Narcissistic Personality Disorder | Causes, Symptoms, Types and Treatments
The ancient Greeks understood narcissistic personality disorder (NPD), even if the term was only coined recently. After all, Greek mythology gave us Narcissus; a handsome young man who callously scorned his would be lovers, driving his many admirers to despair and even death.
One day, one of Narcissus’ victims prayed to heaven:
“So might he himself worship, and not grow the craze he loves”
When Narcissus noticed his image in a pool, he fell in love with himself. Unable to find consolation, he died of sorrow by the same pool.
All the nymphs grieved him and substituted a flower for his missing body at Narcissus’ funeral. Of course, that flower is today called the narcissus.
Causes of Narcissistic Personality Disorder
The cause of narcissistic personality disorder is unknown, although several theories are being investigated.
Some evidence points to genetics and other biological or biochemical factors as causative agents for some people. Psychological factors are also involved for most people.
One might also speculate on what role, if any, societal materialism might play in nurturing narcissistic personality disorder. Americans are famously infatuated with youth and beauty, which are heavily marketed by corporations. Is it possible that an inferiority complex—or simply the desire to look like the beautiful people we see in so many ads—may contribute to narcissistic personality disorder?
Narcissistic Personality Disorder: Symptoms & Diagnosis
Most symptoms of narcissistic personality disorder (NPD) are pretty much what you’d expect, and they come in many flavors…er, synonyms, including arrogance, conceit, vanity, pomposity, grandiosity, self-righteousness and—drum roll—narcissism. Let’s not forget feelings of self-importance or superiority.
As one might expect, a narcissistic individual tends to require constant attention or admiration and may exaggerate their qualities and achievements. Narcissists often have unreasonable expectations of favorable treatment.
Not surprisingly, narcissists’ interactions with others are frequently strained. People afflicted with NPD often react to criticism with rage, shame, humiliation, denial or rationalization. They may disdain advice, thinking they know it all. Jealousy is another trait exhibited by people afflicted with a narcissistic personality disorder.
Their trademark lack of empathy makes it easy for narcissists to take advantage of others in order to achieve their own goals.
When narcissists fail to achieve their goals, or when reality forces them to see what they really are, they may fall victim to depression. Narcissistic patients are also prone to drug abuse. (Drugs can variously heighten narcissist’s feelings of superiority or combat depression.)
Of course, none of the above symptoms are proof of narcissism. Let’s face it, some people are born beautiful and talented, and such people are more likely to rise to powerful or prestigious positions. Other people may turn to drugs as an escape from poverty or as a surrender to peer pressure. But when seemingly successful people are inwardly unhappy or treat others with contempt, narcissistic personality disorder may be a suspect.
So here’s a list of some symptoms of narcissistic personality disorder (as if you didn’t already know):
- narcissism (e.g. arrogance, vanity, etc.)
- ideas of perfection
- excessive imagination of achievement, supremacy, attractiveness, cleverness, or superlative love
- harsh reactions to criticism
- depression (when failing to meet their own standards)
- drug abuse
- lack of empathy
- the absence of self-control
The Me Cult
The term narcissistic personality disorder is applied to people who are popularly dubbed arrogant, vain or self-centered, with a corresponding lack of empathy.
Yet these people—who are often driven to accomplish great things—may be widely admired. How many movie stars suffer from a narcissistic personality disorder? To put it another way, how many movie stars became stars because of narcissistic personality disorder? And is narcissism really such a bad thing if it drives people to excel?
In fact, narcissist individuals may be talented, successful, admired by others and generally symptom-free and able to function normally. Yet even such individuals may be chronically unsatisfied due to their unrealistic self-expectations.
Of course, everyone knows money can’t buy happiness. Successful narcissists may drive their friends away and may find themselves unable to maintain intimate relationships. Their inflated egos may cause them to close their ears to sound advice offered by people they look down on, thus impairing their judgment.
Of course, not all narcissists are successful. When people manifesting narcissist fail to accomplish their goals, or when they are forced to confront reality, they may fall prey to anxiety, anger or depression.
There are two general kinds of narcissists. Cerebral narcissists glory in their intelligence and academic or artistic achievements. Somatic narcissists are more impressed with their bodies.
Similarly, we might think of two levels of narcissism—personal and societal, or cultural. For example, the United States is widely regarded as a very materialistic and narcissistic society. What other nation could produce a gimmick called a Thighmaster?
Since narcissistic individual craves fame and power, one would expect to find lots of people manifesting narcissistic personality disorder in government. In fact, narcissists are instinctively political and often have a keen understanding of power structures.
Unfortunately, narcissistic leaders frequently can’t handle criticism. And what about that trademark lack of empathy for the taxpayers?
On a still more philosophical level, could nationalism be associated with narcissism? Adolph Hitler made both a national passion, with tragic results for millions of people. Can you think of any current national leaders who harbor a striking lack of empathy, don’t give a damn what the voters or other nations think, and are quick to anger when insulted? What are we to make of the sensational hair sported by so many senators and presidential candidates? And what about all those corporate executives who so callously snub or twist the law in order to exploit the masses? Bill Gates is famously spoiled, but could he also be afflicted with a narcissistic personality disorder?
On a still more philosophical level, it’s interesting to ponder which group is more narcissistic—a liberal or conservatives. Conservatives are renowned for their lack of empathy and their self-righteousness, which typically revolves around a nationalistic form of patriotism and Christianity (“America right or wrong!” ). Moreover, many people have learned that criticizing Republicans can be suicidal.
On the other hand, liberals may be overly impressed with their academic achievements, and some observer’s think they’re similarly resting on their laurels when presenting themselves as champions of the poor and under-trodden. (Since when?) Liberals embrace Hollywood, perhaps the most narcissistic enclave on the planet. And am I correct in my perception that some of the most outrageous hair in America is sported by elected Democrats?
Of course, these are the broadest of generalizations, and the comments on hair may be downright trivial. Just consider them ideas to ponder.
Obviously, Adolph Hitler would have been far less dangerous if he had never been elected to public office. However, it would be a mistake to believe that, among us commoners, narcissism at its worst is merely obnoxious or that it’s a “victimless crime.”
People afflicted with this disorder can harm others. Some sexually abuse their spouses. Narcissistic parents can make their children feel worthless. Children who learn to interpret abuse as love may later seek out abusive narcissists as mates, continuing the cycle. Narcissistic personality disorder has even been linked to incest in extreme cases.
John Hinckley, Jr.—the man who tried to kill President Ronald Reagan in orders to impress actress Jodi Foster—was diagnosed with narcissistic personality disorder. He did not see guilty by cause of mental illness.
An extreme narcissistic individual may even get a little outside help in destroying themselves and others; victims of this disorder are prone to alcoholism and drug abuse. Let’s see…how many celebrities have died from drug overdoses?
Victims of a narcissistic personality disorder may truly die alone, staring at their reflection in a pool only they can see. Ask survivors of Nazi Germany.
Treatment of Narcissistic Personality Disorder
According to Greek mythology, when Narcissus was born the seer Tiresias was asked whether the child would live a long life. The seer replied, “If he never knows himself.”
Although the Greeks had a phenomenal grasp of narcissistic personality disorder (NPD), they apparently didn’t have a clue about treating it. Perhaps they didn’t want to since narcissism was such an important part of Greek culture.
At any rate, knowing oneself is central to coping with most mental disorders. Yet the Greeks may have been right all along. Direct confrontation is usually needed to breach a narcissistic victim’s strong defenses. However, this can result in severe depression, and we all know what killed Narcissus.
Of course, this doesn’t mean that people suffering from narcissistic personality disorder should not be treated. On the contrary, they should be treated by competent health care professionals.
Drugs are generally not part of a narcissistic treatment program except where used to treat symptoms or to treat symptoms or side effects of NPD or co-occurring disorders. In fact, patients may regard medication as a sign of personal defectiveness and balk at treatment.
Thus, counseling is prescribed for people afflicted with a narcissistic personality disorder. They need to learn to accept their limitations and to connect with other people emotionally.
Treatment for Difficult Patients of Narcissistic Personality
Mental health professionals often find narcissistic personality disorder patients difficult to work with. Remember, these aren’t always the most cooperative patients. They may be in denial, or they may make unreasonable demands or criticism. Conversely, if a service provider responds negatively to a patient’s arrogance, the patient may interpret it as rejection.
Individuals with a narcissistic personality disorder who seek therapy are seldom interested in changing. Rather, they’re usually seeking relief from depression, which is often precipitated by a crisis that punctures their narcissistic bubble, forcing them to see the discrepancy between their expectations or fantasies and reality. Even this depression hiding beneath the arrogance may consist of narcissistic outrage and humiliation. Narcissists often feel they aren’t responsible for the difficulties they have with other people.
Narcissists may regard treatment as demeaning. Even when a severe crisis compels them to seek treatment, their goal may be to treat the symptoms or even to reaffirm their inflated self-image, rather than treat the root cause.
Yet narcissists are psychologically frail, and service providers must deal with the disillusionment that almost inevitably follows when they burst their bubbles. They must be tactful but firm when confronting patients with the reality they are denying, trivializing or avoiding, remembering that vanity may mask vulnerability. All the while, an NPD patient may persist in blaming others for their problems, interpreting professional feedback as criticism and even adopting an air of superiority over the service provider.
Alternatively, service providers may initially enjoy the company of clients with NPD, who may flatter their counselors. But the relationship changes when the provider realizes s/he is doing all the work. The provider may then feel devalued and may either work harder to win the patient’s approval or become angry or rejecting.
Other “countertransference” issues with narcissistic clients include boredom, frustration, anger and a feeling of being ignored; treatment providers may even come to feel that they don’t quite exist in the treatment room with their subject. For many people afflicted with a narcissistic personality disorder, life is a one-man show, with no room even for mental health providers.
Mend it, Don’t End It
Mental health specialists should not attempt to make individuals with narcissistic personality disorders what they can never be. Since all personality disorders have strengths, along with weaknesses, treatment should aim at the most adaptive expression of that particular personality style.
Remember, narcissism is merely an exaggeration of a healthy phenomenon, an exaggeration that has helped produce some of our greatest political leaders, movie stars and talk show hosts.