Sheep City

Narcissistic personality disorder is a condition characterized by an inflated sense of self-importance, need for admiration, extreme self-involvement, and lack of empathy for others. Individuals with this disorder are usually arrogantly self-assured and confident. They expect to be noticed as superior. Many highly successful individuals might be considered narcissistic. However, this disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. 

Complications:

Vulnerability in self-esteem makes individuals with this disorder very sensitive to criticism or defeat. Although they may not show it outwardly, criticism may haunt these individuals these individuals and may leave them feeling humiliated, degraded, hollow, and empty. They may react with disdain, rage, or defiant counterattack. Their social life is often impaired due to problems derived from entitlement, the need for admiration, and the relative disregard for the sensitivities of others. Though their excessive ambition and confidence may lead to high achievement; performance may be disrupted due to intolerance of criticism or defeat. Sometimes vocational functioning can be very low, reflecting an unwillingness to take a risk in competitive or other situations in which defeat is possible. Individuals with this disorder have special difficulties adjusting to growing old and losing their former superiority. 

Comorbidity:

In this disorder, sustained feelings of shame or humiliation and the attendant self-criticism may be associated with social withdrawal, depressed mood, and Dysthymic or Major Depressive Disorder. In contrast, sustained periods of grandiosity may be associated with a hypomanic mood. Anorexia Nervosa, Substance-Related Disorders (especially related to cocaine), and other Personality Disorders (especially Histrionic, Borderline, Antisocial, and Paranoid) frequently co-occur with this disorder. 

Associated Laboratory Findings:

No laboratory test has been found to be diagnostic of this disorder. 

Prevalence:

The prevalence of Narcissistic Personality Disorder is less than 1% of the general population. It is seen in 2% to 16% of psychiatric outpatients. This disorder is more frequent in males (50% to 75%) than females. 

Course:

Narcissistic traits are very common in adolescents, but most adolescents grow out of this behavior. Unfortunately, for some, this narcissistic behavior persists and intensifies into adulthood; thus they become diagnosed with this disorder.

DSM Criteria

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. has a grandiose sense of self-importance
2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. believes that he or she is “special” and unique
4. requires excessive admiration
5. has a sense of entitlement
6. is interpersonally exploitative
7. lacks empathy
8. is often envious of others or believes others are envious of him or her
9. shows arrogant, haughty behaviors or attitudes