor, known for his knowledge of cognitive techniques. When her first client, a depressed male graduate student, scored in the narcissistic range on the MCMI-III, her new supervisor recommended that she educate the client in the principles of cognitive therapy, focusing particularly on the discovery of automatic thoughts and their connection with his self-image, which featured quickly vacillating appraisals of his ability, ranging from godlike to pathetically inadequate. After the first two sessions, however, she noticed that the client seemed increasingly condescending, apparently chaffed by her attempts. Realizing that the personality disorder was the most important factor driving his depression, Jenna suggested to her new supervisor that perhaps the automatic thoughts underlying the transference itself could be discussed as a means of synergizing the...

General aetiological considerations in delusional disorders

The psychodynamic literature continues to discuss aspects of 'paranoia' but often fails to differentiate clearly between trait, symptom, personality disorder, and psychotic illness. Freud postulated that paranoia (by which he probably meant delusional disorder) was the result of regression from the homosexual phase of psychosexual development to a fixation at the primary narcissistic phase. Homosexual feelings unacceptable to the individual are transformed by projection into suspiciousness and rejection in this theory, an understandable warding-off of supposed homosexual advances. This scenario involving repressed homosexuality is assumed with no convincing proof and there seems to be no established connection between homosexuality and delusional disorder, although cases of delusional disorder in homosexuals are recorded 3 ,40) Klein(42) postulated a fixation at the paranoid-schizoid position, said to occur between the sixth and ninth months of life, inducing profound hatred by the...

Neuroses Psychoses and Personality Disorders

Freud called his earliest conception of neurosis neurasthenia, and he saw all neurasthenias as rooted in sexual difficulties. Later, he differentiated the neurasthenias into different types, such as anxiety, hysteria, melancholia, narcissistic, obsessional, sexual, and war neuroses. He maintained that neuroses had no specific etiologic factor but that their nucleus, regardless of neurotic type, was the Oedipal conflict (or presumably Electra conflict for women) during the phallic stage. Neurotics, in general, had the common symptom of anxiety, either manifest or latent. When DSM-III adopted a more behavioral approach than the formerly psychoanalytically based DSM-II, it dropped the specific term neurosis but not the essential idea that a group of disorders had at their core the symptom of anxiety. Notably, some of Freud's other neuroses were later categorized by the DSM as personality disorders, such as narcissistic (Narcissistic Personality Disorder), obsessional...

Pathophysiology of bulimia nervosa

Comorbid major depression is commonly noted. There is an increased incidence of rapid cycling mood disorders and anxiety and substance-related disorders. Substance abuse involving alcohol and stimulants, occurs in one third of patients with bulimia nervosa. Between 2 and 50 percent of women with bulimia nervosa have borderline, antisocial, histrionic or narcissistic personality disorder.

Variations of the Paranoid Personality

The fanatic paranoid pattern often resembles its less troubled cousin, the narcissistic personality, as this variant is an interweaving of both paranoid and narcissistic traits. Like the narcissist, the fanatic variant of the paranoid pattern comes across as arrogant, pretentious, and expansive and maintains an air of contempt toward others. A major difference is that narcissists often achieve some success, whereas fanatic paranoids have run hard into reality, their narcissism profoundly wounded. Thus fallen from grace, their self-image of perfection shattered, fanatic paranoids seek to reestablish lost pride through extravagant claims and intricate fantasies. By endowing themselves with illusory powers, they become superheroes or demigods, ready to prevail against an evil universe. Developmentally, fanatic paranoids are similar to compensating narcissists. Overindulged and unrestrained by their parents, their imagination of what they might become in life was given free reign and...

Indications and contraindications for therapeutic community treatment Indications

Diagnosis Dependence syndromes but currently abstinent depressive disorders severe or intractable neurotic, stress-related, and somatoform disorders personality disorders , particularly cluster B 'dramatic-erratic' (dyssocial, emotionally unstable, borderline, impulsive, histrionic, and narcissistic)

Disorders of awareness of the body

Narcissism is not generally accepted as a disease entity but is useful to consider as a psychopathological symptom. It is an exaggerated concern with one's self-image, especially with personal appearance. This absorption with self is usually associated with marked feelings of insecurity and ambivalence concerning the self, with feelings of threat to one's integrity.

Contemporary concepts

Kohut, in The Analysis of the Sell,8) described narcissistic personality disorder as presenting a failure to internalize healthy self-esteem it is a derivative of normal infantile grandiosity, causing a poor self-image against which narcissism develops as a defensive reaction. Kernberg (41) divided narcissism into normal infantile, normal adult, and pathological. This idea is in tune with the continuum of psychopathology ( Table 10), in which fixation or regression to infantile narcissistic goals is an important feature of all personality disorders that include narcissistic traits or narcissism as a defensive reaction. Narcissism, in its normal sublimated form, is necessary for the self-esteem essential for a healthy life and a capacity for deep object relations. Table 10 Types of narcissism A narcissistic personality has a pathological grandiose self which hides a diffuse and aimless inner identity. Kernberg argues that self-hatred, rather than self-love, lies at the root of...

The Interpersonal Perspective

Leary (1957) developed the interpersonal circle in an effort to refine and systematize the insights of Sullivan and the socioanalytic perspective of Horney, both of whom reacted to Freud's instinct model by developing psychoanalysis in an interpersonal direction. For Leary, narcissists demonstrated a competitive self-confidence founded on adjustment through competition. Such individuals, he states, seek superiority and are terrified by dependence. Subsequent interpersonal circles have refined Leary's original contribution using more contemporary methods. Kiesler (1996, p. 21) regards narcissists as acting presumptuously forward, incapable of self-criticism, and impossible to embarrass. He uses descriptors such as brazen, cocky, boastful, pushy, egotistical, self-enthralled, and unable to ask for help with anything. Leonardo certainly demonstrates these qualities, and we can see that neither he nor Gerald acknowledge needing anyone else for anything. Although the descriptors offered by...

Developing Clinical Acumen What Happens When Traits from Different Diagnoses Commingle

Because different patterns of developmental pathways lead to different personality disorders, the search for developmental antecedents is often assisted by the person's personality disorder diagnosis. For example, clinical lore suggests that the narcissistic personality is often associated with being the first male or only child. Even if a narcissistic subject has many siblings, it is highly probable that he or she occupied a position of special status in the family. Future narcissists experience noncontingent love so indulging and intense that they fail to learn that others have an independent existence outside their own glow. As a result, they develop egocentricity, arrogance, insensitivity, and a sense of entitlement they expect others to anticipate their needs and may become rageful when they feel ignored. Each personality disorder has its own characteristic early experiences. In-depth knowledge of these developmental pathways can be used to further focus the clinical interview,...

Millon Clinical Multiaxial InventoryIn

The MCMI-III includes 11 Clinical Personality Patterns scales Schizoid, Avoidant, Depressive, Dependent, Histrionic, Narcissistic, Antisocial, Aggressive Sadistic, Compulsive, Nega-tivistic (Passive-Aggressive), and Self-Defeating Personality Disorder. Three Severe Personality Pathology scales are also included and these are Schizotypal, Borderline, and Paranoid Personality Disorder. Each represent more advanced stages of personality pathology with episodes of psychosis. Additionally, 7 Clinical Syndromes scales (Axis I related) are provided, covering moderate clinical presentations (e.g., Anxiety, Somatoform, Dysthymia, Alcohol Dependence) whereas 3 Severe Syndromes scales denote more serious clinical disorders (Thought Disorder, Major Depression, and Delusional Disorder). The MCMI-III has a Validity Index (3 items of an improbable nature) and 3 Modifying Indices (Disclosure, Desirability, and Debasement) designed to detect deviant test-tasking attitudes defensiveness or exaggeration...

From Normality to Abnormality

Although it has appeared across the globe and throughout history among the royal and the wealthy, the narcissistic personality seems to have gained prominence only in the late twentieth century. Narcissism may manifest differently in other cultures (Warren & Capponi, 1995) our experience derives mainly from the more advantaged American middle and upper classes. The International Classification of Diseases, the international equivalent of our DSM-IV, does not include this personality disorder, indicating that its more American expression does not occur with frequency in other nations. Instead, narcissism may be associated with higher levels of Abraham Maslow's (1968) hierarchy of needs. Individuals in disadvantaged nations must navigate the slings and arrows of disease and famine they are too preoccupied with basic safety and survival needs and cannot afford the luxury of a passive existence where the riches of the world are, in their eyes, owed to them. However, as basic survival...

Inside and Outside Feeders

Outside feeders need a great deal of feedback, direction, and confirmation from others (the outside). This is suggested as being consistent with Histrionic, Narcissistic, Borderline, Antisocial, and Dependent Personality Disorders. When they are denied or limited in this source of sustenance, the maladaptive expressions of the personality disorder can be expected to become worse. This is often the response to frequently occurring events in old age, such as retirement and the need to move into assisted housing, among other changes, which reduce the amount of feedback they can receive.

The Clinical Interview of the Patient

In some cases, the personality disorder pathology is quickly noticeable during the interview. For example, some narcissistic patients are demanding, immediately challenging of the therapist's professional qualifications and ability to understand their unique problems, and they tend to brag. One of our patients, a narcissistic older man, started the intake session by reporting

Bipolar disorders Diagnostic issues

While classical bipolar disorder with episodes of euphoric mania interspersed with episodes of depression is one of the clearest clinical syndromes in psychiatry, the boundaries of bipolar disorder remain contested. As case definition is central to epidemiology, all the contested boundaries of bipolar disorder could influence prevalence rates and our understanding of risk factors. Some of the major boundary issues for bipolar disorder include the overlap of bipolar disorder with psychotic features, with schizoaffective disorder and schizophrenia, and the overlap of bipolar disorder with unipolar major depression when patients who present primarily with depression have brief or mild episodes of hypomania. There is also the overlap of bipolar disorder with apparent personality disorder, especially Cluster B personality disorders such as borderline and narcissistic, and the issue of when hyperthymic personality merges into bipolar disorder. (23)

Alpf Medical Research Personality Disorders

If given even a normal measure of reinforcement, most narcissists find an adequate foundation for their exaggerated self-image, allowing them to function somewhat successfully in society. Most are convinced they can get along well on their own, and their pride causes them to reject the defective role of patient. Chase is an exceptional circumstance, then, because narcissists rarely present voluntarily for therapy. Those who do search only for the best doctor, someone of special status who might understand them. Anyone else is devalued. Either way, narcissists who seek therapy do so with the purpose of finding some relief from nagging feelings of emptiness and inefficacy, to be buoyed back to their former grandiose state, that is, to perfect the self, not to understand it (McWilliams, 1994). The therapist has different goals. As this becomes apparent, narcissists may resist diagnostic testing or perhaps attempt to debunk the therapist's credentials. They may assume from the beginning...

Psychoanalytic Theories of Personality Disorders

Freud can also be credited with developing some of the earliest theoretical foundations of personality disorders such as the Dependent, Passive-Aggressive, Borderline, Narcissistic, Histrionic, and Obsessive-Compulsive Personality Disorders. Besides their instinctual bases, he viewed these personality disorders as emerging from unsuccessful resolutions of the psycho-sexual stages of development he posited. We now examine the psychoanalytic concepts relevant to the formation and maintenance of these and other personality disorders.

Alpf Medical Research Personality

Several variants exist of the paranoid personality that combine paranoid traits with other personalities. The fanatical paranoid is a mix with the narcissistic personality who has had a serious narcissistic wound. The malignant paranoid combines the paranoid with the sadistic personality and is hypersensitive to issues of power and domination. The obdurate paranoid shares traits with the compulsive personality and may function more normally in society than most paranoids. The querulous paranoid is a paranoid with negativistic traits who feels perpetually as though he or she has been cheated in life. Last, the insular paranoid shares characteristics with the avoidant personality, tending to be the most isolated of the paranoids. Paranoid traits are expressed by all of the severe personality disorders but also in avoidants, narcissists, sadists, antisocials, and compulsives. They also often overlap with delusional disorder anxiety disorders mood disorders, particularly depression and...

Function of Bolstering

Another example of bolstering is the individual with Narcissistic Personality Disorder who is naturally limited in his capability to work mutually with others. Modeling and coaching can shape his efforts in a group project His adaptive skills at being charming, perhaps, and definitely seeking the recognition of others, can be appropriately directed.

Psychological Treatments

Long-term psychodynamic psychotherapy has historically been the mainstay treatment for the more severe personality disorders, with poor response overall. This has not been shown to be especially effective in the treatment of personality disorders. Many individuals with a personality disorder are not able to tolerate the intervention mainstays of analytically based treatments. For example, confrontation and interpretation could be experienced as a paranoid threat by those in Cluster A, as a threat of narcissistic injury or of abandonment for those in Cluster B, or as intimating rejection and withdrawal of support for those in Cluster C.

HIV and Personality Disorders High Risk Behavior and Disease Susceptibility

Further research will be necessary to test additional hypotheses linking the personality disorders with HIV infection. For example, it is possible that some narcissistic personalities feel a special sense of invulnerability or that they are above using a condom. Dependent personalities might be reluctant to refuse a partner who desires unprotected sex. Individuals with sadistic traits might deliberately infect others. Antisocials might lie about their sexual history or HIV status. Because casual sex is common in our society, those who practice it are obliged to size up their partners for traits that might be linked to high-risk behaviors.

Human evolution and cognition

What is it, exactly, that makes the cognitive processes of modern Homo sapiens unique in the living world And how was that something acquired These twin questions are among the most impenetrable of all those facing science. Yet at the same time they are possibly the most alluring, for our narcissistic species is unfailingly fascinated by the contemplation of itself and of the ways in which we human beings are distinguished from the rest of the living world.

Mechanisms of defence

Within classical psychoanalytical theory and its modern equivalent (ego psychology), conflict is seen as at the core of mental functioning. (2) Here, defences are seen as adaptations to intrapsychic conflict. Within object-relations theories, defences are seen as helpful to the individual to maintain an authentic or 'true' self-representation or a nuclear self.(12) Within attachment theory, defences are construed as assisting in the maintenance of desirable relationships. (32) The Klein-Bion model makes limited use of the notion of defence mechanisms but uses the term in the context of more complex hypothetical structures called defensive organizations 14) The term emphasizes the relative inflexibility of some defensive structures which are thus best conceived of as personality types. For example, narcissistic personality disorder combines idealization and destructiveness genuine love and truth are devalued. Such a personality type may have been protective to the individual at an...

Aetiology and pathogenesis Personality

Hypochondriacal patients are more likely to have abnormal personality characteristics than non-hypochondriacal patients. For instance, Barsky et al.i13 reported that almost two-thirds of such patients scored above the cut-off for personality disorder caseness compared to 17 per cent of controls. Premorbid tendencies to health consciousness, concerns about disease, attention to somatic symptoms, obsessionality, and anxiety have been noted by various authors. (1) Others, following Freud, have described narcissistic traits.

Looking beyond the Obvious Presuming Diagnosis Undermines the Clinical Process

An intelligent-looking undergraduate senior majoring in mathematical physics presented at the university counseling center complaining that his grades were slipping and that he felt incredibly anxious. During the clinical interview, he announced that he was much more intelligent than the other students and always received the highest grades in his mathematics and physics classes, at least until recently. Further exploration revealed that his father was a mathematical physicist at the same university, but had recently accepted the position of department chair at another institution on the opposite coast. Although intellectual testing in fact showed superior intellectual ability, it was also true that the son identified strongly with his father and greatly enjoyed the time he spent with his father, who tutored him through the most difficult problems. Several weeks into counseling, he was able to admit that he feared that without his father, he would no longer receive such high marks and...

Chapter References

In Standard edition of the complete psychological works of Sigmund Freud, Vol. 14 (ed. J. Strachey), pp. 69-102. Hogarth Press, London. 22. Rosenfeld, H. (1964). On the psychopathology of narcissism a clinical approach. International Journal of Psycho-Analysis, 45, 332-7. 23. Grunberger, B. (1979). Narcissism psychoanalytic essays. International Universities Press, New York. 24. Kernberg, O.F. (1975). Borderline conditions and pathological narcissism. Jason Aronson, New York.

Variations of the Borderline Personality

Argue that the DSM borderline pattern overlaps nearly every other personality disorder, with some exceptions. Because most subjects diagnosed as borderline are female by a ratio of 2 to 1 or even higher, subjects with dependent, histrionic, avoidant, depressive, and negativistic features are common, though for different reasons. In general, any personality pattern that makes others the center of life is at risk to develop a borderline personality. The desire to magically fuse with others who will support you emotionally and meet your every need is evidence of both ego weakness and identity disturbance, leading to instability in interpersonal relationships and feelings of emptiness and desperation when others seem to separate. In contrast, a DSM borderline diagnosis is probably less likely for male compulsive, sadistic, paranoid, and some narcissistic personalities, for whom dogmatism, righteous indignation, or grandiosity artificially boost the coherence of the self, giving it rigid...

The Assessment of Personality

As many have argued, there are really two sciences of psychology. One, the nomothetic approach, is focused on hypothetical constructs and the theoretical propositions that relate different constructs to each other, called the nomological network. Research questions such as, What is the relationship of locus of control to depression and How does the continuum of self-schema complexity relate to stress vulnerability focus purely on psychological constructs. Individuality, the focus of clinical work, is actively excluded by gathering large samples of subjects. The particular characteristics of any one person must not contaminate the results. Two narcissists with unhappy marriages could be a coincidence 200 constitute a finding. In any categorical classification system, the question is which labels the subject will receive. The idiographic perspective, however, reminds us that taxonomies take us only so far, that diagnostic constructs are only reference points that facilitate...

The Significance of Collaborative Data Clinical Findings without Client Compliance

Jenna's second client was referred for a psychological evaluation by the university disciplinary committee after recklessly endangering the welfare of others when one of his experiments in the chemistry lab exploded, producing a major fire. Very charming and personable, he denied any wrongdoing, stating that he wanted to cooperate fully. Nevertheless, psychological testing showed that he denied even minor faults to which almost everyone else would ordinarily admit. Despite his protests of innocence, a criminal record, together with consultation with family members, confirmed the presence of narcissistic and antisocial traits, ultimately contributing to his expulsion from the university.

Epidemiology and Gender

Another important epidemiological issue concerns the extent to which gender differentially affects the prevalence of personality disorders among older adults. According to the DSM-IV-TR, three personality disorders (borderline, dependent, and histrionic) are more prevalent in females, and six personality disorders (antisocial, paranoid, schizoid, schizotypal, narcissistic, and obsessive-compulsive) are more prevalent in males. Sadistic Personality Disorder was also thought to be more common in males, whereas Self-Defeating Personality Disorder was thought to be more prevalent in females. No information was provided by the DSM for the Passive-Aggressive Personality Disorder regarding gender. Finally, the Depressive Personality Disorder was thought to occur with equal frequency in both genders.

Developmental issues

Severe frustration with early objects is considered important in the defensive genesis of narcissistic personality disorder. Reich (88) described narcissistic ego-inflation as a defence against narcissistic injuries during both the pre-Oedipal and Oedipal periods of development. Behind the compensatory grandiose self, a hungry and inferior real self resides, as the core problem of narcissistic personality disorder. Nemiah (86) saw the origin of this disorder in high parental expectations and harsh criticism of the child, which become internalized in their developing character. Many narcissistic individuals are gifted and often are the first, if not the only, child in their families. Nemiah proposed that the parents used the child for their own needs, which led the child to seek compensatory admiration and greatness. Since there is often frustration during the vulnerable rapprochement subphase of separation-individuation, splitting of good and bad self and object representatives...

Development of personality

In addition to this pattern of object relations, the other major component of character, from a psychodynamic perspective, is the particular constellation of defence mechanisms that characterizes the individual patient.(31) While defences were traditionally regarded as intrapsychic mechanisms designed to prevent awareness of unconscious aggressive or sexual wishes, the current understanding of defence mechanisms has been expanded far beyond Freud's dual-drive theory. We now understand that defences also preserve a sense of self-esteem in the face of narcissistic vulnerability, assure safety when one feels dangerously threatened by abandonment, and serve to insulate one from external dangers through, for example, denial or minimization.

The Biological Perspective

The role of biological influences in the narcissistic personality seems especially unclear. Although evidence adduced in support of biogenic determinants for most of the other personality patterns was largely of a speculative nature, there was some, albeit tenuous, logic for these speculations. In the case of the narcissistic pattern, however, where the existence of distinctive biophysical precursors seems lacking, conjectures would have unusually weak grounding thus, none are proposed. However, some observations about mood and temperament, presumably of a biophysical nature, are noted here. Narcissists are often seen as being possessed of a buoyant mood and an optimistic outlook under usual circumstances, provided they have managed to settle into an environment that does not meaningfully threaten their sense of superiority. Cheerful and carefree in affect, this personality pattern enjoys an unusually relaxed demeanor, likely because of established self-glorifying cognitions that may...

Sociocultural Influences

Few characterizations of American life are more apt than those that portray our society as upwardly mobile. Ours has been a culture that has maximized the opportunity of its members to progress, to succeed, and to achieve material rewards once considered the province only of the aristocracy and well-to-do. With certain notable and distressing exceptions, the young of our society have been free to rise, by dint of their wits and their talents, above the socioeconomic status of their parents. Implicit in this well-publicized option to succeed, however, is the expectancy that each person will pursue opportunities and will be measured by the extent to which he or she fulfills them. Thus, our society not only promotes ambition but also expects each of its members to meet the challenge successfully. Each aspiring individual is confronted, then, with a precarious choice along with the promising rewards of success are the devastating consequences of failure, as may be seen in the...

Behavioural expression and selfconcept

A seductive and charming appearance, which is engaging and attractive, masks intense preoccupation with self-regard and an unusual absence of concern for others. Narcissistic individuals may be energetic, capable of consistent work, and socially successful, but this is done in order to obtain admiration. These 'Don Juans of achievement' run from one achievement to another, but their successes provide no inner satisfaction and always end with frustration and a feeling of emptiness. Narcissistic grandiosity is often masked by opposing tendencies (false modesty, social aloofness, and a pretended contempt for status). Pathological lying is frequent.

Psychoanalyticpsychodynamic couple therapy

The psychoanalytic approach has been an important source of theoretical ideas in couple therapy, especially the concepts of attachment and loss developed by Bowlby.(6) It has also the distinction of being the first theory to be adapted to this area of work. There are, however, some drawbacks to working in this way, as enumerated by Wile.(7) He sees the emphasis on negative impulses and emotions (e.g. dependence, narcissism, sadism, manipulation, and exploitation) as painting a rather unflattering picture of the couple in therapy. A more serious problem with the approach is that in psychodynamic couple therapy these ideas, whether of

Abnormal Behavior and Personality

Narcissistic Egotistical, arrogant, grandiose, insouciant. Preoccupied with fantasies of success, beauty, or achievement. Sees self as admirable and superior, and therefore entitled to special treatment. Real persons, however, seldom are seen as pure types. The DSM does not require that subjects possess each and every characteristic of a personality disorder before a diagnosis can be made. Typically, some majority of criteria will suffice. For example, five of eight criteria are required for a diagnosis of histrionic personality disorder, and five of nine are required for a diagnosis of narcissistic personality disorder. Many different combinations of diagnostic criteria are possible, a fact that recognizes that no two people are exactly alike, even when both share the same personality disorder diagnosis. Although Charles Manson and Jeffrey Dahmer might both be considered antisocial personalities, for example, their personalities are nevertheless substantially different. Determining...

Somatic Treatments

Cluster B presents its own special challenges. For example, among individuals with Narcissistic Personality Disorder, their propensity toward specialness and special sensitivity could result in reporting peculiar or excessive side effects to medications. Others may do doctor shopping, and not be forthright about what drugs they use or the providers with whom they are involved. This could lead to unintentional polyphar-macy or intentional drug abuse and self-harming behaviors (Kean et al., 2004).

The middle phase

Resistance is inevitably encountered in any long-term psychodynamic treatment. In fact, the presence of resistance is implied by the term 'dynamic', which suggests psychic forces both pulling against and pushing towards change. Like regression, resistance fluctuates in the middle stage of treatment. In borderline and narcissistic disorders, the patient's intense resistance signals the patient's desperation to protect extremely fragile self-esteem. In less severe cases, what appears to be at issue is preventing a painful integration of experience, such as the integration of love and hate directed towards the same object. (38) The nature of the transference appears to systematically relate to specific clinical groups and hence may have an aetiological significance. For example, specific transference patterns appear to characterize particular groups of narcissistic patients. (12) The 'mirroring' transference is one where patients crave for the approbation and admiration of the therapist...

The Item Level

Ideally, every scale item should tap some aspects of the construct the scale is intended to assess. When all the important aspects of a construct have been anchored to different items, the scale is said to possess content validity. The narcissistic personality, for example, consists largely of the traits of grandiosity, exploitiveness, and lack of empathy. As such, any scale lacking items that assess grandiosity cannot be a valid measure of the narcissistic construct, as content essential to the construct is missing. Careful consideration of the different facets of every construct is, therefore, essential to scale development. Scales that perform in accordance with the expectations of psychological theory are said to possess the additional property of construct validity (Cronbach & Meehl, 1955). If a new antisocial personality scale fails to correlate highly with an established measure of substance abuse, for example, this calls the validity of the antisocial scale into question....

Function of Binding

With the loss of another who has served this function, it is understandable that the personality disorder will become more apparent or reappear after a comparatively quiescent phase. For example, someone in a close relationship with an individual with Borderline or Narcissistic Personality Disorder may recognize the early warning signs of a rageful explosion and know how to be able to ward these off. Another example might be an adult woman who assists her mother with Avoidant Personality Disorder, disallowing ( binding ) the maladaptive fearful and avoidant tendencies by being with her for initial contacts with others, and progressively withdrawing unreasonable support.

Goals of Treatment

Using adaptive traits (i.e., giving them a job) reduces the expression of less desirable traits, respecting the concept of reciprocal inhibition. It is always useful to reinforce healthy narcissism, in other words, to make certain the individual has an opportunity to express and is rewarded for expressing that which he most values in himself. Enhancing the positive (or nonmaladaptive) traits increases the probability that the individual will receive positive rather than negative feedback from the environment. It also reduces the strength of the stressor and thereby reduces the challenge to the individual's resiliency.

Chart Records Review

In some clinical contexts in which older patients may be evaluated (e.g., nursing homes and rehabilitation hospitals), charts or records may be available. In long-term care settings in which patients have had lengthy stays, these charts may be voluminous. In cases where records are accessible, it behooves the clinician to thoroughly examine them as part of the assessment process. A review of such records may show important behavioral patterns of the patient that are observed by members of the treatment team. Such patterns may give clues to personality disorder features shown by the patient, especially if the same traits are seen by different professionals. For example, passive and helpless behaviors might be noted by nursing staff and activity directors, suggesting a dependent personality style. Aggressive, haughty, and indignant behaviors in another resident may point to the presence of narcissistic, borderline, or paranoid features. Noncompliance with treatment may be due to several...

Drug treatment

Neuroleptic (antipsychotic) drugs have almost an established place in the treatment of some forms of personality disorder, particularly the antisocial, borderline, narcissistic, and histrionic types. There is some evidence of efficacy in schizotypal personality disorder. Although the effectiveness of these compounds is certainly not striking, it has been better documented than most other treatments.

Early contributions

Freud(83) described primary (normal) and secondary (pathological) narcissism, the nature of narcissistic object choices, and the narcissistic foundation of the ego ideal as a psychic structure in his seminal paper on narcissism. In 1931, Freuddescribed the narcissistic character type, which is considered to be a pioneering portrayal of narcissistic personality disorder. Jones(84) gave a detailed description of narcissistic individuals, who exhibit a 'God complex' and have some cognitive peculiarities. Reich(68) described the phallic-narcissistic character, with grandiosity used as a defence against underlying inferiority. Fenichel (85 saw the narcissist as 'the Don Juan of achievement', pointing out that some narcissistic individuals may adapt a criminal lifestyle owing to superego defects. Nemiah (86) described 'narcissistic character disorder', which was later elaborated by two leading workers in the field, Heinz Kohut and Otto Kernberg.

Mythology And Legend

This story has led to the name being used as the term 'narcissism' or 'narcissistic personality disorder', in which people described by this condition have a grandiose view of their own uniqueness and abilities they are preoccupied with fantasies of great success. To say they are self-centred is an understatement (Davison and Neale, 1998). These characteristics have been validated in empirical studies (Ronnington and Gunderson, 1990) and are often a factor with borderline personality disorders (Morey, 1988). Such people are constantly seeking attention and adulation, and are, underneath, extremely sensitive to criticism and have a deep fear of failure. Many of the contemporary studies have been carried out by Heinz Kohut (Kohut, 1971, 1977 Kohut and Wolf, 1978).


This is particularly clear with the more disturbed narcissistic or borderline patients who bring to the group more primitive psychic structures and processes that put strain on the resources of other group members. Such patients can create turmoil, in which the leader's task is to maintain the responses of the group from a more mature level of psychic organization. By responding to part-object relationships and processes on the level of whole-object relations, more benign containing responses can be established. Progressively, these help to build up for the disturbed patient a more benign world of inner object relationships and processes. (82 More disturbed patients desperately seek attention in ways that are inappropriate and disruptive. This search for attention arises because the patient cannot establish a sense of connection between him- or herself and the processes of the group. Mirroring and resonance can steadily come to replace these isolated and fragmentary responses,...


The fairly convincing evidence that clinicians do not adhere to the existing criteria when making diagnoses is also troubling. How to tackle these failures is a complex issue. Perhaps raising awareness of biases is a first step. If clinicians have taken the time to introspect a little on why they assume histrionics are female and narcissists are male, they may pause to consider alternative diagnoses. The DSM-IV contains only one sentence about this issue buried within the general discussion of personality disorders

Cognitive style

Comorbidity with many personality disorders (histrionic, borderline, obsessive-compulsive, dependent, narcissistic) is also frequently observed. People with these personality disorders may use passive aggression as a defence mechanism. Suicide attempts are not as frequent as in histrionic and borderline personality disorders, and features of passive-aggressive personality are less dramatic, affective, openly aggressive, and severe.

Social issues

Some authors have suggested that narcissistic personality disorder is not a psychopathological entity but merely a sociocultural phenomenon related to the contemporary Western 'culture of narcissism'.(89) This approach is probably misleading. Such an explanation may provide a cultural rationalization for some pathological narcissists, but society cannot produce either normal or pathological narcissism as these disorders are complex and are likely to be established during early childhood.(62) Narcissistic patients seldom approach a psychiatrist, and then usually when depressed or involved in interpersonal problems. The surface functioning of the narcissistic individual may show very little disturbance. However, the inner world of narcissistic patients is extremely pathological, despite their superficially well-adapted behaviour, and this pathology is shown in their self-concept, affectivity, love and sexuality, interpersonal relations and cognitive style. (9.9