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People with narcissistic personality disorder are characterized by an increased sense of self-importance and grandeur, so they are in some sense unique.

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Epidemiology of this disorder

Data on the incidence, prevailing gender and marital pattern for narcissistic personality disorder is unknown. However, there is a possible increased risk for an offspring of parents with such violations, grandeur, beauty and talent. What is more, it is stated that the incidence of these disorders is increasing.

Clinical features

According to DSM-III-R, narcissistic personality disorder is characterized by a sense of the importance of a pretentious self. People look at themselves as special people and expect special treatment. They do not tolerate criticism and show anger if someone tries to criticize them, or they may be completely indifferent to it (Blais et al., 2001). They want to do things in their own way, and they often crave for fame and fortune. Feeling that they are in a special position is astounding. Their relationship with the surrounding is fragile; usually, the other people are very angry because of their refusal to perform normal rules of behavior. People with this disorder are not capable of empathy; they can only pretend to be sympathetic, but only to achieve their selfish goals. Interpersonal relationships are usually used for their own purposes. These people have a fragile self-esteem, and they are prone to depression. Due to behavioral stress, such narcissistic individuals are the least likely to endure in their interpersonal relationships: for them, rejection and loss are often difficult, as well as they suffer from difficulties in their professional life.

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Diagnosis

The following features are the diagnostic criteria of narcissistic personality disorder. First of all, it is a steady pattern of pretension (in fantasy and behavior), lack of empathy and hypersensitivity to the estimates of others, starting at a young age and being manifested in a variety of circumstances, as indicated by the presence of at least five of the following:

  • A person reacts to criticism with a feeling anger, shame, or humiliation (even if he/she does not show it);
  • In interpersonal relations, a person tries to exploit others: trying to get others to do what he/she needs;
  • Such people consider themselves very important: for example, exaggerating achievements and talents, expecting to be known and treated specially, without doing anything extraordinary;
  • They believe that their problems are unique and can only be understood by special people;
  • A person is lost in fantasies about huge success, power, brilliance, beauty or ideal love;
  • A person ascribes to him/herself a high rank: with no reason they expect to be treated particularly well: for example, a person believes that he or she does not have to stand in line, while others have to;
  • A person requires constant attention for recognition: for example, a person goes fishing only to earn compliments;
  • There is inability to empathize the others: a failure to feel what others feel, for example, a person is irritated and surprised when a friend who is seriously ill cancels a date;
  • A person is obsessed with a sense of envy.

The course and prognosis

The disorder is a chronic and difficult to treat. These patients are constantly suffering from pressure due to their narcissism. They do not tolerate aging, because these individuals appreciate the beauty, strength, and everything inherent in their youth. To these things they cling completely inadequately. They are thus more prone to crisis upcoming in the mid-life than other groups.

Differential diagnosis

According to DSM-III-R, a borderline, hysterical and antisocial personality disorder is often combined with a narcissistic personality disorder, which means that the differential diagnosis is difficult to be drawn. Patients with narcissistic personality disorder are less anxious than patients with borderline personality disorder, and their life is less chaotic. Suicide attempts are also not very common for narcissistic personality disorders. There is a history of antisocial personality impulsive behavior. A hysterical personality often has exhibitionism traits and tries to manipulate the others, with no pronounced capacity for sympathy and genuine warmth.

Treatment

Treatment of narcissistic personality disorders is extremely difficult, as these patients have to give up their narcissism, if they want to succeed. Psychiatrists such as Otto Kernberg and Heintz Kohut, believe that it is necessary to apply psychoanalytic approach to bring a change, but in order to make a diagnosis with certainty, it is necessary to spend a lot of studies, and these studies are also needed to assign the most appropriate treatment.

What is more, narcissistic personality disorder is one of the most intractable ones. Those who seek treatment usually do so in a connection with any concomitant disorder, and often due to depression. Starting treatment, people may try to manipulate a therapist to obtain his acknowledgment of their feelings of grandeur. Some people, apparently, also project their greatness onto physicians and begin to show mixed feelings of love and hate to them.

Psychodynamic therapists try to help people with narcissistic personality disorder realize their initial uncertainty and protections to which they resort. Cognitive therapists focus on self-centered mindset of these people. They are trying to force their clients to view representations of others, to improve their manner of interpreting criticism, to increase their ability to empathize with other people and to change their thinking manner like 'all or nothing'. However, all of these approaches seem to bring little success (Rivas, 2001).

Finally, such a personality disorder is characterized by symptoms of dramatization and emotional instability. Unfortunately, none of the known methods of treatment bring effective results. Plus, people with narcissistic personality disorder are characterized by a high opinion of themselves, the need for admiration and lack of empathy. This disorder is one of the most intractable.

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