• What are the DSM-IV criteria for the narcissistic personality?

• How is narcissism expressed in a collectivist culture?

• The self-confident and asserting personalities are normal variants of the narcissistic. Describe their characteristics and relate them to the more disordered criteria of the DSM-IV.

• Explain how different personality styles combine to form each of the subtypes of the narcissistic personality.

• What are the distinctions between phallic and compensatory narcissists?

• How do narcissists use grandiosity, rationalization, and fantasy as defense mechanisms?

• How does the narcissistic personality disorder develop in the psychodynamic perspective?

• How do narcissists manifest their sense of entitlement interpersonally?

• Are the origins of narcissism a defense against early deprivations or the product of overvaluation?

• Explain the role of fantasy in an expansive cognitive style.

• What are the core beliefs of the narcissist?

• Narcissists share characteristics with other personality disorders. List these other disorders and explain the distinction between each and the narcissist.

• Are narcissists more likely to have extramarital affairs?

• Explain how narcissists can be vulnerable to Post Traumatic Stress Disorder (PTSD) and major depression.

• How is narcissism related to substance abuse?

• List therapeutic goals for the narcissistic personality.

We have all met people who constantly present themselves as superior, often with an inviolable arrogance. They seem to reflect on themselves in an exaggerated manner, getting lost in their self-generated fantasies of godlike power, infinite riches, mastermind intelligence, or unparalleled celebrity. They not only perceive themselves as better than others but also hold others in contempt for being inferior, if not just for being average. They are self-proclaimed shining stars, and we are expected to watch and admire. For them, the rest of us are simply worker bees, worthy only of taking and carrying out their every direction but not worthy of ever having an original thought, much less a life independent of their plans and desires. To balance out our indebtedness to them for the honor of their association, we must anticipate their every need and excuse them from any mundane duty, while working tirelessly toward the realization of their glory. Other people in their lives frequently come to feel as though they are possessions of such individuals, existing to be used and exploited without shame. Their egocentricity makes them indifferent to the rights and welfare of others and, sometimes, indifferent to the laws of society as well. To justify their actions, they rationalize ad nauseam, presenting convenient reasons that excuse their inconsiderateness and superior attitude, thus placing themselves in the best possible light. When pressed or confronted, they are likely to become even more haughty, dismissive, and, in some instances, enraged.

Such individuals demonstrate the DSM-IV narcissistic personality pattern. For the people who must interact with them, they are among the most difficult of the personality disorders. Consider the case of our self-proclaimed genius, Gerald (see Case 10.1), who obviously exhibits a grandiose sense of self-importance (see criterion 1). He identifies himself with Einstein and Salk, individuals who "had suffered nobly for being ahead of their time, just like me." Undoubtedly, Gerald's grandiosity is what fuels many of his behaviors. His arrogance leads him to assert that his problems lie in the company, not him, ignoring the fact that his relationships with both his supervisors and his subordinates are already strained to the breaking point. Others in this position would likely take time to reflect on their behavior when faced with a united front, rather than plow ahead foolishly in the face of negative feedback from both above and below in the organizational hierarchy.

Gerald, however, shows such self-importance as to persevere in spite of what he sees as others' ignorance. His grandiosity feeds a fantasy life where unbridled brilliance and success are realized (see criterion 2). He mentions, for example, that he sees himself as president of a new company that will put his ideas into action and he can only imagine that success is just a matter of time. More than likely, Gerald needs these fantasies, which support and protect a superior image of the self against intrusions from an above-average but much less stellar reality. Undoubtedly, his need for superiority has evolved in connection with the worship he receives from his mother, who insists that he will do something important, implying that he will become famous by somehow contributing to human history.

Though Gerald is obviously intelligent, as evidenced by a career that otherwise would likely have ended long ago, his perception is still distorted to magnify his aptitude. His estimation of his own abilities and his expectations that others should bow to his every whim speak to a considerable discrepancy between reality and his own aggrandized self-image. He believes that he is special, and he is pleased that he is being treated by a psychiatrist, for only someone with a medical degree would have a chance of understanding his situation (see criterion 3). Moreover, he feels so special that he is entitled to invent new ways of doing things that disrupt organizational patterns, without worrying about their effects on the lives of others (see criterion 7). Instead of offering sympathy, Gerald expects that his subordinates should simply recognize and automatically effect the wisdom of his intellectual mandate (see criterion 5). If there

Gerald stormed out of his supervisor's office, furious that he was on the edge of being terminated. He stubbornly resisted the demand that he seek counseling, asserting that the problem was the company, not him.

The immediate issue was his strained relationship with his supervisor and the subordinates in his office. Although his credentials were excellent, Gerald had ways of inventing new procedures that impacted standard routines without much sympathy for those affected.1 Everyone was automatically expected to follow his whim. Sometimes his novel notions worked out, and sometimes they didn't. Regardless, the staff resented each such imposition on their time and their job descriptions. When things did work out for the better, Gerald gave only lip service to the role of his coworkers.

Worse, Gerald never gave up any of his ideas. He was sure they were superior to the "old ways" and would work if the staff could just "get their head out their ass long enough to see the big picture and just adjust for the better." "I do not know why the magnitude of my innovations isn't obvious to everyone," he has been heard to state. When asked how he sees himself in five years, Gerald remarks, "I'm a firm believer in the power of positive thinking. For the most part, it's old ways that hold us down. Wherever I've gone I've found new ways, new efficiencies, some of them startling. I can only imagine that in time I will be fantastically successful. It is my destiny."

In fact, Gerald has been pushed out at other companies for making life difficult, just as he is creating problems now. Others, he asserts loudly, "either do not recognize my ability, or else are envious when they do." The problems with the office staff he attributed to jealousy. "They want to get me fired so I don't make them all look bad. In fact, I think some of them might be deliberately sabotaging me." The same was supposedly true of his supervisor.

Gerald also spoke about the "cretins" he was forced to work with, and how their incompetence constantly delayed him from finishing his own projects and implementing his latest ideas. Having been forced to associate with inferiors all his life, he was glad that a psychiatrist was treating him, because a medical doctor would have a better chance of understanding him and sympathizing with his plight. Asked to name people with whom he felt a bond, he mentioned Einstein and Salk, individuals who "had suffered nobly for being ahead of their time, just like me."

Gerald is the only child of a widowed mother, her "pride and joy." She has told him all his life that he would do something important. Ever thinking of others, he maintains an apartment next door so that she won't feel "so alone." The arrangement is ideal: he pays no rent, she does his laundry and makes his meals, and he has all the privacy he needs, as he always has. Indeed, he has come to expect such treatment from everyone.

1Numbers mark aspects of the case most consistent with DSM criteria, and do not necessarily indicate that the case "meets" diagnostic criteria in this respect.

Narcissistic Personality Disorder DSM-IV Criteria

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:

(1) has a grandiose sense of self-importance (exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

(3) believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or highstatus people (or institutions)

(4) requires excessive admiration

(5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

(6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

(7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

(8) is often envious of others or believes that others are envious of him or her

(9) shows arrogant, haughty behaviors or attitudes

Reproduced with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association.

are costs of extra time and effort to their own lives, these are inconsequential and not worth worrying about, at least from Gerald's perspective. Given such a sense of entitlement, Gerald can only exploit those around him (see criterion 6) and shamelessly does so repeatedly (see criterion 7).

Gerald has also created the perfect way of dealing with the displeasure of those he makes miserable: He sees them simply as jealous. Again, it is not Gerald who has the problem. As he sees it, everyone recognizes his outstanding abilities and realizes that he is on his predetermined road to success and riches. Therefore, they inevitably recognize their own unworthiness and, out of spite, put obstacles in his way (see criterion 8). Compared to him, they are just aspirants who can only want for something better but never achieve what they desire, as Gerald is destined to do.

In this chapter, we first compare normality and abnormality; then we move on to variations on the basic narcissistic theme. After that, biological, psychodynamic, interpersonal, and cognitive perspectives on the narcissistic personality are described. These sections form the core of what is scientific in personality. By seeking to explain what we observe in character sketches like Gerald's, the goal is to move beyond literary anecdote and enter the domain of theory. As always, we present history and description side by side, noting the contributions of past thinkers, each of whom tends to bring into focus a different aspect of the disorder. Developmental hypotheses are also reviewed but are tentative for all personality disorders. Next, the section titled "Evolutionary Neuro-developmental Perspective" shows how the etiology and existence of the personality disorder follow from the laws of evolution. Also included are a comparison between the narcissist and other theory-derived constructs and a discussion of how narcissistic personalities tend to develop Axis I disorders. Finally, we survey how the disorder might be treated through psychotherapy, again organizing our material in terms of the classical approaches to the field described in the earlier parts of this chapter.

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