Adolph Hitler, Madonna, Kanye West, Donald Trump, and Sharon Stone. One might struggle to guess what they all have in common. However, if you have studied, or have some type of experience with a personality disorder, you quickly realized that the people listed above are notorious narcissists, or at least rumored to be. Some people have narcissistic traits but do not have narcissistic personality disorder.

So, what is the difference between a trait and the disorder? When those traits are maladaptive and causes dysfunction, impairment, and distress, it is considered narcissistic personality disorder (American Psychological Association, 2013). For the rest of this writing, narcissistic personality disorder will be referred to by its acronym, NPD.

General Description/History of Disorder

In order to define NPD, one can look to the Diagnostic and Statistical Manual of Mental Disorders- (v)5th edition or simply called DSM-V. The DSM-V describes NPD as “a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration and lack of empathy” The person with NPD is also preoccupied with success, beauty, power, and intelligence. He/she feels special and therefore entitled to favorable treatment. Lastly, this person may exploit others for his/her own needs and can be arrogant and envious of others (American Psychological Association, 2013). According to research samples, up to 6.2% of the population is estimated to have NPD. Of those with NPD, 50-75% are men.

According to Greek mythology, Narcissus was the first narcissist. The story is told that he was so intrigued by himself that he sat for hours watching his own reflection in the water.

Historically speaking, narcissism was first introduced by Havelock Ellis as an auto-erotic disorder in 1898. However, led by psychoanalyst theorists such as Freud, Kernberg, and Kohut, narcissism became widely classified as a personality trait. In 1980, NPD was first introduced in the DSM-III.

Even though NPD was prevalent in writings at the time, it lacked empirical research. After DSM-IV, there was a proposal to eliminate it from the DSM altogether due to the lack of empirical research qualifying it as a clinical diagnosis. However, this move caused a backlash from some in the psychoanalytic community, and NDP as a diagnosis was reinstated. The result of the controversy was that NPD became more clearly defined in DSM-V.

There are two subtypes of narcissism to be examined when discussing NPD, grandiose narcissism and vulnerable narcissism. Grandiose is the stereotypical dominating, aggressive, and arrogant form of narcissism. They are usually outspoken and assertive. This grandiose view of self is intended to protect and maintain the illusional self-image of being great and special.

The energy and reaction that this behavior receives only bolsters and reinforces that grandiose image. Whereas grandiose narcissism is associated with feelings of superiority and entitlement, vulnerable narcissists are very defensive, emotional, and anxious. Because of this fragile clinical state, their narcissism serves as a facade to mask those feelings of inferiority and inadequacy. This causes their self-esteem to be vulnerable to injury after criticism, defeat, or feedback.

(Coming soon- Part 2: Is there treatment for Narcissistic Personality Disorder?

By Delmar Devers, Painted Brain intern. You can visit his blog at SingingSocialWorkerBlog

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