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Armchair Psychiatry Corner... NPD
13 years ago
I've always had an interest in psychiatry, even more so since I was diagnosed with bipolar and some other things. I've watched a lot of documentaries on different areas of psychology, psychiatry and neuroscience and this morning I watched one that touched on NPD or Narcissistic Personality Disorder. As some people know my ex-boyfriend has severe NPD and I have experienced the some of the worst parts of what can happen in that situation. Recently I have also come across another person with this condition and thought I'd post up a journal explaining what NPD is, how it is most often caused and how it effects the sufferer and the people around them.
AND ALSO SO PEOPLE CAN PLAY SELF-DIAGNOSIS FUN TIME!!!! LOL! (although that is highly unlikely if they actually have the condition)
Firstly, it does not mean someone who truly loves themselves. If anything they spend the majority of their time avoiding acknowledging who they are and promoting a fantasy version. When you think of the myth of Narcissus you imagine a person who spends all their time staring at their own reflection. However, unless their physical appearance is attractive enough to match up to their fantasy of themselves, they will actively avoid looking at themselves so they aren't reminded of their own failings.
In the DSM-IV NPD is one of the four cluster B or "dramatic" personality disorders along with Anti-Social Personality Disorder, Borderline Personality Disorder and Histrionic Personality Disorder.
Symptoms:
Although many of the symptoms of NPD can mimic those of people with a high level of self-esteem the difference lies in the underlying causes and effects and the pathological nature of these characteristics.
The following are the nine dominating characteristics used by clinicians to diagnose NPD.
1) A grandiose sense of self-importance.
They will exaggerate their achievements and talents and expect to be acknowledged as superior without the equivalent achievements. This may include considering themselves to be the best in their area of interest despite lacking technique, qualifications, skills or understanding. This means that they will react to even the most constructive criticism with disproportionate levels of rage, shame or humiliation. They may also exaggerate traumas, abuse and other incidents in their lives.
Examples:
"I am a martial arts expert!"
They took a few years of judo classes in childhood.
"This person bullied me!"
They were given genuinely constructive criticism.
"I'm a professional wine taster."
They have drunk more than one type of wine.
"I am an amazing boyfriend/girlfriend!"
They've left a path of destruction in their wake.
This does not mean that someone with NPD has no talent. They may be very talented but they will have a disproportionate view of their abilities. It may be that they will avoid or put down others who are more talented than them unless these people have extremely high levels of fame or recognition in which case they will behave in an obsequious manner (see symptom 3).
2) Preoccupied with fantasies of success, power, genius, beauty or "perfect" love.
This is a large part of their fantasy self. It will consume a huge amount of their time. Dreams of fame, infamy and recognition are a form of escapism for them. To me the most destructive of these preoccupations is "perfect" love because it completely removes their partners feelings, unique characteristics and ambitions from the equation.
They will also have unrealistic ambitions and plans. They will desire to be the absolute best in their field without putting in the required amount of practise or training. Any person who tries to bring them down to earth, even if the NPD sufferer is planning something which may put them in harms way, will be treated like an enemy or an idiot.
3) Belief that they are uniquely special.
The super-special-snowflake... They consider themselves above the general populace and believe that they should only associate with other special or high-status people as they will be the only ones capable of understanding them. They should only be seen by the best doctors, taught by the best teachers etc.
When they do encounter someone who embodies their idea of a higher status you will see a sudden and extreme change in behaviour. They will treat these people with excessive reverence and behave in an almost slavish way. In some cases they may change their interests or opinions to match those of these successful individuals.
4) Need for excessive admiration and attention.
They require near constant ego-stroking. Attention is necessary for maintaining their fantasy self and the people they keep close to them will lavish them with praise even when it is not deserved. They will lose interest in and sometimes completely ignore people who do not do this. They may even start to desire infamy if they lack anyone to fulfill their need for praise.
They also thrive on certain kinds of negative attention as long as it fits with their fantasy world. If they have decided another person is a cruel monster then they may try to incite aggressive or cruel responses from that person in order to prove their world view.
Basically, they thrive on drama and extreme emotions. Being non-reactive is the fastest way to infuriate an NPD sufferer.
5) Is extremely entitled.
They believe that they should be treated in a particularly favourable way just for being themselves, expecting people to be instantly compliant with their expectations or commands. They consider themselves to have a right to whatever they want and this includes relationships, employment, money and material goods.
They will announce rather than discuss and tell rather than ask.
6) Interpersonally exploitative.
They will often take advantage of or manipulate friends, family and associates to meet their own ends. This makes them highly unreliable and irresponsible. It will be noticeable in the way they treat other peoples possessions, money and feelings. If they are lent items or money they may treat it as a gift (after all they are entitled). They may borrow or expect money from friends despite knowing that person may not be able to afford to be so generous. As NPD sufferers are extremely emotionally manipulative they will lie and exaggerate problems or issues in order to convince people to help them.
Helping other people is not high on their priority list. If they do help someone they will demand a hugely disproportionate amount of recognition and praise for their act of "generosity". You will see them repeatedly bringing up their rare "charitable" deeds as a means to fish for compliments. Their mood will quickly sour if such responses are not immediately forthcoming.
This characteristic may not be evident when you first encounter an NPD. They can be extremely charming, kind and enthusiastic. This will last as long as they are getting what they want from you be it money, praise or material items. When it comes to partners it lasts until they have them "locked" into a committed relationship. They may promote a facade of being caring and understanding but this is used to manipulate people around them and will jar with how they actually treat people on a day to day basis.
7) Lacking empathy.
Does not take into consideration or acknowledge other peoples feelings or emotional needs. Although they have extremely high expectations of preferential treatment for themselves they will rarely give any consideration for those around them. Their view is very black and white. If they expect something from a person then they will have little tolerance for it not being met. This is only ever apologised for when they are at risk of losing something they want from that individual.
Any apology from an NPD sufferer will be qualified. They will list excuses and mitigating circumstances to show a person why they can not be blamed for their actions. A complete inability to accept responsibility for anything is one of the most pervasive characteristics of NPD. They will project their faults on to others.
8) Envious of others or believes others to be envious of them.
Often showing jealousy for others achievements or talents and accuses others of being envious with no factual basis. NPD sufferers are extremely shallow and, particularly if their appearance does not match up to that of their fantasy self, they will also be extremely jealous and possessive in relationships. Partners of someone with NPD will experience jealousy in a variety of ways. Often they will sabotage any attempts at success their partner may have. If their partner does become very successful this is likely to incite emotionally or physically abusive behaviour.
Example:
Their partner has to spend time studying for their degree. The NPD reaction to this may be to suddenly have a life drama or some reason for demanding excessive amounts of their partners time and attention.
To an NPD sufferer a partner is there to shower them with love or as arm candy. Unfortunately, due to the emotionally and physically abusive nature of these relationships, the partner may no longer match up to their unrealistic expectations.
9) Arrogant behaviour or attitude.
They will be overbearing, prideful and behave in a superior or condescending manner towards people they consider to be inferior (almost everybody).
To be considered to have NPD a person must have at least five of these as dominant characteristics of their personality.
Having a couple of these might make someone an arsehole but it does not make them a clinical narcissist.
People with NPD are often hypomanic which can be misdiagnosed as ADD or ADHD.
Some may also display symptoms of other cluster b personality disorders.
Causes:
There is no one specific cause for NPD but most psychiatrists agree that extremes of parenting are generally at the route of the disorder. Researchers have identified several possible factors:
- Being born with an overly sensitive temperament.
- Excessive admiration with no constructive criticism. As much as some people may try to please an NPD sufferer by being a "yes man" they are causing the condition to worsen and allowing them to perpetuate their fantasy self.
- Excessive praise for good behaviors or excessive criticism for bad behaviors in childhood. This can deeply effect the child's sense of self.
- Overindulgence and overvaluation by parents. They are the very definition of spoilt. They have learned to expect only the very best of everything and this continues on into adult life.
- Being praised for perceived exceptional looks or abilities by adults during childhood. In general, all parents think their child is the most beautiful and talented creature on earth but they usually have a sense of perspective and understand that their opinion is coloured by the love they feel for their child.
- Severe emotional abuse in childhood. One example of this might be extreme humiliation such as still being physically dressed and bathed by a parent into their teenage years.
- Unpredictable or unreliable care-giving from parents. Neglect is often overlooked as a form of abuse but most psychiatrists and psychologists will tell you that it causes as much if not more damage than direct abuse.
- Valued by parents as a means to regulate their own self-esteem. Living vicariously through their child prevents them from developing a strong sense of self. It also puts a huge amount of pressure on the child to succeed for their parent as well as themselves.
There are many theories of what creates NPD but basically narcissism is a defence mechanism brought on by either severe neglectful or extremely overbearing parents during childhood. The child's sense of "actual self" is replaced with a grandiose fantasy to protect them from feelings of inadequacy, shame and humilation.
How it effects their lives:
This entirely depends on the severity of the condition and the intelligence of the sufferer.
In general they will be unable to sustain long term interpersonal relationships particularly in real life. The internet can allow a person to maintain a facade much longer as it is extremely difficult to verify their grandiose claims. The more real life contact a person has with an NPD sufferer the more likely they are to see their flaws and question their demands.
Their lack of respect for other people's property and emotional health can often cause huge rifts in friendships. These are unlikely to ever be properly resolved as the person with NPD will never accept that they are at fault. This can be so extreme as to deny damaging someone's property despite being the only person in the location. They also bare grudges and are extremely slow to forgive others for transgressions whether actual or imagined.
Romantic and sexual relationships are very dangerous where NPD is concerned. Despite their initial charm, being so intimate with another person for prolonged periods of time is going to expose their true selfish and manipulative personality. They also constantly compare the achievements and talents they possess to those of their partner and become destructive if they consider their significant other to be more successful than themselves. Extremely possessive in nature they are rarely supportive of their partners outside interests and hobbies. Only they can make their partner happy and they actively sabotage other acquaintances and activities.
Abuse in an NPD relationship covers emotional, psychological and physical abuse. Most often they will rely on emotional manipulation such as guilt tripping or psychological abuse such as gaslighting.
When relationships or friendships end, as per usual, the NPD sufferer will never admit to any responsibility. If you discuss their exes they will paint each and every one of them as a monster and themselves as a victim no matter what the circumstances.
In rare extreme cases this can even lead to abuse so severe in endangers their partners life or out right murder. As long as they perceive their material gain to be worth the risk. A warning from personal experience, never take out a life insurance policy naming an NPD sufferer as the beneficiary no matter how much you love them.
In the long term they also rarely succeed in business as their plans and ideas are extremely unrealistic. They are also extremely unreliable with money and can blow huge amounts of business cash on living the lifestyle they think they should have.
Treatment:
There is no particularly effective treatment. Medication has no effect and therapy sessions have very mixed results. Often the sufferer will refuse to admit they have any form of problem and will become disruptive during therapy sessions.
TL;DR
People with NPD are incurable and sometimes dangerous bastards. Avoid where possible.
AND ALSO SO PEOPLE CAN PLAY SELF-DIAGNOSIS FUN TIME!!!! LOL! (although that is highly unlikely if they actually have the condition)
Firstly, it does not mean someone who truly loves themselves. If anything they spend the majority of their time avoiding acknowledging who they are and promoting a fantasy version. When you think of the myth of Narcissus you imagine a person who spends all their time staring at their own reflection. However, unless their physical appearance is attractive enough to match up to their fantasy of themselves, they will actively avoid looking at themselves so they aren't reminded of their own failings.
In the DSM-IV NPD is one of the four cluster B or "dramatic" personality disorders along with Anti-Social Personality Disorder, Borderline Personality Disorder and Histrionic Personality Disorder.
Symptoms:
Although many of the symptoms of NPD can mimic those of people with a high level of self-esteem the difference lies in the underlying causes and effects and the pathological nature of these characteristics.
The following are the nine dominating characteristics used by clinicians to diagnose NPD.
1) A grandiose sense of self-importance.
They will exaggerate their achievements and talents and expect to be acknowledged as superior without the equivalent achievements. This may include considering themselves to be the best in their area of interest despite lacking technique, qualifications, skills or understanding. This means that they will react to even the most constructive criticism with disproportionate levels of rage, shame or humiliation. They may also exaggerate traumas, abuse and other incidents in their lives.
Examples:
"I am a martial arts expert!"
They took a few years of judo classes in childhood.
"This person bullied me!"
They were given genuinely constructive criticism.
"I'm a professional wine taster."
They have drunk more than one type of wine.
"I am an amazing boyfriend/girlfriend!"
They've left a path of destruction in their wake.
This does not mean that someone with NPD has no talent. They may be very talented but they will have a disproportionate view of their abilities. It may be that they will avoid or put down others who are more talented than them unless these people have extremely high levels of fame or recognition in which case they will behave in an obsequious manner (see symptom 3).
2) Preoccupied with fantasies of success, power, genius, beauty or "perfect" love.
This is a large part of their fantasy self. It will consume a huge amount of their time. Dreams of fame, infamy and recognition are a form of escapism for them. To me the most destructive of these preoccupations is "perfect" love because it completely removes their partners feelings, unique characteristics and ambitions from the equation.
They will also have unrealistic ambitions and plans. They will desire to be the absolute best in their field without putting in the required amount of practise or training. Any person who tries to bring them down to earth, even if the NPD sufferer is planning something which may put them in harms way, will be treated like an enemy or an idiot.
3) Belief that they are uniquely special.
The super-special-snowflake... They consider themselves above the general populace and believe that they should only associate with other special or high-status people as they will be the only ones capable of understanding them. They should only be seen by the best doctors, taught by the best teachers etc.
When they do encounter someone who embodies their idea of a higher status you will see a sudden and extreme change in behaviour. They will treat these people with excessive reverence and behave in an almost slavish way. In some cases they may change their interests or opinions to match those of these successful individuals.
4) Need for excessive admiration and attention.
They require near constant ego-stroking. Attention is necessary for maintaining their fantasy self and the people they keep close to them will lavish them with praise even when it is not deserved. They will lose interest in and sometimes completely ignore people who do not do this. They may even start to desire infamy if they lack anyone to fulfill their need for praise.
They also thrive on certain kinds of negative attention as long as it fits with their fantasy world. If they have decided another person is a cruel monster then they may try to incite aggressive or cruel responses from that person in order to prove their world view.
Basically, they thrive on drama and extreme emotions. Being non-reactive is the fastest way to infuriate an NPD sufferer.
5) Is extremely entitled.
They believe that they should be treated in a particularly favourable way just for being themselves, expecting people to be instantly compliant with their expectations or commands. They consider themselves to have a right to whatever they want and this includes relationships, employment, money and material goods.
They will announce rather than discuss and tell rather than ask.
6) Interpersonally exploitative.
They will often take advantage of or manipulate friends, family and associates to meet their own ends. This makes them highly unreliable and irresponsible. It will be noticeable in the way they treat other peoples possessions, money and feelings. If they are lent items or money they may treat it as a gift (after all they are entitled). They may borrow or expect money from friends despite knowing that person may not be able to afford to be so generous. As NPD sufferers are extremely emotionally manipulative they will lie and exaggerate problems or issues in order to convince people to help them.
Helping other people is not high on their priority list. If they do help someone they will demand a hugely disproportionate amount of recognition and praise for their act of "generosity". You will see them repeatedly bringing up their rare "charitable" deeds as a means to fish for compliments. Their mood will quickly sour if such responses are not immediately forthcoming.
This characteristic may not be evident when you first encounter an NPD. They can be extremely charming, kind and enthusiastic. This will last as long as they are getting what they want from you be it money, praise or material items. When it comes to partners it lasts until they have them "locked" into a committed relationship. They may promote a facade of being caring and understanding but this is used to manipulate people around them and will jar with how they actually treat people on a day to day basis.
7) Lacking empathy.
Does not take into consideration or acknowledge other peoples feelings or emotional needs. Although they have extremely high expectations of preferential treatment for themselves they will rarely give any consideration for those around them. Their view is very black and white. If they expect something from a person then they will have little tolerance for it not being met. This is only ever apologised for when they are at risk of losing something they want from that individual.
Any apology from an NPD sufferer will be qualified. They will list excuses and mitigating circumstances to show a person why they can not be blamed for their actions. A complete inability to accept responsibility for anything is one of the most pervasive characteristics of NPD. They will project their faults on to others.
8) Envious of others or believes others to be envious of them.
Often showing jealousy for others achievements or talents and accuses others of being envious with no factual basis. NPD sufferers are extremely shallow and, particularly if their appearance does not match up to that of their fantasy self, they will also be extremely jealous and possessive in relationships. Partners of someone with NPD will experience jealousy in a variety of ways. Often they will sabotage any attempts at success their partner may have. If their partner does become very successful this is likely to incite emotionally or physically abusive behaviour.
Example:
Their partner has to spend time studying for their degree. The NPD reaction to this may be to suddenly have a life drama or some reason for demanding excessive amounts of their partners time and attention.
To an NPD sufferer a partner is there to shower them with love or as arm candy. Unfortunately, due to the emotionally and physically abusive nature of these relationships, the partner may no longer match up to their unrealistic expectations.
9) Arrogant behaviour or attitude.
They will be overbearing, prideful and behave in a superior or condescending manner towards people they consider to be inferior (almost everybody).
To be considered to have NPD a person must have at least five of these as dominant characteristics of their personality.
Having a couple of these might make someone an arsehole but it does not make them a clinical narcissist.
People with NPD are often hypomanic which can be misdiagnosed as ADD or ADHD.
Some may also display symptoms of other cluster b personality disorders.
Causes:
There is no one specific cause for NPD but most psychiatrists agree that extremes of parenting are generally at the route of the disorder. Researchers have identified several possible factors:
- Being born with an overly sensitive temperament.
- Excessive admiration with no constructive criticism. As much as some people may try to please an NPD sufferer by being a "yes man" they are causing the condition to worsen and allowing them to perpetuate their fantasy self.
- Excessive praise for good behaviors or excessive criticism for bad behaviors in childhood. This can deeply effect the child's sense of self.
- Overindulgence and overvaluation by parents. They are the very definition of spoilt. They have learned to expect only the very best of everything and this continues on into adult life.
- Being praised for perceived exceptional looks or abilities by adults during childhood. In general, all parents think their child is the most beautiful and talented creature on earth but they usually have a sense of perspective and understand that their opinion is coloured by the love they feel for their child.
- Severe emotional abuse in childhood. One example of this might be extreme humiliation such as still being physically dressed and bathed by a parent into their teenage years.
- Unpredictable or unreliable care-giving from parents. Neglect is often overlooked as a form of abuse but most psychiatrists and psychologists will tell you that it causes as much if not more damage than direct abuse.
- Valued by parents as a means to regulate their own self-esteem. Living vicariously through their child prevents them from developing a strong sense of self. It also puts a huge amount of pressure on the child to succeed for their parent as well as themselves.
There are many theories of what creates NPD but basically narcissism is a defence mechanism brought on by either severe neglectful or extremely overbearing parents during childhood. The child's sense of "actual self" is replaced with a grandiose fantasy to protect them from feelings of inadequacy, shame and humilation.
How it effects their lives:
This entirely depends on the severity of the condition and the intelligence of the sufferer.
In general they will be unable to sustain long term interpersonal relationships particularly in real life. The internet can allow a person to maintain a facade much longer as it is extremely difficult to verify their grandiose claims. The more real life contact a person has with an NPD sufferer the more likely they are to see their flaws and question their demands.
Their lack of respect for other people's property and emotional health can often cause huge rifts in friendships. These are unlikely to ever be properly resolved as the person with NPD will never accept that they are at fault. This can be so extreme as to deny damaging someone's property despite being the only person in the location. They also bare grudges and are extremely slow to forgive others for transgressions whether actual or imagined.
Romantic and sexual relationships are very dangerous where NPD is concerned. Despite their initial charm, being so intimate with another person for prolonged periods of time is going to expose their true selfish and manipulative personality. They also constantly compare the achievements and talents they possess to those of their partner and become destructive if they consider their significant other to be more successful than themselves. Extremely possessive in nature they are rarely supportive of their partners outside interests and hobbies. Only they can make their partner happy and they actively sabotage other acquaintances and activities.
Abuse in an NPD relationship covers emotional, psychological and physical abuse. Most often they will rely on emotional manipulation such as guilt tripping or psychological abuse such as gaslighting.
When relationships or friendships end, as per usual, the NPD sufferer will never admit to any responsibility. If you discuss their exes they will paint each and every one of them as a monster and themselves as a victim no matter what the circumstances.
In rare extreme cases this can even lead to abuse so severe in endangers their partners life or out right murder. As long as they perceive their material gain to be worth the risk. A warning from personal experience, never take out a life insurance policy naming an NPD sufferer as the beneficiary no matter how much you love them.
In the long term they also rarely succeed in business as their plans and ideas are extremely unrealistic. They are also extremely unreliable with money and can blow huge amounts of business cash on living the lifestyle they think they should have.
Treatment:
There is no particularly effective treatment. Medication has no effect and therapy sessions have very mixed results. Often the sufferer will refuse to admit they have any form of problem and will become disruptive during therapy sessions.
TL;DR
People with NPD are incurable and sometimes dangerous bastards. Avoid where possible.
Armchair psychiatry is FUN!
That could be terrifying.
Female narcissists often display elements of HPD. At first I thought the person I came across was HPD but then realised she was definitely NPD.
They only need some of the traits to have the disorder.
Especially if they can use it as another way of excuses their awful mannerisms.
Now I have a mental image of a land whale with a raepface charging at people.
I really feel for your wife. Being the child of someone with this condition is not easy. Kids with an NPD parent often end up with serious anxiety issues and depression.
It's always incredibly difficult when it's a family member. I really feel for your wife.