Narcissistic Personality Disorder
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- Narcissistic personality disorder (NPD) is a cluster B personality disorder (PD), which is rooted in problems with impulse control and emotional regulation. This group also includes antisocial PD, histrionic PD, and borderline PD. A PD is defined as an enduring pattern of inner experience and behavior that causes dysfunction, is inflexible, persists across multiple situations, and leads to clinically significant distress or impairment in functioning.
- NPD is defined as a pervasive pattern of grandiosity, need for admiration, and lack of empathy. These behaviors must be inflexible, maladaptive, and persistent; typically begins by early adulthood and persists in a variety of contexts
- Diagnostic criteria according to section II of the DSM-5 (must meet five or more of the following):
- Grandiose sense of self-importance
- Obsessed with fantasies of unlimited achievement or success, beauty, love
- Believes they are “special” and should only associate with other high-status people or institutions
- Requires excessive admiration
- Has a sense of entitlement or has unreasonable expectations for favorable treatment
- Is interpersonally exploitative, often takes advantage of others to achieve personal success
- Lacks empathy toward others
- Is often envious of others or believes others are envious of him or her
- Shows arrogant, haughty behaviors or attitudes
- Alternative DSM-5 model for PDs (section III) defines PD by specific criteria of impairments of personality functioning and pathologic personality traits. Specific PDs may then be diagnosed based on traits.
- Typical features of NPD in this model include vulnerable and variable self-esteem and attempts to regulate self-esteem, thought approval and attention-seeking, and grandiosity (may be externalized or internalized).
- Controversy over diagnostic criteria and possible subtypes of NPD continue to exist.
- Onset usually in early adulthood
- More common in males than females
- Can still exist at older ages, although less common
Etiology and Pathophysiology
Commonly Associated Conditions
- Mood and/or anxiety disorders
- Substance abuse (especially cocaine abuse)
- Anorexia nervosa
- Bipolar disorder or hypomania
- Obsessive-compulsive disorder
- Substance abuse
- Self-harm behaviors
- Other PDs, including histrionic, borderline, antisocial, and paranoid PDs