Narcissistic personality disorder



Narcissistic Personality Disorder 774
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Definition

Narcissistic personality disorder (NPD) is defined by the Fourth Edition Text Revision of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV-TR , a handbook that mental health professionals use to diagnose mental disorders) as one of ten personality disorders . As a group, these disorders are described by DSM-IV-TR as "enduring pattern[s] of inner experience and behavior" that are sufficiently rigid and deep-seated to bring a person into repeated conflicts with his or her social and occupational environment. DSM-IV-TR specifies that these dysfunctional patterns must be regarded as nonconforming or deviant by the person's culture, and cause significant emotional pain and/or difficulties in relationships and occupational performance.

To meet the diagnosis of a personality disorder, the patient's problematic behaviors must appear in two or more of the following areas:

  • perception and interpretation of the self and other people
  • intensity and duration of feelings and their appropriateness to situations
  • relationships with others
  • ability to control impulses

It is important to note that all the personality disorders are considered to have their onset in late adolescence or early adulthood. Doctors rarely give a diagnosis of personality disorder to children on the grounds that children's personalities are still in process of formation and may change considerably by the time they are in their late teens.

NPD is defined more specifically as a pattern of grandiosity (exaggerated claims to talents, importance, or specialness) in the patient's private fantasies or outward behavior; a need for constant admiration from others; and a lack of empathy for others. The term narcissistic is derived from an ancient Greek legend, the story of Echo and Narcissus. According to the legend, Echo was a woodland nymph who fell in love with Narcissus, who was an uncommonly handsome but also uncommonly vain young man. He contemptuously rejected her expressions of love. She pined away and died. The god Apollo was angered by Narcissus' pride and self-satisfaction, and condemned him to die without ever knowing human love. One day, Narcissus was feeling thirsty, saw a pool of clear water nearby, and knelt beside it in order to dip his hands in the water and drink. He saw his face reflected on the surface of the water and fell in love with the reflection. Unable to win a response from the image in the water, Narcissus eventually died beside the pool.

Havelock Ellis, a British psychologist , first used the story of Echo and Narcissus in 1898 as a capsule summary of pathological self-absorption. The words narcissist and narcissistic have been part of the vocabulary of psychology and psychiatry ever since. They have, however, been the subjects of several controversies. In order to understand NPD, the reader may find it helpful to have an outline of the different theories about narcissism in human beings, its relation to other psychiatric disorders, and its connections to the wider culture. NPD is unique among the DSM-IV-TR personality disorders in that it has been made into a symbol of the problems and discontents of contemporary Western culture as a whole.

Description

A good place to begin a discussion of the different theories about narcissism is with the observation that NPD exists as a diagnostic category only in DSM-IV-TR , which is an American diagnostic manual. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision ( ICD-10 , the European equivalent of DSM ) lists only eight personality disorders. What DSM-IV-TR defines as narcissistic personality disorder, ICD-10 lumps together with "eccentric, impulsive-type, immature, passive-aggressive, and psychoneurotic personality disorders."

DSM-IV-TR specifies nine diagnostic criteria for NPD. For the clinician to make the diagnosis, an individual must fit five or more of the following descriptions:

  • He or she has a grandiose sense of self-importance (exaggerates accomplishments and demands to be considered superior without real evidence of achievement).
  • He or she lives in a dream world of exceptional success, power, beauty, genius, or "perfect" love.
  • He or she thinks of him- or herself as "special" or privileged, and that he or she can only be understood by other special or high-status people.
  • He or she demands excessive amounts of praise or admiration from others.
  • He or she feels entitled to automatic deference, compliance , or favorable treatment from others.
  • He or she is exploitative towards others and takes advantage of them.
  • He or she lacks empathy and does not recognize or identify with others' feelings.
  • He or she is frequently envious of others or thinks that they are envious of him or her.
  • He or she "has an attitude" or frequently acts in haughty or arrogant ways.

In addition to these criteria, DSM-IV-TR groups NPD together with three other personality disorders in its so-called Cluster B. These four disorders are grouped together on the basis of symptom similarities, insofar as patients with these disorders appear to others as overly emotional, unstable, or self-dramatizing. The other three disorders in Cluster B are antisocial, borderline, and histrionic personality disorders.

The DSM-IV-TR clustering system does not mean that all patients can be fitted neatly into one of the three clusters. It is possible for patients to have symptoms of more than one personality disorder or to have symptoms from different clusters. In addition, patients diagnosed with any personality disorder may also meet the criteria for mood, substance abuse, or other disorders.

Subtypes of NPD

AGE GROUP SUBTYPES. Ever since the 1950s, when psychiatrists began to notice an increase in the number of their patients that had narcissistic disorders, they have made attempts to define these disorders more precisely. NPD was introduced as a new diagnostic category in DSM-III , which was published in 1980. Prior to DSM-III , narcissism was a recognized phenomenon but not an official diagnosis. At that time, NPD was considered virtually untreatable because people who suffer from it rarely enter or remain in treatment; typically, they regard themselves as superior to their therapist, and they see their problems as caused by other people's "stupidity" or "lack of appreciation." More recently, however, some psychiatrists have proposed dividing narcissistic patients into two subcategories based roughly on age: those who suffer from the stable form of NPD described by DSM-IVTR , and younger adults whose narcissism is often corrected by life experiences.

This age group distinction represents an ongoing controversy about the nature of NPD—whether it is fundamentally a character disorder, or whether it is a matter of learned behavior that can be unlearned. Therapists who incline toward the first viewpoint are usually pessimistic about the results of treatment for patients with NPD.

PERSONALITY SUBTYPES. Other psychiatrists have noted that patients who meet the DSM-IV-TR criteria for NPD reflect different clusters of traits within the DSM-IV-TR list. One expert in the field of NPD has suggested the following subcategories of narcissistic personalities:

  • Craving narcissists. These are people who feel emotionally needy and undernourished, and may well appear clingy or demanding to those around them.
  • Paranoid narcissists. This type of narcissist feels intense contempt for him- or herself, but projects it outward onto others. Paranoid narcissists frequently drive other people away from them by hypercritical and jealous comments and behaviors.
  • Manipulative narcissists. These people enjoy "putting something over" on others, obtaining their feelings of superiority by lying to and manipulating them.
  • Phallic narcissists. Almost all narcissists in this subgroup are male. They tend to be aggressive, athletic, and exhibitionistic; they enjoy showing off their bodies, clothes, and overall "manliness."

Causes and symptoms

Causes

At present there are two major theories about the origin and nature of NPD. One theory regards NPD as a form of arrested psychological development while the other regards it as a young child's defense against psychological pain. The two perspectives have been identified with two major figures in psychoanalytic thought, Heinz Kohut and Otto Kernberg respectively.

Both theories about NPD go back to Sigmund Freud's pioneering work On Narcissism, published in1914. In this essay, Freud introduced a distinction which has been retained by almost all later writers—namely, the distinction between primary and secondary narcissism. Freud thought that all human infants pass through a phase of primary narcissism, in which they assume they are the center of their universe. This phase ends when the baby is forced by the realities of life to recognize that it does not control its parents (or other caregivers) but is in fact entirely dependent on them. In normal circumstances, the baby gives up its fantasy of being all-powerful and becomes emotionally attached to its parents rather than itself. What Freud defined as secondary narcissism is a pathological condition in which the infant does not invest its emotions in its parents but rather redirects them back to itself. He thought that secondary narcissism developed in what he termed the pre-Oedipal phase of childhood; that is, before the age of three. From a Freudian perspective, then, narcissistic disorders originate in very early childhood development, and this early origin is thought to explain why they are so difficult to treat in later life.

CAUSES IN THE FAMILY OF ORIGIN. Kohut and Kernberg agree with Freud in tracing the roots of NPD to disturbances in the patient's family of origin—specifically, to problems in the parent-child relationship before the child turned three. Where they disagree is in their accounts of the nature of these problems. According to Kohut, the child grows out of primary narcissism through opportunities to be mirrored by (i.e., gain approval from) his or her parents and to idealize them, acquiring a more realistic sense of self and a set of personal ideals and values through these two processes. On the other hand, if the parents fail to provide appropriate opportunities for idealization and mirroring, the child remains "stuck" at a developmental stage in which his or her sense of self remains grandiose and unrealistic while at the same time he or she remains dependent on approval from others for self-esteem.

In contrast, Kernberg views NPD as rooted in the child's defense against a cold and unempathetic parent, usually the mother. Emotionally hungry and angry at the depriving parents, the child withdraws into a part of the self that the parents value, whether looks, intellectual ability, or some other skill or talent. This part of the self becomes hyperinflated and grandiose. Any perceived weaknesses are "split off" into a hidden part of the self. Splitting gives rise to a lifelong tendency to swing between extremes of grandiosity and feelings of emptiness and worthlessness.

In both accounts, the child emerges into adult life with a history of unsatisfactory relationships with others. The adult narcissist possesses a grandiose view of the self but has a conflict-ridden psychological dependence on others. At present, however, psychiatrists do not agree in their description of the central defect in NPD; some think that the problem is primarily emotional while others regard it as the result of distorted cognition, or knowing. Some maintain that the person with NPD has an "empty" or hungry sense of self while others argue that the narcissist has a "disorganized" self. Still others regard the core problem as the narcissist's inability to test reality and construct an accurate view of him- or herself.

MACROSOCIAL CAUSES. One dimension of NPD that must be taken into account is its social and historical context. Psychiatrists became interested in narcissism shortly after World War II (1939–45), when the older practitioners in the field noticed that their patient population had changed. Instead of seeing patients who suffered from obsessions and compulsions related to a harsh and punishing superego (the part of the psyche that internalizes the standards and moral demands of one's parents and culture), the psychiatrists were treating more patients with character disorders related to a weak sense of self. Instead of having a judgmental and overactive conscience, these patients had a weak or nonexistent code of morals. They were very different from the patients that Freud had treated, described, and analyzed. The younger generation of psychiatrists then began to interpret their patients' character disorders in terms of narcissism.

In the 1960s historians and social critics drew the attention of the general public to narcissism as a metaphorical description of Western culture in general. These writers saw several parallels between trends in the larger society and the personality traits of people diagnosed with narcissistic disorders. In short, they argued that the advanced industrial societies of Europe and the United States were contributing to the development of narcissistic disorders in individuals in a number of respects. Some of the trends they noted include the following:

  • The mass media's preoccupation with "lifestyles of the rich and famous" rather than with ordinary or average people.
  • Social approval of open displays of money, status, or accomplishments ("if you've got it, flaunt it") rather than modesty and self-restraint.
  • Preference for a leadership style that emphasizes the leader's outward appearance and personality rather than his or her inner beliefs and values.
  • The growth of large corporations and government bureaucracies that favor a managerial style based on "impression management" rather than objective measurements of performance.
  • Social trends that encourage parents to be self-centered and to resent their children's legitimate needs.
  • The weakening of churches, synagogues, and other religious or social institutions that traditionally helped children to see themselves as members of a community rather than as isolated individuals.

Although discussion continues about the location and forms of narcissism in the larger society, no one now denies that personality disorders both reflect and influence the culture in which they arise. Family therapists are now reporting on the treatment of families in which the children are replicating the narcissistic disorders of their parents.

Symptoms

Most observers regard grandiosity as the most important single trait of a narcissistic personality. It is important to note that grandiosity implies more than boasting or prideful display as such—it signifies self-aggrandizement that is not borne out by reality. For example, a person who claims that he or she was the most valuable player on a college athletic team may be telling the truth about their undergraduate sports record. Their claim may be bad manners but is not grandiosity. On the other hand, someone who makes the same claim but had an undistinguished record or never even made the team is being grandiose. Grandiosity in NPD is related to some of the diagnostic criteria listed by DSM-IV-TR , such as demanding special favors from others or choosing friends and associates on the basis of prestige and high status rather than personal qualities. In addition, grandiosity complicates diagnostic assessment of narcissists because it frequently leads to lying and misrepresentation of one's past history and present accomplishments.

Other symptoms of NPD include:

  • a history of intense but short-term relationships with others; inability to make or sustain genuinely intimate relationships
  • a tendency to be attracted to leadership or high-profile positions or occupations
  • a pattern of alternating between unrealistic idealization of others and equally unrealistic devaluation of them
  • assessment of others in terms of usefulness
  • a need to be the center of attention or admiration in a working group or social situation
  • hypersensitivity to criticism, however mild, or rejection from others
  • an unstable view of the self that fluctuates between extremes of self-praise and self-contempt
  • preoccupation with outward appearance, "image," or public opinion rather than inner reality
  • painful emotions based on shame (dislike of who one is) rather than guilt (regret for what one has done)

People diagnosed with NPD represent a range of levels of functioning. Otto Kernberg has described three levels of narcissistic impairment. At the top are those who are talented or gifted enough to attract all the admiration and attention that they want; these people may never enter therapy because they don't feel the need. On the second level are those who function satisfactorily in their jobs but seek professional help because they cannot form healthy relationships or because they feel generally bored and aimless. Narcissists on the lowest level have frequently been diagnosed with another mental disorder and/or have gotten into trouble with the law. They often have severe difficulties with anxiety and with controlling their impulses.

Demographics

DSM-IV-TR states that 2% to 16% of the clinical population and slightly less than 1% of the general population of the United States suffers from NPD. Between 50% and 75% of those diagnosed with NPD are males. Little is known about the prevalence of NPD across racial and ethnic groups.

Gender issues

The high preponderance of male patients in studies of narcissism has prompted researchers to explore the effects of gender roles on this particular personality disorder. Some have speculated that the gender imbalance in NPD results from society's disapproval of self-centered and exploitative behavior in women, who are typically socialized to nurture, please, and generally focus their attention on others. Others have remarked that the imbalance is more apparent than real, and that it reflects a basically sexist definition of narcissism. These researchers suggest that definitions of the disorder should be rewritten in future editions of DSM to account for ways in which narcissistic personality traits manifest differently in men and in women.

Professional and leadership positions

One important aspect of NPD that should be noted is that it does not prevent people from occupying, as well as aspiring to, positions of power, wealth, and prestige. Many people with NPD, as Kernberg's classification makes clear, are sufficiently talented to secure the credentials of success. In addition, narcissists' preoccupation with a well-packaged exterior means that they often develop an attractive and persuasive social manner. Many high-functioning narcissists are well liked by casual acquaintances and business associates who never get close enough to notice the emptiness or anger underneath the polished surface.

Unfortunately, narcissists in positions of high visibility or power—particularly in the so-called helping professions (medicine, education, and the ministry)—often do great harm to others. In recent years a number of books and articles have been published within the religious, medical, and business communities regarding the problems caused by professionals with NPD. One psychiatrist noted in a lecture on substance abuse among physicians that NPD is one of the three most common psychiatric diagnoses among physicians in court-mandated substance abuse programs. A psychologist who serves as a consultant in the evaluation of seminary students and ordained clergy has remarked that the proportion of narcissists in the clergy has risen dramatically since the 1960s. Researchers in the field of business organization and management styles have compiled data on the human and economic costs of executives with undiagnosed NPD.

Diagnosis

The diagnosis of NPD is complicated by a number of factors.

Complications of diagnosis

NPD is difficult to diagnose for several reasons. First, some people with NPD function sufficiently well that they do not come to the attention of therapists. Second, narcissists are prone to lie about themselves; thus it may take a long time for a therapist to notice discrepancies between a patient's version of his or her life and information gained from others or from public records. Third, many traits and behaviors associated with NPD may be attributed to other mental disorders. Low functioning narcissists are often diagnosed as having borderline personality disorder (BPD), particularly if they are female; if they are male, they may be diagnosed as having antisocial personality disorder (ASPD). If the person with NPD has a substance abuse disorder, some of their narcissistic behaviors may be written off to the mood-altering substance. More recently, some psychiatrists have pointed to a tendency to confuse narcissistic behaviors in people with NPD who have had a traumatic experience with full-blown post-traumatic stress disorder (PTSD). Given the lack of clarity in the differential diagnosis of NPD, some therapists are calling for a fundamental revision of DSM-IV-TR definitions of the personality disorders.

An additional complication is posed by economic considerations. The coming of managed care has meant that third-party payers (insurance companies) prefer short-term psychotherapy that concentrates on a patient's acute problems rather than on underlying chronic issues. Since narcissists are reluctant to trust others or form genuine interpersonal bonds, there is a strong possibility that many therapists do not recognize NPD in patients that they are treating for only a few weeks or months.

Diagnostic interviews

Diagnosis of NPD is usually made on the basis of several sources of information: the patient's history and self-description, information from family members and others, and the results of diagnostic questionnaires. One questionnaire that is often used in the process of differential diagnosis is the Structured Clinical Interview for DSM-III-R Disorders, known as the SCID-II.

The most common diagnostic instrument used for narcissistic NPD is the Narcissistic Personality Inventory (NPI). First published by Robert R. Raskin and Calvin S. Hall in 1979, the NPI consists of 223 items consisting of paired statements, one reflecting narcissistic traits and the other nonnarcissistic. Subjects are required to choose one of the two items. The NPI is widely used in research as well as diagnostic assessment.

Treatments

Treatments for NPD include a variety of pharmacologic, individual, and group approaches; none, however, have been shown to be particularly effective as of 2002.

Medication

As of 2002, there are no medications that have been developed specifically for the treatment of NPD. Patients with NPD who are also depressed or anxious may be given drugs for relief of those symptoms. There are anecdotal reports in the medical literature that the selective serotonin reuptake inhibitors, or SSRIs, which are frequently prescribed for depression, reinforce narcissistic grandiosity and lack of empathy with others.

Psychotherapy

Several different approaches to individual therapy have been tried with NPD patients, ranging from classical psychoanalysis and Adlerian therapy to rationalemotive approaches and Gestalt therapy . The consensus that has emerged is that therapists should set modest goals for treatment with NPD patients. Most of them cannot form a sufficiently deep bond with a therapist to allow healing of early-childhood injuries. In addition, the tendency of these patients to criticize and devalue their therapists (as well as other authority figures) makes it difficult for therapists to work with them.

An additional factor that complicates psychotherapy with NPD patients is the lack of agreement among psychiatrists about the causes and course of the disorder. One researcher has commented that much more research is necessary to validate DSM-IV-TR 's description of NPD before outcome studies can be done comparing different techniques of treatment.

Hospitalization

Low-functioning patients with NPD may require inpatient treatment, particularly those with severe self-harming behaviors or lack of impulse control. Hospital treatment, however, appears to be most helpful when it is focused on the immediate crisis and its symptoms rather than the patient's underlying long-term difficulties.

Prognosis

The prognosis for younger persons with narcissistic disorders is hopeful to the extent that the disturbances reflect a simple lack of life experience. The outlook for long-standing NPD, however, is largely negative. Some narcissists are able, particularly as they approach their midlife years, to accept their own limitations and those of others, to resolve their problems with envy, and to accept their own mortality. Most patients with NPD, on the other hand, become increasingly depressed as they grow older within a youth-oriented culture and lose their looks and overall vitality. The retirement years are especially painful for patients with NPD because they must yield their positions in the working world to the next generation. In addition, they do not have the network of intimate family ties and friendships that sustain most older people.

Prevention

The best hope for prevention of NPD lies with parents and other caregivers who are close to children during the early preschool years. Parents must be able to demonstrate empathy in their interactions with the child and with each other. They must also be able to show that they love their children for who they are, not for their appearance or their achievements. And they must focus their parenting efforts on meeting the child's changing needs as he or she matures, rather than demanding that the child meet their needs for status, comfort, or convenience.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association,2000.

Capps, Donald. The Depleted Self: Sin in a Narcissistic Age. Minneapolis: Fortress Press, 1993.

Donaldson-Pressman, Stephanie, and Robert M. Pressman. The Narcissistic Family: Diagnosis and Treatment. San Francisco, CA: Jossey-Bass Publishers, 1994.

Lowen, Alexander. Narcissism: Denial of the True Self. New York and London: Collier Macmillan, 1983.

Weiser, Conrad W. Healers— Harmed & Harmful. Minneapolis: Fortress Press, 1994.

World Health Organization (WHO). The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: WHO, 1992.

PERIODICALS

Billingham, Robert E. "Narcissistic Injury and Sexual Victimization Among Women College Students." College Student Journal 33: 62-70.

Coid, J. W. "Aetiological Risk Factors for Personality Disorders." British Journal of Psychiatry 174 (June 1999): 530-538.

Gunderson, J. G., and E. Ronningstam. "Differentiating Narcissistic and Antisocial Personality Disorders." Journal of Personality Disorders 15 (April 2001): 103-109.

Imperio, Winnie Anne. "Don't Ignore Colleagues' Psychiatric Disorders." OB/GYN News (March 1, 2001): 36.

Raskin, R., and C. S. Hall. "A Narcissistic Personality Inventory.". Psychological Reports 45 (1979): 590.

Simon, R. I. "Distinguishing Trauma-Associated Narcissistic Symptoms from Post-Traumatic Stress Disorder: A Diagnostic Challenge." Harvard Review of Psychiatry 10 (February 2002): 28-36.

Tschanz, Brian T. "Gender Differences in the Study of Narcissism: A Multi-Sample Analysis of the Narcissistic Personality Inventory." Sex Roles: A Journal of Research 38 (May, 1998): 209-216.

ORGANIZATIONS

American Psychiatric Association. 1400 K Street, NW, Washington, DC 20005. (202) 682-6220. <www.psych.org> .

National Institute of Mental Health. 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513. <www.nimh.nih.gov> .

OTHER

Rhodewalt, Frederick. "Interpersonal Self-Construction: Lessons from the Study of Narcissism." Lecture given at the Second Annual Sydney Symposium on Social Psychology, March 1999.

Rebecca J. Frey, Ph.D.



User Contributions:

annie
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Apr 27, 2008 @ 4:16 pm
This site has been extremely helpful. I grew up with a narcissistic father and enabling mother who just emotionally checked out when she saw what he was really like. Thus, as the eldest child, my life was hell. My biggest fear is that I turn out like my dad. I hope and pray that I never turn out like that. But I was stuck by VJHV's comments, in that I, too, am an extremely sensitive person, who hates injustice of any kind, relish my freedom and am extremely wary of jealousy and control and its after-effects. I just wish I knew how to stop becomming the target for other NPDs I meet along the way. That is my main goal. I seem to have this bull's eye target on me that other NPD seem to see as clear as day. I hope this forum can help.
Judith
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Aug 11, 2009 @ 8:08 am
As a lay person dealing with an undiagnosed narcissistic adult daughter, this is the most helpful article I've read to date. I divorced my narcissistic husband in 1990, never dreaming that nearly 20 years later I would want a "divorce" from my youngest daughter! I started to notice tendencies when she went to college, but she crossed over to the other side 100% after she received her Masters Degree in teaching. Her father and step-Mom have doctorates in the teaching field and her husband is also a teacher.

I had a face-to-face meeting with her this past weekend to share my concerns with her: lack of empathy, sympathy, not caring about the family, making us feel stupid when she's with us, etc. etc. This meeting came at the end of nearly a year going by with us not speaking, because when my mother became ill and passed away a year ago, she never called me once to see how things were going. Her response to me - after one year of silence - was that she was hurt that nobody called HER to let her know what was going on. Give me a break - she's 32 years old! Also, her sister has had a third baby and not only did she not respond to finding out about the pregnancy, she never called her sister during labor, delivery or after that. Of course I have years and years of horrifying incidents that you'd be familiar with.

Her sister is totally finished with her and her whole family. I am trying to at least maintain some form of communication, to try to stay in touch with my two grandsons. My ex-husband, his wife and my daughter's father-in-law and his wife are doing the same for now. Eventually, I feel that even these attempts will fall by the wayside.

I wonder sometimes if I should seek counseling, as a parent, to help me deal with the guilt I feel for not wanting to be with my daughter.
Samuel
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Aug 22, 2009 @ 5:05 am
Its really great and good. I am reading the articsal and when i am donee, I will comment
Patrick J. Hill Sr.
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Aug 22, 2009 @ 4:16 pm
me and my ex-girlfrien have seperated. we are going thru a terrible custody battle with our 14 month son.She was just diagnosed with NPD and a general anxiety disorder.How am i going to deal with her in relations to my son?How do these symtoms intermix?She has accused me of everything under the sun.She will not communicate whatsoever.My sons doctor says that this is all he sees anymore in his practice.Is there anything or any advise as to what i can do about this in a court of law?How can i help my son get away from this?
T.J.
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Aug 24, 2009 @ 12:00 am
Thanks for a very enlightning article!
Living abroad as expatriate, I do not have an opportunity to see a professional to sort out my personal difficulties, so I revert to the internet for information.

I can't find out what the exact difference between NPD and HPD is -is there something in the middle?-
The issues I deal with, particularly the tricks I pull, the mechanisms I have constructed for myself in social (inter) actions, etc seem to be a combination of Histrionic and Narcissistic PD, and I want to find out how to distinguish these two PD's from another.
Any tips for this?

Thanks!
TJ
ama
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Jan 28, 2010 @ 11:23 pm
My ex and i broke up several months ago, and after reading several articles on NPD, now i can understand why he is the way he is. He lied all the time, never had any empathy for me and others in his life, always made me feel like i was stupid and be littled me and others. At the beginning of the relationship i thought something was totally wrong with me. He has only one friend and often would say to me, i dont know why people leave me but whenever i would tell him its because he's overly critical, and doesnt try to undserstand others problems he would go into a rage. I feel sorry for him, i wish i could have a way of telling him whats wrong so he can seek help but am afraid of him.
Dr. Engel
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Feb 2, 2010 @ 7:07 am
I recently broke off contact with my narcissistic brother. This article is his life story - he exhibits almost all of the traits mentioned. He brags about his world records in athletics that in reality he never broke, athletic achievements he never accomomplished, his five trophy wives, his looks, his clothes and on and on. I wish there were some way I could get him to therapy, but as the article states, he thinks he is superior to everyone else. I finally got tired of his big mouth when he critisized and made fun of my family. After reading this article and studying this disorder I now can understand why he acts the way he does. I doubt he will ever change.
DF
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Jun 7, 2011 @ 5:17 pm
Informative and helpful article. As someone who has no interest in others and uses all my freetime for myself, not family and friends, something has got to give...All I've strived for is to get hold of my family's money/property to give me an easier life and early retirement, this has led to increased alienation to others and no chance of finding a partner.
Somnetimes I think I'd be better off dead or just swindling enough money to take off and live mortgage free in another country and forget about my family. The thought of them not realising my mental torture makes me sick! (I work for the family business with a father who thinks about nothing but work).
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Sep 6, 2011 @ 4:04 am
The statement that after WWII a different type of psychiatric patient emerged and became prevalent is very interesting. May I ask what the source is for that information?
Thanks
rose
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Sep 10, 2011 @ 2:02 am
I am 26, I asked to slit up with my bf. and he said "fine" and said that,he was tired and sick of all my drama's in life. He said I am sick and I am a narcissistic person. and I got hurt to know the truth..I read online about NPD then I realized that I am positive. those signs and symptoms I read was right. Now I am looking to find out the cure and treatment about this disorder. And I am hoping that you guys can give me advice on what to do, I am really looking forward I want to heal myself. I don't like to have this disorder for long time. I don't want to hurt people around me.please help me. thank you.
Peter
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Apr 26, 2012 @ 10:22 pm
I am a divored father married again, I have tried for the last 17 years to have a meaningful relationship with my daughter, I have beaten myself up over this situation, I now know this will never happen, I have tried on numerous occasions to calmly talk to her, only to have her to become hysterical, I now know she exhibits every trait of NPD, she is now 32 years old she is no different in her behavior to when she was 14. I fear for her future, but I have now accepted nothing will ever change, I live with my 2nd wife and have a brilliant relationship with her sons and their partners, its a very sad situation, I believe that she could have become like this during the divorce, I also believe her grandfather (mother'side) also exhibited extreme narcissitic behaviour is there a connection ? I am not qualified to say...to other estranged parents I would say concentrate on the positive good things in your life, Thanks for this site..
Polly
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Aug 14, 2012 @ 2:02 am
This has been extremely helpful. As a daughter of a mother who for the past 47 years of my life, has treated her children like her own personal 'audience' and placed her self firmly at the centre of 'everything' as the most important person, around which everything must revolve.. there is so much in this article that I recognise and I am so relieved to have finally found a theory/a framework around which to 'make sense' of my mother's behaviour.

My only issue now is that the 'damage' continues and she has managed to alienate herself from nearly all of her 4 children and grandchildren. We are all exhausted by the ongoing drama's, i.e. 'dissatisfaction'/ 'unhappiness' at how she feels she is treated by others. Needless to say we try to be 'non reactive, thoughtful and considerate' in response, especially now that she is getting older.. But her perception and the 'reality' of a situation or a set of events in which she may feel she has been 'wronged', are two very different things.. either way, she has a very fragile 'sense of self' and essentially creates absolute mayhem, if members of the family/ friends, and acquaintences don't agree with her or give her the 'attention' she feels she deserves. Being in 'conflict' or being unhappy with somebody or something, has been an ongoing feature of her life.. It has of course, provided a convenient 'outlet' for her own deep 'unhappiness'. I'm not sure where we go from here, but thank you at least for providing a very useful account.
sara
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Aug 20, 2012 @ 8:20 pm
Are there any studies that can be helpful in divorce/custody situations? I'm looking for help to understand/illustrate to others the detrimental long term effects on children who live with a narcissistic borderline father. The lies,false accusations,misdirected blame and keeping the children from their mother is very difficult to accept and watch as a grandparent. Are there ways to get some justice within the court system? It seems that this type of disorder is not recognized to the full extent of its detrimental effect on everyone involved...especially little children who are captive because the court automatically grants 50/50 custody and does nothing to address the self serving defiant behavior of the narcisstic borderline father.

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