©Arlene R. Taylor, PhD

There may be narcissism without success, but there is no success without narcissism.
—Albert J. Bernstein
 Emotional Vampires: Dealing with People Who Drain You Dry

Scenario #1.

“Let me get this straight,” said the doctor, pulling out a chair for the woman. “You want help understanding Narcissistic Personality Disorder or NPD and you want to know if it is a mental illness. It that correct?”

Seated on the other side of the desk and looking intently at the doctor, the woman nodded. “A friend of mine told me that there is no success without narcissism and that has confused me.”

“Individuals who are successful do have a measure of self-confidence and believe in their abilities. That is different from a diagnosis of narcissism. It’s a rather complex topic,” the doctor continued. “The DSM-5 Manual considers Narcissistic Personality Disorder or NPD a mental illness. There are, of course, degrees of illness up to and including malignant narcissism.”

“I’m a widow, as you know,” she said, rather hesitantly. “I like my life, am quite happy, and really do not plan to remarry. For several months now I have been friends with a man who I love dearly. But the relationship is confusing. Sometimes he is kind, funny, courtly, and delightful; the next day he can be distant and dismissive. One day he says he loves me more than any other non-family member; the next he completely ignores me. Sometimes he gets incredibly angry at me, and I have no idea what I did to set him off. I feel like I have to tiptoe around him but at the drop of a disagreement he rounds on me and says it takes energy to walk on eggshells around me! I have been told by a friend that this man may have a Narcissistic Personality Disorder (NPD). I really need help understanding NPD. Should I just hang in there and hope the relationship will improve or is it really a brain thing and should I stop trying to make this relationship work? The consistency or his inconsistency is draining, and I feel off kilter somehow.”

Scenario #2.

The couple dragged themselves into the office, their body language shouting discouragement and bewilderment.

“We just met with our son’s psychiatrist,” said the man. “The psychiatrist’s considered opinion is that our son has a Narcissistic Personality Disorder.”

“We were so shocked,” the woman chimed in. So shocked, in fact, that I fear we did not absorb the explanation the doctor provided. We’ve heard the term, of course.”

“Plus Hitler and Mussolini,” added the man.

“We’re just blindsided, that’s what,” said the woman. ”We thought our son was just a bit spoiled from being an only child. We likely doted on him a bit too much. What can we read?”

“Not a book,” the man said. “Something simple but accurate.”

“Understanding Narcissistic Personality Disorder can be complex and confusing,” the counselor agreed. “I will give you references for a couple of articles. That can get you started. You can also find information in the online version of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM 5).”

“Mental Disorders!” exclaimed the man. “We must have missed that part!”

“Narcissistic Personal Disorder is described in a section of the DSM-5 labelled Personality Disorders Cluster B, and it is a type of mental illness.”

The woman began to cry softly.

* * * * *

It can be crazy-making for those who are trying to understand narcissistic behaviors. This mental disorder typically shows up in adolescence or during early adulthood. A combination of genetic, environmental, social, and neurobiological factors likely combine to result in a narcissistic personality. The individual exhibits external behaviors that serve as a protective armor including self-enhanced, self-preoccupied, controlling, insensitive, internal behaviors that indicate vulnerability, dysregulation, and compromised abilities such as low self-esteem, self-criticism, insecurity, inferiority, loneliness, isolation, hypersensitivity, fear, rage, and shame. Generally, any constructive criticism to individuals with a Narcissistic Personality Disorder (NPD) should be very carefully presented and worded  as these individuals may interpret them as humiliating, degrading, or shameful, and can react with disdain or even counteract. Typically, more males receive this diagnosis than females.

Estimates are that up to 5.0 percent of the general population in the United States meets the criteria for Narcissistic Personality Disorder (NPD). Although only about 1.0 percent of individuals in the general population of the USA meet the full diagnostic criteria for NPD, it is present in 2.0 to 16.0 percent of the clinical population. The disorder has been identified in 6.0 percent of the forensic population, 20 percent of the military population, and 17 percent of first-year medical students. NPD traits have been found to be more common in modern societies than in traditional ones so cultural elements may contribute.

Risk factors include:

• A moderate to high heritability as evidenced by twin studies
• A family history of the disorder
• Possible neurobiological factors
• An oversensitive temperament (personality traits) at birth.
• Excessive admiration that is not balanced with realistic feedback
• Severe emotional abuse in childhood
• Unpredictable or unreliable caregiving from parents
• Learning manipulative behaviors from parents or peers
• Valued by parents as a means to regulate their own self-esteem.
• Excessive praise for good or excessive criticism for bad behaviors in childhood
• Overindulgence by parents, other family members, or peers
• Overvaluation by parents, other family members, or peers
• Being praised for perceived exceptional looks or abilities by adults

A list of symptoms can be complex. Examples from the DSM-5 include:

• A grandiose logic of self-importance
• A belief that he or she is extraordinary and exceptional and can only be understood by, or should connect with, other extraordinary or important people or institutions
• A fixation with fantasies of infinite success, control, brilliance, beauty, or idyllic love
• A desire for unwarranted admiration
• A sense of entitlement
• Interpersonally oppressive behavior
• No form of empathy
• Resentment of others or a conviction that others are resentful of him or her
• A display of egotistical and conceited behaviors or attitudes

Those with a serious Narcissistic Personality Disorder (NPD) may realize by around age 50 that the next lover, promotion, new car, or bit of praise will not change anything. They will still feel the same inside. They can change. However, they tend to think they are simply fine, or it is always someone’s else’s problem, or it is too much work to change, or it’s just easier to excuse their behaviors as having “some idiosyncrasies.” If they are in a relationship with someone who they enjoy and who puts up with them, they sometimes think: ‘Why not commit to the person I am with who really loves me and will treat me better than I really deserve?’ At this point, if they commit to the relationship, it does not mean that they have changed. It means they are settling for what they know is a good deal. Getting someone with Narcissistic Personality Disorder to commit to a relationship with you does not make the person stop exhibiting narcissistic behaviors. It only means that both of you will now have to deal with the narcissistic partner’s insecurities, lack of empathy, self-centeredness, rapid mood shifts in short periods of time including intense episodes of anger and devaluing hurtful words and behaviors for as long as the relationship lasts.

Reportedly there is no cure for Narcissistic Personality Disorder. However, treatment and therapy can help individuals manage their moods and gradually change their disruptive behaviors toward others. Skilled therapists can treat comorbid problems such as anxiety disorders and depressive disorders. This depends, however, on whether the individual is willing to acknowledge narcissistic behaviors, identify how their behaviors are self-defeating and demeaning to family, friends, and colleagues, and work with a therapist.