Charles Darwin

"The love for all living creatures is the most noble attribute of man." Charles Darwin

Sunday, May 3, 2015

Narcissism & Narcissistic Personality Disorder

ONE day, the mountain nymph Echo saw the beautiful Narcissus walking in the woods. At first glimpse, she fell deeply in love, and continued to follow him. Sensing he was being followed, Narcissus called out:  
"Who's there?"
"Who's there?" Echo repeated.
She eventually revealed her identity and attempted to embrace him. His rejection left her heartbroken, and she spent the rest of her life in the lonely glens until nothing but an echo remained of her.  
Nemesis, the goddess of revenge, learned of this story and decided to punish Narcissus. She lured him to a pool where he saw his own reflection. He didn't realize it was only an image and fell in love with it. When he eventually realized that his love could not be actualized, he committed suicide. [1][2]

NARCISSISM is the pursuit of gratification 
from vanity or egotistic admiration of one's own attributes. [3]

Narcissism is a concept in psychoanalytic theory, introduced in Sigmund Freud's On Narcissism[3]

In her book, Why Is It Always About You?: The Seven Deadly Sins of Narcissismpsychotherapist Sandy Hotchkiss describes the following 7 traits as characteristic of narcissists: [19][20]

  • SHAMELESSNESS – Shame is the underlying factor in all cases of unhealthy narcissism. In a healthy person, shame is processed in a normal manner, whereas narcissists have difficulty processing this feeling in a healthy way. Narcissists also tend to inflict shame on other people, a concept referred to as projection.

  • MAGICAL THINKING – Narcissists tend to perceive themselves as perfect and flawless. The distorted thinking and illusion that causes narcissists to feel this way is referred to as magical thinking.

  • ARROGANCE  – Arrogance and a disregard for other people’s feelings are typical characteristics of narcissism. Narcissists often have a low self-esteem which they try to relieve by insulting or degrading others. This helps to re-inflate their ego when they are feeling deflated or lacking in worth.

  • ENVY – Due to their sense of being superior to others, narcissists may feel insecure when faced with another person’s ability, which they may try to belittle by demonstrating contempt or dismissal of it.

  • SENSE OF ENTITLEMENT – A sense of being perfect and superior means narcissists often expect to receive favorable treatment and for people to admire and agree with their opinions or actions. Failure to comply may be perceived as an attack on their authority and superiority. A person who flouts their authority is often considered to be a difficult or awkward person by the narcissist, who will proceed to demean them or their opinion, especially in front of others. Defiance can also trigger anger in the narcissist which is referred to as “narcissistic rage.”

  • EXPLOITATION – This refers to the narcissist’s tendency to exploit others and show no regard or empathy for their emotions or interests. This often occurs when the other person is in a subservient position, where it is awkward or impossible to resist the narcissist. On some occasions, this subservience is only assumed rather than real.

  • LACK OF BOUNDARIES – Most narcissists fail to understand their boundaries and recognise that other people are individuals rather than extensions of themselves. Those who support the self-esteem of the narcissist are expected to always do so, with the narcissist failing to recognize the independence of the other person.


  • In children, inflated self-views and grandiose feelings, which are characteristics of narcissism, are part of the normal self-development. [3]

  • In late childhood, views of the self, both positive and negative, begin to develop. [3]

  • It has been suggested that excessive attention, or lack thereof, may interfere with this development. [3]

  • The child may either compensate for lack of attention or act in terms of unrealistic self-perception. [11] 

  • One study [16] (2015), on the origins of narcissism compared two perspectives:
    • Social learning theory (suggests that narcissism is cultivated by parental overvaluation).
    • Psychoanalytic theory (suggests that narcissism is cultivated by lack of parental warmth).

    • Researchers conducted four, 6-month panels on 565 children in late childhood and their parents.
    • Results of the study supported social learning theory and contradicted psychoanalytic theory: 
    • Narcissism was predicted by parental overvaluation, not by lack of parental warmth. Thus, children seem to acquire narcissism, in part, by internalizing parents’ inflated views of them. Whereas parental warmth, not overvaluation, predicted self-esteem.


    *HERITABILITY is the proportion of observed differences in a trait among individuals of a population that are due to genetic differences. [44]

    • In this study [8] (1993), each of 175 volunteer twin pairs (90 identical, 85 fraternal) completed a questionnaire that assessed 18 dimensions of personality disorder. 
    • Data analysis provided estimates of the relative contributions of genetic and environmental causation.
    • Of the 18 personality dimensions, narcissism was found to have the highest heritability at 64%, indicating a significant genetic influence over the development of this trait in identical twins.
    • By comparison, conduct problems had an estimated heritability of 0%.


    • In three studies [15] (2013) investigating narcissism and leadership emergence (the process during which a leader is recognized by their peers as the leader of a firmly leaderless group [43]), participants completed personality questionnaires and engaged in four-person leaderless group discussions. 
    • Results from all three studies revealed a link between narcissism and leader emergence. 
    • Controlling for sex, self-esteem, openness, conscientiousness, extraversion, agreeableness, and neuroticism, studies 1 and 2 revealed that the power dimension of narcissism predicted reported leader emergence.


    • In a series of 11 experiments [17] (2014) involving more than 2,200 people of varied ages, researchers found they could reliably identify narcissistic people by asking them this exact question (including the note):
    To what extent do you agree with this statement: “I am a narcissist.” (Note: The word “narcissist” means egotistical, self-focused, and vain.) 
    • Participants rated themselves on a scale of 1 (not very true of me) to 7 (very true of me).
     “People who are narcissists are almost proud of the fact. You can ask them directly because they don’t see narcissism as a negative quality – they believe they are superior to other people and are fine with saying that publicly.”
    (Brad Bushman, co-author of the study and a professor of communication and psychology at The Ohio State University.)


    *Self-enhancement involves a preference for positive over negative self-views. [10]

    • In this study [3][9][18] (2000), two experiments examined narcissism and *self-enhancement strategies. Participants either completed an interdependent (Experiment 1) or an independent (Experiment 2) achievement task and then received bogus success or failure feedback.
    • Across the two experiments, narcissistic individuals self-enhanced.
    • Non-narcissists also self-enhanced, particularly when estimating the importance of the task. However, unlike the narcissistic individuals, the non-narcissists did not self-enhance when doing so meant comparing themselves favorably to a partner. 


    The term, coined by Robert B. Millman (professor of psychiatry at Cornell University) differs from conventional narcissism in that it develops after childhood and is triggered and supported by the celebrity-obsessed society. Fans, assistants and tabloid media all play into the idea that the person really is vastly more important than other people. [3][4]


    “Narcissus has replaced Oedipus as the myth of our time. Narcissism is now seen to be at the root of everything from the ill-fated romance with violent revolution to the enthralled mass consumption of state-of-the-art products and the 'lifestyles of the rich and famous'”
    Jessica Benjamin “The Oedipal Riddle” [5]

    • Since 2000, U.S. residents have continually scored higher on psychological tests designed to detect narcissism. Psychologists have suggested a link to social networking. [6]

    • A linguistic analysis of the largest circulation Norwegian newspaper found that the use of self-focused and individualistic terms increased in frequency by 69 % between 1984 and 2005 while collectivist terms declined by 32 %. [12]

    • According to Public health officials in the U.K., addiction to social media is an illness, with more than 100 patients seeking treatment every year. [13]
    • "Danny Bowman became so obsessed with capturing the perfect shot that he spent 10 hours a day taking up to 200 selfies. The 19-year-old lost nearly 30 pounds, dropped out of school and did not leave the house for six months in his quest to get the right picture. He would take 10 pictures immediately after waking up. Frustrated at his attempts to take the one image he wanted, Bowman eventually tried to take his own life by overdosing, but was saved by his mom." [13]


    • First diagnosed by psychoanalyst Heinz Kohut in 1968, narcissistic personality disorder is a form of pathological narcissism. [24][40]

    • NPD is a Cluster B personality disorder [23] in which a person is excessively preoccupied with personal adequacy, power, prestige and vanity; and is mentally unable to see the damage they are causing to themselves and others. 

    • There are 4 recognized Cluster B personality disorders: [21][22][25]
    • Antisocial personality disorder 
    • Borderline personality disorder
    • Histrionic personality disorder 
    • Narcissistic personality disorder 

    • The World Health Organization's  ICD-10 lists NPD under (F60.8Other specific personality disorders[35]

    • The Diagnostic and Statistical Manual of Mental Disorders DSM-5, (revised 2011) lists the presence of these traits (A - E) as criteria for diagnosing narcissistic personality disorder: [21][29][45]

    A. Significant impairments in personality functioning manifest by: 
    1. Impairments in self functioning (a or b):

    a. IDENTITY: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.

    b. SELF-DIRECTION: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.


    2. Impairments in interpersonal functioning (a or b):

    a. EMPATHY: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.

    b. INTIMACY: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others‟ experiences and predominance of a need for personal gain

    B. Pathological personality traits in the following domain:

    1. Antagonism, characterized by:

    a. GRANDIOSITY: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others.

    b. ATTENTION SEEKING: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.

    C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

    D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.

    E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

    • Psychiatrist Glen Gabbard suggested NPD could be broken down into two sub-types: The Oblivious & The Hyper-vigilant. [34] 
    • He saw the Oblivious sub-type as being grandiose, arrogant, and thick-skinned, and the Hyper-vigilant sub-type as being easily hurt, oversensitive, and ashamed. [22]
    • In his view, the Oblivious sub-type presents for admiration, envy, and appreciation of a powerful, grandiose self that is the antithesis of a weak internalized self, which hides in shame, while the Hyper-vigilant sub-type neutralizes devaluation by seeing others as unjust abusers. [22]

    • Pathological narcissism can develop from an impairment in the quality of the person's relationship with their primary caregivers, usually their parents, in that the parents could not form a healthy and empathetic attachment to them. [27]
    • This results in the child's perception of himself/herself as unimportant and unconnected to others. The child typically comes to believe they have some personality defect that makes them unvalued and unwanted. [28]

    • Research (2013) has identified a structural abnormality in the brains of those diagnosed with narcissistic personality disorder, specifically noting less volume of gray matter in the left anterior insula. [30][31]  
    • This brain region relates to empathy, compassion,  emotional regulation, and cognitive functioning. [32]

    • Although individuals with NPD are often ambitious and capable, the inability to tolerate setbacks, disagreements or criticism, along with lack of empathy, make it difficult for such individuals to work cooperatively with others or to maintain long-term professional achievements. [33]


    • People rarely seek therapy for NPD. [22]
    • Most are oblivious to the damage they cause to themselves and to others and usually only seek treatment at the insistence of relatives and friends. [36]
    • Unconscious fears of exposure or inadequacy often cause defensive disdain of therapeutic processes. [37][38]
    • However, studies show that group therapy does hold value for patients because it lets them explore boundaries, develop trust, increase self-awareness, and accept feedback. [36]


    • In 2009, Twenge and Campbell conducted studies suggesting that the incidence of NPD had more than doubled in the US in the prior 10 years, and that 1 in 16 of the population have experienced NPD. [39][40][41]

    • Researchers found the prevalence of lifetime NPD was 6.2%, with rates greater for men (7.7%) than women (4.8%).
    • NPD was significantly more prevalent among Black men and women and Hispanic women, younger adults, and separated/divorced/widowed and never married adults.
    • NPD was associated with mental disability among men but not women.
    • High co-occurrence rates of substance use, mood, anxiety, and other personality disorders (PDs) were observed.
    • With additional co-morbidity controlled for, associations with bipolar I disorder, PTSD, and schizotypal and borderline PDs remained significant, but weakened, among men and women. 


    Take the survey HERE. It only takes a few seconds. (External Link to Indiana University.) 


    Saying ‘I’ and ‘me’ all the time doesn’t make you a narcissist / Science News / 
    April 10, 2015

    The 2 Faces of Narcissism: Admiration Seeking and Rivalry / Scientific American / April 9, 2015


    Via YouTube


    [4] Simon Crompton, All about me (London 2007) p. 171
    [5] Benjamin, Jessica (2000). "The Oedipal Riddle". In Du Gay, Paul; Evans, Jessica; Redman, Peter. The Identity Reader. London: Sage. pp. 231–247. Quoted in Tyler, Imogen (September 2007). "From 'The Me Decade' to 'The Me Millennium': The Cultural History of Narcissism". International Journal of Cultural Studies 10 (3): 343–363. doi:10.1177/1367877907080148.
    [9] Campbell, W.K., Reeder G.D., Sedikides, C., Elliot, A.J. (2000). "Narcissism and Comparative Self-Enhancement Strategies".Journal of Research in Personality 34 (3): 329–47.doi:10.1006/jrpe.2000.2282.
    [10] Sedikides, Constantine; Gregg, Aiden P. (2008), "Self-Enhancement: Food for Thought", Perspectives on Psychological Science 3 (2): 102–116, doi:10.1111/j.1745-6916.2008.00068.x,ISSN 1745-6916.
    [11]  Development and Validation of the Childhood Narcissism Scale, SANDER THOMAES, HEDY STEGGE, BRAD J. BUSHMAN, TJEERT OLTHOF, AND JAAP DENISSEN. Department of Psychology, VU University, The Netherlands Department of Psychology, Utrecht University, University of Michigan Department of Communication Sciences.
    [12] Twenge, Jean M. (2011). Campbell, W. Keith; Miller, Joshua D., eds. The Handbook of Narcissism and Narcissistic Personality Disorder: Theoretical Approaches, Empirical Findings, and Treatments. Hoboken NJ: John Wiley & Sons. p. 203.ISBN 9781118029268.
    [15] Carlson EN, Vazire S, & Oltmanns TF (2011). You probably think this paper’s about you: narcissists’ perceptions of their personality and reputation. Journal of personality and social psychology, 101 (1), 185-201 PMID: 21604895
    [24] When Narcissism Becomes Pathological FT Magazine / September 4, 2010
    [26] Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, Ruan WJ, Pulay AJ, Saha TD, Pickering RP, Grant BF.; Dawson; Goldstein; Chou; Huang; Smith; Ruan; Pulay; Saha; Pickering; Grant (July 2008). "Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions". J Clin Psychiatry 69(7): 1033–45. doi:10.4088/JCP.v69n0701PMC 2669224PMID 18557663.
    [27] Ken Magid (1987). High risk children without a conscience. Bantam. p. 67. ISBN 0-553-05290-X.
    [28] Stephen M. Johnson (1 May 1987). Humanizing the narcissistic style. W.W. Norton. p. 39. ISBN 978-0-393-70037-4.
    [30] Schulze L, Dziobek I, Vater A, Heekeren HR, Bajbouj M, Renneberg B, Heuser I, Roepke S; Dziobek; Vater; Heekeren; Bajbouj; Renneberg; Heuser; Roepke (2013). "Gray matter abnormalities in patients with narcissistic personality disorder". J Psychiatr Res 47 (10): 1363–9.doi:10.1016/j.jpsychires.2013.05.017PMID 23777939.
    [33] Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, p. 22.
    [34] Gabbard GO (1989). "Two subtypes of narcissistic personality disorder". Bull Menninger Clin 53 (6): 527–32. PMID 2819295.
    [36] Freeman, Arthur; Angela Breitmeyer; Melissa Flint (2000). "The Challenges in Diagnosing Narcissistic Personality Disorder: Difficult to Define, but "We Know It When We See It"". Clinical Forum.
    [37]  Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, p. 23.
    [38]  Kohut, Heinz, (1971). The Analysis of the Self: A Systematic Approach to the Psychoanalytic Treatment of Narcissistic Personality DisordersISBN 978-0-8236-0145-5
    [39] Groopman, Leonard C. M.D.; Cooper, Arnold M. M.D. (2006). "Narcissistic Personality Disorder". Personality Disorders – Narcissistic Personality Disorder. Armenian Medical Network.
    [41] Twenge, Jean M. & Campbell, W. Keith The Narcissism Epidemic: Living in the Age of Entitlement (2009)



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