Narcissism is described as extreme self-involvement and grandiosity to the degree that it makes a person ignore the needs of those around them. While some people have narcissistic tendencies, in which they are self–centered and have big egos, others have a full-blown disorder that affects their daily functioning. A healthy level of narcissism is correlated with good psychological health in which an individual has self-esteem. On the other hand, a disruptive level of narcissism which is associated with a narcissistic personality disorder is often accompanied by other mental disorders such as depression, histrionic personality disorder, and antisocial personality disorder. This article will look at narcissism as a personality trait and narcissism as a personality disorder. The article will also discuss the behavioral traits that accompany narcissism and treatments that can assist in managing narcissistic personality disorder.
People often use the term narcissism to describe individuals who constantly portray high levels of selfishness, self-involvement, entitlement and a lack of empathy for those around them. Generally, people who have narcissistic tendencies have very big egos. However, the degree of these tendencies are often mild and do not always surface. Narcissistic traits do not affect an individual's daily functioning and are often associated with good psychological health. People who have narcissistic traits do not have a pattern of narcissistic behaviour. Instead, they generally have days when these tendencies show. It is also important to note that these individuals have high self-esteem, and they generally do not need people to reassure them of their abilities. At most, a person with narcissistic traits is a nuisance to those around them and may suffer from mild forms of depression due to possible exclusion from those around them.
Narcissistic Personality Disorder
On the other hand, some individuals have a deeper form of narcissism that affects their daily functioning. Such individuals are said to be suffering from what is known as Narcissistic Personality Disorder (NPD). A narcissistic personality disorder is characterised as a DSM-5 personality disorder in which an individual has an inflated sense of self-importance. Individuals with this mental condition often overestimate their abilities and inflate their accomplishments. They have a pervasive need for admiration and show a lack of empathy with the feelings of others. Sigmund Freud, in his essay titled "On Narcissism: An Introduction" stated that narcissism becomes a neurosis when individuals turn their affection back on themselves after the affection had already been projected outwards to others besides themselves. As a result, these individuals become cut off from society and disinterested in others.
This disorder generally begins to manifest in early adulthood and is present in various contexts. NPD is often accompanied by other psychological disorders, particularly histrionic personality disorder (HPD), antisocial personality disorder (APD) and major depressive disorder (MDD). HPD is a personality disorder where an individual is attention-seeking and uncomfortable or unhappy when they are not the centre of attention. APD is another personality disorder in which an individual has an enduring disregard of other people's rights. It is associated with impulsive behaviour and a lack of remorse for wrongdoing. Finally, MDD is a deep sense of sadness and worthlessness that significantly affects daily functioning.
Several studies indicate that NPD exhibits the highest rates of comorbidity with antisocial and histrionic personality disorders. Due to the lack of empathy and tendency to exploit others for self-benefit, NPD has been compared to antisocial personality disorder. Having violent outbursts and aggressiveness is often linked to histrionic personality disorder.
In a study done by Zimmerman in South Africa, the prevalence rates of NPD in the general population range from 0 percent to 5.3 percent. NPD typically has among the lowest correlation between clinical interviews and self-report ratings; this is most likely due to a lack of insight into how behaviour is perceived by others or a disregard for the negative impact of their behaviour on others . Generally, people with NPD may lack the insight or willingness to disclose narcissistic attitudes or difficulties.
Due to the low prevalence of NPD there is minimal research available on patients with NPD. Most research that has been done on NPD is mainly focused on empathy deficits and self-esteem. In research done in Germany with a diagnosed sample of NPD patients, the investigators used both self-report and experimental methods to assess empathy, and the data that was collected revealed that NPD patients exhibited deficits in emotional empathy compared to controls and patients with borderline personality disorder (Dawood, Schroder,2018). This evidence suggests that a lack of empathy for others needs is pivotal in diagnosing NPD. Some researchers even suggest that if individuals exhibit empathy for others, they cannot be diagnosed with NPD even though they may have other symptoms.
Neuroimaging done in patients with NPD revealed smaller grey matter volume in the left anterior insula as compared to control groups. Grey matter volume in the left anterior insula correlates positively with self-reported emotional empathy (Dawood, Schroder,2018). A loss of grey matter in this area is often associated with emotion dysregulation and deficits in coping behaviours. To support this evidence, Nenadic and associates (2015) used voxel-based morphometry to identify structural issues in the brains of six patients diagnosed with NPD and found grey matter deficits in the right prefrontal and bilateral medial prefrontal regions
Research also suggests that individuals with a narcissistic personality disorder often have a history of failed relationships. A study that was done on narcissistic individuals showed that narcissistic people prefer partners that are openly admiring than partners that are openly loving. Failure to be admired often leads to these individuals becoming angry and aggressive. These toxic attitudes are often positively reinforced with substance abuse and risky sexual behaviour. Research suggests a strong correlation between NPD and substance abuse, especially for those individuals who do not seek for professional help. Some studies associate NPD with delinquent behaviour and criminal activity.
Empirical studies on patients with NPD have caused mixed emotions in the research world. While individuals with NPD exhibit high levels of grandiosity ironically, they have very low self-esteem compared to other controls groups. (Marissen, Brouwer, Hiemstra, Deen, & Franken, 2016) Suggest that this can be justifiable as NPD is comorbid with anxiety disorders , mood disorders and posttraumatic stress disorder.
There is also evidence that suggests that individuals with NPD are often diagnosed with major depressive disorder. Due to poor relations with others, individuals with NPD are often loners who are abandoned. The loneliness accompanied by low self-esteem and toxic behaviour traits such as substance abuse often leads to MDD in such individuals.
Characteristics of Narcissistic Personality Disorder
According to the DSM-5, to diagnose an individual with Narcissistic personality disorder, a patient must meet the clinical threshold for a minimum of five of the following criteria to be diagnosed with NPD:
- Have a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognised as superior without commensurate achievements).
- Be preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- Believe that they are "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
- Requiring excessive admiration.
- Having a sense of entitlement (i.e., unreasonable expectations of especially favourable treatment or automatic compliance with their expectations).
- Be interpersonally exploitative (i.e., take advantage of others to achieve their ends).
- Lacks empathy: be unwilling to recognise or identify with the feelings and needs of others.
- Often envious of others or believes that others are envious of them.
- Showing arrogant, haughty behaviours or attitudes.
Treatment for Narcissistic Personality Disorder
Generally, NPD people are in denial over their condition and hardly ever get diagnosed. Most diagnoses come after individuals approach specialists, mainly with depressive symptoms. Due to the nature of the condition, a significant number of the patients try to justify not having the condition. As a result, NPD is one of the most underdiagnosed disorders in the DSM-5.
Treatment for narcissistic personality disorder centres around talk therapy (psychotherapy). Psychotherapy is essentially when an individual sees a therapist regularly to talk through their issues. Often people are resistant to this kind of treatment. However, there are positive results that come from psychotherapy.
Cognitive behavioural therapy is also another form of treatment that is used for patients diagnosed with NPD. CBT is a type of psychotherapy in which negative patterns of thought about the self and the world are challenged to alter unwanted behaviour patterns or treat mood disorders such as depression. Through this treatment, individuals are helped to realise negative and unhelpful thoughts. This treatment is administered as a form of talk therapy.
In some extreme cases, the disorder is treated using medication. However, this generally treats other underlying conditions such as major depressive disorder. The medication may be used to balance out hormones and improve the mood of the patients.
In conclusion, it is essential to determine the depth of narcissism one has to seek help if the need arises. If you suspect that you may have NPD or know someone you suspect has this condition, it is worth your while to seek professional help early.
Mutsawashe Musvaire is a Talent Acquisition Consultant at Industrial Psychology Consultants (Pvt) Ltd a management and human resources consulting firm. She can be contacted at firstname.lastname@example.org
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