Essential Feature

The essential feature of the narcissistic personality disorder is a pervasive pattern of grandiosity, need for admiration, and lack of empathy (DSM-IV™, 1994, p. 658). Gunderson, et.al, (Livesly, ed., 1995, p. 208) notes that the grandiosity may not be overt or may involve arrogant and haughty behavior.

Kantor (1992, pp. 203-204) describes the clinical characteristics of NPD as:

• inordinate self-pride;
• self-concern;
• an exaggeration of the importance of one's experiences and feelings;
• ideas of perfection;
• a reluctance to accept blame or criticism;
• absence of altruism although gestures may be made for the sake of appearance;
• empathy deficit; and,
• grandiosity.

Frances, et.al. (1995, p. 374) add:

• entitlement;
• shallowness;
• preoccupation with fame, wealth, and achievement;
• craving admiration, attention and praise;
• placing excessive emphasis on displaying beauty and power.

Beck (1990, p. 49) describes the key elements of NPD as presumed superiority and self-aggrandizing behavior. These individuals also give evidence of intense motivation to seek perfection and a feeling state of emptiness, rage and envy (Masterson, 1981, p. 7). They are vulnerable to the most negligible slights and are prone to withdraw and become inaccessible when feeling offended (Benjamin, 1993, p. 141).

Individuals with NPD may show little real ability outside of their fantasies. They can become self-destructive because their grandiosity and self-preoccupation impair their judgment and perspective. They can experience such inappropriate rage in response to someone diminishing their sense of superiority that they attack and attempt to destroy the source of criticism (Oldham, 1990, pp. 93-95). These individuals have a particularly difficult time with the limitations inherent in ageing; NPD has been associated with deterioration in midlife with the realization of mortality and loss of physical vitality (Wink, Costello, ed., p. 149).

On the other hand, individuals with NPD may be talented and successful enough to be admired and emulated by others (McWilliams, 1994, p. 171). They can be nearly symptom-free and well functioning. Even so, they may still be chronically unsatisfied due to habitually unrealistic self-expectations (Sperry & Carlson, 1993, p. 316).

NPD may be comorbid with histrionic, borderline, antisocial, and paranoid personality disorders. NPD traits are common in adolescents and may not necessarily lead to NPD in adulthood. Individuals who are diagnosed with NPD are 50-75% male (DSM-IV™, 1994, p. 660).

Self-Image

Individuals with NPD have a grandiose sense of self-importance. They routinely overestimate their abilities, inflate their accomplishments, and appear boastful, arrogant, and pretentious (DSM-IV, 1994, p. 658). This belief in personal superiority is the "bedrock" of their self-image. Individuals with NPD believe that their presumption of superiority is sufficient proof of its existence. They are able to feel secure and content if they think highly of themselves. Negative aspects of self are met with denial or rationalization (Richards, 1993, p. 251). However, maintenance of the belief that they are superior, often without commensurate achievements, can create a painful disparity between their genuine and their illusory competence. The strain of maintaining a false self-image may lead to feelings of fraudulence, emptiness, and disconsolate feelings (Millon & Davis, 1996, pp. 393, 420-421). McWilliams (1994, pp. 177-178) believes that individuals with NPD have some sense of their psychological fragility. They can experience either a grandiose self-state or a depleted, shamed self-state. With external affirmation, they can feel self-righteous, prideful, contemptuous of others, self-sufficient, and vain. With the loss of external validation, they can feel a vague sense of falseness, envy, ugliness, and inferiority.

Kantor (1992, p. 207) believes that individuals with NPD can sustain good judgement if they demand performance of themselves that vindicates their self-esteem. Judgement becomes impaired when the self-love has little realistic basis. Even as these individuals inflate their efforts and overvalue their abilities, they seem surprised when they do not receive the praise they expect (DSM-IV™, 1994, p. 658). They appear to have little awareness that their behavior may be seen as objectionable or irrational (Millon & Davis, 1996, pp. 405-406).

View of Others

Individuals with NPD assume that other people will submerge their desires in favor of the comfort and welfare of those with NPD. They believe that just because they want something -- that is reason enough for them to have it. They assume that others are as consumed by concern for those with NPD as the individuals themselves are; they believe they deserve special consideration from others (DSM IV™, 1994, p. 659) (Millon & Davis, 1996, p. 394). Narcissistic individuals use others to fulfill their own psychological needs and to maintain the stability of the self; others are valued by how well they provide comfort and emotional stability (Wink, Costello, ed., 1996, p. 149).

Kantor (1992, p. 206) notes that individuals with NPD have trouble cooperating with other people as their attention is on themselves. They view others as vassals or constituents; they seek admiration to document their own grandiosity and to preserve their superior status (Beck, 1990, p. 49). They have difficulty recognizing the experience and feelings of others. They lack empathy and form few genuine emotional commitments. They must, at all times, be admired. If they are able to recognize the needs of others, they tend to view these factors as signs of weakness and vulnerability (DSM-IV™, 1994, p. 659) (Oldham, 1990, p. 96). When able to perceive this vulnerability, individuals with NPD behave in a dominant and coercive manner (Birtchnell, Costello, ed., 1996, p. 186).

Individuals with NPD are often envious of others and believe others to be envious of them. They begrudge others their possessions or successes. They believe that they are so important that others should defer to them; their sense of entitlement is apparent in their lack of sensitivity toward and arrogant exploitation of others (DSM-IV™, 1994, pp. 658-659).

NPD self-esteem is fragile and maintained by external affirmation (McWilliams, 1994, p. 168). These individuals are preoccupied by how well they are perceived by others. They enhance their self-image by associating with people who are also superior, special or unique, and of high status; they want to be connected to people of equally idealized value (DSM-IV™, 1994, pp. 658-659).

Relationships

NPD relationships are impaired because of entitlement, need for admiration, and disregard for the feelings of others (DSM-IV™, 1994, p. 659). Individuals with NPD are interpersonally exploitative; they expect special favors without reciprocal responsibilities (Millon & Davis, 1996, pp. 405-406). Their capacity to feel love for others is marginal (McWilliams, 1994, p. 175) and they possess only the kind of empathy that allows them to manipulate and elicit admiration from others (Wink, Costellos, ed., 1996, p. 159). They can be socially facile, pleasant, and endearing; however, they are unable to respond with true empathy and can be disdainful and irresponsible (Sperry, 1995, p. 114). Their relationships must have potential for advancing their purposes or enhancing their self-esteem (DSM-IV™, 1994, p. 659). Without any apparent pay-off, a relationship has no purpose and is unlikely to be sustained.

A grave concern regarding individuals with severe NPD is their cold seductiveness and promiscuity, their incapacity to stay in love, and their inability to either genuinely comprehend or accept the incest taboo (Akhtar, 1992, p. 69). If they do not see their children as separate individuals but as sources of need gratification, sexual behavior is possible.

Yet, in spite of the apparent self-sufficiency of individuals with NPD, they have intense interpersonal needs (Golomb, 1992, p. 21). Their need for external affirmation of their specialness means they must be in relationships that will allow them to feel unique and admired. This overburdens their relationships with their demands for self-esteem enhancing interaction (McWilliams, 1994, p. 174) and they are likely to contribute little or nothing in return for the gratifications they seek. It is central to NPD that good fortune will come without reciprocity (Millon & Davis, 1996, pp. 405-406).

Individuals with NPD are likely to attempt to get their needs met in relationships without acknowledging the independent existence of those from which they "expect to feed." If they are forced to recognize the presence of a benefactor. they demean the gift or the person who has given it. Mates for individuals with NPD often have a NPD parent who has already indoctrinated them to regard exploitation and disregard as love (Golomb, 1992, pp. 21-22). Individuals with NPD are prone to compete with their mates; they want to be with someone special but they do not want to lose the spotlight (Beck, 1990, p. 244).

Within relationships, individuals with NPD expect admiring deference, have a noncontingent love of self, and take presumptive control of others. They often behave with contempt toward those with whom they are involved. They see their own achievements in grandiose and inflated terms while devaluing the contributions of others. At the same time, these individuals have an extreme vulnerability to criticism or being ignored. When their superior position is challenged or their lack of perfection is demonstrated, their self-concept may, for a while, degrade to severe self-criticism (or they may engage in an outburst of rage). Without effective penetration of their defenses, however, individuals with NPD are pleased with themselves and expect to be noticed and acknowledged as special (Benjamin, 1993, pp. 147-151).

Issues With Authority

Competent individuals with NPD are often in positions of authority themselves. If dealing with other authority figures, they are non-deferential, convivial or condescending, and presumptive of special treatment. They do not reveal any information derogatory to themselves and behave with self-righteous indignation when questioned. Lying is not difficult; concealment is a routine behavior. These individuals are unwilling to accept that society's limitations apply to them.

NPD Behavior

NPD behavior is usually haughty. These individuals behave in an arrogant, supercilious, pompous, and disdainful manner. They have a careless disregard for their own personal integrity and a self-important indifference to the rights or needs of others (Millon & Davis, 1996, p. 405). Yet, they can also show assertiveness, social poise, assurance, leadership potential, and achievement orientation (Wink, Costello, ed., 1996, pp. 153-154). Their ambition and confidence may lead to success, but their performance can also be impaired by their intolerance of criticism (DSM-IV™, 1994, p. 659). For all of their grandiosity, individuals with NPD are remarkably thin-skinned. They are easily offended and frequently feel mistreated (Golomb, 1992, p. 22). Individuals with NPD also experience boredom, dissatisfaction, and a lack of fulfillment and meaning in their work (Wink, Costello, ed., 1996, p. 149). It is problematic for these individuals to stay in long-term employment where responsibility for error or failure get harder and harder to obscure (Richards, 1992, p. 252).

Individuals with NPD do not believe that reciprocal social responsibilities apply to them. They expect others to serve them without giving much in return (Millon & Davis, 1996, p. 405). They are abrasive, abrupt, and lacking in gratitude (Beck, 1990, p. 244). They may engage in temper tantrums, verbal harangues, and emotional, physical, or sexual abuse because of their belief that others should be primarily concerned with making them happy or comfortable. These individuals are particularly apt to become resentful and contemptuous of anyone who tries to hold them accountable for their exploitative, self-centered behavior (Beck, 1990, p. 244).

Sperry (1995, p. 114) notes that individuals with NPD are expansive and inclined to exaggerate; they focus on images and themes and take liberties with the facts. They use self-deception to preserve their own illusions. They will do whatever is needed to reinforce their self-ascribed superior status (Beck, 1990, p. 50). They are competitive, boastful, impatient, arrogant, and hypersensitive (Sperry, 1995, p. 114). Individuals with NPD evidence an uneven morality and a readiness to shift values to achieve goals; they may engage in pathological lying (Akhtar, 1992, p. 69).

Affective Issues

NPD affect is generally nonchalant, imperturbable, and characterized by feigned tranquility. This changes when individuals with NPD experience a loss of confidence. Then they become enraged and may experience feelings of shame and emptiness. If these individuals lose their narcissistic feelings of easy superiority, they become irritable, annoyed, and subject to repeated bouts of dejection and humiliation (Millon & Davis, pp. 405-408).

Richards (1993, p. 249) notes that individuals with NPD frequently experience rage, indignation, and frustrated entitlement. Kernberg (1992, pp. 21-22) suggests that hatred is the core affect of severe personality disorders. He believes that the hatred derives from rage which, early in life, served to eliminate pain but became useful, later in life, to eliminate obstacles to gratification. Beck (1990, p. 235) suggests that individuals with NPD experience intense envy, fear, and rage. They are particularly angry when others do not accord them admiration or respect (Beck, 1990,. p. 50).

NPD rage is more tolerable to these individuals than the shame and envy that is associated with helplessness, a sense of ugliness, and impotence (McWilliams, 1994, p. 172).

Defensive Structure

Individuals with NPD are trapped in a kind of perfectionism. They have unrealistic ideals for themselves; then they either convince themselves that they have attained these ideals (the grandiose posture) or feel inherently flawed and a failure (the depressive posture) (McWilliams, 1994, p. 174).

The NPD illusion of superiority is a facet of a generalized disdain for reality. These individuals feel unconstrained by rules, customs, limits, and discipline. Their world is filled with self-fiction in which conflicts are dismissed, failures redeemed, and self-pride is effortlessly maintained. They easily devise plausible reasons to justify self-centered and inconsiderate behavior. Their memories of past relationships are often illusory and changing. If rationalizations and self-deception fail, individuals with NPD are vulnerable to dejection, shame, and a sense of emptiness. Then they have little recourse other than fantasy. They have an uninhibited imagination and engage in self-glorifying fantasies. What is unmanageable through fantasy is repressed and kept from awareness. As they consistently devalue others, they do not question the correctness of their own beliefs; they assume that others are wrong. The characteristic difficulties of individuals with NPD almost all stem from their lack of solid contact with reality. If the false image of self becomes subtantive enough, their thinking will become peculiar and deviant. Then their defensive maneuvers become increasingly transparent to others (Millon & Davis, 1996, pp. 405-423).

Incidence of Co-Occurring Substance Abuse Disorders