Narcissistic Personality Disorder:  An Overview

 

The person with Narcissistic Personality Disorder (NPD) displays a pattern of grandiosity, need for admiration, and a lack of empathy.

 

Cluster B Personality Disorders

 

Narcissistic Personality Disorder is grouped with Antisocial, Borderline, and Histrionic personality disorders in Cluster B on Axis II.  Common characteristics of these disorders is that behavior often appears dramatic, emotional, or erratic.¹
 
 

Freud and Narcissism

 

The interest in pathological narcissism (now Narcissistic Personality Disorder, or NPD) is long standing, despite the fact that it was not included in the DSM until its third edition (1980).  In his discussion of NPD, Millon cites Freud, who said of the source of narcissistic traits:   “I have found that people who know that they are preferred or are favored by their mother give evidence in their lives of a peculiar self-reliance and an unshakable optimism which often seems like heroic attributes.”²

Millon offers the following helpful synopsis of Freud’s views on narcissism:  “[Freud] described a type of parental style and motivation that he considered to be a central factor contributing to the development of narcissism:  ‘They are impelled to describe to the child all manner of perfection which sober observation would not confirm, to gloss over and forget all his shortcomings. . . .  Moreover, they are inclined to suspend in the child’s favor the operation of all those cultural requirements which their own narcissism has been forced to respect, and to renew in his person the claims for privileges which were long ago given up by themselves' . . . .  In contrast, in the same paper, Freud . . . stated that in certain cases, notable among ‘perverts and homosexuals,’ libidinal self-centeredness stems from the child’s feeling that caregivers cannot be depended on to provide reliable love.  These children ‘give up’ as far as trusting and investing in others as love objects an decide instead that they can trust, and therefore love, only themselves. . . .  ‘The main interest is focused on self-preservation; the type is independent and not easily over awed . . . .  People of this type impress others as being ‘personalities’; it is on them that their fellow men are specially likely to lean; they readily assume the role of leader, give a fresh stimulus to cultural development and break down existing conditions’ . . . . ³  Freud identified several origins of narcissistic self-cathexis, one of which led to feelings of emptiness and low self-esteem, characteristic of the presently predominant NPD type . . . .”⁴
 
 

Psychoanalytic Views of   Narcissistic Personality Disorder

 

In her analysis of Personality Disorders, Ronningstam makes the following observations about NPD with particular reference to Narcissistic Personality Disorder:

In psychoanalytic terms, mental disorders can be characterized according to an individual’s ability to “maintain a sense of reality and identity and their level of defense system.  People functioning on a neurotic level have intact reality testing, stable sense of their identity, and high level defenses such as repression.  People with a psychotic personality organization [such as those with Narcissistic Personality Disorder] have disturbed reality testing, identity diffusion, and low-level defense such as projective identification and splitting."⁵
 
 

Keys Aspects  of Narcissistic   Personality Disorder

 

Most patients with NPD are capable of high functioning owing to their fairly stable although pathological ego structure—that is, they normally do not lose their sense of reality or become psychotic.

In addition, their sense of their own identity, although unrealistically grandiose, usually does not vary except under extraordinary circumstances.

People with NPD may vary in terms of their level of superego pathology.  Some have intact superego with normal moral functioning not influenced by their narcissistic pathology.  Some can even be moral perfectionists and incorporate their high ethical and moral standards as part of their sense of superiority while condemning others.

However, corrupt behavior, lack of commitment, irresponsibility, and more active and deliberately exploitive and ruthless behavior are not uncommon in people with NPD.

Persons with NPD engage in a form of self-love that is pathological— self-centered, grandiose, exhibitionistic.  Moreover, their grandiosity often centers on immature values:  “physical attractiveness, power, clothing, manners, and the like.  Those who are highly intelligent may use their intelligence as the basis for intellectual pretentiousness.”⁶

Kernberg⁷  and Kohut⁸ were both instrumental in developing theoretical perspectives on the narcissistic personality.  Kernberg identified a number of features that are core to the narcissistic personality:

• Unusual degree of self-reference in interactions with others
• Great need to be loved and admired
• Very inflated opinion of self combined with an inordinate need for tribute from others
• Shallow emotional life
• Little empathy for the feelings of others
• Little pleasure in life except that from resulting from being praised or lauded by others or from their own grandiose fantasies
• Restless and bored when the glow of the current admiration subsides and no further admiration is expressed to feed their need for attention
• Envious of others, often idealizing those people whom they feel might add to their own sense of self-importance/self-worth
• Contemptuous of and deprecating toward those whom the feel are their inferiors (including former idols)
• Exploitative and sometimes parasitic interpersonal relationships without any guilt or shame for having used others to gain their own ends
• Charming and engaging on the surface, but ruthless and cold at the core⁹

Kernberg identifies a deep contradiction in the behavior of a pathological narcissist:  “Very often such patients are considered to be ‘dependent’ because they need so much tribute and adoration from others, but on a deeper level they are completely unable really to depend on anybody because of their deep distrust and deprecation of others.”¹⁰

He points out that people with NPD “not only lack emotional depth but fail to understand the complex emotions in other people, but their own feeling lack differentiation, with quick flare-ups and subsequent dispersal of emotion.  They are especially deficient in genuine feelings of sadness and mournful longing; their incapacity for experiencing depressive reactions is a basic feature of their personalities.  When abandoned or disappointed by other people they may show what on the surface looks like depressions, but which on further examination emerges as anger and resentment, loaded with revengeful wishes, rather than real sadness for the loss of a person whom they appreciated.”¹¹

Although a presentation involving haughty self-confidence is more then norm for a client with NPD, Kernberg notes that some express “strong conscious feelings of insecurity and inferiority.  At times, such feelings of inferiority and insecurity may alternate with feelings of greatness and omnipotent fantasies . . . .  At other times, and only after some period of analysis, do unconscious fantasies of omnipotence and narcissistic grandiosity come to the surface.  The presence of extreme contradictions in their self concept is often the first clinical evidence of the severe pathology in the ego and superego of these patients, hidden underneath a surface of smooth and effective social functioning.”¹²
 
 

Types of Narcissistic Personalities

 

A number of researchers have pointed out that the criteria as listed in the DSM-IV-R give a false impression that only one expression of NPD exists; they assert that there are several.¹³

Click on these links to learn more about a particular type:

The Arrogant/Overt Narcissist
The Shy/Covert Narcissist
 
 

Reasons for Seeking Treatment

Interestingly, unlike what one might expect, the person with Narcissistic Personality Disorder does not present for help with their maladaptive behaviors:  hostility, poor interpersonal relationships, rage, grandiosity.  Instead, it is often the depression and anxiety that result from the failure of these same ego defense mechanisms that bring them to therapy.¹⁴
 

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Click on the note number to return to where you were above; click on the author's name to go to the bibliographic entry.

¹APA, 2000, p. 685
²Millon, 1998, p. 398
³Million, 1998, p. 249
⁴Millon, 1998, p. 76
⁵Ronningstam, 1999, p. 677
⁶O. Kernberg, 1998, 35
⁷O. Kernberg, 1975
⁸Kohut, 1971
⁹O. Kernberg, 1984, p. 17
¹⁰O. Kernberg, 1984, p. 17
¹¹O. Kernberg, 1984, p. 229
¹²O, Kernberg, 1984, p. 229
¹³Ronningstam, 1999; Cooper, 1998
¹⁴Corbitt, 1994