Course material

1. Overview of Narcissistic Personality Disorder
BACKGROUNDNarcissistic personality disorder (NPD), has been clearly defined by
Diagnostic and Statistical Manual of Mental Disorders as one among 10 disorders associated
with the personality. These disorders have been perceived to be the inner behaviors and
experience enduring pattern with a high rigidity and deep set of bringing the person into
divergence with the occupational and social surrounding. These patterns that are
dysfunctional are perceived as not conforming resulting to noteworthy pain emotionally
together with relationship difficulties. There are various problematic behaviors that a
person should have, to meet the personality disorder diagnosis which are; (1), the
interpretation and perception of the self and others (2), the strength in the feelings and
durations and situations appropriateness (3), the impulse control ability and (4), the
association with others. It should importantly be noted that all the personality disorders are
usually perceived to begin at the onset of the adolescence towards the early adulthood. The
resistance of the doctors to administer the narcissism personality disorder diagnosis to the
young children is usually based on the assumption that these children are still at their
growth process and there may be a possibility of these traits changing considerable by the
time they approach their late teenage period.LITERATUREMore specifically, Samuel and
Widiger (2008) perceive NPD as a grandiosity pattern in the private fantasies of a patient, a
need to be admired constantly by others. The story of Narcissus and Echo (from which the
term narcissism is derived) was first according to Samuel and Widiger (2008), used by
Havelock Ellis; who is a British psychologist back in the year 1898 as psychological self-
absorption capsule summary. Ever since, the words narcissistic and narcissist have been the
psychology vocabulary part. For the purpose of understanding NPD it would be important
to have various theories outline on human beings in relation to narcissism. Among the DSM
– IV –TR personality disorders, NPD has been perceived to be unique based on the
understanding that it is connected to an array of discontents and problems.Watson et al
(2002) perceives that nine diagnostic criteria are specified for NPD. Watson notes that in
order for the diagnosis to be made by the clinician, there are certain description that an
individual has to fit in: (1), Having a self- importance grandiose sense (2), living in a fantasy
world that is overwhelmed by success, genius, beauty and power among others (3), thinking
of individual self as special based on the understanding that it is only the others that are
special and of high status that can understand them (4), demanding a lot of admiration and
praise from others (5), a feeling of entitlement to difference that is automatic as well as
treatment that is favorable from the others (6) , exploitation towards others in addition to

2. taking advantage of the other people (7), lack of empathy and failure to recognize the others
feelings (8), frequent feel of envy together with having the “ attitude” which drives them to
talking or frequently acting arrogantly.NPD is in addition according to Simon (2002)
grouped with other three personality disorders. The grouping is based on the similarity in
the symptoms; based on the fact that the patients that are suffering from these disorders
are usually perceived have instability, extreme emotions and self-dramatizing
characteristics. However, the clustering system is not an indication that the criteria of
substance abuse and moods among others will be met by all the patients that have these
personality disorders. NPD subtypes Since the year 1950 when an increased number
of patients was realized to have narcissistic disorders, attempts have been made with an
aim of defining these disorders in a more precise way. After the discovery of NPD, it was
initially perceived to have been untreatable virtually based on the fact that the people
suffering from this disorder have rarely remained under the treatment, with a typical habit
in which they tend to regard themselves as more superior when compared to their
therapists with a notion whereby they perceive their problems to have been caused by the
“ stupidity” of other people. However, the proposal by some psychiatrists have been aimed
at dividing the narcissistic patients broadly into two groups on the basis of age; the young
adults with a narcissism that can through life be corrected and those adults whose suffering
from narcissism is more stable. The distinction on the basis of age groups is a
representation of an ongoing controversy that is based on the NPD nature- whether it is a
disorder based on the character or a matter of a behavior that is learned in which there can
be unlearning.Simon (2002) maintains that other patients meeting the NPD criteria have a
reflection of different traits clusters. According to an expert in the NPD field, various
subcategories have been suggested for the narcissistic personalities. Craving narcissists has
been categorized as the people with an emotional need as well as a feeling of being
undernourished, and may have a possibility of appearing clingy as well as demanding.
Paranoid narcissists usually have a feeling of intense self contempt although this feeling is
sometimes projected outwards to other people. This category is usually known to drive
away other people from them through comments that are jealous and hypercritical together
with such behaviors. The manipulative narcissists are usually perceived to enjoy when they
pass over their burden to others. Through such act, they are usually able to have a feeling of
being superior through manipulation of others. Coid (1999) notes another category of the
narcissists that are mainly male and tends to have a tendency of aggressiveness, being
athletic as well as portraying pride in showing their “ manliness” The indispensable
distinctiveness of narcissism personality disorder; based on a study carried out by the
American Psychiatric Association, (2000) has been seen to include self importance
grandiose sense, lack of empathy, entitlement as well as using others for individual gains.
Most of the people suffering from NPD have in most cases been seen have preoccupation
with thoughts and day dreams or even imagination that is preoccupied with power and
success. In other circumstances, it has been quite often to note that those people with NPD
have had little to count on in terms of success or achievements that can be termed as
significant. Due to the idea of preoccupation with power and success, credence has been
lend to the theory that has been based on the fact that these people have been known to be

3. risk takers. Ronningstan, (2005) maintain that these individuals are not willing to stand the
idea of appearing to be less intelligence when compared to the other people that they
associate with. The study has further shown that there is a similarity in the principle
component that usually leads people to narcissism. The idea of similarity as the
imperceptible strength behind narcissism results to insights that are involved in many of
the NPD characteristics. Depression in the individuals suffering from NPD has been
perceived to arise from many personal issues, in reference to which Ronningstam (2005)
points that these victims express envy if they are deprived from praise and instead others
are commended. However, (Ronningstam, 2005) observes that this depression usually do
not last for a long time. With this condition, the victims usually tend to externalize and see
setbacks in addition to taking stock in their own superiority and mastery sense over the
other individuals. In addition, in the bind to sheltering their self-sense which has been
characterized with fragility, they usually have a surety that there is envy in them from the
others that are around them. This now brings an even clear explanation on why the NPD
victims have in most cases been considered to be detached or even not possess an
interpersonal relationship that is strong. However, their self conscious may be leading them
into believing that they actually do have numerous relationships that they are close to, from
which they usually receive a lot of praise.The Narcissism Personality Disorder
etiology According to Gunderson (2001), the narcissistic personality disorder etiology
has always remained unclear. The studies that have been carried out have not been able to
clearly portray the disorder hereditability. Basically the etiology theories have been
psychodynamic, sociological as well as interpersonal. For instance, the western society has
been perceived to have become self centered overly with an importance that is decreasing
being given to the bonds that are familiar together with increasing importance being given
to the self-esteem, materialism as well as self satisfaction. Through the excessive narcissism,
there may also be partial development through the affection and parental attention
contingent provision. Through the parental relationship, the child may learn that there is a
contingence in the sense of worth, meaning and value upon achievement or
accomplishment. However, the perception that is held by other psychologist is that
narcissism results from reception of idealization that was excessive by their parents which
were incorporated by them onto their self image. There is an appearance of the deficits and
conflicts in relation to self esteem which do appear to be central to the Narcissistic
personality disorder psychopathology. There may be a likelihood of the narcissistic person
continually seeking and obtaining the symbols and signs of recognition to the inadequacy
feeling compensation. There is the contingence of the self esteem upon accomplishment,
success or status. Their insecurity feelings may be masked by indifference overt or a
devaluation that is disdainful of the other people’ s opinions, although there may still be
evidence of pathology in such cases by a reliance that is excessive with the recognition and
status being highly valued. In addition, there may be envy by some narcissistic individuals
that are truly indifferent to criticisms and success and who find fantasy in unassuming and
simple life.Freud (1990) postulates that narcissism is an instinctual drive of a person that is
aimed at preservation of oneself. It is on this basis that Freud argues that the society aims
are usually driven towards masking the future of illusion from ourselves. Based on Freud

4. (1990) postulation, the origin of narcissism can be traced back to the early childhood in
which the child is usually subjugated to aspirations and desires that cannot be realized. Due
to this, there is usually a weakening of the ego to the compensation point. As a result of the
children not feeling the parental love, what usually ensues is love for one self. This is what is
claimed by Freud to be the narcissism etiologyThe other notion on narcissism according to
Freud (1990) seems to be one way or another moot. The idea that is based on the
perception that there is a survival instincts in a person and the choice will naturally be
based on his or her self instead of the others has been challenged by other conception that
will include depression, suicide together with other mental illnesses. This calls for the need
to lay a new framework on the causes behind narcissism. According to theories that are
more recent by Davis and Millon (1999), the argument on the biosocial model is based on
the argument that the parents that are overindulgent usually foster to their children a sense
of being special and entitled. It is based on this that there will be an expectation of praise by
these children on all the endeavors regardless of whether it is of a significant value or not.
The conception of biosocial model takes the parents overindulgence even a step further
based on the cognitive theories. A suggestion is held based on the notion that the parents
instilling a specialness and entitlement sense through which the children are actually
deprived the experience that consists of a wide range of effects. It is based on this that the
child will experience the emotions which will include pride or happiness instead of anger
and sadness. This explanation is a coincidence to the DSM-IV TR sixth criteria in which the
selfish is seen to take advantage of others empathy lack according to criteria 7. Since it is
only the positive emotions that are usually experienced by the child, it is mostly not possible
for them to handle the emotions that are negative or even relate to the emotions of the
encounter by the other person. Ronningstam (2005) however points out that the there has
not been enough research on the environmental or dispositional influence to have this
determination made on NPD.According to Samuel and Widiger (2008), there seems to be an
agreement with Freud (1990) when it comes to tracing the NPD roots to the origin family
disturbance, especially to the issues that concerns the relationship between the parent and
child when the child is still young before the age of three. However, the disagreement is
based on their account of these problems nature. The growth of the child to the primary
narcissism is usually caused by the opportunities that are to be reflected by their parents;
through which a more realistic self sense is acquired together with personal values and
ideals set based on these two processes. However, failure by their parents to provide
opportunities that are appropriate for mirroring and idealization makes the child to remain
stuck at the stage of development in which there is a possibility of having the self sense
remaining unrealistic and grandiose while at the same time depending on the approval for
their self- esteem. The view of NPD is depicted in contrast as rooted in the defense of the
child against a parent that is cold and not empathetic. With the emotional hunger and anger
of the parent who is depriving, the child is usually perceived to have a withdrawal into a self
part that is valued by the parent whether based on the looks, ability intellectually together
with other talents or skills. This is the self part that is usually perceived to become
grandiose or hyper inflated. This usually results in spitting off of any weakness that is
perceived into the self part that is hidden. Through splitting, a long life tendency emerges;

5. which is usually perceived to swing between the grandiosity two extremes coupled with a
feeling whereby the patient usually feels empty and worthless. Samuel and Widiger (2008)
affirm that in both accounts, there is development of the child into the adulthood with a
history of relationships that are unsatisfactory with others. In the adult narcissist, there is
basically a possession of a self- grandiose view with psychology that is conflict ridden and
based on dependence on the others. However, Ronningstam (2005) argues that presently
there is no agreement by the psychiatrists based on their way that they centrally
understand the defect of NPD. Some hold strong to believing in the primary emotion of the
problem with others regarding it as resulting from cognition that is distorted. There are
other psychologists that perceive that there is hunger and emptiness in the person with
NPD with others arguing that there is usually a disorganized self in narcissism. There are
still others that refer to the major problem as the inability of narcissists to have a reality test
or have an accurate constructive view.Some interesting results have been revealed by the
twin studies in terms of the NPD influence genetically. In one study, it was particularly
found out that 493 twins pairing had a heritability of 45% by the use of Dimension
Assessment of Personality Problem scale according to Jang et al, (1996). There is yet to be a
replication of further studies in which important insights may be provided on the NPD
biological origins. However, based on other Neuropsychology studies, it has been found that
responses of neuronet are usually developed by the infants in a specific pattern as they
react to styles of parenting (Schore, 1994). As the child is exposed to stress, there is usually
a back reverting based on a particular behavior pattern of the neuronet. In a study by
Schore (1994), two parenting styles were indentified through which there would be a
contribution to the NPD development. There is first the resistance that is insecure that is
connected to the style of parenting. Due to this parenting style, there is a contribution of
hyper activation as well as under regulation of effect (Ronningstam, 2005). This results in a
grandiose of self importance and entitlement sense coupled aggression that is usually
directed to other people. Depressive hypo repressive is the second parenting style, which
may result to overregulation of affect and low energy. It is the depressive hypo arousing
that has the potential of resulting to the shy type of narcissism. The appearance in these
individuals is usually timid with signs of fragility sometimes. However, a closer
examination of these individuals finds them to have a fantasy life filled with grandiose and a
lot of activeness. As a result of the genetic and neuropsychological examination of the NPD,
some insights are provided to the future assessment as well as the options of treatment.
However, there is a need for conducting further research which should be aimed at
obtaining a even clear picture that can result to understanding the origin of NPD genetically
and also from the neuropsychological perceptive.Macrosocial cause Grandiosity has
been regarded by most observers as the trait that is most important in the narcissistic
personality. It should however be importantly noted that grandiosity has an implication of
more than just display of pride or boasting, it is an indication of self- aggrandizement that is
not sourced from the reality. For instance, a person claiming to have been the most valuable
player in the athletic team of the college may be having the probability of telling the truth
about their sports record during their undergraduate study period. There many are some
bad manners in their claim but however, this cannot be perceived as grandiosity. However,

6. there may be another person that may be making a claim while he had a record that is
undistinguished or he even was never part of the team may result in grandiose. In the NPD,
the grandiosity has been connected to some of the criteria of diagnosis that includes special
favor demands or using the basis of high status and prestige when choosing the associates
and friends and not based on the personality qualities. In addition, the narcissist’ s
diagnostic assessment is complicated by the grandiosity based on the fact that it has been
seen to frequently result to misrepresentation and lying of the past history of an individual
as well as the accomplishments in the present.Simon (2002) notes that there are various
functioning that are usually represented by the people that are diagnosed with NPD. Based
on the description of Simon, there are three narcissistic impairment levels. The first
category consists of the individuals that are sufficiently gifted and talented to have an
attraction of all the attention and admiration as they want; the reason for these people not
entering therapy is usually based on them not having the desire to do so. There is also the
category of the individuals that have a satisfactory functioning in their occupation although
they seek help professionally based on their understanding that they are usually unable to
form a relationship that is healthy and due to the tendency of feeling aimless and bored. The
lowest level of narcissists has the history of having been diagnosed with a mental disorder
or have ever been involved in troublesome act with the law. This category has been
perceived to have difficulties that are severe when it comes to impulses control and
anxiety.Narcissistic personality assessment The MMPI development was initially used
in primarily detecting the Axis 1 mental disorders, although it is at times used in detecting
the personality characteristics that are maladaptive in the individuals that are affected by
the psychological disorder. From the MMPI, there are several scales that have been
developed with an aim of assessing narcissism according to Rathvon and Holstrom (1996).
The MCM – III-R has been another personality measure that has been commonly used in
which there is specific scale for the narcissism assessment. While the designing of the MCR-
III-R and the MMPI-2 have been aimed at measuring the personality, Samuel and Widiger
(2008) notes that perhaps the NPI (Narcissism Personality Inventory) is the scale that is
specifically designed directly measuring the narcissism. Samuel and Widiger (2008)
highlights that there are several studies indicating that NPI has the ability of measuring
various narcissism facets in a way that is moderately accurate. The NPI lack of sensibility
may be based on the fact that there are several of its subscales that are usually aimed at
measuring the personality pathology that are at a more global range against the narcissistic
traits that are more specific. Even though, various other studies are based on the argument
that NPI has the ability of capturing the narcissism complexity, and presenting it in a new
continuum form that ranges from pathological narcissism to functional narcissism (Watson
et al, 2002).An examination was done by Samuel and Widiger (2008) on the validity
construct of the NPI with a comparison being done to three other narcissism measures that
included the MCM-III. This examination was initially not able to determine if NPI was
actually useful in measuring the narcissism. However, in the second and third studies, there
was indeed a confirmation of a strong validity construct in the scale. This study was
replicated by Soyer et al (2001) with these studies being extended further through
examination of the NPI divergent validity. NPI was seen by this study to have a validity

7. construct that was high; not of covert narcissism but of overt narcissism. Other narcissism
measures however contained a higher convergent and construct validity for the convert
narcissism assessment (Soyer et al, 2001). NPI was not seen to measure narcissism but was
rather seen to be related in a positive way to the achievement need. Samuel and Widiger
(2008), highlights that there is no narcissism measure that has entirely been conclusive or
even have the ability of measuring the narcissism accurately across the orientations that are
theoretical. They claim that this conundrum is as a result of operational definition
multiplicity that shoots from each of the theoretical orientation. For instance, the TAT
narrative is used by the Social Cognitive and Object Relations Scale for measuring specific
personality disorders therefore not capable of being used in the analysis of the behavioral
orientation. The DSM-IV TR criteria primary based instruments further more are only able
to measure the narcissism characteristics that are external with an inclusion of exhibition
and grandiosity and the correlation with vulnerability, depression and sensitivity is not
positive. However, through other measures that are based on the five factor model, the
destructive effects of narcissism can be measured.According to studies conducted with the
Five Factor Model in relation to narcissism, there is a perception of having the ability of
giving a picture that is more complex and complete in relation to measuring the other
manipulation, lack of empathy as well as measuring the narcissism convert form. In other
studies, there has been a confirmation that the NPD instrument that is based on the FFM is
perceived to measure NPD more adaptable form than it has been expected previously
(Miller and Campbell, 2008). According to the findings, it has been found that the NPD
infected people usually tend to load high on the extraversion factors and on the
agreeableness, it has been seen to be low (Lynam and Widiger, 2007).According to a study
that was recently conducted by Gunderson (2001), ways of definition of narcissism were
found out that were beyond the Five Factor Model. The Five Factor Model empirical
soundness is supported by Gunderson (2001) although the SWAP 200 has been seen to
provide a data that is highly complex on the personality traits that have not been found in
the Five Factor Model. Further argument is held that since there is a self administration of
the Five Factor Model, the truth burden completely relies on the source from which the
information is gotten.Research recommendations Understanding narcissistic disorder
is complex based on the fact that this kind of disorder is more of personality than physical.
The assumption is most likely with most of these patients denying accepting the fact that
there is indeed an abnormality in them. In addition, the validity of new measures for
narcissism has to be ascertained; which will display a high overall reliability rate. Further
more, there is a strong urge are more studies are carried out with an aim of ensuring the
conclusion validity and reliability in addition to determining the true cause of this
personality disorder, which is yet to be clearly determined. This study forms the basis for
analysis through which the mystery behind the narcissistic personality disorder can be
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