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Narcissistic personality disorder (NPD), a term first used by Heinz Kohut in 1971, is a form of pathological narcissism acknowledged in the Diagnostic and Statistical Manual of Mental Disorders in 1980, in the edition known as DSM III-TR. Narcissistic Personality Disorder, is a maladaptive, rigid, and persistent condition that may cause significant distress and functional impairment.
At least five of the following are necessary for a diagnosis:
The common use of the term “narcissism” refers to some of the ways people defend themselves against this narcissistic dynamic: a concern with one’s own physical and social image, a preoccupation with one’s own thoughts and feelings, and a sense of grandiosity. There are, however, many other behaviors that can stem from narcissistic concerns, such as immersion in one’s own affairs to the exclusion of others, an inability to empathize with others’ experience, interpersonal rigidity, an insistence that one’s opinions and values are “right,” and a tendency to be easily offended and take things personally.
To the extent that people are narcissistic, they can be controlling, blaming, self-absorbed, intolerant of others’ views, unaware of other’s needs and of the effects of their behavior on others, and require that others see them as they wish to be seen. They may also demand certain behavior from their children because they see the children as extensions of themselves, and need the children to represent them in the world in ways that meet the parents’ emotional needs. (For example, a narcissistic father who was a lawyer demanded that his son, who had always been treated as the “favorite” in the family, enter the legal profession as well. When the son chose another career, the father rejected and disparaged him.)
These traits will lead narcissistic parents to be very intrusive in some ways, and entirely neglectful in others. The children are punished if they do not respond adequately to the parents’ needs. This punishment may take a variety of forms, including physical abuse, angry outbursts, blame, attempts to instill guilt, emotional withdrawal, and criticism. Whatever form it takes, the purpose of the punishment is to enforce compliance with the parents’ narcissistic needs.
People who are narcissistic commonly feel rejected, humiliated and threatened when criticised. To protect themselves from these dangers, they often react with disdain, rage, and/or defiance to any slight, real or imagined. To avoid such situations, some narcissistic people withdraw socially and may feign modesty or humility.
There is a broad spectrum of narcissistic personalities, styles, and reactions -- from the very mild, reactive and transient, to the severe and inflexible narcissitic personality disorder.
Though individuals with NPD are often ambitious and capable, the inability to tolerate setbacks, disagreements or criticism makes it difficult for such individuals to work cooperatively with others or to maintain long-term professional achievements. The narcissist's perceived fantastic grandiosity, often coupled with a hypomanic mood, is typically not commensurate with his or her real accomplishments.
The interpersonal relationships of patients with NPD are typically impaired due to the individual's lack of empathy, disregard for others, exploitativeness, sense of entitlement, and constant need for attention. They frequently select as mates, and engender in their children, "co-narcissism," which is a term coined to refer to a co-dependent personality style similar to co-alcoholism and co-dependency. Co-narcissists organize themselves around the needs of others. They feel responsible for others, accept blame readily, are eager to please, defer to other's opinions, and fear being considered selfish if they act assertively.
It is unusual for people suffering from narcissism to seek treatment for their problems, or even to consider that they might have a problem. The fears that narcissistic people have of being inadequate make it very difficult for them to imagine having “something wrong” with them, and they certainly would not feel safe in acknowledging these fears to another person. They are typically very threatened by the notion of entering psychotherapy, since they fear the result would be that the therapist would be critical and rejecting towards them. Essentially, they imagine that the therapist would relate to them as their parents did. They are very likely to be disdainful and disparaging in response to the notion of psychotherapy. Unfortunately, narcissism is a relatively stable condition and tends to remain relatively unchanged over one’s lifetime. Current treatments for psychological disorders have little help to offer narcissistic people.