Summary

The narcissistic personality disorder is frequently experienced by others as obnoxious, grandiose, and unempathic. Narcissists' immense arrogance, their belief that they possess unsurpassed intelligence and celebrity, and their degradation of the mere mortals who inhabit the planet make them insufferable as family members, partners, and coworkers. Several normal-range variants of the narcissist exist, such as Oldham and Morris's (1995) self-confident style and Millon's (Millon et al., 1994) asserting pattern; these possess traits that are actually assets when trying to get ahead in a capitalist society. At the disordered level, however, self-confidence and healthy assertiveness turn into grandiose self-regard; complete disregard for other people's strengths, talents, and feelings; and extreme haughtiness.

Several subtypes also exist that combine aspects of these personalities with the narcissistic. The unprincipled narcissist combines elements of a sadistic personality with the narcissist's skills of social influencing but few internalized moral prohibitions. Amorous narcissists are focused on erotic seduction with multiple partners. Compensating narcissists have some elements of the avoidant and negativistic personality. The elitist narcissist is full of aggressive confidence.

Narcissistic characteristics can be traced throughout historical literature, from Greek mythology to the Bible, but it wasn't until almost the twentieth century when it was given explicit psychological meaning by Haveloch Ellis, an English psychologist. The psycho-dynamic history of the narcissistic personality disorder is extensive and convoluted, but over time it has changed from Freud's purely intrapsychic model of narcissism as self-cathexis to the idea that narcissism is a pathology of early relatedness. Horney, Reich, and Kernberg all contributed to this change. Grandiosity, rationalization, and fantasy are the most common defense mechanisms used by narcissists; in classical analytic terms, they are the ego ideal incarnate. Developmentally, psychoanalysis proposes that the narcissists' parents loved them for imaginary qualities instead of for their true selves. Further, Kernberg proposed that narcissists fail to develop integrated conceptions of self and other object images.

Interpersonally, narcissists are noted for their sense of entitlement and subsequent lack of empathy toward others. This makes intimate relationships nearly impossible, as others are seen only as appendages of the narcissist's ego, not as a partner. Narcissists often make a good first impression, but soon others regard them as arrogant and snobbish because of their seeming calm and confident nature. They are also extremely sensitive to perceived slights and often seek a close circle of admirers who will worship them. Benjamin suggests that developmentally, narcissists' parents failed to disclose their own needs, instead worshipping the infant. As a result, the child failed to learn that others are separate beings with their own desires.

Cognitively, narcissists substitute imagination and daydreams for reality. Their past, present, and future are colored by these imaginings, all adding to their glory. Other cognitive processes protect narcissists' vulnerabilities, such as their refusal to test hypotheses, because their ideas must be innately correct. They are also prone to black-and-white thinking and focus on small differences between themselves and others.

Biophysical hypotheses concerning narcissistic patterns are still unclear, although some observations may be noted in terms of mood and temperament. Under most circumstances, narcissists are possessed of a carefree mood and a positive outlook, enjoying an unusually relaxed demeanor. However, changes taking the form of edginess and irritability or dejection characterized by feelings of emptiness, worthlessness, or humiliation may quickly become their baseline if their sense of superiority is penetrated.

From an evolutionary perspective, the narcissist is passively self-oriented. Narcissists believe they are worthy of unconditional praise and tribute for just being themselves, with no actions or responsibilities required to earn rewards. Oddly, there seem to be two developmental pathways to narcissistic personality disorder: One is overly indulgent parents; the other is neglectful or authoritarian parents.

Narcissists share surface similarities with histrionic, antisocial, paranoid, and sadistic personalities. Although not linked systematically to any Axis I disorders, narcissism certainly colors any that do occur. Narcissists experience fewer anxiety disorders than many other personalities but still may develop social phobias and obsessions. They are also resilient against many depressive disorders but may experience low-grade depressive symptoms. Substance abuse is frequently a problem; for narcissists, it is a way to numb their awareness of events that intrude on their sense of self-worth.

Most narcissists strongly resist psychotherapy. For those who choose to remain in therapy, there are several pitfalls that are difficult to avoid, including the therapist's being too reinforcing of the narcissist and, subsequently, the narcissist's never wanting to leave therapy. Interpretation and even general assessment are often difficult to accomplish. For successful treatment, there must be a strong working alliance established, and confronting the narcissist's behaviors and patterns must be timed properly. A combination of interpersonal and cognitive strategies may prove the most effective treatment to decrease sense of entitlement and increase awareness of others' feelings.

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