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Narcissistic Personality Disorder - DSM 5

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Mar 28th, 2015
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  1. The essential feature of narcissistic personality disorder is a pervasive pattern of grandiosity,
  2. need for admiration, and lack of empathy that begins by early adulthood and is present
  3. in a variety of contexts.
  4. Individuals with this disorder have a grandiose sense of self-importance (Criterion 1).
  5. They routinely overestimate their abilities and inflate their accomplishments, often appearing
  6. boastful and pretentious. They may blithely assume that others attribute the same value to
  7. their efforts and may be surprised when the praise they expect and feel they deserve is not
  8. forthcoming. Often implicit in the inflated judgments of their own accomplishments is an underestimation
  9. (devaluation) of the contributions of others. Individuals with narcissistic personality
  10. disorder are often preoccupied with fantasies of unlimited success, power, brilliance,
  11. beauty, or ideal love (Criterion 2). They may ruminate about "'long overdue" admiration and
  12. privilege and compare themselves favorably with famous or privileged people.
  13. Individuals with narcissistic personality disorder believe that they are superior, special,
  14. or unique and expect others to recognize them as such (Criterion 3). They may feel
  15. that they can only be understood by, and should only associate with, other people who are
  16. special or of high status and may attribute "unique," "perfect," or "gifted" qualities to those
  17. with whom they associate. Individuals with this disorder believe that their needs are special
  18. and beyond the ken of ordinary people. Their own self-esteem is enhanced (i.e., "mirrored")
  19. by the idealized value that they assign to those with whom they associate. They are
  20. likely to insist on having only the "top" person (doctor, lawyer, hairdresser, instructor) or
  21. being affiliated with the "best" institutions but may devalue the credentials of those who disappoint
  22. them.
  23. Individuals with this disorder generally require excessive admiration (Criterion 4). Their
  24. self-esteem is almost invariably very fragile. Tliey may be preoccupied with how well they
  25. are doing and how favorably they are regarded by others. This often takes the form of a need
  26. for constant attention and admiration. They may expect their arrival to be greeted with great
  27. farifare and are astonished if others do not covet their possessions. They may constantly fish
  28. for compliments, often with great charm. A sense of entitlement is evident in these individuals'
  29. unreasonable expectation of especially favorable treatment (Criterion 5). They expect
  30. to be catered to and are puzzled or furious when this does not happen. For example, they
  31. may assume that they do not have to wait in line and that their priorities are so important
  32. that others should defer to them, and then get irritated when others fail to assist "in their
  33. very important work." This sense of entitlement, combined with a lack of sensitivity to the
  34. wants and needs of others, may result in the conscious or unwitting exploitation of others
  35. (Criterion 6). They expect to be given whatever they want or feel they need, no matter what
  36. it might mean to others. For example, these individuals may expect great dedication from
  37. others and may overwork them without regard for the impact on their lives. They tend to
  38. form friendships or romantic relationships only if the other person seems likely to advance
  39. their purposes or otherwise enhance their self-esteem. They often usuφ special privileges
  40. and extra resources that they believe they deserve because they are so special.
  41. Individuals with narcissistic personality disorder generally have a lack of empathy and
  42. have difficulty recognizing the desires, subjective experiences, and feelings of others (Criterion
  43. 7). They may assume that others are totally concerned about their welfare. They tend to
  44. discuss their own concerns in inappropriate and lengthy detail, while failing to recognize
  45. that others also have feelings and needs. They are often contemptuous and impatient with
  46. others who talk about their own problems and concerns. These individuals may be oblivious
  47. to the hurt their remarks may inflict (e.g., exuberantly telling a former lover that "I am now
  48. in the relationship of a lifetime!"; boasting of health in front of someone who is sick). When
  49. recognized, the needs, desires, or feelings of others are likely to be viewed disparagingly as
  50. signs of weakness or vulnerability. Those who relate to individuals with narcissistic personality
  51. disorder typically find an emotional coldness and lack of reciprocal interest.
  52. These individuals are often envious of others or believe that oéiers are envious of them
  53. (Criterion 8). They may begrudge others their successes or possessions, feeling that they better
  54. deserve those achievements, admiration, or privileges. They may harshly devalue the contributions
  55. of others, particularly when those individuals have received acknowledgment or
  56. praise for their accomplishments. Arrogant, haughty behaviors characterize these individuals;
  57. they often display snobbish, disdainful, or patronizing attitudes (Criterion 9). For example, an
  58. individual with this disorder may complain about a clumsy waiter's "rudeness" or "stupidity"
  59. or conclude a medical evaluation with a condescending evaluation of the physician.
  60. Associated Features Supporting Diagnosis
  61. Vulnerability in self-esteem makes individuals with narcissistic personality disorder very
  62. sensitive to "injury" from criticism or defeat. Although they may not show it outwardly,
  63. criticism may haunt these individuals and may leave them feeling humiliated, degraded,
  64. hollow, and empty. They may react with disdain, rage, or defiant counterattack. Such experiences
  65. often lead to social withdrawal or an appearance of humility that may mask and
  66. protect the grandiosity. Interpersonal relations are typically impaired because of problems
  67. derived from entitlement, the need for admiration, and the relative disregard for the sensitivities
  68. of others. Though overweening ambition and confidence may lead to high
  69. achievement, performance may be disrupted because of intolerance of criticism or defeat.
  70. Sometimes vocational functioning can be very low, reflecting an unwillingness to take a
  71. risk in competitive or other situations in which defeat is possible. Sustained feelings of
  72. shame or humiliation and the attendant self-criticism may be associated with social withdrawal,
  73. depressed mood, and persistent depressive disorder (dysthymia) or major depressive
  74. disorder. In contrast, sustained periods of grandiosity may be associated with a
  75. hypomanie mood. Narcissistic personality disorder is also associated with anorexia nervosa
  76. and substance use disorders (especially related to cocaine). Histrionic, borderline,
  77. antisocial, and paranoid personality disorders may be associated with narcissistic personality
  78. disorder.
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