Relationships with people with narcissistic personality disorder

This article is about personality disorder. For the personality trait, see Narcissism; for sexual deviation, see Narcissism (sexology).

Narcissistic personality disorder
Narcissus (1590s) by Caravaggio (Galleria Nazionale d'Arte Antica, Rome)
ICD-10	60.860.8
ICD-10-CM	F60.81
ICD-9	301.81301.81
ICD-9-CM	301.81[1][2]
DiseasesDB	000934
MedlinePlus	000934
Media files on Wikimedia Commons

Narcissistic personality disorder

- a personality disorder characterized by a belief in one’s own uniqueness, special position, superiority over other people, grandiosity; an inflated opinion of one’s talents and achievements; preoccupation with fantasies about one’s successes; expectation of unconditionally good attitude and unquestioning submission from others; seeking the admiration of others to confirm one’s uniqueness and significance; inability to show empathy; ideas about their own freedom from any rules, that others envy them. Narcissistic individuals constantly try to control others' opinions of them. They tend to devalue almost everything around them in the world, while idealizing what they associate themselves with.

Descriptions

By McWilliams

Nancy McWilliams describes the personality with narcissistic disorder as “ organized around maintaining self-esteem by seeking validation from others.”

”, clarifying that we are talking about people for whom this task outshines all others, and not about people who are simply sensitive to criticism or praise.
“ Preoccupied with how they are perceived by others, narcissistic people experience a core feeling that they are deceived and unloved
.”
Attention is also drawn to the fact that narcissistic pathology is not a normal childhood sense of grandiosity preserved until adulthood, but rather a compensation for early, and therefore global, disappointments in relationships. “ The subjective experience of narcissistic people is permeated with shame and the fear of feeling shame
.”
Unlike guilt, which is the feeling that you have done or have acted badly, shame is the feeling that you are perceived
as bad, that the reason you are “bad” is not because of how you act, but because of how you are treated. other. That is, for the narcissist, the locus of control over his self-esteem is somewhere outside of himself, which forces him to constantly try to control the opinions of others about himself. Narcissistic individuals tend to devalue almost everything in the world, while idealizing what they associate themselves with. Everything that is not ideal seems insignificant to them, and vice versa, everything that is important seems ideal to them. Moreover, the perception of objects can change sharply and diametrically at any moment, since the line between ideal and insignificant for a narcissist is very thin. Due to the fact that for the narcissistic personality, the ability of people to support him, the narcissist, his own sense of importance is extremely important, all other aspects of the relationship fade for such a person, and he experiences great difficulty in being able to love someone. “Their need for others is great, but their love for them is superficial”[3].

Most analysts believe that people take this path because others use them as their own narcissistic appendage... ...Narcissistic patients may be extremely important to their parents or other caregivers, not because of who they really are, but because that perform some function. The contradictory message that he is valued (but only for the special role he plays) makes the child feel that if his true feelings - especially hostile and selfish - are revealed, rejection or humiliation will follow. This contributes to the development of a “false self”—presenting to others only what one has learned is acceptable.

— Nancy McWilliams[3]

According to Kernberg

According to Kernberg, narcissistic character traits strongly overlap with hysterical ones, and, in the case of severe personality disorders of the hysterical group, both traits are found in combination.

The super-ego of a narcissistic personality is not developed, nor is the ideal self developed, and the main personal goal may be the achievement of status attributes characteristic of a given society.

The narcissist is hardly capable of interpersonal intimacy, he is incapable of love, as well as jealousy - narcissistic jealousy arises only after the fact, when the other party announces a break in the relationship. The narcissist needs a partner as a mirror to reflect himself.

According to Kernberg, male promiscuity, as a rule, is of a narcissistic nature, while female promiscuity is found in almost any personality disorder[4].

A narcissistic mother is typically unable to meet the emotional needs of her child and contributes to the transmission of narcissistic pathology from generation to generation.

Diagnostic criteria

ICD-10

This section is translated from the article Personality Disorder. (edit | history)

Diagnostic criteria from the version of the International Classification of Diseases, 10th revision ICD-10, adapted for use in Russia (general diagnostic criteria for personality disorders, which must be met in all subtypes of disorders)[5]:

Conditions that are not directly attributable to extensive brain damage or disease or other mental disorder and meet the following criteria:

• a) marked disharmony in personal attitudes and behavior, usually involving several areas of functioning, such as affectivity, excitability, impulse control, perceptual and mental processes, as well as style of relating to other people; in different cultural conditions it may be necessary to develop special criteria regarding social norms;
• b) the chronic nature of an abnormal style of behavior that arose a long time ago and is not limited to episodes of mental illness;
• c) the abnormal style of behavior is comprehensive and clearly disrupts adaptation to a wide range of personal and social situations;
• d) the above-mentioned manifestations always arise in childhood or adolescence and continue to exist into adulthood;
• e) the disorder causes significant personal distress, but this may only become apparent later in the course of time;
• f) usually, but not always, the disorder is accompanied by a significant deterioration in professional and social productivity.

— International Classification of Diseases (10th revision), adapted for use in the Russian Federation — /F60/ Specific personality disorders. Diagnostic criteria[5]

To classify a personality disorder into one of the subtypes defined in ICD-10 (for diagnosis of most subtypes), it is necessary that it meets at least three criteria defined for this type [5].

Diagnostic criteria from the official, international version of ICD-10 from the World Health Organization (general diagnostic criteria for personality disorders, which must be met in all subtypes of disorders)[6]:

• G1. An indication that an individual's characteristic and consistent patterns of internal experience and behavior as a whole deviate significantly from the culturally expected and accepted range (or "norm"). Such a deviation must manifest itself in more than one of the following areas: 1) cognitive sphere (that is, the nature of perception and interpretation of objects, people and events; the formation of attitudes and images of “” and “others”);
• 2) emotionality (range, intensity and adequacy of emotional reactions);
• 3) controlling drives and satisfying needs;
• 4) relationships with others and the manner of solving interpersonal situations.

• G2. The deviation must be complete in the sense that inflexibility, lack of adaptability, or other dysfunctional characteristics are found in a wide range of personal and social situations (that is, not limited to one “trigger” or situation).
• G3. The behavior noted in G2 indicates
  personal distress or adverse effects on the social environment.
• G4. There must be evidence that the deviation is stable and long-lasting, beginning in late childhood or adolescence.
• G5. The disorder cannot be explained as a manifestation or consequence of other mental disorders of adulthood, although episodic or chronic conditions from sections F0 to F7 of this classification may exist simultaneously with it or arise against its background.
• G6. Organic brain disease, trauma or brain dysfunction should be excluded as a possible cause of the deviation (if such an organic condition is identified, rubric 07 should be used).

Original text (English)

• G1. Evidence that the individual's characteristic and enduring patterns of inner experience and behavior deviate markedly as a whole from the culturally expected and accepted range (or 'norm'). Such deviation must be manifest in more than one of the following areas: (1) cognition (ie ways of perceiving and interpreting things, people and events; forming attitudes and images of self and others);
• (2) affectivity (range, intensity and appropriateness of emotional arousal and response);
• (3) control over impulses and need gratification;
• (4) relating to others and manner of handling interpersonal situations.
• G2. The deviation must manifest itself pervasively as behavior that is inflexible, maladaptive, or otherwise dysfunctional across a broad range of personal and social situations (ie not being limited to one specific 'triggering' stimulus or situation).
• G3. There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behavior referred to under G2.
• G4. There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence.
• G5. The deviation cannot be explained as a manifestation or consequence of other adult mental disorders, although episodic or chronic conditions from sections F0 to F7 of this classification may co-exist, or be superimposed on it.
• G6. Organic brain disease, injury, or dysfunction must be excluded as possible cause of the deviation (if such organic causation is demonstrable, use category F07).

— International Classification of Diseases (10th revision) — /F60/ Specific personality disorders. Diagnostic criteria[6]

There are no specific diagnostic criteria for narcissistic personalities in the ICD-10, there is only a mention among “other specific personality disorders.” Formally, to make a diagnosis of narcissistic personality disorder, it is sufficient to meet the general diagnostic criteria for a personality disorder and not meet the diagnostic criteria for other specific personality disorders.

DSM-IV

According to the American classification, the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), this disorder, in addition to meeting the general criteria for a personality disorder, is manifested by pervasive grandiosity (in fantasies and behavior), a need for admiration, and a lack of empathy, which can be observed from early adolescence in various contexts by five or more of the following characteristics[7][8]:

1. Grandiose self-importance (eg, an exaggerated opinion of one's talents and achievements)
2. Preoccupation with fantasies of unlimited success, power, splendor, beauty, or ideal love
3. Belief in one’s “exclusiveness”, the belief that one should be friends and can only be understood by one’s own “exceptional” or high-ranking people
4. Needs excessive praise
5. Feels that he has some special rights (for example, an unreasonable demand for preferential treatment or automatic satisfaction of his own expectations from others)
6. Uses others to achieve own goals
7. Can't sympathize
8. Often envies others and believes that others are jealous of him
9. Exhibits arrogant, haughty behavior or attitude.

DSM-5

When considering the diagnostic features of the disorder, the DSM-5 proposed an alternative model of narcissistic personality disorder that included the following criteria:

A. Significant impairments in personality functioning, which are manifested by: 1. Impairments in one’s own functioning (a or b): a. Identity. Excessive reliance on others for self-determination and self-esteem regulation; Inadequate self-esteem, which can be overestimated or underestimated, and also fluctuate between extremes; emotional state reflects fluctuations in self-esteem. b. Self-reliance. Goal setting is based on receiving recognition from others; Personal standards are unjustifiably high to make one feel exceptional, or low, based on the feeling that everyone owes the person something; They are often unaware of their own motives. 2. Interpersonal functioning disorders (a or b): a. Empathy: Impaired ability to acknowledge or identify with the feelings and needs of others; overly attuned to the reactions of others, but only if they are perceived as relevant to themselves; over- or underestimation of one's own influence on others. b. Intimacy: Relationships are mostly superficial and are needed to serve the regulation of self-esteem; Reciprocity is limited by little genuine interest in the other and the predominance of the need for personal gain. B. Pathological personality traits in the following areas: 1. Antagonism, characterized by a. Grandiosity: The feeling that everyone owes you something, overt or hidden; egocentrism; confidence in one's own superiority; condescending attitude towards others. b. Attention-seeking: excessive attempts to attract attention and be the center of it; search for admiration. C. Impairments in personality functioning and expressed personality traits are stable over time and appear in different situations. D. Disturbances in personality functioning and expressed personality traits cannot be better understood as normal for the developmental stage or cultural environment. E. Impairments in personality functioning and pronounced personality traits are not related to the physiological effects of substances (medicines, surfactants) or a general medical condition (for example, serious head injuries).

However, the final version of DSM-5 retained the 9 diagnostic criteria for narcissistic personality disorder that existed in DSM-IV. To confirm a diagnosis of narcissistic personality disorder, at least 5 of these criteria must be met[9].

Comorbidity

Narcissistic personality disorder has a high comorbidity with other mental disorders[10]. People with narcissistic personality disorder are prone to depressive episodes[11]. In addition, narcissistic personality disorder may be associated with bipolar disorder, anorexia, and substance abuse[12], particularly cocaine use[13]. Narcissistic personality disorder can also be comorbid with histrionic personality disorder, borderline personality disorder, dissocial personality disorder and paranoid personality disorder[13].

Symptoms and signs

Narcissistic Personality Disorder
To be definitively diagnosed as having narcissistic personality disorder rather than as a character trait, a subject must exhibit at least five of the nine characteristic traits.

1. A keenly developed sense of self-importance. Such a person exaggerates his achievements and skills and expects to be recognized as the best in his chosen field, without real achievements and actions;
2. Constant fantasies about one’s own success, strength, brilliance, beauty, the ideal object of love;
3. Belief in one’s own uniqueness, belonging to the society of only the best people: the richest, highest-ranking, famous;
4. Constant need for admiration;
5. The belief that everyone owes him, that is, unreasonably high expectations that they will provide special honors and fulfill his desires;
6. Exploitative behavior in life, using others to realize one’s plans;
7. Complete lack of empathy. Reluctance to acknowledge other people's feelings and inability to identify with their needs;
8. Envy of more successful people or the belief that others are jealous of him or her;
9. Displaying arrogant behavior or individualistic views

Narcissistic injury (pathogenesis)

Main article: Narcissistic injury

The personalities of those who were raised by narcissistic people or simply had too many traumatic experiences with them, in many cases carry a specific mark called “narcissistic injury”, which is a heightened sensitivity to shame (shame so strong inside that it is blocked and it does not exist, it does not exist for others), as well as difficulty in maintaining “boundaries” between oneself and other people. Most people with narcissistic injury either, like narcissistic individuals, invest a lot of energy in maintaining a sense of their over-importance, or tend to meekly comply with the whims of others, fearing to face their anger.

Meanwhile, unlike true narcissistic individuals, narcissistically injured people retain a sufficient level of reflection to be able to recognize their own envy, shame and guilt.

Proponents of the psychodynamic school theorize more than others about narcissistic personality disorder, again postulating that this disorder begins with cold, rejecting parents. According to them, some people with similar backgrounds spend their lives constantly defending themselves against feelings of dissatisfaction, rejection by others, inadequacy and fear of the world (Wink, 1996), repeatedly convincing themselves that they are truly perfect (even though in reality they may not be rather, with delayed development, due to the fact that they do not accept criticism and refuse to improve, since they already consider themselves perfect) and are desirable and strive to evoke admiration from others (Vaillant, 1994). Object relations theorists also believe that these individuals develop a grand image of themselves in order to convince themselves that they are completely self-sufficient and do not need a warm relationship with their parents or anyone else (Kernberg, 1989; Siomopoulos, 1988). In support of psychodynamic theories, researchers have found that children who are maltreated and those whose parents are divorced are more likely to be victims of narcissistic personality disorder. The same applies to children who were raised by foster parents or whose mother or father died (Kernberg, 1989).

Some behavioral and cognitive theorists suggest that narcissistic personality disorder may develop in people as a result of being treated too well rather than too poorly in childhood. They argue that some individuals begin to believe in their superiority and greatness when their “admiring and love-blinded parents” indulge them and repeatedly teach their children to “overestimate their own merits” (Millon, 1987). These ideas are supported by the fact that first-born and only children, who are indeed often considered exceptionally talented or intelligent by their parents, score higher than their peers on tests assessing narcissistic traits (Curtis & Cowell, 1993).

What is narcissistic personality disorder

The narcissistic personality is not easy to recognize. Very often, at the very beginning, they make a favorable impression - they look after you beautifully, give compliments, and give expensive gifts. But sooner or later, their inability to empathize, their focus only on themselves, their lack of empathy becomes visible.

The main signs of a narcissist are:

• Heightened self-esteem;
• Desire for unlimited power and wealth;
• Excessive need for attention from others;
• Confidence in one’s own exclusivity and chosenness;
• Using other people for personal gain;
• Inability to sympathize and empathize;
• Arrogance and disregard for other people.

As a rule, narcissistic disorder develops in childhood. If the parents were cold with the child and did not listen to his opinion, then he will strive to achieve career heights and win the admiration of others. Another situation - excessive love and admiration for a child also contributes to the formation of narcissism.

Epidemiology

A systematic review of studies conducted from 1980 to 2008 on the prevalence of narcissistic personality disorder found an average prevalence of NPD of 1.06%. The prevalence of narcissistic personality disorder can range from 0% to 6.2%[14]. The prevalence of narcissistic personality disorder among patients with mental disorders associated with alcohol abuse is 6.2%. In this group of patients, the prevalence is higher among men (7.7%) than among women (4.4%)[15].

According to the US National Institutes of Health, published in 2008 in the Journal of Clinical Psychiatry, there has been a significant increase in the number of Americans demonstrating behavior that meets the criteria for clinical narcissism. Among 20-29 year olds there were 10% of them, and among those 60-69 years old - only 3%[16].

Symptoms

People with narcissistic personality disorder experience:

• heightened self-esteem;
• exaggeration of one's abilities;
• excessive boastfulness;
• vulnerability;
• manipulating other people to achieve one's goals;
• lack of sympathy and empathy.

Narcissists always fantasize about wealth, strength, power and the special attention of others to their person. As a rule, such fantasies do not come true in real life. Persons suffering from this psychopathy are very vulnerable and fragile. Therefore, if they are not admired, they become angry and offended.

The symptoms of narcissistic disorder are fairly easy to identify. Narcissism is the most basic sign of narcissism. In addition, you can notice confidence in your talents and abilities. People with narcissistic disorder believe they can handle any problem or task.

As a rule, such people are very envious. And if an object of envy appears in front of them, they may become irritable and angry. Dislike for others manifests itself in the form of arrogance and arrogance. This is how narcissists demonstrate their superiority over others. Narcissists strive for wealth and a better life, so any action, no matter how insignificant, will be regarded as a step towards achieving their goal.

Individuals with narcissistic disorder have difficulty accepting criticism. If his self-esteem was somehow hurt, then this makes them furious and irritated. In some cases, this leads to deep depression.

Often, many people suffering from this psychopathy do not have personal relationships, so narcissists tend to be lonely.

Dealing with narcissists is not much fun. Such communication causes nothing but coldness and rejection. There is a feeling of discomfort when communicating with a narcissist.

No matter what the achievements of a person with this psychopathy, deep down he will still feel unhappy. Over the years, the understanding comes that health and external beauty are not eternal; against this background, neurosis can develop.

Therapy

Psychoanalytic therapy is highly complex (Lawrence, 1987).

An important task for the therapist is to increase the degree of awareness and honesty of the narcissistic patient in relation to the nature of his own behavior. For example, it may be important to discuss how directly the patient usually expresses his or her needs. This is because narcissistic people are deeply embarrassed to ask for anything; They believe that acknowledging any need allows others to see the deficiency in their own "". As a result, they find themselves in interpersonal situations where they feel humiliated, since the other person, without asking on their part, has difficulty guessing their needs, and asking is humiliating for them. Continuing this behavioral pattern in therapy, narcissistic individuals often try to convince the therapist that their problem boils down to the insensitivity and inattention of the people with whom they live. Thus, articulating the patient's needs reveals his beliefs that needing someone is shameful, and also allows the therapist to teach the patient ideas about human interdependence.

It is necessary to avoid stimulating strong shame in the patient, as it will make him want to stop therapy, or will lead to the emergence of secrets between the client and the therapist[3].

Notes

1. Disease ontology database (English) - 2020.
2. Monarch Disease Ontology release 2018-06-29sonu - 2018-06-29 - 2018.
3. ↑ 1 2 3 McWilliams, Nancy.
   Narcissistic personalities // Psychoanalytic diagnosis: Understanding personality structure in the clinical process = Psychoanalytic diagnosis: Understanding personality structure in the clinical process. - M.: Klass, 1998. - 480 p. — ISBN 5-86375-098-7.
4. Kernberg, Otto.
   Love relationships, norm and pathology = Love Relations. Normality and Pathology. - Moscow: Class, 2006. - 256 p. — (Library of psychology and psychotherapy). — 2000 copies. — ISBN 5-86375-124-X.
5. ↑ 1 2 3 World Health Organization.
   F6 Personality and behavior disorders in adulthood [F60—F69] // International Classification of Diseases (10th revision). Class V: Mental and behavioral disorders (F00-F99) (adapted for use in the Russian Federation). - Rostov-on-Don: Phoenix, 1999. - P. 245-246. — ISBN 5-86727-005-8.
6. ↑ 1 2 World Health Organization.
   The ICD-10 Classification of Mental and Behavioral Disorders. Diagnostic criteria for research. — Jeneva. — P. 149-150. — 263 p. (English)
7. Burgo, 2020, p. 17.
8. DSM-IV: Diagnostic and Statistical Manual of Mental Disorders. — 4th edition. - Washington: American Psychiatric Publishing, May 1994. - pp. 645-650. — 620 s. — ISBN 0-89042-061-0, ISBN 978-0890420614.
9. American Psychiatric Association. Alternative DSM-5 model for personality disorders. Fifth edition. Washington, DC. American Psychiatric Publishing Inc; 2013. 761-81
10. Joel Paris.
    Modernity and narcissistic personality disorder. (English) // Personality Disorders: Theory, Research, and Treatment. — 2014. — Vol. 5, iss. 2. - P. 220–226. — ISSN 1949-2715 1949-2723, 1949-2715. - doi:10.1037/a0028580.
11. Diagnostic and Statistical Manual of Mental Disorders. - 5. - P. 671. - ISBN 978-0890425558.
12. New Insights Into Narcissistic Personality Disorder (unspecified)
    (February 29, 2016).
13. ↑ 12
    Diagnostic and statistical manual of mental disorders: DSM-5.. - 5th ed. - Arlington, VA: American Psychiatric Association, 2013. - xliv, 947 pages p. — ISBN 978-0-89042-554-1, 0-89042-554-X, 978-0-89042-555-8, 0-89042-555-8.
14. Dhawan et. al. Prevalence and treatment of narcissistic personality disorder in the community: a systematic review. Comprehensive Psychiatry. 2010 Jul-Aug;51(4):333-9.
15. Stinson et. al., Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2008 Jul;69(7):1033-45. pmid 20579503
16. Chamorro-Premuzic, 2014.