Narcissism or narcissistic personality disorder

The Narcissism it's a personality disorder characterized by grandiosity, a need for admiration and a lack of empathy. It is classified in theaxis II of the Diagnostic Manual of Mental Disorders, to which all personality disorders belong. The other mental disorders (mood disorders, schizophrenia, etc.), are instead part of the I axis.

What are personality disorders?

Before delving into the clinical entity that takes the name of Narcissistic Disorder, it is necessary first of all to clarify what personality disorders are: they affect the totality of the individual and concern his own intrinsic way of being. These alterations make it difficult, if not impossible, for him to adapt to social and cultural customs.
L'axis II of the DSM-IV is divided in turn into three subclasses (A, B and C), which differ from each other in the predominant personality traits of the affected subjects:

• Group A: The disorders (remember: habitual patterns of experience) appear strange and eccentric.
Group B: Disorders appear amplifying (dramatic), emotional or unpredictable. This is where we find the Narcissistic Disorder.
• Group C: the behavior is anxious or fearful.

What is narcissistic personality disorder?

Narcissus, in Greek mythology, was a young man famous both for his beauty and for his proud, insensitive being; this led the gods to punish him for his temperament: in fact they decided that Narcissus he would have fallen in love with her reflection in the water of a lake. Every time Narcissus was about to touch his reflection, it disappeared. It is no coincidence that psychiatry has given its name to this particular disorder: the main characteristics of Narcissistic Disorder are the sense of grandeur, the need for admiration and the lack of empathy. There prevalence in the hospitalized population is less than 1%, so it's hard to find. It occurs within early adulthood and, as with other personality disorders, those affected may also have pathologies of the axis I of the DSM-IV, such as Dysthymia, Major Depressive Disorder or Anxiety Disorder.

Symptoms of Narcissism

The Narcissistic Disorder has a high variability of presentation and the symptoms, in addition to being heterogeneous, have different levels of severity. Affected individuals may be extroverted or so insecure that they choose social isolation. To recognize them, therefore, we need to consider others psychological aspects narcissism, in addition to the essential ones mentioned above.
The most recent studies find a synthesis in the Wink theory, which distinguishes narcissism covert and narcissism overt.

Overt narcissism is characterized by:
- Hypertrophic self-esteem and poor tolerance to criticism;
- Devaluation of others;
- Avoidance of interpersonal relationships (since the subject experiences them as a threat to his greatness);
- Disdainful attitude;
- Obsession with success;
- Absent empathy (from which short and superficial relationships arise).
- Handling;
- Insensitivity to the needs of others.

Covert narcissism: this is the case of the "vulnerable narcissist" (literally, covert it means undercover). It comes with:
- Hypersensitivity to criticism;
- Envy for the successes of others;
- Grandiosity "masked" with shyness and periods of isolation and depression;
- Constant brooding, distress and self-depreciation;
- Hypercritical attitude towards others (and, therefore, difficulties in maintaining long-term relationships);

Covert and Overt have in common the need for admiration, the fantasies of success, manipulation; both thus strengthen their self-esteem. They are like two sides of the same coin: both absorbed by themselves, they feel their greatness and, while the Overt flaunts it, the Covert hides it under an insecure and shy appearance.
The most severe form of pathological narcissism is what Kernberg calls it Malignant narcissist or Perverse narcissism: aggressive and sadistic tendencies towards others are added to delusions of grandeur. They are perverse manipulators, who lie and chronically circumvent.
Malignant narcissism is the most serious form because it has a strong repercussion on others, especially in couple relationships. In fact, the subject uses emotional ties and sexual relations as pure manipulation tools for his own gain.
Thus the partner becomes a victim in all respects and suffers serious repercussions in the long term. In fact, we speak of Narcissistic trauma or Trauma from narcissism: a psychophysical condition caused by the relationship with a person suffering from narcissistic personality disorder, the consequences of which are the collapse of self-esteem and emotional dependence.
The malignant narcissist attracts these subjects because they are particularly vulnerable people, presenting what is defined by psychoanalysis narcissistic wound: an unconscious lack of self-love that leads to idealizing the partner in an attempt to compensate for the injury itself.
It is important to note that, in this case, it is not the social dysfunction of those affected that makes the disorder particularly serious, but the repercussions on others.

Narcissistic personality disorder

Narcissus, the Greek mythological character from whose vanity psychiatry took inspiration for narcissistic personality disorder.

Causes of Narcissistic Disorder

• The most accredited hypothesis (also valid for other personality disorders) is that there is a combination of genetic factors and early life experiences: it is thought that these disorders are the result of the interaction between temperament (a factor genetic-biological), which also includes i strokes personality (i.e. constant modes of behavior, thought and sensitivity) with the experiences lived and theenvironment.
• The Psychoanalytic Theory is based on the self psychology: the Self it is the perception of one's own psychic totality (of which the Ego is the conscious part), which develops in childhood through interaction with the environment and with the reference figures. The child will therefore assume positions of superiority in search of feedback, especially from the caregiver. If gears are affected in this important phase of development, the Self does not "mature" properly. Second Kernberg, the lack of attention on the part of anaffective parents in this delicate phase of development leads to Pathological self: the subject perceives himself and his neighbor in an idealized way, which becomes an instrument that must reflect his grandeur (like the mirror for Narcissus). It is therefore a defense mechanism, triggered in childhood, to compensate for the narcissistic wound suffered in the development phase and which leads to the typical traits of narcissism in adulthood.

Diagnosis of Narcissism

The first step is to exclude that the person's behavior is not due to alcohol or drug abuse. Therefore they will be prescribed blood and urine toxicological screening.
The second step is careful psychological evaluation, both for the personality disorder itself and for any associated mental pathologies.
To better assess the patient, it is also good to consider any manifestations of Covert narcissism, the diagnosis of which is not always easy.
We also report i DSM-IV diagnostic criteria:

Criteria general for the diagnosis of personality disorder:

a) A habitual pattern of experience and behavior manifesting in two or more of the following areas:
- Cognitiveness (or the way of perceiving and interpreting oneself, others and events);
- Affectivity;
- interpersonal relationships;
- impulse control.
b) The pattern of thought and behavior is inflexible and concerns various personal and social situations;
c) The model causes clinically significant distress and impairs social, occupational, etc. functioning.
d) Onset in adolescence or early adulthood;
e) It is not best justified as a manifestation of another mental disorder;
f) It is not attributable to the effects of a substance (drug or drug) or to an underlying medical condition (eg head injury).

Criteria specific for the diagnosis of Narcissistic Personality Disorder:

• Picture of grandeur that arises within early adulthood and in multiple contexts, as indicated by these elements:
1) Exaggeration of results and talents;
2) Fantasies of success, charm, beauty and ideal love;
3) The subject believes he is special and has to attend high-class people / institutions to be understood
4) Requires excessive admiration;
5) He unreasonably expects favorable treatment, or that his expectations are immediately met;
6) Exploitation of others for one's own purposes;
7) Lack of empathy;
8) Envy, or conviction of being envied by others;
9) Arrogant and presumptuous attitudes.

Narcissism therapy

There is one care for the narcissistic personality disorder? The treatment of first choice is the psychotherapy: the aim is to re-dimension the expectations and dysfunctional thoughts typical of narcissistic subjects to replace them with more functional ones, so that they develop a less idealized perception of reality.
There pharmacological therapy is a good support for secondary manifestations ofaxis I. Although it does not resolve the disorder itself, it can manage some aspects of it. The most used drugs are:
Selective serotonin reuptake inhibitors for depressive states;
Benzodiazepines for anxious states;
Anticonvulsants (so called because used in the treatment of epileptic seizures) for excesses of anger and impulsive behaviors.

Bipolar Narcissism and Narcissistic Depression

Psychotherapy can be difficult as these patients are very skeptical of any treatment; however, it is common for patients to go to their doctor for depressive episodes that they cannot manage. At the base of this narcissistic depression is the continuous clash between the subject's idealized expectations and reality; to this can be added the discomfort deriving from social exclusion and the sense of despair due to one's constantly unfulfilled aspirations.
Drug or alcohol addiction and Anxiety Disorder are other reasons that lead to a specialist.
Manifestations of hypertrophic self-esteem and grandiosity are also common in the manic or hypomanic phases of Bipolar Disorder: the type of narcissism that bipolar patients show is however different, as it is typically associated with other symptoms such as euphoria, recklessness, logorrhea, psychomotor agitation (typical symptoms that direct towards a mood disorder and which are instead absent in actual Narcissism).



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