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