Generality
Narcissism is a very complex personality disorder, in which the subject who suffers from it develops a true obsession with his own image .
The clinical and symptomatological characteristics of the pathological picture are variable, but it is always possible to recognize three distinctive elements:
- Self-consideration in terms of superiority ( grandeur ) in fantasy or behavior;
- The constant need for admiration ;
- Lack of empathy (ie the inability to recognize that other people also have desires, feelings and needs).
The impact of pathological narcissism can be significant in many areas of life, such as relationships, work, school or financial affairs.
The treatment of this disorder is centered on medium-long term cognitive therapy, as personality traits and interpersonal attitudes characteristic of the pathology require prolonged time to be modified.
Narcissistic personality disorder
Narcissism is a trait of personality and can be considered, within certain limits, a normal state. However, if this psychological attitude seriously interferes with interpersonal relationships, daily commitments and quality of life, it can assume pathological dimensions and meaning.
In psychiatry, narcissism is indicated among personality disorders .
People who are affected tend to magnify their abilities exceedingly and make themselves the exclusive and pre-eminent center of their own interest, becoming the object of a complacent admiration. Subjects who manifest a narcissistic personality are constantly absorbed by fantasies of unlimited success and manifest an almost exhibitionistic need for attention and admiration . Furthermore, these people are unable to recognize and perceive the feelings of others, tend to exploit others to achieve their goals or despise the value of their work.
Behind this mask, however, the narcissist has a fragile self-esteem that makes him vulnerable to the slightest criticism. If he encounters a failure, due to his high opinion of himself, he can easily manifest extreme anger or depression.
Causes of pathological narcissism
The causes of narcissism are not yet well understood, but the opinion is shared that this personality disorder may represent the result of the complex combination of multiple social, psychological and biological factors .
These elements would intervene during the development of the individual, influencing their behavior and thinking. In particular, the clinical picture can be favored by parents who believe in the superiority of the future narcissist and attach great importance to success, excessively criticizing fears and failures.
Narcissistic personality disorder can also result from growth in a family environment unable to provide the child with the necessary care; over time, in response to this attitude, the subject would solve the continuing threat to his self-esteem, developing a sense of superiority and behavior that demonstrates the need for constant admiration.
Usually, the narcissistic personality disorder appears in adolescence or early adulthood .
During childhood, children can manifest a narcissistic attitude, but this can simply represent a transitory character of their age and does not mean that they will go on to develop a true pathological picture.
Estimates of the prevalence of narcissistic personality disorder fluctuate between 2 and 16% in the clinical population, while they are less than 1% in the general population.
50-75% of the individuals receiving this diagnosis belong to the male sex.
Symptoms
- The narcissistic personality disorder manifests itself with an exaggerated sense of superiority : the subjects who suffer from it tend to consider themselves better than the others, they exalt their abilities and their successes and they exaggeratedly believe in their own value. This behavior makes the narcissists presumptuous, arrogant, selfish and exhibitionist.
- The direct consequence of such conduct is the constant need for admiration on the part of others, who are idealized or devalued according to whether or not they recognize their status as unique and special people.
- Another peculiar characteristic is the lack of empathy, from which derives the belief that one's needs come before anything else. Since they see themselves superior to others, narcissists believe that they are authorized to satisfy their needs without waiting, so they can exploit others, whose needs and opinions are considered of little value. Moreover, narcissistic people claim that their way of seeing things is the only one universally.
- Often, individuals with narcissistic personality disorder believe that others envy or admire them, but are hypersensitive to criticism, failure and defeat . Feelings of vulnerability, insecurity, fragility and fear of confrontation contrast with the dimension represented by the tendency to grandeur, uniqueness and superiority. When faced with the inability to satisfy the high opinion they have of themselves, narcissists can react with anger or contempt, develop panic attacks, get deeply depressed or even attempt suicide.
Diagnostic criteria
To define the profile of the pathological narcissist, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, focuses on the following elements:
- It has a grandiose sense of importance (for example: it exaggerates results and talents, it expects to be considered superior without adequate motivation, etc.).
- It is absorbed by unlimited fantasies of success, power, charm, beauty or ideal love.
- He believes he is "special" and unique and can only be understood by - or having to attend - other special or high class people (or institutions).
- It requires excessive admiration.
- He has a sense of entitlement, that is the unreasonable expectation of special favorable treatment or immediate satisfaction of his expectations.
- Use interpersonal relationships, that is, take advantage of other people for their own purposes.
- It lacks empathy: it is incapable of recognizing or identifying with the feelings and needs of others.
- He is often envious of others (or believes others envy him).
- Show arrogant and presumptuous behaviors or attitudes.
Signals to be reckoned with
In the presence of pathological narcissism, the patient may not be aware of having a personality disorder and is more likely to consult a doctor when developing symptoms of depression, often due to perceived criticism or rejection.
Therefore, if the subject suffering from it feels overwhelmed by extreme sadness or recognizes certain traits of the narcissistic personality disorder, he should consider resorting to the help of a specialist, who helps him to understand what are the reasons for his attitudes and to undertake a course of care.
Indeed, a correct approach to narcissism allows us to intervene on the origin of problems and can contribute to making life more rewarding.
Possible complications
If not treated properly, narcissistic personality disorder can predispose to various complications, including:
- Problems in interpersonal relationships;
- Difficulties in daily activities (work or school);
- Depression;
- Addictions (alcohol, smoking or drugs);
- Suicidal thoughts or behavior.
Diagnosis
The diagnosis of pathological narcissism is formulated by a specialist on the basis of an accurate medical history, which accurately examines the patient's personal and medical history, without neglecting the style of life and daily commitments. This in-depth psychological analysis makes it possible to search for repetitive and maladaptive patterns of thought and behavior during the patient's evolutionary history. The diagnostic test can also use a physical examination to ensure that the problem is not favored by organic causes .
Some features of pathological narcissism are similar to those of other personality disorders. The differential diagnosis is placed, in particular, against the antisocial, histrionic and borderline disorder, with which narcissism shares the sensitivity to criticism and rejection, anger and the demands of attention. The most useful element in the discrimination of these conditions is the grandiosity, a distinctive trait of the narcissistic disorder.
Treatment
The treatment of narcissistic personality disorder is very difficult, as the patient is often not aware of his problematic and of the negative effect it causes on other people. Furthermore, the traits of pathological narcissism develop over many years, so the therapeutic approach requires prolonged time.
drugs
No specific drugs are available to treat narcissistic personality disorder. However, if you have manifestations of depression or other related conditions, medications such as antidepressants or anxiolytics may be helpful. In fact, the management of emotional symptoms and anxiety represents the first goal of treatment, even if the traditional antidepressant therapies do not intervene on the personality characteristics.
Other drugs that can effectively intervene on psychopathological phenomena frequently associated with pathological narcissism are anticonvulsants and mood stabilizers. Drug therapy can also use risperidone, which has proved useful both with depression and with depersonalization.
Psychotherapy
Narcissistic personality disorder can benefit from medium-to-long term cognitive therapy, but it requires specialists who emphasize empathy and do not challenge the perfectionism of their patients, feelings of privilege and grandeur.
The areas of intervention of psychotherapy are aimed at helping:
- Understanding the causes of their emotions and what drives them to compete and despise themselves or others;
- Learn to relate to others, both in terms of intimate and personal relationships, and in collaboration with colleagues;
- Recognize and accept the actual current and potential competences, so as to be able to tolerate any criticism;
- Increase the ability to understand one's feelings;
- Understand and tolerate the impact of self-esteem problems;
- Get acceptance of what is reachable and what can be achieved.
The participation of family members in the treatment is often useful as they unintentionally can behave in such a way as to reinforce the patient's troublesome thoughts and behaviors.
Some personality traits may be difficult to change, so narcissism therapy may take several years.
