What is Narcissistic Personality Disorder? What are the symptoms? What are the causes?

Main Category: Public Health
Article Date: 21 Jun 2004 - 20:00 PDT

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Narcissistic Personality Disorder is a persistent pattern of grandiosity, hypersensitivity to the evaluation of others, and lack of empathy that begins early in adulthood and is present in a variety of contexts.

What are the symptoms of Narcissistic Personality Disorder?

The sufferer may:

-- react to criticism with feelings or rage, shame or humiliation

-- take advantage of others to achieve own goals

-- have a grandiose sense of self-importance

-- hold a belief that his/her problems are unique and can only be understood by other special people

-- have a preoccupation with fantasies of unlimited success, power, beauty, intelligence, or ideal love

-- have unreasonable expectations of especially favorable treatment

-- require constant attention and admiration

-- be unable to recognize and experience how others feel

-- be preoccupied with feelings of envy

What causes Narcissistic Personality Disorder?

The cause of Narcissistic Personality Disorder is unknown at this time. There is some evidence that genetic predisposition and other biological or biochemical factors are involved for some people. Psychological factors are also involved for most people

What happens to people who have Narcissistic Personality Disorder?

The course is variable and often prolonged. The disorder usually surfaces during early adulthood. Some impairment in relationships is inevitable, and depression is a frequent complication. Work functioning may be impaired by depressed mood, relationship problems, or the pursuit of unrealistic goals. In other cases, work functioning may be enhanced by an unquenchable thirst for success.

What is the treatment for Narcissistic Personality Disorder?

Treatment of Narcissistic Personality Disorder usually consists of individual, group or family therapy, structure (scheduling one's time so there are no long periods of unplanned time), support, medications for specific symptoms, limit-setting, consistent rules, education about the illness, social skills training, behavior modification and learning more effective communication and coping skills. Inpatient or day hospitalization may be necessary when symptoms make the patient a danger to self or others.

What can I do to help control Narcissistic Personality Disorder?

-- Learn ways to tolerate emotional distress. Distress usually rises to a peak quickly when you're hurt or upset, but if you tolerate the distress and do absolutely nothing about it, the pain will gradually diminish. Practice making no other response to emotional distress than to just tolerate it.

-- Learn to fail. In other words, practice every day doing the things you find most difficult. Often the things we view as stupid are the things we find most difficult, so practice those things too. Learning that you can fail and survive is important.

-- Play games with people who are better than you, so you can learn how to lose without severe distress.

-- Identify the ways you put other people down. Ask other people to help you do this since it's often easier for other people to see your behavior more clearly than for you to see your own. Once you know exactly how you put other people down, stop doing it.

How can I keep the symptoms from returning once they are in control?

There will be times when symptoms become more pronounced. These times are often times of stress or anxiety and are called relapses. If signs of relapse appear, there should be a specific plan decided in advance for actions that can be taken (e.g. brief hospitalization, medication, increased structure, etc.)

Should I call my therapist if I'm having a crisis between appointments?

Patients should discuss with their therapist when to call between sessions.

Where can I get more information about Narcissistic Personality Disorder?

There are several good books about Narcissistic Personality Disorder:

Marsha Linehan. Skills Training Manual for Treating Borderline Personality Disorder. 1993.

John Oldham and Lois B. Morris. Personality Self-Portrait, revised. 1995.

This article comes from the New York-Presbyterian Hospital

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