Is the NPD recognized in psychology

Narcissistic Personality Disorder

Narcissistic personality disorder: description

When people present themselves very much in love with themselves, who always look for faults in others instead of themselves, the term "narcissism" is quick to come up with. But what is a narcissist? People with a narcissistic personality have an extreme need for attention, approval, and admiration. Often they stand out for their arrogance and self-idealization. They cannot stand criticism and failure can plunge them into serious crises. However, narcissistic people have difficulty empathizing with other people. They are often condescending towards others. Dealing with narcissists is therefore very challenging.

There are always discussions about whether our society is becoming increasingly narcissistic. Are people only focused on their success and perfect self-expression? There is no clear answer to this. However, narcissism is a phenomenon that has preoccupied people for a long time. Even in Greek mythology you can find Narcissus - a youth who falls in love with his own reflection and rejects the love of everyone else.

It is important to distinguish between narcissism and a true narcissistic personality disorder. Narcissists are often very ambitious. You can therefore also be found in management positions and can lead a very successful life. However, when narcissism is strong and leads to suffering for the person concerned and his environment, narcissism becomes pathological (pathological narcissism). The transition from personality trait to disorder is fluid. While there is a lot of discussion about narcissism in society, there is still little research into narcissistic personality disorder.

Narcissistic Personality Disorder: How Many Are Affected?

About one percent of the population suffer from Narcissistic Personality Disorder. Men are more likely to get the diagnosis than women. Most people seek treatment for other mental illnesses. They often suffer from depression, other personality disorders, somatoform disorders (physical complaints without an organic cause), fears, eating disorders or addiction problems.

Types of Narcissistic Personality Disorder

According to a study by Russ and colleagues (2008), narcissistic personality disorder can be divided into three types:

  • grandiose malignant narcissism
  • vulnerable-fragile narcissism
  • exhibitionistic narcissism with a high functional level

Narcissistic personality disorder: grandiose malignant type

People of the grandiose, malignant or vicious type can become a threat to society. Malignant narcissism is a combination of narcissism, aggression, paranoia, and antisocial behavior. A diabolical mixture that can move people into extremely cruel deeds. For example, Stalin and Hitler are referred to as malignant narcissists. They are convinced of their greatness. If they feel that they are not adequately valued by others, take revenge without remorse. The rejection doesn't have to be real. Due to their paranoid tendencies, they are quick to see enemies in their fellow human beings.

Narcissistic personality disorder: vulnerable-fragile type

Vulnerable-fragile narcissism initially seems atypical, as it is characterized by a depressed mood, anxiety and shame. This form is therefore also known as "covert narcissism". People of this type are very sensitive to criticism and failure. You have great difficulty putting yourself in other people's shoes. Those affected seek therapeutic help more often than the other types because of depression and other psychological symptoms.

Narcissistic personality disorder: exhibitionistic type

The exhibitionist type publicly demonstrates its greatness. By doing this, he will draw the attention he needs. This type can adapt well and be very successful in our competitive world. His appearance seems very self-confident. These people behave arrogantly and coolly towards others. This form is also known as "open narcissism".

People with narcissistic personality disorder can also appear very self-confident and grandiose in one moment and show signs of depression and anxiety shortly afterwards. It is therefore conceivable that the different types are facets of the same disorder. Research on this is still at the beginning.

Narcissistic personality disorder: symptoms

A personality disorder is when people show a certain pattern of behavior, thinking and feelings that differ greatly from the expectations of the sociocultural environment. These inflexible personality traits lead to suffering and impairment in social, professional or other areas.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), at least five of the following symptoms must be present for the diagnosis of Narcissistic Personality Disorder:

The affected

  • have an exaggerated sense of their own importance
  • have fantasies of limitless success, power, beauty, or ideal love
  • believe they are special and unique and only understood by special or respected people
  • expect undue admiration from others
  • expect others to give them special preferential treatment and automatically respond to their expectations
  • take advantage of others to achieve their own goals
  • have little empathy; do not want to put themselves in the shoes of others
  • often feel envious of others or think others are jealous of them
  • behave arrogantly and arrogantly

The symptoms of narcissism are not always that clear, however. Some do not show their arrogance openly. The signs can only be seen if you look very closely.

For a long time, experts have assumed that narcissistic personality disorder is associated with high self-esteem. However, recent studies show that those affected have low self-esteem. They disguise their doubts about self-worth through their high-handed self-expression. So there can be no talk of self-love. Rather, people with Narcissistic Personality Disorder suffer from inner emptiness and are very dependent on the approval of others. Appreciating yourself or devaluing others is an attempt to cope with negative feelings. An offense, such as the separation of a partner, can lead to vindictiveness, but it can also lead to depression and even suicide.

Narcissistic personality disorder: causes and risk factors

Narcissistic personality disorder arises from the interaction of various factors. According to the latest twin studies, genes have a greater influence in narcissistic personality disorder than in other personality disorders. However, environmental influences also play an important role.

Narcissistic Personality Disorder: Environmental Factors

Many experts see the roots of narcissism in childhood. However, the theories about its origins vary widely and there are currently no reliable findings. There is only consensus that the narcissistic disorder is due to adverse interactions with caregivers.

The leading researcher in the field of narcissistic personality disorder, Otto Kernberg, assumes that emotionally cold or latently aggressive parents encourage excessive self-expression. Children who receive little recognition manage this self-esteem violation by focusing on accomplishments for which they are praised (for example, school achievements). Other researchers suggest that children who are given no limits by their parents can develop an unrealistic and perfectionist self-image. Both styles of upbringing ultimately represent a neglect of the needs of children. Children need security and love, but also boundaries. For healthy development, they must also learn to deal with disappointments, the ability to withdraw from themselves and to empathize with the feelings of others.

Narcissistic Personality Disorder: Investigations and Diagnosis

A psychiatrist or psychotherapist should be consulted to diagnose Narcissistic Personality Disorder. The therapist can make a diagnosis based on specific questions based on the diagnostic criteria. The diagnosis also serves to distinguish it from other personality disorders, for example histrionic personality disorder, which is characterized by egocentric and theatrical behavior, or a borderline disorder. If possible, the therapist will also ask close relatives how they experience the person affected. The following questions the therapist might ask about the diagnosis of Narcissistic Personality Disorder:

  1. Do you feel like you are doing great things in life?
  2. Do you often get the impression that others fail to see your greatness?
  3. Do you find it exhausting to deal with other people's feelings and interests?

Those affected often perceive the diagnosis of narcissistic personality disorder as an attack on themselves. A good explanation of the background to the diagnosis is therefore of great importance. The diagnosis is not intended to judge the person affected, but rather to help him understand himself and his environment better. This understanding is often very relieving for both those affected and their relatives.

Narcissistic personality disorder: treatment

Narcissistic people have no understanding that their own behavior creates problems. They are - at least superficially - convinced of the greatness of themselves and look for faults in other people. When narcissists seek treatment, it is mostly for an additional mental disorder, such as depression, alcohol or drug addiction. Psychotherapeutic methods are used to treat Narcissistic Personality Disorder.

Narcissistic Personality Disorder: Relationship Building

An essential building block for a successful narcissism therapy is a trusting relationship between the person concerned and the therapist. Narcissistic persons often find it very difficult to engage with the therapist. Narcissists perceive the admission that they need help as a defeat and a threat to their self-image. Often they first devalue the therapist in order to maintain their superiority. It can therefore take some time before the person concerned is ready to trust and work with the therapist.

Narcissistic Personality Disorder: Ability to Empathize

The therapist helps the person affected to better understand their behavior and feelings. Narcissistic behaviors are often an attempt to compensate for negative feelings. However, arrogance and arrogance do not go down well with fellow human beings. In order to improve the relationship with other people, the person concerned has to work on his or her ability to empathize, i.e. to better empathize with others. The therapist works with the client to develop new behavioral strategies that contribute to better interaction with other people.

Narcissistic Personality Disorder: Realistic Claims

The mental health of people with narcissistic personality disorder is particularly at risk if their excessive demands are not met. Every hurt is a threat to yourself. It is therefore an important measure in therapy to question the demands and to set goals that can actually be achieved.

Narcissistic Personality Disorder: Therapy and Healing

Family members hope that the therapist can cure narcissism. Nowadays, unlike in the past, it is no longer assumed that narcissistic personality disorder cannot be changed. But unlike an illness, a personality disorder is inherent in the personality itself. In the strict sense, therefore, one cannot expect narcissism to be curable. In around half of the people, however, the symptoms reduce - thanks to therapy - within two years.

The goal of therapy is not to turn the narcissist into another person. Rather, the therapy is an offer to those affected to change extreme behavior and ways of thinking with the help of the therapist and thus also to improve their own life. The therapist develops the therapy goals together with the person concerned. Ultimately, therapy is about reducing suffering.

Narcissistic Personality Disorder: Relationship

Partnering with someone who has a narcissistic personality disorder is a great challenge. For narcissists, the world is practically all about them. Empathizing with your partner (or other people) is not one of your strengths.

For a functioning partnership it is not only important that the narcissist can be treated by a therapist. The partner should also seek professional help to learn more about how to properly deal with a narcissist.

You can read more on this topic in the article Narcissistic Personality Disorder: Relationship.

Narcissistic personality disorder: course and prognosis

People who have a sense of achievement and good relationship experiences have a favorable prognosis. The better the self-perception, the easier it becomes to recognize and work on the narcissistic traits oneself. For those affected who, due to their arrogance, cannot get involved with the therapist, have many failures in life and abuse drugs or alcohol, the prognosis is worse.

The Narcissistic Personality Disorder also brings with it an increased risk of suicide. When one's greatness is shaken, a deep mortification sets in. As a result, some of those affected take their own lives.

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