Narcissistic Personality Disorder - Clinical Features

Clinical Features of the Narcissistic Personality Disorder 

Opinions vary as to whether the narcissistic traits evident in infancy, childhood and early adolescence are pathological. Anecdotal evidence suggests that childhood abuse and trauma inflicted by parents, authority figures, or even peers provoke "secondary narcissism" and, when unresolved, may lead to the full-fledged Narcissistic Personality Disorder (NPD) later in life.

Person washing his hands (Photo credit: Wikipedia)

This makes eminent sense as narcissism is a defense mechanism whose role is to deflect hurt and trauma from the victim's "True Self" into a "False Self" which is omnipotent, invulnerable, and omniscient. This False Self is then used by the narcissist to garner narcissistic supply from his human environment. Narcissistic supply is any form of attention, both positive and negative and it is instrumental in the regulation of the narcissist's labile sense of self-worth.

Perhaps the most immediately evident trait of patients with Narcissistic Personality Disorder (NPD) is their vulnerability to criticism and disagreement. Subject to negative input, real or imagined, even to a mild rebuke, a constructive suggestion, or an offer to help, they feel injured, humiliated and empty and they react with disdain (devaluation), rage, and defiance.

From the book "Malignant Self Love - Narcissism Revisited": 

"To avoid such intolerable pain, some patients with Narcissistic Personality Disorder (NPD) socially withdraw and feign false modesty and humility to mask their underlying grandiosity. Dysthymic and depressive disorders are common reactions to isolation and feelings of shame and inadequacy."

Due to their lack of empathy, disregard for others, exploitativeness, sense of entitlement, and constant need for attention (narcissistic supply), narcissists are rarely able to maintain functional and healthy interpersonal relationships.

Many narcissists are over-achievers and ambitious. Some of them are even talented and skilled. But they are incapable of team work because they cannot tolerate setbacks. They are easily frustrated and demoralized and are unable to cope with disagreement and criticism. Though some narcissists have meteoric and inspiring careers, in the long-run, all of them find it difficult to maintain long-term professional achievements and the respect and appreciation of their peers. The narcissist's fantastic grandiosity, frequently coupled with a hypomanic mood, is typically incommensurate with his or her real accomplishments (the "grandiosity gap").

There are many types of narcissists: the paranoid, the depressive, the phallic, and so on. 

An important distinction is between cerebral and somatic narcissists. The cerebral's derive their Narcissistic Supply from their intelligence or academic achievements and the somatics derive their Narcissistic Supply from their physique, exercise, physical or sexual prowess and romantic or physical "conquests".

Another crucial division within the ranks of patients with Narcissistic Personality Disorder (NPD) is the classic variety (those who meet five of the nine diagnostic criteria included in the DSM), and the compensatory kind (their narcissism compensates for deep-set feelings of inferiority and lack of self-worth).

Some narcissists are covert, or inverted narcissists. As codependents, they derive their narcissistic supply from their relationships with classic narcissists.

Treatment and Prognosis 

Talk therapy (mainly psychodynamic psychotherapy or cognitive-behavioral treatment modalities) is the common treatment for patients with Narcissistic Personality Disorder (NPD). The therapy goals cluster around the need to modify the narcissist's antisocial, interpersonally exploitative, and dysfunctional behaviors. Such re-socialization (behavior modification) is often successful. Medication is prescribed to control and ameliorate attendant conditions such as mood disorders or obsessive-compulsive disorders.

The prognosis for an adult suffering from the Narcissistic Personality Disorder (NPD) is poor, though his adaptation to life and to others can improve with treatment.

---

---