Narcissistic Personality Disorder

Definition:

Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance and a deep need for admiration. Those with narcissistic personality disorder believe that they're superior to others and have little regard for other people's feelings. But behind this mask of ultra-confidence lies a fragile self-esteem, vulnerable to the slightest criticism.

Narcissistic personality disorder is one of several types of personality disorders. Personality disorders are conditions in which people have traits that cause them to feel and behave in socially distressing ways, limiting their ability to function in relationships and in other areas of their life, such as work or school.

Narcissistic personality disorder treatment is centered around psychotherapy.

Symptoms

Narcissistic personality disorder is characterized by dramatic, emotional behavior, in the same category as antisocial and borderline personality disorders.

Narcissistic personality disorder symptoms may include:

• Believing that you're better than others
• Fantasizing about power, success and attractiveness
• Exaggerating your achievements or talents
• Expecting constant praise and admiration
• Believing that you're special and acting accordingly
• Failing to recognize other people's emotions and feelings
• Expecting others to go along with your ideas and plans
• Taking advantage of others
• Expressing disdain for those you feel are inferior
• Being jealous of others
• Believing that others are jealous of you
• Trouble keeping healthy relationships
• Setting unrealistic goals
• Being easily hurt and rejected
• Having a fragile self-esteem
• Appearing as tough-minded or unemotional

Although some features of narcissistic personality disorder may seem like having confidence or strong self-esteem, it's not the same. Narcissistic personality disorder crosses the border of healthy confidence and self-esteem into thinking so highly of yourself that you put yourself on a pedestal. In contrast, people who have healthy confidence and self-esteem don't value themselves more than they value others.

When you have narcissistic personality disorder, you may come across as conceited, boastful or pretentious. You often monopolize conversations. You may belittle or look down on people you perceive as inferior. You may have a sense of entitlement. And when you don't receive the special treatment to which you feel entitled, you may become very impatient or angry. You may insist on having "the best" of everything — the best car, athletic club, medical care or social circles, for instance.

But underneath all this behavior often lies a fragile self-esteem. You have trouble handling anything that may be perceived as criticism. You may have a sense of secret shame and humiliation. And in order to make yourself feel better, you may react with rage or contempt and efforts to belittle the other person to make yourself appear better.

When to see a doctor: When you have narcissistic personality disorder, you may not want to think that anything could be wrong — doing so wouldn't fit with your self-image of power and perfection. But by definition, narcissistic personality disorder causes problems in many areas of your life, such as relationships, work, school or your financial affairs. You may be generally unhappy and confused by a mix of seemingly contradictory emotions. Others may not enjoy being around you, and you may find your relationships unfulfilling.

If you notice any of these problems in your life, consider reaching out to a trusted health care provider or mental health provider. Getting the right treatment can help make your life more rewarding and enjoyable.

Causes:

It's not known what causes narcissistic personality disorder. As with other mental disorders, the cause is likely complex. Some evidence links the cause to a dysfunctional childhood, such as excessive pampering, extremely high expectations, abuse or neglect. Other evidence points to genetics or psychobiology — the connection between the brain and behavior and thinking.

Risk Factors:

Narcissistic personality disorder is rare. It affects more men than women. Narcissistic personality disorder often begins in early adulthood. Although some adolescents may seem to have traits of narcissism, this may simply be typical of the age and doesn't mean they'll go on to develop narcissistic personality disorder.

Although the cause of narcissistic personality disorder isn't known, researchers continue to learn more about the factors that may increase the risk of developing the condition. In the past, experts believed excessive praise, admiration and indulgence from parents may lead to a pathologically inflated sense of self. Today, however, psychiatrists believe parental neglect is more likely responsible.

Risk factors for narcissistic personality disorder may include:

• Parental disdain for fears and needs expressed during childhood
• Lack of affection and praise during childhood
• Neglect and emotional abuse in childhood
• Unpredictable or unreliable caregiving from parents
• Learning manipulative behaviors from parents

Children who learn from their parents that vulnerability is unacceptable may lose their ability to empathize with others' needs. They may also mask their emotional needs with grandiose, egotistical behavior that's calculated to make them seem emotionally "bulletproof."

Complications:

Complications of narcissistic personality disorder, if left untreated, can include:

• Substance abuse
• Alcohol abuse
• Depression
• Suicidal thoughts or behavior
• Eating disorders, particularly anorexia nervosa
• Relationship difficulties
• Problems at work or school

Lifestyle and Home Remedies:

Whether you decide to seek treatment on your own or are encouraged by loved ones or a concerned employer, you may feel defensive about treatment or think it's unnecessary. The nature of narcissistic personality disorder can also leave you feeling that therapy or the therapist is not worth your time and attention, and you may be tempted to quit. Try to keep an open mind, though, and to focus on the rewards of treatment.

Also, be sure to:

• Stick to your treatment plan. Attend scheduled therapy sessions and take any medications as directed. Remember that it can be hard work and that you may have occasional setbacks.
• Learn about it. Educate yourself about narcissistic personality disorder so that you can better understand symptoms, risk factors and treatments.
• Get treatment for substance abuse or other mental health problems. Your addictions, depression, anxiety and stress can feed off each other, leading to a cycle of emotional pain and unhealthy behavior.
• Learn relaxation and stress management. Try such stress-reduction techniques as meditation, yoga or tai chi. These can be soothing and calming.
• Stay focused on your goal. Recovery from narcissistic personality disorder can take time. Keep motivated by keeping your recovery goals in mind and reminding yourself that you can work to repair damaged relationships and become happier with your life.

Prevention:

There's no known way to prevent narcissistic personality disorder with any certainty. Getting treatment as soon as possible for childhood mental health problems may help. Family therapy may help families learn healthy ways to communicate or to cope with conflicts or emotional distress. Parents with personality disorders may benefit from parenting classes and guidance from therapists or social workers.

Author's note: Do not discount the above personality disorder. Little do we know that it actually exists among our friends, our office colleagues, our loved ones. Chronic cases are those who are abusive (wife abuse, child abuse) to the point of doing bodily harm without them realizing it.

(Excerpt from Mayo Clinic Health Manager)