Criteria for Malignant NPD Pathological narcissism, that is, narcissism that can be definitively diagnosed and treated as a personality disorder, is relatively rare. The Diagnostic and Statistical Manual of Mental Disorders (DSM‑IV‑TR), used by mental health professionals to diagnose disorders, maintains that 2 to 16 percent of the population currently in treatment, and less than 1 percent of the general population, suffer from narcissistic personality disorder. Many professionals believe that this is a drastic underestimate. High levels of narcissistic traits behaviors associated with Cluster B disorders are clearly com‑ mon in our culture. In fact, some research suggests that as much as 5.3 percent of the population, or over 16 million people, show signs of NPD. Narcissistic personality disorder must be diagnosed by a properly trained mental health professional (such as a psychiatrist, psychologist, or licensed social worker) through a process of personal interviews, observations, psychological tests, and interviews with significant others. The diagnosis can be made when an individual meets at least five of the following nine characteristics. 1. A grandiose sense of self‑importance. A person with NPD exaggerates his achievements and talents, and expects to be recognized as superior without the qualities to sup‑ port that conclusion. 2. A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love. 3. A sense of specialness, a belief that he is so unique that he can only be understood by, or should only associate with, other special or high‑status individuals or institu‑ tions. 4. A need for excessive admiration. 5. A heightened sense of entitlement, leading to unreason‑ able expectations that others should treat him especially favorably, or comply automatically with his expectations. 6. A tendency to be interpersonally exploitative. A person with NPD does not hesitate in taking advantage of others to meet his or her own ends. 7. A lack of empathy, an inability or unwillingness to rec‑ ognize or identify with the feelings or needs of others. 8. An envy of other people, or, conversely, a belief that other people envy him. 9. A tendency toward arrogant behavior or attitude. One reason it’s difficult to diagnose NPD is that the various Cluster B personality disorders all share certain characteristics, among them grandiosity, lack of empathy, exploitative interper‑ sonal relations, and a need to be seen as special or unique. Instead, specialists typically distinguish NPD from borderline, antisocial, and histrionic disorders by the absence of certain behaviors. Narcis‑ sists are rarely inclined to hurt themselves, for instance, whereas individuals with borderline personality disorder are prone to self‑ injury and attempted suicide. Narcissists avoid intimacy, while people with histrionic or borderline disorders exhibit intense de‑ sires for relationships. Narcissists rarely commit violent crimes, but individuals with antisocial personality disorder or psychopa‑ thy have no remorse over using physical violence. Despite the low numbers of individuals who are diagnosed with narcissistic personality disorder, there has been an obvious increase in narcissistic and other Cluster B styles of behavior. I have witnessed the growth personally in my own medical career, but you don’t have to be a doctor to see evidence of the trend ev‑ erywhere in our culture. As we’ve seen, one night watching reality TV, flipping through the tabloids, or surfing the Internet would be bound to turn up many instances of behavior that fits most of the criteria above. And NPD isn’t confined to the ranks of celebrity: Any of the talk shows that feature average people in crisis—Dr. Phil, (The Mirror Image)
Posted on: Sun, 17 Nov 2013 17:39:55 +0000
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